Nelson A. Neumann

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

OBJETIVOS: Determinar a prevalencia e investigar fatores associados a ocorrencia de anemia entre menores de seis anos de idade atendidos pela Pastoral da Crianca em Pelotas, RS. METODOS: Na fase de rastreamento de uma intervencao nutricional, as criancas foram avaliadas atraves de estudo transversal. No domicilio, apos consentimento informado, a mae foi entrevistada, sendo coletadas informacoes sobre caracteristicas demograficas e socioeconomicas da familia, saude da crianca, caracteristicas ao nascer, amamentacao e frequencia semanal de consumo de alimentos. As criancas foram pesadas e medidas. Foi coletada uma amostra de sangue capilar da polpa digital em microcuveta e a leitura da concentracao de hemoglobina foi feita em fotometro portatil (Hemocue). Considerou-se como tendo anemia quando a concentracao de hemoglobina era inferior a 11 g/dl. Por se tratar de desfecho frequente, a associacao com as variaveis independentes foi analisada por regressao de Poisson. A analise obedeceu a modelo hierarquico previamente definido. RESULTADOS: Foram identificadas 362 criancas menores de seis anos, sendo a hemoglobina dosada em 304 (84,0%) delas. A prevalencia de anemia foi de 53,0% (IC95% 47,2% - 58,7%). Os fatores de risco foram a menor idade da crianca, cor nao branca, presenca de familia numerosa e classe social E (em comparacao a D). A disponibilidade de agua encanada dentro de casa e o maior peso ao nascer mostraram-se fatores protetores. CONCLUSOES: os achados deste estudo mostram uma alta prevalencia de anemia entre as criancas alvo da acao da Pastoral da Crianca, bem como a presenca de diversos fatores de risco e poucos fatores de protecao, o que mostra a necessidade de intervencoes preventivas.

Qualidade e eqüidade da atenção ao pré-natal e ao parto em Criciúma, Santa Catarina, Sul do Brasil

Este estudo transversal de base populacional teve por objetivo avaliar a qualidade e a equidade da atencao ao pre-natal, ao parto e ao recem-nascido em uma amostra probabilistica de 2180 criancas menores de tres anos residentes na area urbana do municipio de Criciuma, SC. 96,6% das maes destas criancas realizaram pelo menos uma consulta de pre-natal; o parto hospitalar foi praticamente universal. As maes de menor renda iniciaram o pre-natal mais tarde e realizaram menos consultas. Gestantes com maior risco reprodutivo apresentaram menor percentagem de atendimento com qualidade adequada. Dos 13 procedimentos de pre-natal e parto pesquisados, o 1o e 4o quartil de renda familiar realizaram 8,6 e 9,4 procedimentos, respectivamente. Os exames ginecologico especular e de mamas foram os menos realizados (51% para ambos). As gestantes do 4o quartil de renda familiar total tiveram 1,5 e 1,9 vezes mais estes procedimentos em relacao as do 1o quartil. Esforcos devem ser feitos no sentido de captar precocemente as maes provenientes de familias de menor poder aquisitivo e deve ser utilizado o enfoque de risco com discriminacao positiva. Os medicos devem ser re-treinados quanto aos seus procedimentos tanto no pre-natal quanto na assistencia ao parto.

Perfil dos idosos residentes em dois municípios pobres das regiões Norte e Nordeste do Brasil: resultados de estudo transversal de base populacional

This study aimed to determine the profile of the elderly population (>or= 60 years) in two poor municipalities in North and Northeast Brazil in 2005. Using a cross-sectional survey with a systematic sample, previously trained interviewers applied a standard household questionnaire on demographic characteristics, socioeconomic status, household conditions, physical activity, immunization status, health problems, and expenditures on medicines. Of the total sample (n = 1,013), 528 lived in Caracol, Piauí State, and 478 in Garrafão do Norte, Pará State. 56% were 60-69 years old, 10% lived alone, 69% were illiterate, 8% had a family income less than the minimum wage, 24% of the households had a flush toilet, 60% had a radio, television, and refrigerator, 88% reported at least one chronic disease, 47% had to purchase all their medicines out-of-pocket, 84% had received influenza vaccination, and 90% were able to perform normal activities of daily living. Elderly people included in this study showed poor household conditions, inadequate access to health care, and high levels of morbidity.

