Sueli Rosina Tonial

Características da gravidez na adolescência em São Luís, Maranhão

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of Sao Luis, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.OBJETIVO: Identificar as principais caracteristicas socioeconomicas, demograficas, antropometricas e comportamentais, bem como os resultados perinatais da gravidez na adolescencia. Conhecer os tipos de servicos de saude utilizados pelas gestantes adolescentes. METODOS: A amostra de 2.429 partos de mulheres residentes em Sao Luis, MA, abrangeu 94% dos nascimentos hospitalares. As mulheres foram separadas em seis grupos de idade para melhor avaliacao do comportamento das variaveis entre os dois grupos de adolescentes (abaixo de 18 anos; 18 a 19 anos) e entre as adolescentes e as demais mulheres. O teste do qui-quadrado foi utilizado para a comparacao de proporcoes e a razao de prevalencias foi empregada como medida de efeito. RESULTADOS: Das 2.429 mulheres, 714 eram adolescentes (29,4%). Seu coeficiente especifico de fecundidade, 72,2 por mil, foi mais elevado que em outras regioes do Pais. As adolescentes apresentaram piores condicoes socioeconomicas e reprodutivas que as demais mulheres, maior proporcao de pre-natal inadequado (39,2%) e muitas nao tinham companheiro (34,5%). Por outro lado, tiveram menor proporcao de parto cesareo (23,0%) e de fumantes (3.5%). CONCLUSOES: Apesar da situacao socioeconomica igualmente desfavoravel, as adolescentes de 18 a 19 anos apresentaram resultados perinatais semelhantes as mulheres de 25 a 29 anos. Ja as menores de 18 anos tiveram maiores proporcoes de filhos com baixo peso ao nascer, prematuros e com maior risco de mortalidade infantil. Isto sugere que a imaturidade biologica possa estar associada a maiores taxas de prematuridade, baixo peso ao nascer e mortalidade infantil.OBJECTIVE To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of São Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.

Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.

Cobertura vacinal e fatores de risco associados à não-vacinação em localidade urbana do Nordeste brasileiro, 1994

INTRODUCTION The assessment of vaccination coverage and risk factors for non-vaccination is important to evaluate vaccination programs and to identify children not properly vaccinated. METHODS A cross-sectional household survey was carried out in the municipality of S. Luís, Maranhão, Brazil by means of a standardized questionnaire. Multistage cluster sampling was used to identify children of 12-59 months of age residing in the city in 1994. The mother or other person responsible for the children was interviewed. Fifty census clusters were visited and 40 households were sampled in each. On average, 15 children were found in each cluster. Design effect was calculated for each estimate. Health service utilization was analyzed according to socioeconomic and demographic indicators, and perceived morbidity using proportional hazard modeling (Coxs regression). RESULTS Vaccination coverage levels were 72.4% for BCG, 59.9% for three doses of polio vaccine, 57% for three doses of DTP vaccine and 54.7% for measles vaccine. Vaccination levels have remained statistically unchanged over the last three years. Lower maternal schooling continues to be associated with increased risk of non-vaccination in the multivariable analysis. CONCLUSION Vaccination levels were low. Health education activities are one of the suggested strategies to increase vaccination coverage.INTRODUCAO: A identificacao da cobertura vacinal e dos fatores responsaveis pelo retardo ou pela falta de imunizacoes e fundamental para a adequada monitorizacao dos programas de vacinacao e para se identificar e atingir as criancas que nao sao vacinadas adequadamente. METODOS: Foi realizado inquerito domiciliar transversal, em amostra aleatoria por conglomerados em multiplos estagios de criancas de 12 a 59 meses de idade, no Municipio de Sao Luis, Maranhao, Brasil, em 1994. Utilizou-se questionario padronizado respondido pela mae ou responsavel pela crianca. Foram visitados 50 setores censitarios; em cada um foram amostrados 40 domicilios, onde foram encontradas, em media, 15 criancas. O efeito de desenho foi calculado para cada estimativa. A nao-vacinacao foi analisada em relacao a indicadores socioeconomicos, demograficos e a morbidade referida pela regressao de Cox. RESULTADOS: A cobertura vacinal foi de 72,4% para BCG, 59,9% para 3 doses da vacina Sabin, 57% para 3 doses de vacina DPT (difteria, coqueluche e tetano) e 54,7% para a vacina anti-sarampo. A baixa escolaridade materna foi o principal fator de risco para a nao-vacinacao apos o controle dos fatores de confusao. CONCLUSAO: As coberturas vacinais foram baixas. Uma das estrategias sugeridas para o aumento das coberturas e o incremento das atividades de educacao em saude.

