Paulo Roberto Borges de Souza Junior

Infecção pelo HIV durante a gestação: estudo-Sentinela Parturiente, Brasil, 2002

OBJETIVO: Avaliar a cobertura efetiva da deteccao da infeccao pelo HIV durante a gestacao, em âmbito nacional. METODOS: A cobertura efetiva do teste de HIV na gestacao foi definida como a proporcao de gestantes que teve atendimento pre-natal (pelo menos uma consulta), pedido de teste de HIV e conhecimento do resultado antes do parto, sendo estimada por processo de amostragem, utilizando-se as informacoes coletadas no Estudo-Sentinela Parturiente, 2002. As desigualdades da cobertura efetiva foram analisadas por: grande regiao; tamanho populacional do municipio de ocorrencia do parto; e grau de instrucao da mae. RESULTADOS: A cobertura efetiva do teste de HIV durante a gestacao foi estimada em 52%. As enormes desigualdades socioespaciais ficaram evidenciadas na comparacao entre as regioes Nordeste (24%) e Sul (72%); entre parturientes analfabetas (19%) com as que tem o ensino fundamental completo (64%); entre as que realizaram o parto em municipios pequenos (36%) com as que o realizaram em municipios com mais de 500 mil habitantes (66%). As recomendacoes do Ministerio da Saude foram atendidas, completamente, por somente 27% parturientes. CONCLUSOES: Os resultados estabelecem a necessidade de haver medidas voltadas para maior cobertura da deteccao do HIV na gestacao, e indicam que os programas do Programa Nacional de DST e Aids e os programas de saude da mulher devem ser intensificados, com estrategias conjuntas entre eles.

Pesquisa Nacional de Saude no Brasil: concepcao e metodologia de aplicacao

The National Health Survey is a household-based nationwide survey carried out by the Ministry of Health in partnership with the Brazilian Institute of Geography and Statistics. The scope of the survey is to establish the health status and lifestyles of the population - as well as how they look after their health - with regard to access and use of services, preventive actions, continuity of care, and health care financing. The sample size is 80,000 households and enables the calculation of some indicators at different geographic levels, namely states, capitals, metropolitan and rural areas. The questionnaire is divided into three parts. The first two are answered by one resident and include questions on the household characteristics and on the social and economic level and health status of all inhabitants. The individual questionnaire is answered by an adult (aged 18 years or more), selected with equal probability among the adult residents, and focuses on morbidity and lifestyle. For this individual, measurements of weight, height, waist circumference and blood pressure are taken, as well as laboratory exams to characterize the lipid profile and blood glucose level, as well as determine the urine sodium content. The laboratory exams are taken in a subsample of 25% of the census sectors selected.

Analysis of Data Collected by RDS Among Sex Workers in 10 Brazilian Cities, 2009: Estimation of the Prevalence of HIV, Variance, and Design Effect

Background:Respondent-driven sampling (RDS) is a chain-referral method that is being widely used to recruit most at-risk populations. Because the method is respondent driven, observations are dependent. However, few publications have focused on methodological challenges in the analysis of data collected by RDS. Methods:In this article, we propose a method for estimating the variance of the HIV prevalence rate, based on the Markov transition probabilities and within recruitment cluster variation. The method was applied to a female commercial sex workers study carried out in 10 Brazilian cities in 2008. Both the inverse of network size and the size of the city were considered in the estimation of overall sampling weights. The study included a behavior questionnaire and rapid tests for HIV and syphilis. Results:About 2523 interviews were conducted successfully, excluding the seeds. Results show a positive homophily between recruits for those HIV+; HIV- recruiters selected HIV+ recruits 4% of the time; HIV+ recruiters selected other HIV+ recruits 19.6% of the time, about 5 times higher. The prevalence rate was estimated at 4.8% (95% confidence interval: 3.4 to 6.1), and a design effect of 2.63. Conclusions:Using statistical methods for complex sample designs, it was possible to estimate HIV prevalence, standard error, and the design effect analytically. Additionally, the proposed analysis lends itself to logistic regression, permitting multivariate models. The stratification in cities has proved suitable for reducing the effect of design and can be adopted in other RDS studies, provided the weights of the strata are known.

[Trends in the AIDS epidemic in groups at highest risk in Brazil, 1980-2004].

