Acesso e utilização de fórmula infantil e alimentos entre crianças nascidas de mulheres com HIV/AIDS / Access and use of infant formula and other foods among children born to HIV positive mothers / Acceso y utilización de fórmula infantil y alimentos entre niños nacidos de mujeres con VIH/SIDA

O objetivo deste estudo foi conhecer as práticas alimentares de crianças de 0-2 anos, filhas de mães portadores de HIV e foi fundamentado na metodologia qualitativa. Para a coleta de dados utilizaram-se entrevistas com 15 mulheres soropositivas acompanhadas no ambulatório de pediatria de um Hospital de Doenças Infecciosas em Fortaleza, Ceará, de março a junho de 2005, cujas análises apontaram duas categorias temáticas: 1. recebendo o leite artificial - experiência das mulheres soropositivas e 2. os alimentos oferecidos às crianças. Apreendeu-se que existem dificuldades para receber o leite doado a seus filhos, bem como na preparação dos alimentos. Há falta de rotina na distribuição da fórmula infantil nas Unidades de Saúde, demonstrando a complexidade do acompanhamento desse tipo de demanda. As práticas alimentares inadequadas utilizadas pelas mães foram: diluições incorretas, adição de complementos energéticos e introdução precoce de alimentos não lácteos. Conclui-se que há necessidade de equipe capacitada para melhorar a organização e distribuição da fórmula infantil e, principalmente, na orientação e preparo dos alimentos, garantindo a segurança alimentar deste grupo vulnerável.

The aim of this qualitative study was to: examine child feeding practices of children 0-2 years of age born to HIV+ mothers and, identify factors related to the distribution and receipt of infant formula at government health units. Fifteen in-depth interviews were conducted with women who had children between 0 and 2 years of age and who were receiving health services at the referral Hospital for Infectious Diseases in Brazil by trained interviewers using a semi-structured questionnaire including open-ended questions. Two main themes were identified: 1. issues related to access and receipt of infant formula by HIV+ mothers; 2. child feeding practices. Study results showed that HIV+ mothers face several barriers to access and receive infant formulas for their children and that they also have difficulties with daily child feeding practices. The lack of preparedness of the health units to address the needs of HIV+ mothers with infants was revealed by this study, indicating the complexity of rendering services to this population group by current existing health services. In addition, study results showed that the diet of the children is rich in carbohydrates and dairy, with early introduction of "table food" and processed foods. Findings suggest the need for multidisciplinary teams adequately trained to follow up the growth and development of these children in order to guarantee the food security of this high-risk group.

El estudio tuvo como objetivo conocer las prácticas alimentares de madres, portadoras de VIH positivo, con sus hijos nacidos después del diagnostico de la infección. Estudio seccional exploratorio, fundamentado en la metodología cualitativa. Para la colecta de datos se utilizaron entrevistas individuales con 15 mujeres seropositivas seguidas en el ambulatorio de pediatría de un Hospital de Enfermedades Infecciosas en Fortaleza, Ceará, de marzo a junio de 2005, cuyos análisis indicaron dos categorías temáticas: recibiendo la leche artificial- experiencia de las mujeres seropositivas; alimentos ofrecidos a los niños. Se observó que existen dificultades para recibir la leche donada a sus hijos, así como en la preparación de los alimentos. Hay una falta de rutina en la distribución de la fórmula infantil en las Unidades de Salud, demostrando la complejidad del seguimiento de este tipo de demanda. Las prácticas alimentarias inadecuadas utilizadas por las madres fueron: dilución incorrecta, adición de complementos energéticos e introducción precoz de alimentos no lácteos. Se concluye que hay necesidad de un equipo capacitado para mejorar la organización y la distribución de la fórmula infantil y principalmente para la orientación y preparación de los alimentos, garantizando la seguridad alimentaría de este grupo vulnerable.

Long lasting BCG protection against leprosy.

