Sandra Rêgo de Jesus

A hierarchical model for studying risk factors for childhood diarrhoea: a case–control study in a middle-income country

OBJECTIVE To identify factors associated with diarrhoea occurrence in children in a city in a middle-income country, with high access to water and sanitation. METHODS A case-control study in the city of Salvador, north-eastern Brazil was conducted from November 2002 to August 2004. The study population consisted of children presenting at a health facility. A total of 1688 cases of diarrhoea and 1676 controls were selected. Data collection was by a questionnaire and structured observation during home visits. The explanatory variables were grouped according to a conceptual model defined previously. Analysis was done using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhoea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated. RESULTS Socioeconomic factors contributed most to determining diarrhoea occurrence, followed by interpersonal contact, while factors related to food preparation, the environment and water and sanitation made a smaller contribution. CONCLUSION The findings indicate that the transmission of diarrhoea is influenced by factors from all hierarchical levels, with interpersonal transmission playing a relatively higher role than previously thought. This is compatible with a predominance of viruses and other agents spread by interpersonal routes including Shigella, Giardia and Cryptosporidium. Diarrhoea control strategies in similar settings (middle-income countries in which a large proportion of the population has access to water and sanitation) must give greater emphasis to policies geared towards reducing person-to-person transmission for the prevention of diarrhoea.

Prevalência e intensidade da infecção por parasitas intestinais em crianças na idade escolar na Cidade de Salvador (Bahia, Brasil)

As part of a major study to evaluate the relationship between environmental changes and occurrence of the infection, prevalence and intensity of infection by intestinal parasites was studied in a sample of school children aged 7 to 14 years living in the City of Salvador. The prevalence of infection by at least one species of protozoa or helminth was 66.1%. Prevalence of infection by helminths increased with age. For all helminth species male children presented the highest prevalence.

Effectiveness of rotavirus vaccine against hospitalized rotavirus diarrhea: A case-control study

Rotavirus is one of the leading cause of hospitalization and outpatients visits among children under five years. This study evaluated overall and genotype-specific vaccine effectiveness of oral monovalent rotavirus vaccine (G1P[8] strain) in preventing hospital admission of Brazilian children with rotavirus acute diarrhea. A hospital based case-control study was conducted in five Regions of Brazil using the National Rotavirus Acute Diarrhea Surveillance System from July 2008 to August 2011. A total of 215 cases (aged 4-24 months) admitted with confirmed rotavirus diarrhea were recruited and 1961 controls hospitalized without diarrhea were frequency matched by sex and age group to cases. Two-dose adjusted vaccine effectiveness (adjusted by year of birth and the frequency matching variables) was 76% (95%CI: 58-86) lasting for two years. Effectiveness controlled by the available potential confounders was 72% (95%CI: 44-85), suggesting no appreciable confounding by those factors for which adjustment was made. In a half of the cases the rotavirus genotype was G2P[4] and in 15% G1P[8]. Genotype-specific VE (two doses) was 89% (95%CI: 78-95), for G1P[8] and 76% (95%CI: 64-84) for G2P[4]. For all G1, it was 74% (95%CI: 35-90), for all G2, 76% (95%CI: 63-84), and for all non G1/G2 genotypes, 63% (95%CI: -27-99). Effectiveness for one dose was 62% (95%CI: 39-97). Effectiveness of two-dose monovalent rotavirus vaccine in preventing hospital admission with rotavirus diarrhea was high, lasted for two years and it was similar against both G1P[8] and G2P[4]. Based on the findings of the study we recommend the continued use of rotavirus in the Brazilian National Immunization Program and the monitoring of the early emergence of unusual and novel rotavirus genotypes.

A comparison of the Beers and STOPP criteria for identifying the use of potentially inappropriate medications among elderly patients in primary care

RATIONALE, AIMS AND OBJECTIVES Explicit criteria for evaluating the appropriateness of medication use among the elderly have been extensively employed in several countries. The aim of the current study was to assess and characterize the prevalence of potentially inappropriate medications (PIMs) according to the Screening Tool of Older Peoples Prescriptions (STOPP) criteria and compare these data with the 2012 Beers criteria. METHODS A prospective survey of the medications used by elderly patients was performed. A total of 142 participants were randomly selected via systematic sampling. The Beers and STOPP criteria were applied to evaluate the use of PIMs among the sample. All of the medications included in these criteria were assessed for their availability in Brazil. The prevalence of PIMs was chosen as an occurrence measure and compared among the exposure group using the prevalence ratio (PR) as a measure of association. RESULTS The prevalence of PIM use in the sample was 33.8% according to the STOPP criteria and 51.8% using the 2012 Beers criteria. The most prevalent PIMs according to the Beers criteria were short-acting nifedipine (17.4%) and glyburide (11.9%); according to the STOPP criteria, they were acetylsalicylic acid (32.9%), clonazepam (10.1%) and diclofenac (6.3%). The use of four or more drugs (polypharmacy) was associated with a higher prevalence of PIM use (PR = 3.11, 95% CIs = 1.65-5.85). CONCLUSIONS The 2012 Beers criteria identified more PIMs than the STOPP criteria. This difference highlights the need to develop national criteria.

Overweight, asthma symptoms, atopy and pulmonary function in children of 4-12 years of age: findings from the SCAALA cohort in Salvador, Bahia, Brazil.

