Juraci Almeida Cesar

Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case›control study

Abstract Objective: To determine whether breast feeding protects infants against pneumonia and whether the protection varies with age. Design: Nested case-control study. Setting: Pelotas, southern Brazil. Subjects: Cases were 152 infants aged 28-364 days who had been admitted to hospital for pneumonia. Controls were 2391cases in a population based case-control study. Main outcome measure: Odds ratio of admission for pneumonia according to type of milk consumed (breast milk alone, breast and formula milk, or formula milk and other fluids only), use of fluid supplements apart from formula milk, and use of solid supplements. Results: Infants who were not being breast fed were 17 times more likely than those being breast fed without formula milk to be admitted to hospital for pneumonia (95% confidence interval 7.7 to 36.0). This relative risk was 61 (19.0 to 195.5) for children under 3 months old, decreasing to 10 (2.8 to 36.2) thereafter. Supplementation with solids was associated with a relative risk of 13.4 (7.6 to 23.5) for all infants and 175 (21.8to 1405.1) for those under 3 months old. Conclusion: Breast feeding protects young children against pneumonia, especially in the first months of life. These results may be used for targeting intervention campaigns at the most vulnerable age groups.

Estudo longitudinal da população materno-infantil da região urbana do Sul do Brasil, 1993: aspectos metodológicos e resultados preliminares

All babies born in the hospitals of the city of Pelotas, Brazil, in 1982 were studied soon after delivery and followed up prospectively during the first years of their lives. In 1993, this study was repeated with a similar methodology, with the aim of assessing eventual changes in the level of maternal and child health. All five maternity hospitals in the city were visited daily and the 5,304 babies born included in the study. They were weighed and measured, and their gestational age was assessed using the Dubowitz method. Their mothers were examined and interviewed regarding a large number of risk factors. The mortality of these children was studied through the surveillance of all hospitals, cemeteries and death registries, and all hospital admissions were also recorded. Two nested case-control studies were carried out to assess risk factors for mortality and hospital morbidity. A systematic sample of 655 children were examined at home at one and three months of age, and these infants, as well as another sample of 805 children including all low-birthweight babies were also examined at the ages of six and twelve months. Their psychomotor development was also assessed. Losses to follow-up were only 6.6% at twelve months. Relative to the 1982 indicators, perinatal mortality fell by about 30% and infant mortality by almost 50%. The median duration of breastfeeding increased from 3.1 to 4.0 months. On the other hand, there was little change in the prevalences of low birthweight or of length for age at twelve months. The article that refers this abstract describes the methodology of the study and forthcoming publications will present detailed results.

Qualidade e eqüidade na assistência à gestante: um estudo de base populacional no Sul do Brasil

This population-based study aimed to evaluate prenatal coverage according to family income in a municipality (county) in Southern Brazil. Data were collected using a questionnaire with mothers in the first 24 hours postpartum. Prenatal coverage, first prenatal consultation in the first trimester, six or more consultations, breast and colposcopic examination, routine prenatal laboratory tests according to the protocol of the Program for Humanization of Prenatal and Delivery Care (PHPN), and prenatal ultrasound increased proportionally with family income, and all were more frequent in women from the highest income quartile (p < 0.001). Despite these results, the prevalence of low birth weight did not show a statistically significant difference between the quartiles. The local health service appeared not to be very effective, since only 26.8% of the women were classified as having received adequate prenatal care according to the PHPN criteria, and care was unequal, since quality of care for women in the lowest income quartile was inferior to that of women in the highest quartile.

Tendências e diferenciais na saúde materno-infantil: delineamento e metodologia das coortes de 1982 e 1993 de mães e crianças de Pelotas, Rio Grande do Sul