BACKGROUND: BCG vaccine protects against leprosy. OBJECTIVES: Estimate BCG protection against leprosy by age by age. METHODS: A case control study with 226 cases of leprosy and 857 controls. BCG vaccination was ascertained via examination of BCG scars. Protection is presented for three age groups. RESULTS: BCG protection against leprosy was 86% (95% CI: 77-92%) in the age group 18-29; 54% (95% CI: -37% to 85%) in the age group 30-39 and 32% (95% CI: -3% to 56%) in those aged 40 or more. CONCLUSIONS: BCG efficacy against leprosy may well last for three decades and possibly even longer. BCG vaccination must have contributed to worldwide reduction in leprosy incidence.

Mortalidade infantil e contexto socioeconômico no Ceará, Brasil, no período de 1991 a 2001 / Infant mortality and the socio-economic scenario in the State of Ceará, Brazil in 1991 and 2001

A Taxa de Mortalidade Infantil (TMI) foi eleita como um dos mais importantes indicadores de saúde pela Organização Mundial da Saúde, na Conferência de Alma-Ata, onde também foi reconhecida a atenção primária como a chave para alcançar um nível mínimo satisfatório de saúde. O Fundo das Nações Unidas para a Infância e a Organização Pan-americana de Saúde determinaram estratégias de ação de baixo custo para países pobres, visando à redução da TMI, tais como acompanhamento do crescimento, reidratação oral, aleitamento materno e imunização. O pressuposto de que reduções substanciais nessa taxa estariam condicionadas a melhorias na qualidade de vida vem sendo questionado, devido a intervenções específicas do setor saúde. Neste contexto, o Ceará e grande parte da região Nordeste vêm enfrentando historicamente as adversidades em áreas sociais, econômicas, demográficas e de atenção à saúde, sugerindo a existência de relação de causalidade entre esses seguimentos e, de forma específica, com a mortalidade infantil. Os determinantes macroepidemiológicos da sobrevivência infantil estão fora da capacidade do setor saúde de provocar algum tipo de intervenção, por isso somente mudanças significativas dos padrões econômicos ou a intensificação de políticas sociais, com continuidade para as questões da educação, do saneamento e da geração de emprego e renda, poderiam provocar transformações de impacto na condição de saúde das populações e, por conseqüência, na mortalidade infantil. Tal conjectura justifica a execução de investigações mais apuradas do ponto de vista metodológico de maneira a elucidar essa hipótese.

The Infant Mortality Rate (IMR) has been determined as one of the most important health indicators by the Alma-Ata Conference of the World Health Organization that also recognized primary health care as the key for health promotion. The United Nations International Childhood Fund and the Pan-American Health Organization devised low cost strategies for poor countries to reduce Infant Mortality Rates such as growth monitoring, oral rehydration, breastfeeding, and vaccination. The assumption that substantial IMR reduction is related to quality of life improvement has been questioned due to specific interventions of the health sector. In this scenario Ceará and a large part of the Northeast has historically coped with adversities in the social, economic and demographic areas including health care, thus establishing a causal relation among these sectors especially concerning infant mortality. Macroepidemiological determinants for infant survival would be out of the health sector capacity of intervening therefore, only significant change of economic standards or social policies intensification, assuring continuity of education issues, of sanitation and generation of employment and income could have an impact on the population health and consequently on infant mortality. Such hypothesis justifies a more in-depth investigation under a methodological viewpoint.

Epidemiologia da hanseniase no Municipio de Sobral, Estado do Ceara-Brasil, no periodo de 1997 a 2003 / Epidemiology of leprosy in Sobral municipality, state of Ceara-Brazil, from 1997 to 2003

A hanseniase persiste como um importante problema de saude publica no Brasil. O municipio de Sobral na zona do sertao centro-norte do Estado do Ceara e considerado pelo Ministerio da Saude como um dos municipios prioritarios para o controle da hanseniase. Para analisar a situaçao epidemiologica da hanseniase em Sobral nos anos de 1997 a 2003, foi realizado um estudo epidemiologico descritivo longitudinal. Os dados foram obitidos a partir da base do Sistema de Informaçao de Agravos de Notificaçao (SNAN). No periodo de estudo foram notificados 1.305 casos novos de hanseniase, 661 (50,3 por cento) do sexo feminino e 644 (49,7 por cento) do sexo masculimo. Em 2003, o coeficinete de detecçao no sexo feminino foi de 23,8/10.000 mulheres, representando um acrecimo de 9,6 por cento comparado ao sexo masculino. O maior percentual de casos novos foi detectado em 2003, superando os valores esperados para o periodo...