OBJECTIVE To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4-12 years of age living in the city of Salvador in 2005. DESIGN Cross-sectional study nested in a cohort. SETTING The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS The study included 1129 children of 4-12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poissons multivariate regression was adopted. RESULTS Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing. CONCLUSIONS These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.

Giardia duodenalis infection and anthropometric status in preschoolers in Salvador, Bahia State, Brazil

The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The childrens breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR = 2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR = 2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR = 2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The childs unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The childrens breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR=2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR=2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR=2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The childs unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.

Velocidade de ganho de peso nos primeiros anos de vida e excesso de peso entre 5-11 anos de idade, Salvador, Bahia, Brasil

Overweight children are more prone to become overweight or obese adults. The most effective prevention is intervention in early childhood. We analyzed the association between early weight gain and overweight/obesity in 1,056 children under 11 years of age. Data were collected on lifestyle, sanitation, socioeconomic status, birth weight, and breastfeeding. Weight gain from birth until different age brackets ( 12 to 18, > 18 to 24, and > 24 to 60 months) was considered a continuous variable in z-scores. Overweight was defined as body mass index (BMI) > +1 z-score, based on 2006 and 2007 World Health Organization (WHO) guidelines. Poisson regression and linear regression were used in the multivariate statistical analysis. Weight gain rate was associated with BMI, and overweight or obesity in the 5-11-year age bracket increased twofold for each unit increase in the weight gain standard deviation between 24 and 60 months of age (RR = 2.08; 95%CI: 1.87-2.32). For all early childhood age brackets, there was an association between rapid weight gain and subsequent overweight or obesity.

Weight gain in the first two years of life, asthma and atopy: the SCAALA cohort study

OBJECTIVE To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function. DESIGN Cohort study. SETTING The metropolitan region of Salvador, Bahia, Brazil. SUBJECTS The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis. RESULTS Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <-0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99). CONCLUSIONS Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.

Effectiveness of rotavirus vaccine against hospital admission for rotavirus diarrhoea in Brazilian children: a case-control study

Abstract Background In Brazil, before the introduction of the monovalent rotavirus vaccine in 2006, between 22% and 38% of children younger than age 5 years admitted to hospital with diarrhoea had positive stool samples for rotavirus. Rotavirus vaccine effectiveness against hospital admission caused by the G2[P4] genotype in Brazil is estimated to be 40–85%. We estimated overall and genotype-specific vaccine effectiveness and the effect of time since vaccination on hospital admission for Brazilian children with rotavirus diarrhoea. Methods We did a case-control study of ten general hospitals from the Rotavirus Diarrhoea Surveillance System of five regions of Brazil, from July 2008, to August 2011. 215 patients (aged 4–24 months) with confirmed rotavirus diarrhoea were recruited and 1961 controls (admitted to hospital without diarrhoea) were frequency matched to cases by sex and age group. We estimated vaccine effectiveness with multivariable logistic regression adjusted for year of birth; sex and age; variance estimation of Jackknife (crude) and confounders (adjusted). Findings Two-dose crude vaccine effectiveness was 76% (95% CI 58–86), lasting for 2 years. Two-dose adjusted effectiveness was 72% (44–85), suggesting no noticeable confounding. 80 (51%) patients had genotype G2[P4] and 24 (15%) had G1[P8]. Two-dose vaccine effectiveness was 89% (78–95) for G1[P8] and 76% (64–84) for G2[P4]; 74% (35–90) for all G1, 76% (63–84) for all G2, and 63% (27–99) for all non-G1 or non-G2. One dose vaccine effectiveness for all genotypes was 62% (39–97). Interpretation Two-dose vaccine effectiveness for prevention of hospital admission with rotavirus diarrhoea was high, lasted for at least 2 years, and was similar for both G1[P8] and G2[P4]. On the basis of these findings we recommend the continued use of this vaccine in the Brazilian Immunization Program and monitoring of the emergence of unusual and novel rotavirus genotypes. Funding Health Surveillance of the Ministry of Health of Brazil.

Cadernos de Saúde Pública

The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The childrens breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR = 2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR = 2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR = 2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The childs unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.The aim of this study was to estimate the association between Giardia duodenalis infection and anthropometric deficits, as measured by weight-for-age and height-for-age. This cross-sectional study included 629 children from 12 to 48 months of age, selected from 30 geographic areas in the city of Salvador, Bahia State, Brazil. Poisson regression and linear regression were used for the multivariate statistical analyses. G. duodenalis was diagnosed in 13.5% of the children. The childrens breastfeeding duration and living conditions (garbage collection and paved streets or sidewalks) modified the effect of G. duodenalis infection on anthropometric status. Among infected children, there were statistically significant associations between weight deficit and shorter breastfeeding (PR=2.22; 95%CI: 1.56-3.14) and inadequate paving of streets and sidewalks (PR=2.00; 95%CI: 1.37-2.92), while height deficit was associated with deficient public garbage collection (PR=2.21; 95%CI: 1.31-2.51). In the linear regression, the association with the anthropometric indicators remained positive and statistically significant. The childs unhealthy living environment aggravated the negative effect of G. duodenalis infection on anthropometric status, and breastfeeding was a protective factor in the outcome.