Mônica da Silva-Nunes

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados

This cross-sectional population-based study investigated prevalence rates and associated factors for anemia, iron deficiency anemia, and iron deficiency among children 6 to 60 months of age in two towns in Acre State, Brazil (N = 624). Hemoglobin, plasma ferritin, and soluble transferrin receptor were measured in venous blood samples. Socioeconomic, demographic, and disease data were obtained using a questionnaire. Prevalence ratios were calculated by Poisson regression in a hierarchical model. Prevalence rates for anemia, iron deficiency anemia, and iron deficiency were 30.6%, 20.9%, and 43.5%, respectively. Children younger than 24 months showed higher risk of anemia, iron deficiency anemia, and iron deficiency. The highest family income tertile was a protective factor against iron deficiency anemia (PR: 0.62; 95%CI: 0.40-0.98). The highest height-for-age quartile was protective against anemia (0.62; 0.44-0.86) and iron deficiency anemia (0.51; 0.33-0.79), and recent history of diarrhea was associated with increased risk of anemia (1.47; 1.12-1.92) and iron deficiency anemia (1.44; 1.03-2.01). Geohelminth infection was associated with increased risk of anemia, iron deficiency anemia, and iron deficiency.

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados Anemia and iron defi ciency among schoolchildren in the Western Brazilian Amazon: prevalence and associated factors

This cross-sectional population-based study investigated prevalence rates and associated factors for anemia, iron deficiency anemia, and iron deficiency among children 6 to 60 months of age in two towns in Acre State, Brazil (N = 624). Hemoglobin, plasma ferritin, and soluble transferrin receptor were measured in venous blood samples. Socioeconomic, demographic, and disease data were obtained using a questionnaire. Prevalence ratios were calculated by Poisson regression in a hierarchical model. Prevalence rates for anemia, iron deficiency anemia, and iron deficiency were 30.6%, 20.9%, and 43.5%, respectively. Children younger than 24 months showed higher risk of anemia, iron deficiency anemia, and iron deficiency. The highest family income tertile was a protective factor against iron deficiency anemia (PR: 0.62; 95%CI: 0.40-0.98). The highest height-for-age quartile was protective against anemia (0.62; 0.44-0.86) and iron deficiency anemia (0.51; 0.33-0.79), and recent history of diarrhea was associated with increased risk of anemia (1.47; 1.12-1.92) and iron deficiency anemia (1.44; 1.03-2.01). Geohelminth infection was associated with increased risk of anemia, iron deficiency anemia, and iron deficiency.

Epidemic and Endemic Malaria Transmission Related to Fish Farming Ponds in the Amazon Frontier

Fish farming in the Amazon has been stimulated as a solution to increase economic development. However, poorly managed fish ponds have been sometimes associated with the presence of Anopheles spp. and consequently, with malaria transmission. In this study, we analyzed the spatial and temporal dynamics of malaria in the state of Acre (and more closely within a single county) to investigate the potential links between aquaculture and malaria transmission in this region. At the state level, we classified the 22 counties into three malaria endemicity patterns, based on the correlation between notification time series. Furthermore, the study period (2003–2013) was divided into two phases (epidemic and post-epidemic). Higher fish pond construction coincided both spatially and temporally with increased rate of malaria notification. Within one malaria endemic county, we investigated the relationship between the geolocation of malaria cases (2011–2012) and their distance to fish ponds. Entomological surveys carried out in these ponds provided measurements of anopheline abundance that were significantly associated with the abundance of malaria cases within 100 m of the ponds (P < 0.005; r = 0.39). These results taken together suggest that fish farming contributes to the maintenance of high transmission levels of malaria in this region.

Ensino médico e extensão em áreas Ribeirinhas da Amazônia

ABSTRACT The model of medical education has been undergoing a transition between classical theory and pro-blem-oriented teaching based in the past years. Relying on an outpatient practice, we created an outreach project for the simultaneous teaching of students from different years of the medical course integrated with the consultation of a riverside population, where each used their academic skills al-ready acquired in the course to create an outpatient service (pre-consultation, medical consultation, vaccination and drug dispensing) in order to promote a health service. This action occurred in the most remote areas of the Brazilian Amazon, showing that it is possible to combine community outre-ach projects and teaching while making future medical doctors more aware of the different Brazilian socioeconomic and cultural realities. Recebido em: 01/02/2013Reencaminhado em: 14/06/2013Aprovado em: 28/08/2013 REVISTA BRASILEIRA DE EDUCACAO MEDICA 566 37 (4) : 566-572; 2013 I Universidade Federal do Acre, Rio Branco, AC, Brasil.