[Residual effect of commercial applications of larvicides temefos and Bacillus thuringiensis israelensis on Aedes aegypti larvae in recipients with water renewal]. / Efeito residual de apresentações comerciais dos larvicidas temefos e Bacillus thuringiensis israelensis sobre larvas de Aedes aegypti em recipientes com renovação de água.

The residual effect of temefos (commercial applications A, B and C) and Bacillus thuringiensis israelensis (D and E) on Aedes aegypti larvae was evaluated, in recipients with water renewal. Forty-four beakers of 1,000ml each (8 for each application and 4 controls) were used. In each beaker, 25 larvae were introduced daily. After 24 hours, the dead larvae were counted, the beakers emptied to 200ml and refilled to original volume, with addition of new larvae. The duration of the maximum residual effect (100% of mortality) was: A-19; B-39; C-40; D-8; E-19 days. The mortality ratio of all applications remained equivalent for 25 days; B, C and E maintained MR equivalent up to 45 days; B and C showed MR 2.40 times greater than E, between 46-95 days; B, compared with A, showed MR 1.90-7.51 times greater between 26-95 days. The conclusion was greater effectiveness of two presentations of temefos, even in an epidemiological situation with long exposure to the product and renewal of water in recipients.

Efeito residual de apresentações comerciais dos larvicidas temefos e Bacillus thuringiensis israelensis sobre larvas de Aedes aegypti em recipientes com renovação de água / Residual effect of commercial applications of larvicides temefos and Bacillus thuringiensis israelensis on Aedes aegypti larvae in recipients with water renewal

Avaliou-se o efeito residual do temefos (apresentações comerciais A, B, C) e Bacillus thuringiensis israelensis (D e E) sobre larvas de Aedes aegypti, em recipientes com renovação de água. Utilizaram-se 44 béqueres de 1.000ml (8 para cada apresentação e 4 controles). Em cada béquer introduziram-se diariamente 25 larvas. Após 24 horas, contavam-se as larvas mortas, esvaziavam-se os béqueres até 200ml, repunha-se o volume original e acrescentavam-se novas larvas. A duração do efeito residual máximo (100 por cento de mortalidade) foi: A-19; B-39; C-40; D-8; E-19 dias. A razão de mortalidade permaneceu equivalente entre todos os larvicidas durante 25 dias; B e C mostraram RM 2,40 vezes maior do que E entre 46-95 dias; B, comparado com A, mostrou RM 1,90-7,51 vezes maior entre 26-95 dias. Conclui-se pela maior eficácia de duas apresentações do temefos, mesmo em uma situação epidemiológica de longa exposição ao produto e com renovação de água dos recipientes.

Uma reflexão sobre o processo de avaliação das pós-graduações brasileiras com ênfase na área de saúde coletiva / Reflections on the evaluation of brazilian graduate studies with an emphasis on the collective health field

Este artigo busca promover uma reflexão acerca dos critérios adotados pelo sistema de avaliação da Pós-graduação em curso no país e seu impacto no âmbito dos diferentes programas, conferindo destaque na análise à área de Saúde Coletiva. Ressalta-se, por um lado, a importância que os processos avaliativos têm na consolidação do sistema de ensino e pesquisa, contribuindo, de modo decisivo, para a promoção e monitoramento da sua qualidade. Em contrapartida, os autores convidam a uma reflexão sobre a concepção de ciência subjacente aos critérios adotados e seu impacto no conjunto dos cursos que compõem a pós-graduação em Saúde Coletiva. Para tanto, apontam obstáculos situados em planos distintos e as desigualdades, não apenas regionais, mas entre instituições geograficamente próximas mas que desenvolvem suas práticas em contextos distintos. O texto finaliza indagando sobre a correspondência entre o percurso histórico e os compromissos que marcam a trajetória da Saúde Coletiva e os rumos atuais da avaliação da pós-graduação nesse campo de saberes e práticas.