Mudancas ocorridas na ultima decada em termos economicos e assistenciais podem haver afetado a saude materno-infantil. Dois estudos foram realizados em Pelotas, Rio Grande do Sul. As coortes de maes e recem-nascidos nos anos de 1982 e 1993 foram estudadas desde o nascimento. As maes foram identificadas nos hospitais-maternidade e responderam a um questionario padronizado, sendo seus filhos examinados. Mais de 99% dos recem-nascidos foram incluidos nas coortes, totalizando 5.914 nascidos vivos em 1982 e 5.249 em 1993. A mortalidade das criancas foi monitorizada, e em 1993 as hospitalizacoes tambem o foram. Em 1982, tentou-se localizar cerca de 25% das criancas aos 12 meses de idade e todas com a idade media de vinte meses. Foi possivel encontrar cerca de 82% das criancas aos 12 meses e, gracas a uma mudanca de estrategia, 87% aos vinte meses. Em 1993, tentou-se acompanhar 20% das criancas e mais todos os recem-nascidos de baixo peso aos 12 meses de idade, sendo 95% localizados. Este artigo descreve os principais aspectos metodologicos de ambos os estudos, cujos principais resultados estao incluidos nos proximos artigos desse suplemento.

Fatores associados à não realização de exame citopatológico de colo uterino no extremo Sul do Brasil

Early detection of cervical cancer substantially increases the probability of cure. The aim of this study was to determine the prevalence and factors associated with non-participation in cervical cancer screening among women 15 to 49 years of age in Rio Grande, Southern Brazil. A representative survey was carried out using a systematic sample based on a census tract. Trained interviewers used standard, individualized, household questionnaires to interview the women. Data analysis used logistic regression according to a previously determined hierarchical framework. Among 1,302 women interviewed, 57% had never had a Pap smear. The risk factors most closely associated with non-participation in screening were black or brown skin color, young age, low family income, low schooling, living alone, and first childbirth after 25 years of age. Coverage for early detection of cervical cancer was very low. In addition, women at high risk of developing cervical cancer were shown to have a significantly higher risk of non-participation in this type of screening.A identificacao precoce do câncer de colo uterino aumenta substancialmente a sua probabilidade de cura. Este estudo mediu a prevalencia e identificou alguns fatores associados a nao realizacao de exame citopatologico de colo uterino entre mulheres em idade fertil, no Municipio de Rio Grande, Rio Grande do Sul, Brasil. Utilizou-se delineamento transversal, de base populacional com amostragem sistematica por conglomerados. Aplicou-se questionario individual, padronizado mediante visita domiciliar, por entrevistadores previamente treinados. Os dados foram analisados por regressao logistica obedecendo a modelo hierarquico previamente determinado. Dentre as 1.302 mulheres entrevistadas, 57% nunca se submeteram ao exame citopatologico para deteccao de câncer uterino. Mulheres de cor parda ou preta, de menor idade, renda familiar e escolaridade, que estavam vivendo sem companheiros e que tiveram o primeiro parto com 25 anos ou mais de idade foram as que apresentaram as maiores razoes de prevalencias para a nao realizacao deste tipo de exame. A cobertura para deteccao precoce de câncer de colo uterino por meio de exame citopatologico foi muito baixa em Rio Grande. Alem disso, mulheres com maior probabilidade de ter esta doenca foram as que apresentaram maiores razoes de prevalencias a sua nao realizacao.

The use of maternal and child health services in three population-based cohorts in Southern Brazil, 1982-2004

This study aimed to describe indicators of health care assistance during antenatal care, delivery and in the first year of life in Pelotas, Rio Grande do Sul State, Brazil. In 1982, 1993, and 2004, all hospital newborns from the urban area of Pelotas were enrolled in a cohort study. In this period, the number of pregnant women that did not attend antenatal care fell from 4.9% to 1.9%; the mean number of appointments increased from 6.7 to 8.1; and the number of women who began antenatal care in the third trimester of pregnancy decreased from 14.8% to 7%; caesarean sections increased from 27.7% to 45.2% and the proportion of deliveries assisted by physicians increased from 61.2% to 89.2%. Improvements in immunization rates during the first year of life mainly occurred between 1982 and 1993, while the number of preventive medical appointments improved among those born in 2004. This increase in coverage was greater for low-income mothers and children, which may reflect the implementation of universal coverage in Brazil; however, coverage levels in 1982 were already high for wealthy mothers and children, reducing the scope for further gains.