Desnutrição infantil em um dos municípios de maior risco nutricional do Brasil: estudo de base populacional na Amazônia Ocidental Brasileira

Objective: To estimate the prevalence of child undernutrition and associated factors in a municipality with high nutritional risk in Brazil. Methods: This cross-sectional, population-based study was conducted with a sample of 478 children aged under 5 years in the city of Jordao, Acre, Brazil. The following indicators were calculated: weight for age (W/A), height for age (H/A), and weight for height (W/H), using the growth curves of the WHO as reference, which adopts a cutoff of -2 z scores for identification of malnourished children. Adjusted prevalence ratios (PRs) were obtained using multiple Poisson regression models with robust error estimate (p < 0.05). Results: A high prevalence of stunting (35.8%) was observed. Children with indigenous ancestry living in rural areas showed the highest prevalence of malnutrition (59.4%). After controlling for age, gender, and indigenous ancestry, the factors associated with stunting risk were: living in rural area (PR = 1.6; 95%CI 1.2 - 2.1); lower tertile of household wealth index (PR = 1.6; 95%CI 1.1 - 2.3); living in houses made of walking palm (PR = 1.6; 95%CI 1.1 - 2.4); maternal height less than or equal to 146.4 cm (PR = 3.1; 95%CI 1.9 - 5.0); and history of introduction of cows milk before 30 days of age (PR = 1.4; 95%CI 1.0 - 1.8). Children with updated vaccination cards were inversely associated with stunting risk (PR = 0.7; 95%CI 0.5 - 0.9). Conclusion: Child undernutrition remains a serious public health problem in the Amazon, indicating additional difficulties in facing the problem in this region of the country.Objective: To estimate the prevalence of child undernutrition and associated factors in a municipality with high nutritional risk in Brazil. Methods: This cross-sectional, population-based study was conducted with a sample of 478 children aged under 5 years in the city of Jordão, Acre, Brazil. The following indicators were calculated: weight for age (W/A), height for age (H/A), and weight for height (W/H), using the growth curves of the WHO as reference, which adopts a cutoff of -2 z scores for identification of malnourished children. Adjusted prevalence ratios (PRs) were obtained using multiple Poisson regression models with robust error estimate (p < 0.05). Results: A high prevalence of stunting (35.8%) was observed. Children with indigenous ancestry living in rural areas showed the highest prevalence of malnutrition (59.4%). After controlling for age, gender, and indigenous ancestry, the factors associated with stunting risk were: living in rural area (PR = 1.6; 95%CI 1.2 - 2.1); lower tertile of household wealth index (PR = 1.6; 95%CI 1.1 - 2.3); living in houses made of walking palm (PR = 1.6; 95%CI 1.1 - 2.4); maternal height less than or equal to 146.4 cm (PR = 3.1; 95%CI 1.9 - 5.0); and history of introduction of cows milk before 30 days of age (PR = 1.4; 95%CI 1.0 - 1.8). Children with updated vaccination cards were inversely associated with stunting risk (PR = 0.7; 95%CI 0.5 - 0.9). Conclusion: Child undernutrition remains a serious public health problem in the Amazon, indicating additional difficulties in facing the problem in this region of the country.

Stunting in children under five years old is still a health problem in the Western Brazilian Amazon: a population-based study in Assis Brasil, Acre, Brazil

Despite the process of nutritional transition in Brazil, in some places, such as the Amazon region, stunting is still an important public health problem. We identified the prevalence and factors associated with stunting in children under five years old residing in the urban area of Assis Brasil. A survey was conducted in which a questionnaire on socioeconomic, maternal and childrens conditions was applied, and height or length was measured. The children with height for age index below -2 Z-scores were considered stunted, according to the criteria by the World Health Organization. Four hundred and twenty-eight children were evaluated. Of these, 62 were stunted. Factors associated with stunting, according to adjusted models, were: the presence of open sewer, the wealth index for households, the receipt of governmental financial aid and the mothers height, age and education. Therefore, it was observed that family and the mothers characteristics as well as environmental and socioeconomic factors were closely related to the occurrence of stunting in the population studied, and such nutritional disturbance is still a health problem in the Brazilian Amazon.