Spatial analysis of the distribution of leprosy in the State of Ceará, Northeast Brazil

The aim of this study was to describe spatial patterns of the distribution of leprosy and to investigate spatial clustering of incidence rates in the state of Ceará, Northeast Brazil. The average incidence rate of leprosy for the period of 1991 to 1999 was calculated for each municipality of Ceará. Maps were used to describe the spatial distribution of the disease, and spatial statistics were applied to explore large- and small-scale variations of incidence rates. Three regions were identified in which the incidence of leprosy was particularly high. A spatial gradient in the incidence rates was identified, with a tendency of high rates to be concentrated on the North-South axis in the middle region of the state. Moran's I statistic indicated that a significant spatial autocorrelation also existed. The spatial distribution of leprosy in Ceará is heterogeneous. The reasons for spatial clustering of disease rates are not known, but might be related to an heterogeneous distribution of other factors such as crowding, social inequality, and environmental characteristics which by themselves determine the transmission of Mycobacterium leprae.

Selective mass treatment with ivermectin to control intestinal helminthiases and parasitic skin diseases in a severely affected population.

OBJECTIVE: To assess the short-term and long-term impact of selective mass treatment with ivermectin on the prevalence of intestinal helminthiases and parasitic skin diseases in an economically depressed community in north-east Brazil. METHODS: An intervention was carried out in a traditional fishing village in north-east Brazil where the population of 605 is heavily affected by ectoparasites and enteroparasites. The prevalence of intestinal helminths was determined by serial stool examination and the prevalence of parasitic skin diseases by clinical inspection. A total of 525 people out of a target population of 576 were treated at baseline. The majority of these were treated with ivermectin (200 microg/kg with a second dose given after 10 days). If ivermectin was contraindicated, participants were treated with albendazole or mebendazole for intestinal helminths or with topical deltamethrin for ectoparasites. Follow-up examinations were performed at 1 month and 9 months after treatment. FINDINGS: Prevalence rates of intestinal helminthiases before treatment and at 1 month and 9 months after mass treatment were: hookworm disease 28.5%, 16.4% and 7.7%; ascariasis 17.1%, 0.4% and 7.2%; trichuriasis 16.5%, 3.4% and 9.4%; strongyloidiasis 11.0%, 0.6% and 0.7%; and hymenolepiasis 0.6%; 0.4% and 0.5%, respectively. Prevalence rates of parasitic skin diseases before treatment and 1 month and 9 months after mass treatment were: active pediculosis 16.1%, 1.0% and 10.3%; scabies 3.8%, 1.0% and 1.5%; cutaneous larva migrans 0.7%, 0% and 0%; tungiasis 51.3%, 52.1% and 31.2%, respectively. Adverse events occurred in 9.4% of treatments. They were all of mild to moderate severity and were transient. CONCLUSION: Mass treatment with ivermectin was an effective and safe means of reducing the prevalence of most of the parasitic diseases prevalent in a poor community in north-east Brazil. The effects of treatment lasted for a prolonged period of time.

Inequality and leprosy in Northeast Brazil: an ecological study.

