Thiago Santos de Araújo

Child health and nutrition in the Western Brazilian Amazon: population-based surveys in two counties in Acre State

The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.

Anemia em crianças de 6 a 59 meses e fatores associados no Município de Jordão, Estado do Acre, Brasil

This study investigated anemia prevalence and associated factors using a cross-sectional approach with 429 children 6 to 59 months of age in Jordao, Acre State, Brazil. Multiple Poisson regression in hierarchical models was used in the analysis. Overall anemia prevalence was 57.3% (95%CI: 52.5%-2.1%). Age under 24 months [prevalence ratio - PR (95%CI): 1.40 (1.09-1.74)], living in rural areas [PR: 1.23 (1.04-1.44)], households with 5-14 children [PR: 1.23 (1.04-1.44)], stunting [PR: 1.19 (1.01-1.39)], maternal anemia [PR: 1.18 (1.00-1.39)], and smoking during pregnancy [PR: 1.29 (1.09-1.53)] were associated with increased risk of anemia. Children of working mothers were at lower risk of anemia [PR: 0.78 (0.64-0.94)]. Anemia prevalence in childhood was found to be a serious public health problem in this municipality. Multi-sector prevention strategies should be implemented, addressing poverty and maternal-infant healthcare.

Epidemiology and Control of Child Toxocariasis in the Western Brazilian Amazon – A Population-Based Study

Toxocara spp. infection and the seroconversion rate in the Amazon have been poorly investigated. This study analyzed individual and household-level risk factors for the presence of IgG antibodies to Toxocara spp. in urban Amazonian children over a period of 7 years and evaluated the seroconversion rates over a 1-year follow-up. In children < 59 months of age, the overall prevalence rate was 28.08% in 2003 and 23.35% in 2010. The 2010-2011 seroconversion rates were 13.90% for children 6-59 months of age and 12.30% for children 84-143 months of age. Multilevel logistic regression analysis identified child age, previous wheezing, and current infection with hookworm as significant associated factors for Toxocara spp. seropositivity in 2003. In 2010, age, previous helminthiasis, and having a dog were associated with seropositivity, whereas having piped water inside the household was a protective factor. Control programs mainly need to target at-risk children, water quality control, and animal deworming strategies.

Inquerito por telefone: pesos de pos-estratificacao para corrigir vicios de baixa cobertura em Rio Branco, AC

OBJETIVO: Analisar efeitos do uso de pesos de pos-estratificacao para corrigir vicios decorrentes da baixa cobertura de domicilios com telefone. METODOS: Comparacao dos resultados levantados pelo Inquerito Domiciliar com o Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (Vigitel), em Rio Branco, AC, 2007, cuja cobertura era de 40% de telefonia fixa. O vicio potencial do Vigitel foi expresso pela diferenca entre as prevalencias do Vigitel e do Inquerito Domiciliar, calculada a raiz quadratica do erro quadratico medio como medida de acuracia da estimativa. RESULTADOS: O procedimento de ponderacao do Vigitel corrigiu o vicio potencial nas prevalencias de consumo de frutas, legumes e verduras, de carnes com gordura visivel, o ser fumante, a autoavaliacao do estado de saude ruim e da morbidade referida de colesterol ou trigliceride. O procedimento adotado pelo Vigitel nao reduziu o vicio nas prevalencias da pratica de atividade fisica no tempo livre e de morbidade referida de asma, bronquite asmatica, bronquite cronica ou enfisema. CONCLUSOES: E necessario o uso de metodos alternativos de ponderacao e a estrategia de selecao de variaveis externas para construcao de pesos de pos-estratificacao que minimizem o vicio potencial das estimativas das variaveis decorrentes da baixa cobertura de domicilios com telefone fixo.OBJECTIVE To evaluate the effects of using post-stratification weight to correct the bias due to low coverage of households with telephones. METHODS A Comparison was made of results collected by the Household Survey with those of the VIGITEL (Telephone Survey to Monitor Risk and Protective Factors for Chronic Diseases) in Rio Branco, Northern Brazil, in 2007 whose coverage was 40% of landline phones. The potential bias in the VIGITEL survey was expressed by the difference between the rates of prevalence of the VIGITEL and Household Survey, calculated as the square root mean square error (MSE) as a measure of the accuracy of the estimate. RESULTS The weighting procedure of VIGITEL corrected potential bias in the prevalence of consumption of fruit and vegetables, meat with visible fat, smoking, bad self-assessment of health status and morbidity of cholesterol or triglycerides. In the prevalence of physical activity in leisure time and morbidity of asthma, bronchial asthma, chronic bronchitis or emphysema, the procedure adopted by VIGITEL did not reduce the potential bias. CONCLUSIONS in order to construct post-stratification weights which minimize the potential bias in estimates of the variables due to low coverage of households with landlines, it becomes necessary to use alternative methods of weighting and strategies of selecting external variables.