Association between malaria and anemia in an urban area with Plasmodium transmission: Mâncio Lima, Acre State, Brazil

El objetivo de este trabajo es analizar la prevalencia de anemia atribuible a la malaria en una poblacion urbana, residente en el Municipio de Mâncio Lima, Acre, Brasil. Se trata de un estudio de cohorte no-concurrente con 1.167 personas acompanadas por tres meses anteriores a la fecha de la entrevista a traves de datos del SIVEP-Malaria. Se calcularon las medidas de frecuencia y la prevalencia de anemia en pacientes con y sin historial de malaria reciente, conforme las variables de interes. Los resultados mostraron que un 50,2% de los individuos eran de sexo masculino y 67,96% se encontraban en la franja de edad de 15 anos o mas. La prevalencia general de anemia fue de un 7,1%, siendo mayor en la franja de edad de 6 meses hasta 5 anos de edad. En relacion con el historial de malaria reciente, se verifico que un 8,3% de los hombres que tuvieron malaria presentaron anemia. En general, la prevalencia de anemia atribuible a la malaria fue nula, excepto para los hombres (2,4%) y en el barrio Cobal (51,4%). Los resultados demuestran baja prevalencia de anemia y que la contribucion de la malaria a la anemia existe solamente en hombres y areas geograficas especificas.The aim of this study was to analyze the prevalence of malaria-attributable anemia in the urban population of Mâncio Lima, Acre State, Brazil. This was a non-concurrent cohort study of 1,167 persons followed for the three months prior to the interview using data from the SIVEP-Malaria database. Anemia frequency and prevalence rates were calculated in patients with and without a recent history of malaria, according to target variables. 50.2% of the individuals were males, and 67.96% were 15 years or older. Overall anemia prevalence was 7.1%, higher in the 6 months to 5 years age bracket. Some 8.3% of men with a recent history of malaria presented anemia. Overall, prevalence of malaria-attributable anemia was negligible, except in men (2.4%) and the Cobal neighborhood (51.4%). The results showed that anemia prevalence was low and that malarias contribution to anemia only existed in men and in specific geographic areas.

Asociación entre malaria y anemia en un área urbana de transmisión del Plasmodium : Mâncio Lima, Acre, Brasil

El objetivo de este trabajo es analizar la prevalencia de anemia atribuible a la malaria en una poblacion urbana, residente en el Municipio de Mâncio Lima, Acre, Brasil. Se trata de un estudio de cohorte no-concurrente con 1.167 personas acompanadas por tres meses anteriores a la fecha de la entrevista a traves de datos del SIVEP-Malaria. Se calcularon las medidas de frecuencia y la prevalencia de anemia en pacientes con y sin historial de malaria reciente, conforme las variables de interes. Los resultados mostraron que un 50,2% de los individuos eran de sexo masculino y 67,96% se encontraban en la franja de edad de 15 anos o mas. La prevalencia general de anemia fue de un 7,1%, siendo mayor en la franja de edad de 6 meses hasta 5 anos de edad. En relacion con el historial de malaria reciente, se verifico que un 8,3% de los hombres que tuvieron malaria presentaron anemia. En general, la prevalencia de anemia atribuible a la malaria fue nula, excepto para los hombres (2,4%) y en el barrio Cobal (51,4%). Los resultados demuestran baja prevalencia de anemia y que la contribucion de la malaria a la anemia existe solamente en hombres y areas geograficas especificas.The aim of this study was to analyze the prevalence of malaria-attributable anemia in the urban population of Mâncio Lima, Acre State, Brazil. This was a non-concurrent cohort study of 1,167 persons followed for the three months prior to the interview using data from the SIVEP-Malaria database. Anemia frequency and prevalence rates were calculated in patients with and without a recent history of malaria, according to target variables. 50.2% of the individuals were males, and 67.96% were 15 years or older. Overall anemia prevalence was 7.1%, higher in the 6 months to 5 years age bracket. Some 8.3% of men with a recent history of malaria presented anemia. Overall, prevalence of malaria-attributable anemia was negligible, except in men (2.4%) and the Cobal neighborhood (51.4%). The results showed that anemia prevalence was low and that malarias contribution to anemia only existed in men and in specific geographic areas.

