Zeína Soares Moulin

Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados

The Child Health Record (CHR) is an essential document for childrens health care activities. A cross-sectional study was performed with simple random sampling, aimed at analyzing factors related to quality of data completion on the CHR. Interviews and direct verification of 365 CHRs from 9 health districts in Belo Horizonte, Minas Gerais State, Brazil, were performed. A scoring system was created to classify the CHRs in terms of quality of data completion and to relate them to explanatory variables. Odds ratios were calculated by logistic regression. Completion of the 20 scoring items varied from 3.1% (use of iron supplements) to 99.7% (date of birth). Factors associated with worse scores were: children > 12 months old (OR = 1.77), mothers with < or = 6 years of schooling (OR = 1.97), children not treated by general practitioners (OR = 3.18), and mothers who had not received explanations on the CHR while in the maternity ward (OR = 1.77). The results show poor use of the CHR and emphasize the need for on-going efforts to train health professionals and prepare health services for their important role in the promotion of childrens health.

Recommendations for breastfeeding during maternal infections

OBJETIVO: Revisao da literatura com o enfoque de amamentacao e doencas infecciosas maternas, no intuito de contribuir com conhecimentos para decisoes a serem tomadas pelo profissional de saude. FONTES DE DADOS: Informacoes foram obtidas em consultas que incluiram livros-texto, normas tecnicas, artigos selecionados por meio de busca na base de dados Lilacs e MEDLINE, alem de referencias especificas. SINTESE DOS DADOS: Nutrizes com doencas infecciosas podem transmitir agentes patogenicos pelo leite materno para a crianca. Embora a amamentacao confira protecao a crianca, ela pode tambem ser uma importante fonte de infeccao. Doencas maternas causadas por virus, fungos e agentes parasitarios podem, em alguns casos, ser transmitidas via leite humano. Para maes com infeccoes pelo virus da imunodeficiencia humana e virus T-linfotropicos humanos tipo I, a recomendacao e nao amamentar. Nas demais doencas, e necessaria uma avaliacao cuidadosa, mas, em geral, na maioria dos casos, o aleitamento materno e mantido. CONCLUSOES: Algumas doencas, principalmente as causadas por virus, podem ser transmitidas durante a amamentacao. O profissional de saude, ao identificar uma nutriz com infeccao viral ativa ou outra doenca infecciosa, necessita tomar a decisao de suspender ou nao a amamentacao, o que pode ser um fato angustiante pelo seu papel fundamental na promocao e estimulo ao aleitamento materno.

Caderneta de Saúde da Criança: avaliação do preenchimento dos dados sobre gravidez, parto e recém-nascido

OBJECTIVE: Evaluate pregnancy, birth and neonatal data filling of the Childs Health Record (CHR) and study mothers perception about the function of this tool in Belo Horizonte, Minas Gerais, Brazil. METHODS: This was a cross-sectional descriptive study of 797 CHR of infants born between April and December 2005 and delivered to their mothers soon after birth. A written protocol was used to assess the first pages of the CHR and mothers were asked two questions. Each CHR item was classified as correctly, incorrectly or not filled in. RESULTS: The name of the child was not in the CHR in 44%. The first prenatal visit and the number of prenatal visits were absent in respectively 40 and 31% of the records. The type of birth was not recorded in 15% of the CHR, as well as the gestational age in 24% and the Apgar score at five minutes in 23%. The newborns weight, length and head circumference were not informed in 9, 10 and 15%, respectively. The slot with the orientation to take the newborn to the first pediatric visit on the 5th day of life was blank in 75%. Only 32% of the mothers received information about the CHR at the maternity ward. To 313 mothers, the CHR was important to record follow-up of growth and/or development of their child. CONCLUSIONS: An important lack of information was noted in the CHR. Efforts should be directed to improve the quality of information in order to enhance childrens health promotion.

Bacterial contamination of breast milk collected through manual expression and stored at room temperature

OBJECTIVES: To the determine the bacterial contamination profile of unheated expressed breast milk, collected without rigid hygienic precautions and stored at room temperature for nine hours. The purpose was to give poor lactating mothers the alternative of storing their own milk out of refrigerator. A research on cultural, social and economical aspects as well as on donatorś knowledge about breastfeeding was considered necessary. METHODS: 35 donators were interviewed and an experimental investigation was performed with 33 samples of breast milk stored at room temperature (17 masculine C to 30.5 masculine C) and bacteriologically analyzed at zero, three, six and nine hours after collection. The same breast milk was stored at refrigerator (2 masculine C to 6 masculine C) as a control procedure. Total count of bacterial contents and identification of Staphylococcus aureus and Escherichia coli were evaluated.RESULTS: The enterviews revealed the low socio-economical and cultural level of lactating mothers and their little experience in expressing, collecting and using their own milk. Bacteriological data analysis showed mesophyllous average of 7.1x10(3)UFC/mL, acceptable outline of bacterial contamination, despite the use of a simplified hygiene technique. After nine hours, samples stored at room temperature showed final average of bacterial contents similar to the first ones (7.3x10(3)UFC/mL) and without relevant statistic differences from the ones kept under refrigeration (p=0.05) for studied bacterias.CONCLUSION: This study shows that it is possible to use unprocessed breast milk for babýs consumption if it is stored at room temperatures until nine hours after it has been collected. However, mothers have to be told about the possibility of storing breast milk for babies later consumption.

Well-being of children and adolescents: a multidimensional construct

Objectives: To review the literature on the well-being of children and adolescents from a multidimensional perspective. Methods: A narrative review was conducted and articles from the PubMed database, from publications of national and international institutions, dissertations and theses were selected. Results: The production of articles on the wellbeing of children and adolescents still cannot be considered significant when compared to other themes in the scientific production involving individuals in this age group. These findings highlight the importance of a targeted approach to this issue. It is clear that the term well-being, despite being commonly used, is inconsistently defined. A single domain is unable to encompass all the complexity involved in this concept , as attested by the extensive list of studies and reports monitoring well-being throughout the world. Analysis based on data from the Health Beaga Study reveals the existence of important intra-urban differences in the various domains of well-being of adolescents living in Belo Horizonte, a large urban center in Brazil, reinforcing the importance of studying well-being from a multidimensional perspective, one that can visualize is as a potential indicator of social inequities. Conclusion: We found that well-being is influenced not only by individual attributes but also by contextual factors such as family, neighborhood, and country characteristics.