Marilia Arndt Mesenburg

Prevalence of Trypanosoma cruzi/HIV coinfection in southern Brazil

Chagas disease reactivation has been a defining condition for acquired immune deficiency syndrome in Brazil for individuals coinfected with Trypanosoma cruzi and HIV since 2004. Although the first coinfection case was reported in the 1980s, its prevalence has not been firmly established. In order to know coinfection prevalence, a cross-sectional study of 200 HIV patients was performed between January and July 2013 in the city of Pelotas, in southern Rio Grande do Sul, an endemic area for Chagas disease. Ten subjects were found positive for T. cruzi infection by chemiluminescence microparticle immunoassay and indirect immunofluorescence. The survey showed 5% coinfection prevalence among HIV patients (95% CI: 2.0-8.0), which was 3.8 times as high as that estimated by the Ministry of Health of Brazil. Six individuals had a viral load higher than 100,000copies per μL, a statistically significant difference for T. cruzi presence. These findings highlight the importance of screening HIV patients from Chagas disease endemic areas.

Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries

Summary Background Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions. Methods We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), womans education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression. Findings Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries. Interpretation The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. Funding The Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.

Serological diagnosis of Chagas disease in HIV-infected patients

INTRODUCTION This study assessed the rate of request for the serological diagnosis of Chagas disease among human immunodeficiency virus (HIV)-infected patients treated at the Specialized Care Service of Pelotas, Rio Grande do Sul, Brazil. METHODS This cross-sectional study used secondary data obtained from the medical records of 252 patients aged between 18 and 75 years. RESULTS The serological diagnosis of Chagas disease was requested only in 3.2% of cases. CONCLUSIONS The results demonstrate poor adherence to protocols on the part of healthcare professionals, indicating the need to reevaluate the procedures applied to HIV-infected patients from endemic regions for both diseases.

Acesso à vacina contra a hepatite B entre parturientes que realizaram o pré-natal em Pelotas, Rio Grande do Sul

OBJETIVO:avaliar a falta de acesso a vacina contra a hepatite B, motivos e fatores associados, entre parturientes que realizaram pre-natal no municipio de Pelotas, Rio Grande do Sul, Brasil.METODOS:estudo transversal de base populacional, incluindo todas as parturientes internadas nas maternidades do municipio por ocasiao do parto, em periodo de 30 dias, no ano de 2013.RESULTADOS:foram entrevistadas 352 parturientes; a falta de acesso a vacina foi de 23,1 (IC95%: 18,5-27,6) e o principal motivo foi nao indicacao pelo medico (70,1%); nao foi encontrada associacao entre falta de acesso e os fatores sociodemograficos estudados.CONCLUSOES:o acesso a vacina contra a hepatite B entre parturientes foi limitado, principalmente devido a sua nao recomendacao por parte do medico; os resultados evidenciam a necessidade de estabelecer medidas e acoes que proporcionem melhorias na atencao pre-natal, no que se refere as estrategias de vacinacao contra o virus da hepatite B.Objective: to evaluate lack of access to hepatitis B vaccination, its reasons and associated factors in pregnant women attending antenatal care in Pelotas. Methods: this was a cross-sectional population-based study using primary data at the municipality maternity facilities, including all women giving birth during a 30 day period in 2013. Results: 352 women were interviewed. There was 23.1% (95%CI, 18.5-27.6) lack of access to hepatitis B vaccine and the main reason for non-vaccination was the absence of the doctors recommendation (70.1%). No association was found between lack of access and the sociodemographic factors studied. Conclusions: the study found limited access to hepatitis B vaccine among pregnant women in Pelotas- RS, due mainly to the lack of the physician recommendation. The results highlight the need for measures and actions to improve prenatal care regarding HBV vaccination strategies.