Corrimento vaginal referido entre gestantes em localidade urbana no Sul do Brasil: prevalência e fatores associados

Abstract The purpose of this study was to determine the prevalence and risk factors associated with self-reported vaginal discharge among pregnant women in the city of Rio Grande, South Brazil. Using a cross-sectional design, a standard inter-view was applied to pregnant women at home by previously trained interviewers, covering the following: demographic, reproductive, and so-cioeconomic data, household conditions, health care, and illnesses during pregnancy, including vaginal discharge. The chi-square test was used to compare proportions, and Poisson regression was used in the multivariate analysis. Among the 339 pregnant women interviewed, 52% reported vaginal discharge. The following variables were significantly associated with the outcome: age (prevalence rate, PR = 1.49), marital status (PR = 1.31), urinary tract infection (PR = 1.56), hyper-glycemia (PR = 1.48), use of an intrauterine de-vice (PR = 2.35), and history of preterm delivery (PR = 1.37), with oral contraception showing a protective effect (PR = 0.79). Prevalence of self-reported discharge was high among this group of pregnant women. Several risk factors were also identified for the disease under study. These findings can contribute to the implementation of preventive interventions.Vaginal Discharge; Pregnant Women; Preva-lence; Risk Factors

Health care during pregnancy and childbirth: results of two cross-sectional surveys in poor areas of North and Northeast Brazil

In 2002 and 2005, two surveys were conducted in poor areas of North and Northeast Brazil to evaluate prenatal care received by mothers of children under five years old. The study covered 1,528 and 1,529 children in 2002 and 2005, respectively. In this three-year period, maternal schooling and monthly family income increased by 1.5 years and US

Desempenho da Pastoral da Criança na promoçao de açoes de sobrevivência infantil e na educaçao em saúde em Criciúma, uma cidade do sul do Brasil

50.00, respectively, availability of safe drinking water increased from 23% to 41%, the proportion of pregnant woman with six or more prenatal visits increased from 42% to 52%, and immunization against neonatal tetanus increased from 54% to 77%. Coverage of uterine height evaluation increased from 54% to 77%. Testing for HIV and syphilis virtually doubled, from 8% to 16%. Meanwhile, gynecological examinations dropped from 41% to 31% and counseling for breastfeeding decreased from 66% to 55%. Despite improvements, the studys results show that the target indicators in these areas fall short of those in more developed regions of Brazil. Efforts should be made to reduce this gap.

Diferentes estratégias de visita domiciliar e seus efeitos sobre a assistência pré-natal no extremo Sul do Brasil

Milhares de criancas menores de 5 anos ainda morrem em todo o mundo devido a doencas preveniveis. As intervencoes comunitarias que enfatizam cuidados primarios de saude e nutricao tem sido apontadas como uma das solucoes para superar este problema. O presente trabalho descreve um estudo transversal, de base populacional, cujo objetivo foi avaliar se criancas e maes acompanhadas pela Pastoral da Crianca, entidade ligada a Conferencia Nacional dos Bispos do Brasil e que atua junto a comunidades carentes, apresentam melhores indicadores de saude e conhecimento sobre as acoes basicas de sobrevivencia infantil do que as criancas e maes nao acompanhadas. O estudo foi desenvolvido em 1996 na area urbana do municipio de Criciuma, estado de Santa Catarina, Brasil, com uma amostra probabilistica de 2 208 criancas menores de 3 anos. A analise ajustada para possiveis fatores de confusao demonstrou que a Pastoral esteve significativamente associada ao conhecimento materno quanto a conduta alimentar durante a diarreia, a idade ideal para o aleitamento materno exclusivo, a contra-indicacao do leite em po, a interpretacao da curva de crescimento e quanto ao esquema vacinal. A participacao na Pastoral esteve positivamente associada a maior duracao total do aleitamento materno, a introducao tardia da mamadeira, ao maior numero de pesagens no trimestre imediatamente anterior a pesquisa e a posse de colher-medida para reidratacao oral. Nao houve associacao significativa entre a vinculacao a Pastoral e a duracao do aleitamento materno exclusivo ou predominante nem o manejo da diarreia. A avaliacao mostrou aspectos positivos da atuacao da Pastoral, assim como areas em que maiores investimentos sao necessarios. A Pastoral e outras entidades do mesmo tipo devem priorizar ainda mais a educacao das maes quanto aos cuidados com a crianca. Estas entidades devem tentar recrutar as maes ainda durante a gestacao, quando o impacto das acoes de educacao e potencialmente maior.