Acute lower respiratory illness in under-five children in Rio Grande, Rio Grande do Sul State, Brazil: prevalence and risk factors

This study aimed to determine the prevalence of acute lower respiratory illness and to identify associated factors among children less than five years of age in the city of Rio Grande, southern Brazil. Using a cross-sectional survey, a standardized household questionnaire was applied to mothers or guardians. Information was collected on household conditions, socioeconomic status, and parental smoking. Prenatal care attendance, nutritional status, breastfeeding pattern, and use of health services for the children were also investigated. Data analysis was based on prevalence ratios and logistic regression, using a conceptual framework. Among 771 children studied, 23.9% presented acute lower respiratory illness. The main risk factors were previous episodes of acute lower respiratory infection or wheezing, crowding, maternal schooling less than five years, monthly family income less than US

Exame citopatológico de colo uterino em mulheres com idade entre 20 e 59 anos em Pelotas, RS: prevalência, foco e fatores associados à sua não realização

200, four or more people per room, asthma in family members, and maternal smoking. Mothers 30 years or older were identified as a protective factor. These results can help define specific measures to reduce morbidity and mortality due to acute lower respiratory illness in this setting.

Hospitalização por pneumonia: influência de fatores socioeconômicos e gestacionais em uma coorte de crianças no Sul do Brasil

OBJETIVO: Determinar a prevalencia e o foco de realizacao do exame citopatologico do colo uterino e tambem fatores associados a sua nao realizacao em mulheres com idade entre 20 e 59 anos residentes na cidade de Pelotas, RS. METODOS: Entre outubro e dezembro de 2003 foi realizado um estudo transversal de base populacional. Atraves de amostragem por conglomerados foram sorteados 144 setores censitarios em multiplos estagios. Foram investigadas variaveis sociodemograficas e a realizacao de exame citopatologico do colo uterino. RESULTADOS: Dentre as 1404 mulheres que constituem a populacao-alvo dos programas de prevencao do câncer do colo uterino, 83,0% realizaram o exame citopatologico do colo uterino nos tres anos antecedentes a este estudo. Mostraram-se significativamente associadas (P<0,05) a nao realizacao deste tipo de exame nos ultimos tres anos as seguintes variaveis: faixas etarias de 20 a 29 anos e 50 a 59 anos em relacao as mulheres de 40 a 49 anos de idade, menor escolaridade, menor quintil de pontos obtidos para construcao do nivel socioeconomico segundo a Associacao Nacional de Empresas de Pesquisa (ANEP), cor da pele mulata ou preta e nao consultar um ginecologista nos ultimos 12 meses. CONCLUSOES: Apesar de este estudo mostrar alta cobertura na realizacao de citopatologico do colo uterino nos tres anos antecedentes a entrevista, as mulheres com maior numero de fatores de risco do câncer de colo uterino apresentaram menor indice de realizacao deste exame.

Prevalência e fatores associados à ocorrência de anemia entre menores de seis anos de idade em Pelotas, RS

OBJETIVO: Investigar a influencia de fatores socioeconomicos e gestacionais sobre a hospitalizacao por pneumonia no periodo pos-neonatal. MATERIAL E METODO: Longitudinal. Criancas com idade entre 28 e 364 dias, nascidas na cidade de Pelotas, RS (Brasil), em 1993. A definicao de caso foi a permanencia em ambiente hospitalar por um periodo igual ou superior a 24 horas em consequencia de pneumonia. Foi aplicado delineamento longitudinal. RESULTADOS: Dentre as 5.304 criancas da coorte, 152 (2,9%) foram hospitalizadas por pneumonia no periodo. O valor preditivo positivo do diagnostico clinico comparado com o radiologico alcancou 76%. A analise atraves de regressao logistica mostrou que a classe social e a escolaridade materna estiveram forte e inversamente associadas a admissao hospitalar. Filhos de maes adolescentes tiveram risco duplicado a internacao; paridade igual ou superior a tres representou risco 2,8 vezes maior em relacao as maes primiparas; ganho de peso inferior a 10 kg durante a gestacao implicou risco cerca de 40% maior a hospitalizacao. CONCLUSOES: A classe social e a escolaridade materna foram os principais determinantes da hospitalizacao. Idade e paridade materna e o ganho de peso durante a gestacao foram tambem fatores de risco importantes.