Fatores de risco para hospitalização de crianças de um a quatro anos em São Luís, Maranhão, Brasil

Os fatores de risco para hospitalizacao infantil foram estudados por inquerito domiciliar transversal, em amostra aleatoria por conglomerados em multiplos estagios de 596 criancas de um a quatro anos de idade, em Sao Luis, Maranhao, Brasil, em 1994. A taxa de hospitalizacao foi de 24,4%, sendo as maiores por pneumonia (7,3%) e diarreia (7,1%). A maioria das internacoes foi custeada pelo SUS (78,1%) e apenas 18,2% pelo seguro-saude. Apos o ajuste para fatores de confusao pela regressao de Cox modificada para estudos transversais, criancas de familias de renda familiar de ate um salario minimo e as que possuiam seguro-saude tiveram maior risco de serem hospitalizadas em relacao as demais. A maioria das hospitalizacoes em Sao Luis ocorreu por causas evitaveis ou sensiveis a atencao ambulatorial. O padrao de hospitalizacao em U levanta questoes acerca da baixa qualidade da atencao ambulatorial para os segmentos mais pobres da populacao e indica, provavelmente, a ocorrencia de internacoes desnecessarias e iatrogenicas entre os usuarios de seguro-saude.

Water-contact patterns and risk factors for Schistosoma mansoni infection in a rural village of Northeast Brazil

Schistosomiasis mansoni in the Serrano village, municipality of Cururupu, state of Maranhão, Brazil, is a widely spread disease. The PECE (Program for the Control of Schistosomiasis), undertaken since 1979 has reduced the prevalence of S. mansoni infection and the hepatosplenic form of the disease. Nevertheless piped water is available in 84% of the households, prevalence remains above 20%. In order to identify other risk factors responsible for the persistence of high prevalence levels, a cross-sectional survey was carried out in a systematic sample of 294 people of varying ages. Socioeconomic, environmental and demographic variables, and water contact patterns were investigated. Fecal samples were collected and analyzed by the Kato-Katz technique. Prevalence of S. mansoni infection was 24.1%, higher among males (35.5%) and between 10-19 years of age (36.6%). The risk factors identified in the univariable analysis were water contacts for vegetable extraction (Risk Ratio--RR = 2.92), crossing streams (RR = 2.55), bathing (RR = 2.35), fishing (RR = 2.19), hunting (RR = 2.17), cattle breeding (RR = 2.04), manioc culture (RR = 1.90) and leisure (RR = 1.56). After controlling for confounding variables by proportional hazards model the risks remained higher for males, vegetable extraction, bathing in rivers and water contact in rivers or in periodically inundated parts of riverine woodland (swamplands).

Estado nutricional de adolescentes do Maranhão, Brasil, por critérios nacional e internacional

This study sought to compare national and international criteria for assessing the nutritional status of adolescents. A cross-sectional analytical study was conducted in the period from July 2007 to January 2008 with a representative sample comprised of 1256 adolescents from the state of Maranhao. Body mass index (BMI) for age and gender was used to diagnose underweight, normal weight and overweight, using the criteria proposed by Conde and Monteiro and the World Health Organization (WHO). Chi-square, McNemar concordance and Spearman correlation tests were applied. According to the criteria of Conde and Monteiro and the WHO, there were significant differences among the boys with respect to low weight and obesity. It was observed that there was no significant divergence between the two criteria, and a significant positive correlation (0.011) between the two criteria was detected. With this analysis it can be seen that there are many divergences between the criteria used, therefore the best option and the advantage of using one or the other cannot be singled out. However, it should be stressed that the national criterion can also be used more, since there are no significant differences with the criteria advocated by the Ministry of Health of the WHO.