Assessment of sexual risk behaviors and perception of vulnerability to sexually transmitted diseases/acquired immunodeficiency syndrome in women, 1999-2012: a population based survey in a medium-sized Brazilian city

Sexual behavior is a key factor for susceptibility to sexually transmitted diseases. An evaluation of the sexual behavior of women at reproductive age was conducted in 1999. A replication of this study aims to evaluate the current situation and identify changes in sexual behavior, 13 years later. This is a population-based cross-sectional study, conducted with 1071 women in Pelotas, Brazil. Compared to the 1999 study, a 14% increase in early sexual debut and an 8% decrease in the non-use of condoms were observed in 2012. The proportion of women who reported anal sex doubled between these periods. There was no trend of increase or decrease in the prevalence of behaviors with distinct patterns being observed for each of them. Reduction of non-use of condoms may be an indicator of the effectiveness of campaigns to promote safe sex. However, the increased prevalence of early sexual debut and anal sex indicates the need for campaigns to continue and to expand their focus, especially among vulnerable groups.

Prenatal and postnatal maternal depression and infant hospitalization and mortality in the first year of life: A systematic review and meta-analysis

BACKGROUND Prenatal and postnatal depression have been well studied in recent decades, but few studies address their relationship with hospitalization and mortality in one-year-old children. OBJECTIVE Review the literature about the effects of maternal depression on hospitalization and mortality of the child from birth to one year of age and conduct a meta-analysis. METHODS A systematic search was performed in the PubMed and LILACS databases. We included original studies that evaluated the effect of prenatal and/or postnatal depressive symptoms on child hospitalization or mortality up to one year of age. Meta-analyses were conducted according to the outcome and stratified by prenatal and postnatal depression, using random effects models. RESULTS Six studies were included in this review (170,371). Children of mothers with prenatal and postnatal depressive symptoms or depression had 1.44 (CI95% 1.10 - 1.89) greater risk of hospitalization, and children of mothers with postnatal depressive symptoms or depression had 1.93 (CI95% 1.02-3.64) greater risk of death before one year of age than those whose mothers did not have the disorder. LIMITATIONS Small number of studies (n < 10), different instrument and cut points were used to evaluate maternal depressive symptoms or diagnose depression. CONCLUSION Maternal depressive symptoms or depression have an unfavorable effect on hospitalization and mortality in children up to one year of age. This finding is relevant to public health and should stimulate the systematic screening of prenatal and postnatal depressive symptoms, so that adequate care can be provided for women and their children.

Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort

BackgroundThe disrespect and abuse of women during the process of childbirth is an emergent and global problem and only few studies have investigated this worrying issue. The objective of the present study was to describe the prevalence of disrespect and abuse of women during childbirth in Pelotas City, Brazil, and to investigate the factors involved.MethodsThis was a cross-sectional population-based study of women delivering members of the 2015 Pelotas birth cohort. Information relating to disrespect and abuse during childbirth was obtained by household interview 3 months after delivery. The information related to verbal and physical abuse, denial of care and invasive and/or inappropriate procedures. Poisson regression was used to evaluate the factors associated with one or more, and two or more, types of disrespectful treatment or abuse.ResultsA total of 4275 women took part in a perinatal study. During the three-month follow-up, we interviewed 4087 biological mothers with regards to disrespect and abuse. Approximately 10% of women reported having experienced verbal abuse, 6% denial of care, 6% undesirable or inappropriate procedures and 5% physical abuse. At least one type of disrespect or abuse was reported by 18.3% of mothers (95% confidence interval [CI]: 17.2–19.5); and at least two types by 5.1% (95% CI: 4.4–5.8). Women relying on the public health sector, and those whose childbirths were via cesarean section with previous labor, had the highest risk, with approximately a three- and two-fold increase in risk, respectively.ConclusionsOur study showed that the occurrence of disrespect and abuse during childbirth was high and mostly associated with payment by the public sector and labor before delivery. The efforts made by civil society, governments and international organizations are not sufficient to restrain institutional violence against women during childbirth. To eradicate this problem, it is essential to 1) implement policies and actions specific for this type of violence and 2) formulate laws to promote the equality of rights between women and men, with particular emphasis on the economic rights of women and the promotion of gender equality in terms of access to jobs and education.

Trypanosoma cruzi seroprevalence and associated risk factors in cancer patients from Southern Brazil.

