Fernando Lamy Filho

Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.

Carga de trabalho de profissionais da saúde e eventos adversos durante ventilação mecânica em unidades de terapia intensiva neonatal

Objective:To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. Method:This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of Sao Luis, state of Maranhao, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. Results: Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. Conclusions: The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomesOBJECTIVE To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. METHOD This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. RESULTS Adverse events occurred 117 times during this period. The associations between workload and adverse events were analyzed by means of generalized estimating equations. The adjustment variables were: birth weight, gender, maternity unit, Clinical Risk Index for Babies score, and care demand, the latter measured by the Northern Neonatal Network Scale. The larger the number of newborns classified by care demand (NCCD) per nurse and nursing technician, the more likely the occurrence of intermediate adverse events linked to mechanical ventilation. A number of NCCD > 22 per nurse (relative risk [RR] = 2.86) and > 4.8 per auxiliary nurse (RR = 3.41) was associated with a higher prevalence of intermediate adverse events. CONCLUSIONS The workload of NICU professionals seems to interfere with the intermediate results of neonatal care and thus should be taken into consideration when evaluating NICU outcomes.

Pediatric cardiac surgery under the parents sight: a qualitative study

INTRODUCTION Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. OBJECTIVE The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. METHODS A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. RESULTS The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the childs treatment contributed to minimizing the suffering generated by hospitalization. CONCLUSION The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.

Prevalência de colonização por estreptococos do grupo B em gestantes atendidas em maternidade pública da região Nordeste do Brasil

PURPOSE to assess the prevalence of group B streptococcus colonization (GBS) in pregnant women in prodrome or in labor. METHODS vaginal and rectal cultures were collected from 201 pregnant women, in the admission sector of a public maternity center in the northeast region of Brazil (São Luís, Maranhão). The samples obtained were inoculated in a Todd-Hewiths selective culture medium and after that they were sub-cultivated in blood-agar plates. The CAMP (Christie, Atkins, Munch-Petersen) test was used to identify GBS, which was then serologically confirmed by the BioMérieux Api 20 Strep kit microtest. GBS positive samples were submitted to an antibiotic sensitivity test. Sociodemographic variables, gynecological-obstetrical antecedents, and perinatal outcomes were studied. The Epi-Info 3.3.2 programs from World Health Organization and Statistical Package for Social Sciences 14.0 version were used for the statistical analysis. The prevalence ratio was used as risk measure, considering p<0.05 as significance level, and accepting 80% power. RESULTS the prevalence of SGB colonization in the mothers was 20.4%. There was no association between the sociodemographic variables or gynecological-obstetrical antecedents and a larger presence of SGB colonization. There were two cases of infectious outbreak among neonatal babies from colonized mothers, but hemocultures resulted negative. High resistance rates were found for the following antibiotics: clindamycin, 25.4%; erythromycin, 23.4% and ceftriaxone, 12.7%. CONCLUSIONS the prevalence of SGB colonization was high among the mothers, similar to what had been described in other studies. The elevated rates of antimicrobial resistance, especially to ceftriaxone indicate the need for further studies to determine the serology of this agent and of orientation protocols for rational use of antimicrobials.

Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of Sao Luis to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

Secular trends in the rate of low birth weight in Brazilian State Capitals in the period 1996 to 2010

Epidemias de malaria ocorrem anualmente nos municipios da Regiao Amazonica, Brasil, no entanto os servicos de saude nao adotam, de maneira sistematica, instrumentos para deteccao e contencao oportunas desses eventos. O objetivo foi caracterizar as epidemias de malaria na regiao segundo duracao, especie de Plasmodium e vulnerabilidade das populacoes. Foi avaliado um sistema de monitoramento automatizado da incidencia da malaria, com base no diagrama de controle segundo quartis, para identificar as epidemias da doenca. Em 2010, ocorreram epidemias em 338 (41,9%) municipios da regiao. Houve epidemias por P. falciparum e por P. vivax, separadamente, e tambem por ambas as especies. Epidemias com duracao de um a quatro meses ocorreram em 58,3% dos municipios epidemicos; de cinco a oito meses, em 24,3%; e de nove a 12 meses, em 17,4%. O monitoramento automatizado da variacao da incidencia da malaria podera contribuir para deteccao precoce das epidemias e melhorar o seu controle oportuno.Malaria epidemics occur annually in various municipalities (counties) in the Brazilian Amazon. However, health services do not systematically adopt tools to detect and promptly control these events. This article aimed to characterize malaria epidemics in the Brazilian Amazon Region based on their duration, the Plasmodium species involved, and the populations degree of vulnerability. An automatic malaria incidence monitoring system based on quartiles was assessed for prompt identification of malaria epidemics. In 2010, epidemics were identified in 338 (41.9%) of the counties in the Brazilian Amazon. P. falciparum and P. vivax epidemics were detected, both singly and in combination. Epidemics lasted from 1 to 4 months in 58.3% of the counties, 5 to 8 months in 34.5%, and 9 to 12 months in 17.4%. Systematic monitoring of malaria incidence could contribute to early detection of epidemics and improve the effectiveness of control measures.

