Karin Regina Luhm

HIV testing during pregnancy: use of secondary data to estimate 2006 test coverage and prevalence in Brazil

This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (<50,000; 50,000-399,999; 400,000+). In the second stage, 100-120 women were selected systematically. Data collection was based on HIV-test results registered in pre-natal cards and in hospital records. The analysis focused on coverage of HIV-testing during pregnancy and HIV prevalence rate. Logistic regression models were used to test inequalities in HIV-testing coverage during pregnancy by macro-region of residence, municipality size, race, educational level and age group. The study included 16,158 women. Results were consistent with previous studies based on primary data collection. Among the women receiving pre-natal care with HIV-test results registered in their pre-natal cards, HIV prevalence was 0.41%. Coverage of HIV-testing during pregnancy was 62.3% in the country as a whole, but ranged from 40.6% in the Northeast to 85.8% in the South. Significant differences according to race, educational level and municipality size were also found. The proposed methodology is low-cost, easy to apply, and permits identification of problems in routine service provision, in addition to monitoring compliance with Ministry of Health recommendations for pre-natal care.

Surveillance programme for multidrug-resistant bacteria in healthcare-associated infections: an urban perspective in South Brazil.

Multidrug-resistant bacteria (MDRB) have emerged as a public health problem and the World Health Organization recommends actions to control MDRB in healthcare-associated infections (HCAIs). This study describes a surveillance programme for MDRB in HCAIs at Curitiba, Brazil. MDRB in pneumonia, bloodstream, urinary tract and surgical site infections has been surveyed since January 2010. Carbapenem-resistant Acinetobacter baumannii and third generation resistant Klebsiella pneumoniae were the most frequent MDRB in HCAIs. Infection control strategies enrolling hospitals and public health have been developed. The data presented describe MDRB prevalence and the feasibility of this municipal MDRB surveillance programme in Brazil.

Sistemas informatizados de registro de imunização: uma revisão com enfoque na saúde infantil

Resumo Sao apresentadas diferentes experiencias e metodologias empregadas por registros informatizados de imunizacao (RII), no enfoque da saude infantil. O levantamento bibliografico abrangeu publicacoes de 1990 a 2006, existentes nas bases MEDLINE, SciELO, PubMed e EMBASE. Outros sitios eletronicos de organizacoes nacionais e internacionais de saude foram pesquisados. Em virtude da ausencia de publicacoes sobre RII no Brasil, as fontes de informacao foram a Coordenacao Nacional e as Coordenacoes Estaduais do Programa Nacional de Imunizacoes, alem do Departamento de Informatica do Sistema Unico de Saude. Selecionaram-se apenas artigos que abordam RII em saude infantil. Foram localizados 109 artigos publicados em 35 revistas especializadas. Sao apresentados aspectos historicos e conceituais, objetivos, funcoes, relevância e indicadores de desempenho e de custo-efetividade, alem das proprias limitacoes dos RII, assim como experiencias em paises selecionados, inclusive no Brasil. Os RII integrados a outros sistemas de informacao vem sendo aplicados como importante instrumento para a identificacao de populacoes com menor acesso ou adesao aos programas de vacinacao e em sistemas de vigilância ativa de eventos adversos pos-vacina. Palavras-chave: registros de imunizacao; registros informatizados; sistemas de informacao em saude; saude infantil; programas de imunizacao; cobertura vacinal; seguranca de vacinas; equidade em saude. Summary Different experiences and methodologies used for immunization computerized database (ICD) with focus in child health were presented. Bibliographical survey from 1990 to 2006 was undertaken, using as sources MEDLINE, SciELO, PubMed and EMBASE databases. Other sites of national and international organizations of health had also been searched. As have no publications on ICD in Brazil, survey of these registers was carried through, taking as source the national and State Coordinations of the National Program of Immunizations and the Department of Computer Science of the National System of Health. Only articles with focus on child health were selected: 109 publications in 35 specialized journals were localized. Historical and conceptual aspects, objective, functions, relevance, performance and costeffectiveness indicators, and own limitations of the ICD are presented, as well as experiences in selected countries, including Brazil. The ICD integrated to other information systems is being applied as important instrument for the identification of populations with lower access or adherence to the vaccination programs and in active surveillance of adverse effects post-vaccination.

Tendência de mortalidade por infarto agudo do miocárdio em Curitiba (PR) no período de 1998 a 2009

BACKGROUND Acute Myocardial Infarction (AMI) is the single leading cause of death among non-transmitted chronic diseases in Brazil. The knowledge of mortality trends is necessary for planning prevention strategies. OBJECTIVE To evaluate trends in mortality from myocardial infarction in the period from 1998 to 2009 in Curitiba (PR), their distribution by gender, age and their impact in reducing the absolute number of deaths from this disease in this period. METHODS Demographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE) and death data were obtained from the Mortality Information System of the Ministry of Health, considering gender, age and residence. From the fit of a Poisson regression model we estimated mortality rates and expected number of deaths that were not observed. RESULTS We found significant downward trend (p < 0.001) in the period. The estimated average reduction in death rate from AMI each year was 3.8% (95% CI: 3.2% - 4.5%). There was no significant difference between genders (p = 0.238), although the evolution of age-specific standard mortality rates differed significantly between the groups (p = 0.018). It is estimated that the annual reduction of 3.8% in the mortality rate has resulted in 2,168 deaths below the number expected given the mortality rate observed in 1998 and projecting that number on the population growth occurred during the study period. CONCLUSION Although it remains an important cause of death, mortality from AMI decreased significantly during the evaluation period.

Estimation of HIV incidence in two Brazilian municipalities, 2013

ABSTRACT OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.