The objective of this paper was to present the trends in the AIDS epidemic in the population groups at highest risk in Brazil. Discriminant analysis was used to reclassify cases with unknown risk into one of the three groups: IDU (injecting drug users), MSM (men who have sex with men), and heterosexuals. AIDS incidence rates by gender and exposure category were estimated for the period 1980-2004. In 1980-1988, 63.6% of AIDS cases were homosexual or bisexual males and 10% were females. Since 1988, there has been a decrease in the proportion of MSM and an increase in the other categories. Despite the incidence trends observed by exposure category, when the incidence rates were compared, the risk was much higher among MSM as compared to heterosexuals. Analysis of the AIDS epidemic dynamics in Brazil emphasizes the importance of MSM and male IDU as higher-risk groups.

Desenho da amostra Nascer no Brasil: Pesquisa Nacional sobre Parto e Nascimento

Este artigo descreve a amostra da Pesquisa Nacional sobre Parto e Nascimento no Brasil. Os hospitais com 500 ou mais nascidos vivos em 2007 foram estratificados por macrorregiao, capital de estado ou nao, e tipo, e selecionados com probabilidade proporcional ao numero de nascidos-vivos em 2007. Amostragem inversa foi usada para selecionar tantos dias de pesquisa (minimo de 7) quantos fossem necessarios para alcancar 90 entrevistas realizadas com puerperas no hospital. As puerperas foram amostradas com igual probabilidade entre as elegiveis que entraram no hospital no dia. Os pesos amostrais basicos sao o inverso do produto das probabilidades de inclusao em cada estagio e foram calibrados para assegurar que estimativas dos totais de nascidos vivos dos estratos correspondessem aos totais de nascidos vivos obtidos no SINASC. Para os dois seguimentos telefonicos (6 e 12 meses depois), a probabilidade de resposta das puerperas foi modelada pelas variaveis disponiveis na pesquisa de base, a fim de corrigir, para a nao resposta, os pesos amostrais em cada onda de seguimento.This paper describes the sample design for the National Survey into Labor and Birth in Brazil. The hospitals with 500 or more live births in 2007 were stratified into: the five Brazilian regions; state capital or not; and type of governance. They were then selected with probability proportional to the number of live births in 2007. An inverse sampling method was used to select as many days (minimum of 7) as necessary to reach 90 interviews in the hospital. Postnatal women were sampled with equal probability from the set of eligible women, who had entered the hospital in the sampled days. Initial sample weights were computed as the reciprocals of the sample inclusion probabilities and were calibrated to ensure that total estimates of the number of live births from the survey matched the known figures obtained from the Brazilian System of Information on Live Births. For the two telephone follow-up waves (6 and 12 months later), the postnatal womans response probability was modelled using baseline covariate information in order to adjust the sample weights for nonresponse in each follow-up wave.

Correcao de informacoes vitais: estimacao da mortalidade infantil, Brasil, 2000-2009