Changes in perinatal health in two birth cohorts (1997/1998 and 2010) in São Luís, Maranhão State, Brazil

The objective of this study was to analyze changes in perinatal health in two birth cohorts started in 1997/1998 and 2010, respectively, in São Luís, Maranhão State, Brazil. A total of 2,493 live born infants were included in 1997/1998 and 5,166 in 2010. Low birth weight (LBW) rate did not change (8.5% in 1997/1998 and 8.6% in 2010). Preterm birth (PTB) rate also remained stable (13.2% in 1997/1998 and 13% in 2010). Teenage deliveries and births to single mothers decreased. Maternal schooling and prenatal care coverage increased. Intrauterine growth restriction (IUGR) decreased from 13.3% to 10.6% (p < 0.001). The perinatal mortality rate decreased from 36.6 to 20.7 per 1,000 (p < 0.001) and the infant mortality rate (IMR) dropped from 28.5 to 12.8 per 1,000 (p < 0.001). The cesarean rate increased from 34.1% to 47.5% (p < 0.001). In conclusion, despite favorable changes in socio-demographic, behavioral, and health service factors and decreasing rates of IUGR and perinatal and infant mortality, LBW and PTB remained stable, while the cesarean rate increased.

[Vaccination coverage and factors associated with incomplete basic vaccination schedule in 12-month-old children Sao Luis Maranhao State Brazil 2006]

The study aimed to evaluate vaccination coverage and factors associated with incomplete basic vaccination schedule at 12 months of age in 427 children aged 12-59 months in São Luis, Maranhão State, Brazil, 2006. This cross-sectional, population-based household survey used complex cluster sampling. Poisson regression with robust adjustment of variance was applied. Complete basic vaccination coverage was 71.9% for applied doses, 61.8% for valid doses, and 23.6% for correct doses. Hepatitis B and tetravalent vaccines showed higher percentages of doses on dates or at intervals lower than recommended. Percentages of delayed vaccination were high, except for BCG. Incomplete basic vaccination was more frequent in girls and children from low-income and black families. Racial, gender, and socioeconomic factors posed barriers to complete vaccination, thus emphasizing the need for policies to address such inequalities.

Cobertura vacinal e fatores associados ao esquema vacinal básico incompleto aos 12 meses de idade, São Luís, Maranhão, Brasil, 2006

O estudo objetivou avaliar a cobertura vacinal e os fatores associados ao esquema vacinal basico incompleto aos 12 meses de idade, em 427 criancas de 12 a 59 meses, em Sao Luis, Maranhao, Brasil, 2006. Trata-se de inquerito domiciliar transversal, de base populacional, com amostragem complexa por conglomerados. Empregou-se regressao de Poisson com ajuste robusto da variância. A cobertura para o esquema basico completo foi de 71,9% segundo doses aplicadas, 61,8% para doses validas e 23,6% para doses corretas. As vacinas contra hepatite B e tetravalente apresentaram maiores percentuais de doses aplicadas em datas ou intervalos inferiores aos recomendados. Os percentuais de atraso vacinal foram elevados, exceto para a BCG. Percentuais mais elevados de esquema vacinal basico incompleto foram encontrados em criancas das classes economicas D e E, do sexo feminino e de chefes de familia de cor da pele preta. As desigualdades raciais, de genero e socioeconomicas representaram barreiras a vacinacao completa, indicando necessidade de reforcar as politicas equitativas que eliminem essas desigualdades.

Tendência secular da taxa de baixo peso ao nascer nas capitais brasileiras de 1996 a 2010

Secular trends in rates of low birth weight in Brazilian state capital cities were evaluated for the period 1996 to 2010 using joinpoint regression models. The rates were calculated using data from the Live Births Information System. Newborns weighing less than 500 g were excluded. Only data for capital cities was included since under-registration of births in these cities is lower and new trends can be detected earlier. There was a significant increase in the rate of low birth weight in the Brazilian capitals of the North Region, Northeast Region, South Region and Southeast Region up to 2003/2004, stabilizing thereafter. In the capitals of the Center-west Region the rate increased throughout the whole study period. The rate of low birth weight was higher in the capitals of the more developed regions. The rate of multiple births increased significantly in all Brazilian capitals, while the stillbirth rate decreased and showed a negative correlation with the rate of low birth weight. The increase in the rate of low birth weight may be partially explained by the increase in multiple births, an increase in the birth of infants weighing 500 to 999 g and by the reduction in the stillbirth rate.