Associação entre malária e anemia em área urbana de transmissão do Plasmodium: Mâncio Lima, Acre, Brasil

El objetivo de este trabajo es analizar la prevalencia de anemia atribuible a la malaria en una poblacion urbana, residente en el Municipio de Mâncio Lima, Acre, Brasil. Se trata de un estudio de cohorte no-concurrente con 1.167 personas acompanadas por tres meses anteriores a la fecha de la entrevista a traves de datos del SIVEP-Malaria. Se calcularon las medidas de frecuencia y la prevalencia de anemia en pacientes con y sin historial de malaria reciente, conforme las variables de interes. Los resultados mostraron que un 50,2% de los individuos eran de sexo masculino y 67,96% se encontraban en la franja de edad de 15 anos o mas. La prevalencia general de anemia fue de un 7,1%, siendo mayor en la franja de edad de 6 meses hasta 5 anos de edad. En relacion con el historial de malaria reciente, se verifico que un 8,3% de los hombres que tuvieron malaria presentaron anemia. En general, la prevalencia de anemia atribuible a la malaria fue nula, excepto para los hombres (2,4%) y en el barrio Cobal (51,4%). Los resultados demuestran baja prevalencia de anemia y que la contribucion de la malaria a la anemia existe solamente en hombres y areas geograficas especificas.The aim of this study was to analyze the prevalence of malaria-attributable anemia in the urban population of Mâncio Lima, Acre State, Brazil. This was a non-concurrent cohort study of 1,167 persons followed for the three months prior to the interview using data from the SIVEP-Malaria database. Anemia frequency and prevalence rates were calculated in patients with and without a recent history of malaria, according to target variables. 50.2% of the individuals were males, and 67.96% were 15 years or older. Overall anemia prevalence was 7.1%, higher in the 6 months to 5 years age bracket. Some 8.3% of men with a recent history of malaria presented anemia. Overall, prevalence of malaria-attributable anemia was negligible, except in men (2.4%) and the Cobal neighborhood (51.4%). The results showed that anemia prevalence was low and that malarias contribution to anemia only existed in men and in specific geographic areas.

Lobomycosis of the Lower Limb in an Amazonian Patient.

A 56 year-old human immunodeficiency virus (HIV)–negative Amazonian male farmer presented with multiple skin nodules in the left lower limb, which started 28 years ago after a penetrating trauma in the lower limb with the thorn of a plant (Figure 1A ). He complained of frequent itching, ulceration, and bleeding of the nodules (Figure 1B). A biopsy revealed a chronic granulomatous process (Figure 1C, arrows) affecting the dermis, with rounded fungi with a thick double wall, forming single chains (Figure 1C–F, asterisk), and fulfilling the morphologic diagnostic criteria of Lacazia loboi.1 Lobomycosis is endemic in the Amazon region and is suspected when long-lasting dermal, keloid-like lesions are present in patients from the rainforest or farmers, and diagnosis is based on the biopsy findings. Differential diagnosis includes lepromatous and reactional tuberculoid leprosy, verrucous cutaneous leishmaniasis, chromomycosis, sporotrichosis, and keloids. The patient was referred for surgical resection of the nodules at the Dermatology State Service. Figure 1. (A) Hyperplastic lesions in the lower left limb; (B) hyperplastic ulcerated lesions; (C) biopsy showing chronic granulomatous inflammation with forms of Lacazia loboi inside giant cells; (D) Grocott stain showing round yeasts with a double wall, forming ... Treatment of lobomycosis is very difficult. Until recently, no efficient drug treatment was available for this disease. Recently, Bustamante and others2 described successful treatment with posaconazole in a patient that received 400 mg 2 × a day for 27 months. Woods and others3 also described successful drug treatment of lobomycosis in 10 patients that had leprosy. As the patients received regular treatment of leprosy with rifampicin, clofazimine, and dapsone, lobomycosis lesions decreased in size, and remaining lesions were excised. Since lobomycosis is only seen in certain geographical regions of the world, and usually in poorly developed areas, there is a substantial lack of scientific knowledge, and more research is needed on treatment of this disease.