Maria Angela Pires Esteves

Socio-demographic determinants of self-rated health in Brazil

Self-rated health has been used extensively in epidemiologic studies, not only due to its importance per se but also due to the validity established by its association with clinical conditions and with greater risk of subsequent morbidity and mortality. In this study, the socio-demographic determinants of good self-rated health are analyzed using data from the World Health Survey, adapted and carried out in Brazil in 2003. Logistic regression models were used, with age and sex as covariables, and educational level, a household assets index, and work-related indicators as measures of socioeconomic status. Besides the effects of sex and age, with consistently worst health perception among females and among the eldest, the results showed pronounced socioeconomic inequalities. After adjusting for age, among females the factors that contributed most to deterioration of health perception were incomplete education and material hardship; among males, besides material hardship, work related indicators (manual work, unemployment, work retirement or incapable to work) were also important determining factors. Among individuals with long-term illness or disability, the socioeconomic gradient persisted, although of smaller magnitude.

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.

Health conditions and residential concentration of poverty: a study in Rio de Janeiro, Brazil.

STUDY OBJECTIVES To establish the geographical relation of health conditions to socioeconomic status in the city of Rio de Janeiro, Brazil. DESIGN All reported deaths in the municipality of Rio de Janeiro, from 1987 to 1995, obtained from the Mortality Information System, were considered in the study. The 24 “administrative regions” that compose the city were used as the geographical units. A geographical information system (GIS) was used to link mortality data and population census data, and allowed the authors to establish the geographical pattern of the health indicators considered in this study: “infant mortality rate”; “standardised mortality rate”; “life expectancy” and “homicide rate”. Information on location of low income communities (slums) was also provided by the GIS. A varimax rotation principal component analysis combined information on socioeconomic conditions and provided a two dimension basis to assess contextual variation. MAIN RESULTS The 24 administrative regions were aggregated into three different clusters, identified as relevant to reflect the socioeconomic variation. Almost all health indicator thematic maps showed the same socioeconomic stratification pattern. The worst health situation was found in the cluster composed of the harbour area and northern vicinity, precisely in the sector where the highest concentration of slum residents are present. This sector of the city exhibited an extremely high homicide rate and a seven year lower life expectancy than the remainder of the city. The sector that concentrates affluence, composed of the geographical units located along the coast, showed the best health situation. Intermediate health conditions were found in the west area, which also has poor living standards but low concentration of slums. CONCLUSIONS The findings suggest that social and organisation characteristics of low income communities may have a relevant role in understanding health variations. Local health and other social programmes specifically targeting these communities are recommended.

Avaliação das condições de atendimento do Programa de Saúde do Adolescente no Município do Rio de Janeiro

The aim of this study was to assess the prevalence and severity of dental caries and need for treatment among 18 years-old males in Florianópolis, Southern Brazil. In addition, the associations between dental caries and socioeconomic conditions were tested. A cross sectional study was carried out. A random sample of 300, was selected from a list of Brazilian Army conscripts. Clinical data were collected according to World Health Organization criteria. Socioeconomic data (years of education of the subjects, their fathers and mothers and family income) were collected through interviews. The statistical significance of associations between socioeconomic indicators and dental caries prevalence were tested using the chi-square test whilst for severity of dental caries Mann-Whitney test was used. The prevalence of dental caries was 81% and the mean DMF-T was 4.5. The mean number of teeth that needed treatment was 1.2. Both dental status and treatment need were statistically significantly associated with socioeconomic indicators. Those with low levels of education and income experienced more disease and needed more treatment than those from high levels of education and income.

Dinâmica da epidemia de AIDS no Município do Rio de Janeiro, no período de 1988-1996: uma aplicação de análise estatística espaço-temporal

Neste estudo, aplicou-se um modelo espaco-temporal para examinar a disseminacao espacial da epidemia de AIDS entre os casos adultos do Municipio do Rio de Janeiro em tres periodos: 1988-1990, 1991-1993 e 1994-1996. As regioes administrativas foram as unidades geograficas de estudo. Posteriormente, realizou-se analise espacial dos casos pediatricos por transmissao vertical do HIV, por periodo de nascimento, 1985-1990 e 1991-1996. Para a totalidade dos casos adultos, o periodo inicial e caracterizado por um conglomerado poligonal em torno da Zona Portuaria, que se expande na direcao oeste-leste. Entre os casos homossexuais, o crescimento in situ predominou, notando-se arrefecimento da disseminacao espacial nos ultimos anos. Entre os casos heterossexuais, a epidemia demonstrou expansao geografica expressiva, sobretudo de 1988-1990 a 1991-1993. Entre os casos do sexo feminino, no ultimo periodo, houve a formacao de um conglomerado de taxas elevadas na direcao noroeste, que compreende areas muito pobres. Entre 1991 e 1996, observou-se correlacao significativa das taxas de incidencia de AIDS perinatal com o indice de concentracao de pobreza. Os resultados sugerem que o entendimento da dinâmica espaco-temporal da epidemia pode subsidiar, de forma relevante, as acoes preventivas.This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro, Brazil, during three periods: 1988-1990, 1991-1993, and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission, according to period of birth, 1985-90 and 1991-96. For total adult AIDS cases, the initial period was characterized by a polygonal cluster located around the harbor area, which expanded from west to east. Among homosexual cases, in situ growth predominated, and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases, the epidemic displayed a relevant geographic spread, mainly from 1988-1990 to 1991-1993. Among female cases in the final time period, a cluster of high incidence rates was found towards the northwest, including very poor areas. Among pediatric cases in 1991-1996, a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures.This study uses a spatial-temporal model to analyze the spatial spread of the AIDS epidemic (adult cases) in the municipality of Rio de Janeiro Brazil during three periods: 1988-1990 1991-1993 and 1994-1996. City districts were used as the geographic units of analysis. A spatial analysis was also performed for pediatric AIDS cases due to vertical HIV transmission according to period of birth 1985-90 and 1991-96. For total adult AIDS cases the initial period was characterized by a polygonal cluster located around the harbor area which expanded from west to east. Among homosexual cases in situ growth predominated. and a decrease in the intensity of the diffusion process was observed from the second to the final period. Among heterosexual cases the epidemic displayed a relevant geographic spread mainly from 1988-1990 to 1991-1993. Among female cases in the final time period a cluster of high incidence rates was found towards the northwest including very poor areas. Among pediatric cases in 1991-1996 a significant correlation was found between AIDS incidence rates and poverty levels in the respective municipal districts. The results suggest that a more complete understanding of AIDS spatial-temporal dynamics can make a major contribution to preventive measures. (authors)

State of animus among Brazilians: influence of socioeconomic context?

Preliminary results of the World Health Survey, conducted in Brazil in 2003, indicate a high frequency of self-perceived problems related to state of animus. The main objective of the present study is to investigate the hypothesis that material deprivation and job insecurity are important determinants of self-reported mental problems, such as feelings of depression and anxiety. Analysis of factors associated with self-perceived problems related to state of animus was performed with multivariate logistic regression models. Among females, key factors associated with feelings of depression and anxiety were level of education and unemployment after controlling for age, presence of long duration disease or disability and of body injury limiting everyday activities. Among males, feelings of depression were most strongly associated with unemployment, followed by poverty (as measured by a household asset indicator), with being married (or cohabiting) showed a protector effect. With regard to severe feelings of anxiety, only unemployment contributed significantly. These findings highlight the influence of social and economic contexts, beyond strictly individual characteristics, on the health of Brazilians.