Fatores associados à realização de consultas médicas de crianças menores de 5 anos

Abstract Children outpatient health care utilizationwas estimated by a cross-sectional house-hold survey using multi-stage cluster sam-pling in the city of Sao Luis, in the State ofMaranhao, Brazil. 711 mothers or caretak-ers of children aged from 3 to 59 monthsanswered a standardized questionnaire.The aim was to study factors associated withnon-consultation and verify if the NationalHealth Service (SUS) implementation andpublic outpatient care expansion reducedinequality in the use of health services.More than two thirds, 67.2% of the children,had been seen by a physician when sick inthe previous trimester. The National HealthService funded 74.9% of the services. A lowpercentage, 0.7%, did not get an appoint-ment, indicating that very few cases re-mained unattended to. After adjustment forconfounding factors by means of the Coxproportional hazards model modified forcross-sectional design, predisposing fac-tors, i.e. maternal education, child age andgender, maternal age, number of siblings,and head of household’s occupation ex-plained little of the non-consultation rate.Enabling factors, i.e. family income andhealth insurance did not predict non-con-sultation. The main predictor for not hav-ing an appointment was not needing medi-cal care, because healthy children were at agreater risk of not visiting a doctor.KeywordsKeywords: Health services research.Referral and consultation. Social inequity.Health services research. Child, preschool.A utilizacao de consultas medicas por criancas foi estimada por inquerito domiciliar transversal, em amostra aleatoria por conglomerados em multiplos estagios, no municipio de Sao Luis, Maranhao, Brasil, em 1994. Foi aplicado questionario padronizado em entrevistas com 711 maes ou responsaveis por criancas de 3 a 59 meses de idade. Pretendeu-se identificar demanda reprimida, estudar alguns fatores associados a nao realizacao de consultas e verificar se a implantacao do SUS (Sistema Unico de Saude) e a expansao da rede de ambulatorios publicos reduziram a desigualdade na utilizacao dos servicos de saude. Mais de dois tercos, 67,2% das criancas realizaram consulta medica com finalidade curativa no ultimo trimestre. Destas, 74,9% foram atendidas no SUS. Um percentual muito reduzido, 0,7%, procurou e nao obteve consultas, caracterizando baixa repressao a demanda. Apos o ajuste para fatores de confusao, pela regressao de Cox adaptada para estudos transversais, os fatores predisponentes, como escolaridade materna, sexo e idade da crianca, idade materna, numero de irmaos e ocupacao do chefe de familia explicaram pouco a nao realizacao de consultas. Os fatores facilitadores, como renda familiar e posse de seguro-saude, nao foram preditores. O preditor mais importante da nao realizacao de consultas foi a nao necessidade, pois as criancas cujas maes referiram nao estar doentes apresentaram maior risco de nao serem consultadas. A expansao do atendimento publico contribuiu para reduzir ou anular o peso das diferencas sociais na utilizacao de consultas curativas.

Acompanhamento e crescimento das crianças maranhenses com ênfase nas ações das equipes de saúde da família

Helicobacter pylori is a Gram negative bacterium that cause chronic gastritis, duodenal ulcers and can predispose the gastric cancer. The study aimed to determinate the prevalence of H. pylori infection by different methods of diagnosis in patients submitted to endoscopy. Of the 145 patients included in the study, were collected fragments of gastric mucosa for histological analysis, and for the rapid urease test. The breath test was also performed. The H. pylori infection was detected in 84 (57.9%) patients by histological study, the rapid test of urease was positive in 81 (55,8%) and the breath test in 62 (56,3%). There was no statistically significant difference when comparing the prevalence of infection by different methods of diagnosis. The prevalence of H. pylori infection in our community was lower than that found in the literature for patients with age similar to this study (mean = 53.19 years).