OBJECTIVE To propose a simplified method of correcting vital information and estimating the coefficient of infant mortality in Brazil. METHODS Vital data in the information systems on mortality and live births were corrected using correction factors, estimated based on events not reported to the Brazilian Ministry of Health and obtained by active search. This simplified method for correcting vital information for the period 2000-2009 for Brazil and its federal units establishes the level of adequacy of information on deaths and live births by calculating the overall coefficient of mortality standardized by age and the ratio between reported and expected live births, respectively, in each Brazilian municipality. By applying correction factors to the number of deaths and live births reported in each county, the vital statistics were corrected, making it possible to estimate the coefficient of infant mortality. RESULTS The highest correction factors were related to infant deaths, reaching values higher than 7 for municipalities with very precarious mortality information. For deaths and live births, the correction factors exhibit a decreasing gradient as indicators of adequacy of the vital information improve. For the year 2008, the vital information corrected by the simplified method per state were similar to those obtained in the research of active search. Both the birth rate and the infant mortality rate decreased in the period in all Brazilian regions. In the Northeast, the annual rate of decline was 6.0%, the highest in Brazil (4.7%). CONCLUSIONS The active search of deaths and births allowed correction factors to be calculated by level of adequacy of mortality information and live births. The simplified method proposed here allowed vital information to be corrected per state for the period 2000-2009 and the progress of the coefficient of infant mortality in Brazil, its regions and states to be assessed.OBJECTIVE : To propose a simplified method of correcting vital information and estimating the coefficient of infant mortality in Brazil. METHODS : Vital data in the information systems on mortality and live births were corrected using correction factors, estimated based on events not reported to the Brazilian Ministry of Health and obtained by active search. This simplified method for correcting vital information for the period 2000-2009 for Brazil and its federal units establishes the level of adequacy of information on deaths and live births by calculating the overall coefficient of mortality standardized by age and the ratio between reported and expected live births, respectively, in each Brazilian municipality. By applying correction factors to the number of deaths and live births reported in each county, the vital statistics were corrected, making it possible to estimate the coefficient of infant mortality. RESULTS : The highest correction factors were related to infant deaths, reaching values higher than 7 for municipalities with very precarious mortality information. For deaths and live births, the correction factors exhibit a decreasing gradient as indicators of adequacy of the vital information improve. For the year 2008, the vital information corrected by the simplified method per state were similar to those obtained in the research of active search. Both the birth rate and the infant mortality rate decreased in the period in all Brazilian regions. In the Northeast, the annual rate of decline was 6.0%, the highest in Brazil (4.7%). CONCLUSIONS : The active search of deaths and births allowed correction factors to be calculated by level of adequacy of mortality information and live births. The simplified method proposed here allowed vital information to be corrected per state for the period 2000-2009 and the progress of the coefficient of infant mortality in Brazil, its regions and states to be assessed.

Sampling design for the Birth in Brazil: National Survey into Labor and Birth

Este artigo descreve a amostra da Pesquisa Nacional sobre Parto e Nascimento no Brasil. Os hospitais com 500 ou mais nascidos vivos em 2007 foram estratificados por macrorregiao, capital de estado ou nao, e tipo, e selecionados com probabilidade proporcional ao numero de nascidos-vivos em 2007. Amostragem inversa foi usada para selecionar tantos dias de pesquisa (minimo de 7) quantos fossem necessarios para alcancar 90 entrevistas realizadas com puerperas no hospital. As puerperas foram amostradas com igual probabilidade entre as elegiveis que entraram no hospital no dia. Os pesos amostrais basicos sao o inverso do produto das probabilidades de inclusao em cada estagio e foram calibrados para assegurar que estimativas dos totais de nascidos vivos dos estratos correspondessem aos totais de nascidos vivos obtidos no SINASC. Para os dois seguimentos telefonicos (6 e 12 meses depois), a probabilidade de resposta das puerperas foi modelada pelas variaveis disponiveis na pesquisa de base, a fim de corrigir, para a nao resposta, os pesos amostrais em cada onda de seguimento.This paper describes the sample design for the National Survey into Labor and Birth in Brazil. The hospitals with 500 or more live births in 2007 were stratified into: the five Brazilian regions; state capital or not; and type of governance. They were then selected with probability proportional to the number of live births in 2007. An inverse sampling method was used to select as many days (minimum of 7) as necessary to reach 90 interviews in the hospital. Postnatal women were sampled with equal probability from the set of eligible women, who had entered the hospital in the sampled days. Initial sample weights were computed as the reciprocals of the sample inclusion probabilities and were calibrated to ensure that total estimates of the number of live births from the survey matched the known figures obtained from the Brazilian System of Information on Live Births. For the two telephone follow-up waves (6 and 12 months later), the postnatal womans response probability was modelled using baseline covariate information in order to adjust the sample weights for nonresponse in each follow-up wave.

Self-rated health by HIV-infected individuals undergoing antiretroviral therapy in Brazil

In 2008, a survey was applied to a probabilistically selected sample of 1,245 HIV-infected patients on antiretroviral therapy in Brazil. In this work, the analysis was focused on self-rated health. The analysis was conducted according to sex, age, socioeconomic variables, and clinical and treatment-related patient characteristics. Through stepwise logistic regression procedures, the main predictors of good perception of health status were established. Results showed that 65% self-rated health state as good or excellent, 81% do have no or slight difficulty in following treatment, but 34% men and 47% women reported intense or extreme degree of anxiety/worry feelings. Educational level, work situation, presence of side effects and AIDS-related symptoms were the main predictors of good self-perception of health. Problems related to animus status, involving worry and anxiety about the future are still barriers that must be overcome to improve quality of life of people living with HIV/AIDS.