Associação da força de preensão manual com morbidades referidas em adultos de Rio Branco, Acre, Brasil: estudo de base populacional

This study aimed to analyze the association of handgrip strength with self-reported diseases and multimorbidity among adults in Rio Branco, Acre State, Brazil, through a population based survey involving 1,395 adults of both sexes. Associations by sex were estimated by logistic regression analysis. The mean handgrip strength in men (44.8kg) is higher than in women (29kg) and decrease with age. The mean handgrip strength difference between those classified as strong and weak was 21kg and 15.5kg for men and woman, respectively. Controlling for age group, body mass index and physical activity when it was relevant, men with low handgrip strength were more likely to have hypertension [OR = 2.21 91.35; 3.61)], diabetes [OR = 4.18 (1.35; 12.95)], musculoskeletal disorders [OR = 1.67 (1.07; 2.61)] and multimorbidity [OR = 1.99 (1.27; 3.12)]. Among woman, associations between handgrip strength and cardiovascular disease, dyslipidemia, musculoskeletal disorders and multimorbidity were not sustained in the multivariate models. This study endorses the use of handgrip strength as a health biomarker.Este estudo objetivou analisar a associacao da forca de preensao manual com morbidades referidas e multimorbidade em adultos de Rio Branco, Acre, Brasil, mediante inquerito de base populacional com 1.395 adultos de ambos os sexos. As associacoes, por sexo, foram estimadas com a tecnica de regressao logistica. A media de forca de preensao manual nos homens (44,8kg) e maior que entre as mulheres (29kg) e reduz com a idade. A diferenca da forca de preensao manual media entre aqueles classificados como fortes e fracos foi 21kg e 15,5kg, para homens e mulheres, respectivamente. Controlando para a faixa etaria, indice de massa corporal e atividade fisica quando relevante, homens com baixa forca de preensao manual tiveram maiores chances de ocorrencia de hipertensao [OR = 2,21 (1,35; 3,61)], diabetes [OR = 4,18 (1,35; 12,95)], disturbio musculoesqueletico [OR = 1,67 (1,07; 2,61)] e multimorbidade [OR = 1,99 (1,27; 3,12)]. Nas mulheres, associacoes entre forca de preensao manual e evento cardiovascular, dislipidemia, disturbio muscolesqueletico e multimorbidade nao se mantiveram nos modelos multivariados. Este estudo endossa o uso da forca de preensao manual como biomarcador de saude.

Association of handgrip strength with self-reported diseases in adults in Rio Branco, Acre State, Brazil: a population-based study