Evaluation of knowledge on prenatal care and pregnancy risk among women living in a peripheral area of Rio Grande, Rio Grande do Sul State, Brazil

This non-randomized community intervention study evaluated the impact of prenatal home visits by community health agents and volunteer leaders from the Childrens Mission on prenatal care among poor pregnant women in Rio Grande, Rio Grande do Sul State, Brazil. Previously trained interviewers applied pre-coded questionnaires to the women at home, investigating demographic and reproductive characteristics, socioeconomic status, housing conditions, and prenatal care. Of the 339 pregnant women interviewed, 115 were assigned to the intervention group visited by community health agents, 116 to the group visited by volunteer leaders, and 108 to the control group. Pregnant women visited by community health agents began prenatal visits earlier than other groups, had more prenatal visits, lab tests, and clinical exams, and received more counseling on breastfeeding and iron supplementation. Participation by family members during medical consultations for pregnant women visited by volunteer leaders was higher than for community health agents. Pregnant women visited by community health agents received better prenatal care than the other groups. Home visits can improve the quality of prenatal care for poor women and increase participation by family members (mainly husbands) during the pregnancy.

Saúde infantil em áreas pobres das regiões Norte e Nordeste do Brasil: comparando indicadores básicos em áreas atendidas pela Pastoral da Criança e áreas-controle

The aim of this study was to assess knowledge on prenatal care and pregnancy risk among women in poor neighborhoods in the city of Rio Grande, Rio Grande do Sul State, Brazil. Data were collected using a cross-sectional design. A standard questionnaire was applied to all pregnant women from poor neighborhoods. Trained interviewers visited these women at home, covering demographic, socioeconomic, and reproductive data and knowledge concerning prenatal care and pregnancy risk factors. A total of 367 pregnant women were interviewed using non-random sampling. Except for urine tests and HIV testing, spontaneously reported as necessary, other procedures were reported by no more than 30% of the women. Digital vaginal examination, clinical breast examination, and Pap smear were reported by a maximum of 7% of the women. Only two-thirds felt that vaginal bleeding and abdominal pain were serious signs during gestation. Other signs and symptoms were reported by a maximum of one-third of the women. In conclusion, knowledge of prenatal tests and situations indicating serious risk fell far short of the desired levels. Improving this level of information in pregnant women could help reduce maternal and child morbidity and mortality.

A Pastoral da Criança em Criciúma, Santa Catarina, Brasil: cobertura e características sócio-demográficas das famílias participantes

Community surveys are essential to estimate health indicators, evaluate health programs, and define health interventions. In 2002, a cross-sectional survey of children under five was conducted in 18 areas of the poorest counties in North and Northeast Brazil. Nine areas were visited by volunteer community health workers (CHW) under the Childrens Mission, and the others were not visited. Using a standard questionnaire, trained interviewers collected information at the household level for 1,528 children, 782 of whom were visited monthly by CHWs and 772 were not. All the children and their families were living below the poverty line; 40.0% of the parents were illiterate, per capita daily income was about US