INTRODUCTION: The aim of this study was to investigate the prevalence of Chagas disease in patients treated at a Public Oncology Service in the City of Pelotas, Southern Brazil. METHODS: This study included 200 individuals undergoing cancer treatment and involved the use of a questionnaire and venous blood collection for the detection of anti-Trypanosoma cruzi antibody. RESULTS: The study found a 5% prevalence of patient seropositivity. Significant variables are presented and discussed in the article. CONCLUSIONS: Serological T. cruzi checks are recommended in cancer patients, especially individuals from endemic areas in Brazil and other Latin American countries.

Acceso a la vacuna contra la hepatitis B entre parturientas que realizaron el prenatal en Pelotas, Rio Grande do Sul

OBJETIVO:avaliar a falta de acesso a vacina contra a hepatite B, motivos e fatores associados, entre parturientes que realizaram pre-natal no municipio de Pelotas, Rio Grande do Sul, Brasil.METODOS:estudo transversal de base populacional, incluindo todas as parturientes internadas nas maternidades do municipio por ocasiao do parto, em periodo de 30 dias, no ano de 2013.RESULTADOS:foram entrevistadas 352 parturientes; a falta de acesso a vacina foi de 23,1 (IC95%: 18,5-27,6) e o principal motivo foi nao indicacao pelo medico (70,1%); nao foi encontrada associacao entre falta de acesso e os fatores sociodemograficos estudados.CONCLUSOES:o acesso a vacina contra a hepatite B entre parturientes foi limitado, principalmente devido a sua nao recomendacao por parte do medico; os resultados evidenciam a necessidade de estabelecer medidas e acoes que proporcionem melhorias na atencao pre-natal, no que se refere as estrategias de vacinacao contra o virus da hepatite B.Objective: to evaluate lack of access to hepatitis B vaccination, its reasons and associated factors in pregnant women attending antenatal care in Pelotas. Methods: this was a cross-sectional population-based study using primary data at the municipality maternity facilities, including all women giving birth during a 30 day period in 2013. Results: 352 women were interviewed. There was 23.1% (95%CI, 18.5-27.6) lack of access to hepatitis B vaccine and the main reason for non-vaccination was the absence of the doctors recommendation (70.1%). No association was found between lack of access and the sociodemographic factors studied. Conclusions: the study found limited access to hepatitis B vaccine among pregnant women in Pelotas- RS, due mainly to the lack of the physician recommendation. The results highlight the need for measures and actions to improve prenatal care regarding HBV vaccination strategies.

Access to hepatitis B vaccine by pregnant women attending antenatal care in Pelotas, Rio Grande do Sul State, Brazil

OBJETIVO:avaliar a falta de acesso a vacina contra a hepatite B, motivos e fatores associados, entre parturientes que realizaram pre-natal no municipio de Pelotas, Rio Grande do Sul, Brasil.METODOS:estudo transversal de base populacional, incluindo todas as parturientes internadas nas maternidades do municipio por ocasiao do parto, em periodo de 30 dias, no ano de 2013.RESULTADOS:foram entrevistadas 352 parturientes; a falta de acesso a vacina foi de 23,1 (IC95%: 18,5-27,6) e o principal motivo foi nao indicacao pelo medico (70,1%); nao foi encontrada associacao entre falta de acesso e os fatores sociodemograficos estudados.CONCLUSOES:o acesso a vacina contra a hepatite B entre parturientes foi limitado, principalmente devido a sua nao recomendacao por parte do medico; os resultados evidenciam a necessidade de estabelecer medidas e acoes que proporcionem melhorias na atencao pre-natal, no que se refere as estrategias de vacinacao contra o virus da hepatite B.Objective: to evaluate lack of access to hepatitis B vaccination, its reasons and associated factors in pregnant women attending antenatal care in Pelotas. Methods: this was a cross-sectional population-based study using primary data at the municipality maternity facilities, including all women giving birth during a 30 day period in 2013. Results: 352 women were interviewed. There was 23.1% (95%CI, 18.5-27.6) lack of access to hepatitis B vaccine and the main reason for non-vaccination was the absence of the doctors recommendation (70.1%). No association was found between lack of access and the sociodemographic factors studied. Conclusions: the study found limited access to hepatitis B vaccine among pregnant women in Pelotas- RS, due mainly to the lack of the physician recommendation. The results highlight the need for measures and actions to improve prenatal care regarding HBV vaccination strategies.