Estimação da razão de mortalidade materna no Brasil, 2008-2011

This study proposes a methodology for estimating maternal mortality rates (MMR) in Brazil between 2008 and 2011 using data obtained from Ministry of Health information systems. The method assesses underreporting of maternal deaths, the investigation rates of deaths among women of reproductive age, as well as the proportion of maternal deaths that were misclassified as other causes before investigation. MMR was estimated for each state in Brazil in the 2009 to 2011 triennium. Overall MMR in Brazil was lower in 2011 (60.8 per 100,000 live births) and higher in 2009 (73.1 per 100.000 live births) probably due to the H1N1 influenza epidemic that occurred in the same year. MMR was highest in the States of Maranhão and Piauí (over 100 per 100,000 live births) and lowest in the State of Santa Catarina, the only state with a MMR of less than 40 per 100,000 live births. The results show that rates are higher than the target rate of the fifth Millennium Development Goal, but indicated a significant decrease in MMR during the period 1990 to 2011.Neste trabalho, propoe-se uma metodologia de estimacao da razao de mortalidade materna (RMM), no Brasil, 2008-2011, por meio das informacoes do Ministerio da Saude. O metodo proposto leva em consideracao, o sub-registro geral de obitos, as proporcoes de investigacao de mortes de mulheres em idade fertil, bem como as proporcoes de obitos maternos que foram atribuidos, indevidamente, a outras causas antes da investigacao. A RMM foi estimada por Unidade de Federacao no trienio de 2009-2011. No Brasil, a RMM atinge o valor minimo em 2011 (60,8/100 mil nascidos vivo) e o maximo em 2009 (73,1/100 mil nascidos vivos), explicado, provavelmente, pela epidemia de influenza A (H1N1). Os maiores valores da RMM foram encontrados no Maranhao e no Piaui, ultrapassando 100/100 mil nascidos vivos, e o menor foi apresentado por Santa Catarina, o unico estado com magnitude inferior a 40/100 mil nascidos vivos. Os resultados indicaram valores superiores aos que deveriam ter sido alcancados de acordo com a quinta meta do milenio, mas apontaram para um decrescimo significativo no periodo de 1990-2011, se as estimativas anteriores da RMM forem consideradas.

O processo de desenvolvimento da Pesquisa Nacional de Saúde no Brasil, 2013

Este trabalho teve o objetivo de relatar a fase preparatoria da Pesquisa Nacional de Saude (PNS) e a experiencia de execucao do trabalho de campo, com o intuito de colaborar para o desenvolvimento e aprimoramento da metodologia de construcao de inqueritos populacionais em saude no pais. A elaboracao da PNS iniciou-se em 2009 e passou por um amplo processo de consulta, envolvendo pesquisadores e representantes das areas tecnicas do Ministerio da Saude. De setembro de 2012 a junho de 2013, foram aplicados testes sobre o questionario e realizado estudo-piloto. Aprovado o projeto da pesquisa pela Comissao Nacional de Etica em Pesquisa (CONEP) em julho de 2013, realizou-se o treinamento do pessoal de campo. O trabalho de campo iniciou-se em agosto de 2013 e teve duracao de seis meses. A primeira divulgacao de resultados ocorreu em dezembro de 2014, relativa aos estilos de vida, autopercepcao da saude e doencas cronicas.Este trabalho teve o objetivo de relatar a fase preparatoria da Pesquisa Nacional de Saude (PNS) e a experiencia de execucao do trabalho de campo, com o intuito de colaborar para o desenvolvimento e aprimoramento da metodologia de construcao de inqueritos populacionais em saude no pais. A elaboracao da PNS iniciou-se em 2009 e passou por um amplo processo de consulta, envolvendo pesquisadores e representantes das areas tecnicas do Ministerio da Saude. De setembro de 2012 a junho de 2013, foram aplicados testes sobre o questionario e realizado estudo-piloto. Aprovado o projeto da pesquisa pela Comissao Nacional de Etica em Pesquisa (CONEP) em julho de 2013, realizou-se o treinamento do pessoal de campo. O trabalho de campo iniciou-se em agosto de 2013 e teve duracao de seis meses. A primeira divulgacao de resultados ocorreu em dezembro de 2014, relativa aos estilos de vida, autopercepcao da saude e doencas cronicas.