Roberto Nascimento Rodrigues

Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities

Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.

Determinantes da autopercepção de saúde entre idosos do Município de São Paulo, Brasil

OBJETIVO: Investigar a influencia de determinantes demograficos e socioeconomicos, das doencas cronicas e da capacidade funcional sobre a autopercepcao de saude entre os idosos do Municipio de Sao Paulo e verificar a existencia de diferencas entre os sexos quanto a autopercepcao de saude. METODOS: O estudo foi desenvolvido com base em dados do Projeto Saude, Bem-Estar e Envelhecimento na America Latina e Caribe (SABE). Foram analisados os dados de 2 135 idosos (sendo 58,6% mulheres; idade media e mediana = 69,4 e 68,0 anos). A variavel dependente foi a autopercepcao de saude (ruim ou boa). As variaveis independentes foram: as demograficas (idade, sexo, estado conjugal e arranjo familiar), as socioeconomicas (educacao e renda), o numero de doencas cronicas (hipertensao, artrite ou reumatismo, doenca cardiovascular, diabetes, asma, bronquite ou enfisema, embolia ou acidente vascular cerebral e câncer) e a capacidade funcional. Para estimar a associacao entre a autopercepcao de saude e as variaveis independentes e estudar as diferencas entre os sexos, foi realizada uma analise de regressao logistica binaria multipla. RESULTADOS: A presenca de doencas cronicas associada ao sexo do idoso foi o determinante mais fortemente relacionado a autopercepcao de saude no Municipio de Sao Paulo. Para os homens, a presenca de quatro ou mais doencas cronicas implicou um risco 10,53 vezes maior de uma autopercepcao ruim de saude. Para as mulheres, esse risco foi 8,31 vezes maior. A capacidade funcional, o nivel de escolaridade e a renda tambem foram altamente associados com a percepcao de saude, e a idade teve uma significativa influencia. Na ausencia de doencas cronicas, ou na presenca de duas ou mais doencas cronicas, as mulheres idosas tiveram maior probabilidade de relatar uma boa autopercepcao de saude em comparacao com os homens. CONCLUSOES: Os resultados indicam a necessidade de acoes integradas que abordem simultaneamente os principais fatores determinantes da autopercepcao de saude como forma de promover o bem-estar e a qualidade de vida dos idosos.

Factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil

This article calls attention to factors associated with sexual and reproductive behavior among adolescents from the Northeast and Southeast regions of Brazil. The analyses focus on three dimensions of this process: sexual initiation, use of contraceptives in the first sexual relationship, and fertility. Hierarchical models are implemented, because adolescents selected from the same community are more likely to have similar sexual and reproductive behavior than those from different communities. Level of schooling was the most important risk factor in the three analyses. Girls with 5 or more years of schooling were less likely to have their first sexual relationship during adolescence and more likely to use contraceptive methods in this relationship, besides demonstrating less risk of having children than their counterparts with less than 5 years of schooling.

The determinants of delivery care in Kenya

Abstract This paper examines the determinants of place of delivery and childbirth attendant in Kenya based on the 1993 Kenya Demographic and Health Survey data. The analysis utilizes multilevel logistic and multilevel multinomial regression models for the place of delivery and the type of childbirth attendant, respectively. The results show that delivery care in Kenya is determined by a wide range of factors: socioeconomic and cultural factors associated with the individual woman or her household, her demographic status or reproductive behavior relating to a specific birth, as well as availability and accessibility of health services within her community. In addition, a significant variation in delivery care behavior is observed between women and between communities, implying that there are unobserved factors within families and communities that have a significant effect on delivery care. The woman or family effect on delivery care is particularly strong, but varies by distance to the nearest delivery care facility.

Life expectancy among elderly Brazilians in 2003 according to different levels of functional disability

The aim of the present study was to estimate disability-free life expectancy for the Brazilian elderly in 2003, by gender and age, based on different concepts of functional disability. The Sullivan method is used to combine the period life tables from the Brazilian Institute of Geography and Statistics (IBGE, 2003) and the prevalence of functional disability according to the 2003 National Sample Household Survey (PNAD 2003). The main results of the study indicate that at age 60, Brazilian men can expect to live 19 years, 39% with mild, 21% with moderate, and 14% with severe functional disability, respectively. At the same age, Brazilian women can expect to live 22 years: 56% with mild, 32% with moderate, and 18% with severe functional disability.

Expectativa de vida saudável para idosos brasileiros, 2003

The increase of the percentage of elderly population in Brazil and the increase in longevity incite a demand for information on the quantity of years spent in good health. The aim of the present study is to measure the life expectancy for the elderly of 60 years and above, by sex and age, in the year of 2003. The Sullivan method was used, which combined the life-table with the current experience of mortality and the self-perceived health. The mortality information was obtained from the life tables published by the IBGE (Brazilian Institute of Geography and Statistics), 2003. The self-perceived health was used and it was dichotomized in good and bad. This information came from the National Research of Household Sample (PNAD), 2003. The results indicate that women live longer, but spend a higher number of years perceiving their health as bad, as compared to men. The results also highlights to the need of considering the differences between sexes in relation to the demand for health care. It is also important to consider the need to have policies designed to allow the increase in the number of years that the elderly can live in good health conditions.

