Sonia Azevedo Bittencourt

O Sistema de Informação Hospitalar e sua aplicação na saúde coletiva

The objective of this study was to survey the scientific production of applications for data from the Hospital Information System of Brazils Unified National System (SUS) in analyses of relevant Public Health issues. To find articles published in scientific journals from 1984 to 2003, the authors consulted the SciELO, MEDLINE, and Virtual Public Health Library databases. To locate monographs, theses, and dissertations, the authors consulted the websites of institutions providing Masters and doctoral courses in Public Health. A total of 76 articles were identified for the reference period, and they were classified into five categories with different analytical approaches. Although the Hospital Information System in the SUS has incomplete coverage and there are uncertainties about the reliability of its data, the range of studies showed internal consistency with current knowledge, reinforcing the systems importance and the need to understand its strengths and weaknesses.

Birth in Brazil: national survey into labour and birth

BackgroundCaesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.MethodsNationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.DiscussionThis study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.

Trajetória das mulheres na definição pelo parto cesáreo: estudo de caso em duas unidades do sistema de saúde suplementar do estado do Rio de Janeiro

Cesarean section rates are very high in Brazil mainly in private hospitals, probably due to socioeconomic and cultural factors. The objective of this study was to describe socioeconomic, demographic, cultural and reproductive characteristics of women in the postpartum period and the factors that had determined their decision for caesarean section in two units of the supplementary health care system of the State of Rio de Janeiro. The study population was composed of 437 women that had vaginal or caesarean childbirths in the two selected units. Data were collected by means of interviews with mothers and consultation of hospital records. The factors associated with the decision for cesarean section as mode of delivery were evaluated using non-conditional logistic regression analysis and following the hierarchic models established at three definite moments. Although 70% of the women had no initial preference for cesarean section, 90% of them had this mode of birth. It was verified that, despite their initial desire, the interaction with the health services resulted in cesarean section as mode of birth. Educative actions directed to pregnant women and to the public at large as well as changes in the childbirth care model can be promising strategies for reverting this picture.

Pesquisa Nascer no Brasil: perfil da mortalidade neonatal e avaliação da assistência à gestante e ao recém-nascido

Estudo de coorte sobre a mortalidade neonatal na pesquisa Nascer no Brasil, com entrevista e avaliacao de prontuarios de 23.940 puerperas entre fevereiro de 2011 e outubro de 2012. Utilizou-se modelagem hierarquizada para analise dos potenciais fatores de risco para o obito neonatal. A taxa de mortalidade foi 11,1 por mil; maior nas regioes Norte e Nordeste e nas classes sociais mais baixas. O baixo peso ao nascer, o risco gestacional e condicoes do recem-nascido foram os principais fatores associados ao obito neonatal. A inadequacao do pre-natal e da atencao ao parto indicaram qualidade nao satisfatoria da assistencia. A peregrinacao de gestantes para o parto e o nascimento de criancas com peso < 1.500g em hospital sem UTI neonatal demonstraram lacunas na organizacao da rede de saude. Obitos de recem-nascidos a termo por asfixia intraparto e por prematuridade tardia expressam a evitabilidade dos obitos. A qualificacao da atencao, em especial da assistencia hospitalar ao parto se configura como foco prioritario para maiores avancos nas politicas publicas de reducao das taxas e das desigualdades na mortalidade infantil no Brasil.This study examined neonatal deaths in the live-births cohort in the Birth in Brazil survey, which interviewed and examined medical records of 23,940 mothers from February 2011 to October 2012. Potential risk factors were analyzed using hierarchical modeling. Neonatal mortality rate was 11.1/1,000, the highest rates occurring in the North and Northeast regions and in lower social classes. Low birth weight, risks during pregnancy and conditions of the newborn were the main factors associated with neonatal death. Inadequate prenatal and childbirth care point to unsatisfactory quality of health care. Difficulty in gaining hospital admission for delivery, and children with birth weight<1,500g born at hospitals without a neonatal intensive care unit, indicate gaps in health system organization. Deaths from intra-partum asphyxia in term babies and late prematurity express preventable neonatal mortality. Better quality health care, especially hospital care during labor and birth, poses the main public policy challenge to progress in reducing mortality and inequalities in Brazil.

Comparação das informações sobre as prevalências de doenças crônicas obtidas pelo suplemento saúde da PNAD/98 e as estimadas pelo estudo Carga de Doença no Brasil

In this study, prevalence estimates of five chronic disease cirrhosis, depression, diabetes, chronic rhenal insufficiency and tuberculosis based on the 1998 PNAD Health Supplement were compared to those obtained by the Brazilian Global Burden of Disease Project. These estimates were based on systematic literature review as well as on available data set of morbidities. The results show that PNAD presented higher number of cases for depression and Chronic rhenal insufficiency while the prevalence rates estimated by Brazilian Global Burden of Disease Project were higher for cirrhosis, diabetes and tuberculosis.

Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care

Estudo de coorte sobre a mortalidade neonatal na pesquisa Nascer no Brasil, com entrevista e avaliacao de prontuarios de 23.940 puerperas entre fevereiro de 2011 e outubro de 2012. Utilizou-se modelagem hierarquizada para analise dos potenciais fatores de risco para o obito neonatal. A taxa de mortalidade foi 11,1 por mil; maior nas regioes Norte e Nordeste e nas classes sociais mais baixas. O baixo peso ao nascer, o risco gestacional e condicoes do recem-nascido foram os principais fatores associados ao obito neonatal. A inadequacao do pre-natal e da atencao ao parto indicaram qualidade nao satisfatoria da assistencia. A peregrinacao de gestantes para o parto e o nascimento de criancas com peso < 1.500g em hospital sem UTI neonatal demonstraram lacunas na organizacao da rede de saude. Obitos de recem-nascidos a termo por asfixia intraparto e por prematuridade tardia expressam a evitabilidade dos obitos. A qualificacao da atencao, em especial da assistencia hospitalar ao parto se configura como foco prioritario para maiores avancos nas politicas publicas de reducao das taxas e das desigualdades na mortalidade infantil no Brasil.This study examined neonatal deaths in the live-births cohort in the Birth in Brazil survey, which interviewed and examined medical records of 23,940 mothers from February 2011 to October 2012. Potential risk factors were analyzed using hierarchical modeling. Neonatal mortality rate was 11.1/1,000, the highest rates occurring in the North and Northeast regions and in lower social classes. Low birth weight, risks during pregnancy and conditions of the newborn were the main factors associated with neonatal death. Inadequate prenatal and childbirth care point to unsatisfactory quality of health care. Difficulty in gaining hospital admission for delivery, and children with birth weight<1,500g born at hospitals without a neonatal intensive care unit, indicate gaps in health system organization. Deaths from intra-partum asphyxia in term babies and late prematurity express preventable neonatal mortality. Better quality health care, especially hospital care during labor and birth, poses the main public policy challenge to progress in reducing mortality and inequalities in Brazil.

Uma alternativa para a política nutricional brasileira

This article focuses on the alternative nutrition policy as a public policy issue. It discusses such important and controversial questions as the efficacy and safety of multimixture. It also analyzes six epidemiological studies focusing on the evaluation of the reliability of results. The article concludes that the numerous ambiguities, gaps, and contradictions in knowledge concerning alternative nutrition do not support the incorporation of this intervention proposal as a food and nutritional policy for Brazil.

Uso de indicadores de nível local para análise espacial da morbidade por diarreia e sua relação com as condições de vida

Nos paises em desenvolvimento, cada crianca, apresentou em media tres episodios de diarreia por ano, no seculo XX. No Brasil, a diminuicao do numero de obitos por diarreia esteve mais associada a aplicacao de tecnicas de controle do que por transformacoes nas condicoes de vida. Este artigo tem por objetivo analisar a distribuicao espacial da morbidade por diarreia em criancas e sua associacao com condicoes de vida. Estudo ecologico, tendo como unidade de analise os bairros do municipio de Itaborai. A populacao do estudo foram as criancas < 5 anos hospitalizadas por diarreia, nos anos 2006 a 2009, disponiveis no SIH. Foram estabelecidos os indicadores Razao de Internacoes por Diarreia (RID) e Indicador Composto de condicoes de vida (ICV). As diarreias ainda representam elevada parcela das hospitalizacoes em criancas (15,5% entre 2006 e 2009). A RID foi elevada no periodo (69,7 hospitalizacoes/ 1.000 NV). A analise espacial identificou que os bairros com maiores valores de RID foram, em sua maioria, aqueles com maiores aglomeracoes populacionais e melhores condicoes de vida.The use of thalidomide was never discontinued in Brazil where it is prescribed for leprosy type 2 reaction. Babies with birth defects compatible with the thalidomide embryopathy phenotype were born after 1965, an indication that control on drug dispensing and use failed in the country. The article reports data on thalidomide dispensing and clinical uses in the Federal District in 2011/12, when new rules were put into effect, and data on drug dispensing and use obtained ten years earlier. It was found that the number of patients making use of thalidomide declined from 819 in 2001 to 369 in 2011/12. Leprosy accounted for over 70% of prescriptions in both time periods analyzed in this study. In the same time interval, however, use for lupus erythematosus decreased from 13.7 to 4.9%, while that for multiple myeloma increased from 2.9 to 20.3% of all prescriptions. Thalidomide prescription for the remaining approved indications was far less frequent, and so was the use for off label indications that accounted for <1% of prescriptions in 2001 and 2011/12. Registration of prescribing doctors, patients and dispensing units at the state department of health, apparently rendered this control more effective and reliable.

Avaliação da estrutura de sete unidades de saúde da família para a oferta da assistência nutricional no pré-natal no município do Rio de Janeiro, Brasil

OBJECTIVES: to evaluate the extent to which seven family health units in the municipality of Rio de Janeiro are equipped to provide prenatal care on nutrition. METHODS: a cross-sectional study was carried out in 2008. Seven family health units were selected and their structure was observed directly. Seven health workers and 230 pregnant women were interviewed at these units. The building structure, material resources, referral system, human resources and norms and routines were examined at each unit. RESULTS: direct observation and the interviews with the health workers ascertained that all the units had a suitable building structure and material resources. The norm that was least commonly complied with was the preventive maintenance of scales. The Ministry of Healths current prenatal card was found to have been implemented for 45% of the pregnant women. Access to ferrous sulfate and folic acid were reported by around 70% of pregnant women. There was found to be a shortfall in human resources and in referral of pregnant women to nutritionists. CONCLUSIONS: the study points out the importance of ensuring the minimum team size and installing Family Health Support Unites, when expanding the scope and improving the integration of prenatal care.

Crescimento, diarréia e aleitamento materno: o caso da Vila do João

A prospective study on children under six months old living in an urban area on the periphery of Rio de Janeiro was carried out to examine the possible effect of diarrhea in differentiating the monthly growth rate in weight and height, according to type of nursing. The results seem to indicate that infants show a delay in growth of weight and height as a result of greater incidence and prevalence of diarrhea. It was also shown that human breast milk has a protective effect, reducing weight loss from episodes of diarrhea. The study concludes that the promotion of breastfeeding, together with the control of diarrheal diseases, can provide immediate benefits in improving the nutritional status of the infant population.