This study aimed to analyze the association of handgrip strength with self-reported diseases and multimorbidity among adults in Rio Branco, Acre State, Brazil, through a population based survey involving 1,395 adults of both sexes. Associations by sex were estimated by logistic regression analysis. The mean handgrip strength in men (44.8kg) is higher than in women (29kg) and decrease with age. The mean handgrip strength difference between those classified as strong and weak was 21kg and 15.5kg for men and woman, respectively. Controlling for age group, body mass index and physical activity when it was relevant, men with low handgrip strength were more likely to have hypertension [OR = 2.21 91.35; 3.61)], diabetes [OR = 4.18 (1.35; 12.95)], musculoskeletal disorders [OR = 1.67 (1.07; 2.61)] and multimorbidity [OR = 1.99 (1.27; 3.12)]. Among woman, associations between handgrip strength and cardiovascular disease, dyslipidemia, musculoskeletal disorders and multimorbidity were not sustained in the multivariate models. This study endorses the use of handgrip strength as a health biomarker.Este estudo objetivou analisar a associacao da forca de preensao manual com morbidades referidas e multimorbidade em adultos de Rio Branco, Acre, Brasil, mediante inquerito de base populacional com 1.395 adultos de ambos os sexos. As associacoes, por sexo, foram estimadas com a tecnica de regressao logistica. A media de forca de preensao manual nos homens (44,8kg) e maior que entre as mulheres (29kg) e reduz com a idade. A diferenca da forca de preensao manual media entre aqueles classificados como fortes e fracos foi 21kg e 15,5kg, para homens e mulheres, respectivamente. Controlando para a faixa etaria, indice de massa corporal e atividade fisica quando relevante, homens com baixa forca de preensao manual tiveram maiores chances de ocorrencia de hipertensao [OR = 2,21 (1,35; 3,61)], diabetes [OR = 4,18 (1,35; 12,95)], disturbio musculoesqueletico [OR = 1,67 (1,07; 2,61)] e multimorbidade [OR = 1,99 (1,27; 3,12)]. Nas mulheres, associacoes entre forca de preensao manual e evento cardiovascular, dislipidemia, disturbio muscolesqueletico e multimorbidade nao se mantiveram nos modelos multivariados. Este estudo endossa o uso da forca de preensao manual como biomarcador de saude.

Seroprevalence and Seroconversion of Dengue and Implications for Clinical Diagnosis in Amazonian Children

This study aimed to evaluate the prevalence of serum IgG dengue in children in an Amazonian population, to assess the seroconversion rate in 12 months, and to estimate how many seropositive children had a prior clinical diagnosis of dengue. We conducted a population-based study between 2010 and 2011, with children aged 6 months to 12 years that were living in the urban area of a small town in the Brazilian Amazon. The prevalence of IgG antibodies against dengue antigens was determined by indirect ELISA technique, and seronegative children were reexamined after 12 months to determine seroconversion rates. Results showed seroprevalence of IgG antibodies against dengue type of 2.9%, with no significant association between age, race, and sex. In seropositive children, only 8.4% had received a clinical diagnosis of dengue, and the ratio of clinically diagnosed cases and subclinical cases was 1 : 11. The seroconversion rate between 2010 and 2011 was 1.4% (CI 3.8% to 35.1%). The seroprevalence of dengue in this pediatric population was low, and the vast majority of cases were not clinically detected, suggesting a difficulty in making the clinical diagnosis in children and a high frequency of asymptomatic infections.

Telephone survey: post-stratification adjustments to compensate non-coverage bias in city of Rio Branco, Northern Brazil