BACKGROUND: Leprosy is an important public health problem in many developing countries and many features of its determinants are still obscure. METHODS: To investigate whether the incidence of leprosy is related to certain environmental and socioeconomic determinants, an ecological study was undertaken in 165 municipalities of the state of Ceará, Brazil. Social, economic, education, sanitation, demography, meteorology, and health data were collected. The dependent variable was the average incidence rate of leprosy from 1991 to 1999. Simple and multiple linear regressions were performed to assess the relationship between the dependent and the independent variables. RESULTS: The average incidence rate for all the municipalities for the 1991-1999 period, varied from 0.06 to 14.68 per 10000 persons per year. The level of inequality (beta = 1.67, P = 0.011), the mean years of study among the population >or=25 years old (beta = 1.35, P < 0.001), the population growth from 1991 to 1996 (beta = 0.02, P = 0.007), the percentage of children 7-14 years old that did not go to the school (beta = 0.02, P = 0.028), and the presence of a railroad in the municipality (beta = 0.45, P = 0.038) were found to be predictors of the incidence rate of leprosy in Ceará. CONCLUSION: Our findings fit the assumption that, in Ceará, leprosy is associated with a high level of poverty and uncontrolled urbanization. We put forward the hypothesis that urbanization increases not only social inequality eventually leading to strong polarization, but also excludes people from social and material opportunities. Apparently, such deprivations render them susceptible for leprosy.

Prevention of HIV infection among migrant population groups in Northeast Brazil.

HIV infection is spreading among the poor, women, and migrant communities in the interior of Northeast Brazil. The research focused on different configurations, beliefs, representations, and forms of social organization of behavior thought to be associated with the population's capacity to efficiently follow AIDS prevention measures. Participants located in neighborhoods known for having large migrant populations were identified by Family Health Program Workers in Fortaleza and Teresina. The study adopted a qualitative methodology. Several belief-system concepts and values, as well as the social organization of sexuality revealed in the study, represent obstacles both to AIDS prevention and condom use. Hunger, lack of prospects, and fear are associated with a social situation of poverty, exclusion, prejudice, and total absence of basic human rights. When examined together, these elements define different configurations in the migrants' increased vulnerability to HIV/AIDS. The groups' increased vulnerability relates to the socioeconomic complexity that must be considered in HIV/AIDS control and prevention programs.

Prevention of HIV infection among migrant population groups in Northeast Brazil

A infecção pelo HIV entre pobres, mulheres e populações migrantes do interior do Nordeste Brasileiro vem crescendo. As diferentes configurações, crenças e representações e formas de organização do comportamento, associadas à capacidade de seguir adequadamente medidas de prevenção, foram o foco desta investigação. Os participantes foram localizados em bairros com altas taxas de migração através do Programa Saúde da Família em Fortaleza e Teresina. Empregou-se a metodologia qualitativa nesta investigação. Vários sistemas de crenças, valores e organização social da sexualidade desta população representam obstáculos à prevenção da AIDS e inibem o uso do preservativo. Pobreza, falta de perspectiva e medo estão associados à situação de pobreza, exclusão social e preconceito e à total ausência de direitos humanos. Quando examinados conjuntamente, estes fatores definem diferentes configurações dos migrantes com uma elevada vulnerabilidade ao HIV/AIDS. A alta vulnerabilidade destes grupos, relacionada à complexidade sócio-econômica, deve ser considerada nos programas de prevenção e controle da AIDS.

Spatial analysis of the distribution of leprosy in the State of Ceará, Northeast Brazil.

The aim of this study was to describe spatial patterns of the distribution of leprosy and to investigate spatial clustering of incidence rates in the state of Ceará, Northeast Brazil. The average incidence rate of leprosy for the period of 1991 to 1999 was calculated for each municipality of Ceará. Maps were used to describe the spatial distribution of the disease, and spatial statistics were applied to explore large- and small-scale variations of incidence rates. Three regions were identified in which the incidence of leprosy was particularly high. A spatial gradient in the incidence rates was identified, with a tendency of high rates to be concentrated on the North-South axis in the middle region of the state. Moran's I statistic indicated that a significant spatial autocorrelation also existed. The spatial distribution of leprosy in Ceará is heterogeneous. The reasons for spatial clustering of disease rates are not known, but might be related to an heterogeneous distribution of other factors such as crowding, social inequality, and environmental characteristics which by themselves determine the transmission of Mycobacterium leprae.