Fatores associados à prevalência de diabetes auto-referido entre idosos de Minas Gerais

The prevalence of diabetes has been increasing worldwide. This study has the objective of analyzing the prevalence of self-reported diabetes among the elderly of age 60 or over living in the State of Minas Gerais, Brazil. Methods: The study is based on cross-sectional data derived from PNAD-2003 taken from a sample of 3662 persons aged 60 years or over. Factors associated with diabetes were organized according to individual and community/household levels and analyzed using five multivariate logistic regression models. The first model included only more distant variables while the others were included progressively, according to their proximity to diabetes. In the final model, the chance of acquiring diabetes was greater for elderly residents living in urban areas over rural areas, women over men, those who have high blood pressure over those who do not, those with heart disease over those without, pension receivers over non-receivers, and those without instruction, or from one to three years of schooling over those with five or more years of study. The chances of having diabetes was greater for those in single-person households versus those with more than one person, those between ages 70 and 74 over those between 60 and 64, as well as those with income below one minimum wage and between three and five minimum wages over those with incomes of five times the minimum wage or over. Conclusion: The relationship between individual income and diabetes indicates that more research is needed to investigate the association between the access to health services by the elderly and self-reported diabetes, even when other demographic and socioeconomic factors are controlled.

Female sterilization in Latin America: cross-national perspectives.

Fertility levels have dropped substantially in Latin America in recent decades, fuelled by increased contraceptive use and notably a method mix skewed towards female sterilization. This study examined choice of female sterilization in four Latin American countries: Brazil, Colombia, the Dominican Republic and Peru. Data were drawn from national Demographic and Health Surveys conducted in 1995--1996. Discrete-time hazard models were used on the five-year calendar modules of womens reproductive histories to consider the effects of a number of sociodemographic and contextual determinants as they pertained to status at the moment of the event. The results revealed that the likelihood of a womans having undergone contraceptive sterilization was increasing over time in Brazil and Peru, suggesting that the potential for future growth of this method remains strong. A consistent pattern of increased probability of sterilization with higher education was seen across all countries, seemingly dispelling certain controversial claims that the procedure may have been disproportionately performed on the poor. At the same time, the multilevel analytical approach pointed to significant cluster-level random effects, suggesting that there were additional unmeasured contextual influences on womens propensity to choose sterilization.

Sex differences in healthy life expectancy from self-perceived assessments of health in the City of Sao Paulo, Brazil

ABSTRACT Whether life is spent in good health or disability has a critical influence on the use of health-care services. It is also known that average healthy life expectancy differs by sex. This paper reports estimations of healthy and unhealthy life expectancy in old age using self-reported health assessments for the City of São Paulo, Brazil in 2000–01. The data derived from the Health, Well-being and Aging in Latin America and the Caribbean Project (SABE), and from population censuses and mortality statistics. Sullivans estimation method was used. It combines the age-specific schedule of the current probabilities of death with the prevalence of self-perceived ‘poor’ and ‘good’ health. The paper also reports multivariate analyses of the factors associated with variations by age group and sex in self-perceived health. The findings revealed that, at all ages, women live longer than men and for more years in a healthy state. Among men, those aged 60, 65 and 70 years were expected to live a higher percentage of their remaining life than women in a healthy state, but among those aged 75, 80 and 85 years, the opposite held. Among women, the percentage of remaining years that were unhealthy did not increase as age increased, which differs from previous findings. The multivariate analyses showed that with increasing age, for women the number of chronic diseases decreased but dependency increased, and for men the opposite held. This finding indicated that the percentage of life spent in poor self-perceived health more accurately predicts mortality in men than women.

A relação entre renda e morar sozinho para idosos paulistanos: 2000

The number of people living alone in Sao Paulo is not high compared to other living arrangements, but the number of elderly people living alone has been increasing over the years. The present study discusses the relationship between income and living alone among the elderly in the City of Sao Paulo, 2000, using the SABE database. Since living alone is influenced by demographic, socioeconomic and health-related aspects, these variables were also considered in this study, and a binary logistic regression was used. Two models were built. Model 1 included only income as a predictor; model 2 included other variables and income as predictors. The results show a significant association between income and living alone. Even after controlling for other explanatory variables, income remained significant.The number of people living alone in Sao Paulo is not high compared to other living arrangements, but the number of elderly people living alone has been increasing over the years. The present study discusses the relationship between income and living alone among the elderly in the City of Sao Paulo, 2000, using the SABE database. Since living alone is influenced by demographic, socioeconomic and health-related aspects, these variables were also considered in this study, and a binary logistic regression was used. Two models were built. Model 1 included only income as a predictor; model 2 included other variables and income as predictors. The results show a significant association between income and living alone. Even after controlling for other explanatory variables, income remained significant.