OBJETIVO: Analisar efeitos do uso de pesos de pos-estratificacao para corrigir vicios decorrentes da baixa cobertura de domicilios com telefone. METODOS: Comparacao dos resultados levantados pelo Inquerito Domiciliar com o Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (Vigitel), em Rio Branco, AC, 2007, cuja cobertura era de 40% de telefonia fixa. O vicio potencial do Vigitel foi expresso pela diferenca entre as prevalencias do Vigitel e do Inquerito Domiciliar, calculada a raiz quadratica do erro quadratico medio como medida de acuracia da estimativa. RESULTADOS: O procedimento de ponderacao do Vigitel corrigiu o vicio potencial nas prevalencias de consumo de frutas, legumes e verduras, de carnes com gordura visivel, o ser fumante, a autoavaliacao do estado de saude ruim e da morbidade referida de colesterol ou trigliceride. O procedimento adotado pelo Vigitel nao reduziu o vicio nas prevalencias da pratica de atividade fisica no tempo livre e de morbidade referida de asma, bronquite asmatica, bronquite cronica ou enfisema. CONCLUSOES: E necessario o uso de metodos alternativos de ponderacao e a estrategia de selecao de variaveis externas para construcao de pesos de pos-estratificacao que minimizem o vicio potencial das estimativas das variaveis decorrentes da baixa cobertura de domicilios com telefone fixo.OBJECTIVE To evaluate the effects of using post-stratification weight to correct the bias due to low coverage of households with telephones. METHODS A Comparison was made of results collected by the Household Survey with those of the VIGITEL (Telephone Survey to Monitor Risk and Protective Factors for Chronic Diseases) in Rio Branco, Northern Brazil, in 2007 whose coverage was 40% of landline phones. The potential bias in the VIGITEL survey was expressed by the difference between the rates of prevalence of the VIGITEL and Household Survey, calculated as the square root mean square error (MSE) as a measure of the accuracy of the estimate. RESULTS The weighting procedure of VIGITEL corrected potential bias in the prevalence of consumption of fruit and vegetables, meat with visible fat, smoking, bad self-assessment of health status and morbidity of cholesterol or triglycerides. In the prevalence of physical activity in leisure time and morbidity of asthma, bronchial asthma, chronic bronchitis or emphysema, the procedure adopted by VIGITEL did not reduce the potential bias. CONCLUSIONS in order to construct post-stratification weights which minimize the potential bias in estimates of the variables due to low coverage of households with landlines, it becomes necessary to use alternative methods of weighting and strategies of selecting external variables.

Evolution of Socioeconomic Conditions and Its Relation to Spatial-Temporal Changes of Giardiasis and Helminthiasis in Amazonian Children.

This study analyzed the evolution of socioeconomic, sanitary, and personal factors as well as spatiotemporal changes in the prevalence of helminthiasis and giardiasis in urban Amazonian children between 2003 and 2011. Child age, lack of sanitation, and lack of access to bottled water were identified as significant associated factors for helminthiasis and giardiasis. There was an overall improvement in socioeconomic and sanitary conditions in the city resulting in decreased helminth prevalences from 12.42 to 9.63% between 2003 and 2010, but the prevalence increased to 15.03% in 2011 due to migratory movement and unstable sanitary conditions. As for Giardiasis, socioeconomic and environmental changes were not enough to reduce prevalence (16% in 2003 and 23% in 2011). Spatial analysis identified a significant cluster for helminthiasis in an area of poor housing conditions. Control programs in the Amazon need to target high-risk areas focusing changes in sanitation, water usage, and health education.

Morbidade e mortalidade perinatal em gestações que cursaram com amniorrexe prematura em maternidade pública do Norte do Brasil

OBJETIVO: Identificar os fatores obstetricos e perinatais associados a morbimortalidade perinatal em gestacoes que cursaram com amniorrexe prematura.METODOS: Estudo transversal de base hospitalar, com dados secundarios de prontuarios de pacientes (n=87) que evoluiram com quadro de amniorrexe prematura com idade gestacional entre 24 e 42 semanas, definida pela ultrassonografia, e internadas no periodo de janeiro a abril de 2013 em uma maternidade publica no estado do Acre, regiao Norte do Brasil. Os dados foram submetidos a analise bivariada para selecao de variaveis que compuseram o modelo multiplo utilizando a tecnica de regressao logistica de Poisson. RESULTADOS: A prevalencia de morbimortalidade perinatal foi de 51,4%. Nesse total estao computados 2,3% de obitos fetais (2 casos) e 9,2% de obitos neonatais (8 casos). As variaveis que apresentaram associacao no modelo multiplo final com morbimortalidade foram: numero de consultas de pre-natal ≥6, com razao de prevalencia (RP) 0,5 e intervalo de confianca de 95% (IC95%) 0,3-0,9, idade gestacional ≥30 semanas (RP=0,6; IC95% 0,4-0,8), baixo peso ao nascer (RP=2,9; IC95% 1,5-5,4) e necessidade de ventilacao mecânica (RP=3,8; IC95% 2,0-7,2).CONCLUSAO: Observou-se elevada morbimortalidade perinatal entre casos que cursaram com amniorrexe prematura. A morbimortalidade esteve associada a fatores como menor numero de consultas de pre-natal, extrema prematuridade e o baixo peso.