Concepção, gravidez, parto e pós-parto: perspectivas feministas e interseccionais / Conception, pregnancy, childbirth and postpartum: perspectives feminist and intersectional

Essa edição se inicia com duas discussões conceituais que são estruturantes para toda a obra: gênero e interseccionalidade. Isso porque as questões de saúde da mulher abordadas estão ancoradas no lugar que a mulher ocupa na sociedade, ou seja, possui um recorte de classe, raça e gênero.

Polycystic kidney disease complicates renal pathology in a family with Fabry disease.

Fabry disease is a rare lysosomal storage disorder that primarily affects the heart and kidneys, often presenting with reduced renal function. Polycystic kidney disease is a renal condition in which cysts are found, which have a different presentation than the cysts associated with Fabry disease. We report a 60-year-old male patient who was diagnosed with Fabry disease with the classic c.730G > A (p.Asp244Asn) variant of the GLA gene at 34 years of age. Fabry symptoms in this patient include hypohidrosis, hearing loss, corneal whorling, and edema. He also presented with polycystic kidney disease with multiple simple and mildly complex cysts on abdominal ultrasound. Family history of note included Fabry disease in his mother and maternal uncle as well as polycystic kidneys in his mother. Molecular analysis for polycystic kidney disease revealed a variant of uncertain significance (VUS) in the PKD1 gene. Although the in silico studies of this VUS have inconclusive results, the patient fills clinical criteria of autosomal dominant polycystic kidney disease, therefore, Fabry disease and polycystic kidney disease are considered two co-existing manifestations in this family. This case demonstrates the possibility of two renal comorbidities in the same individual and the risk of one diagnosis being overlooked by the other.

Experiências positivas de parto em Mato Grosso do Sul: propostas para a gestão e atenção primária à saúde / Positive childbirth experiences in Mato Grosso do Sul: proposals for governance and primary health care

Introdução: As ações de gestão da rede e promoção da saúde no pré-natal devem ser planejadas para que as gestantes possam tomar decisões com autonomia, contando com estruturas físicas e equipes adequadas às suas necessidades de cuidados em saúde. Objetivo: Avaliar a organização da rede de atenção ao parto e monitorar os fatores determinantes para taxas de cesariana acima da média nacional. A partir destes dados planejar uma ferramenta de preparação para o parto voltada para a atenção primária do SUS. Métodos: Estudo ecológico com triangulação de técnicas qualitativas e quantitativas de caráter compreensivo-interpretativo e orientado à ação. O grupo assessor da pesquisa contribuiu para a definição da pergunta, o recrutamento dos sujeitos e a discussão dos resultados. Para o componente quantitativo da pesquisa, foram analisados os dados epidemiológicos relacionados ao tipo de parto registrados no Sistema Nacional de Registros de Nascimentos (SINASC). Após a aprovação no Comitê de Ética em Pesquisa, foram recrutadas mulheres que tiveram partos em Mato Grosso do Sul no ano 2020. Elas foram entrevistadas virtualmente pelo aplicativo WhatsApp seguindo um roteiro semiestruturado. A análise do conteúdo foi feita com auxílio do software NVivo. Resultados: A análise dos dados epidemiológicos de 2009 a 2019 permitiu identificar que a rede de atenção está organizada para oferecer cesarianas. Em 15 municípios mais de 75% dos nascimentos da década aconteceram via cesariana. Dentre as mulheres com cesariana anterior apenas 3% tiveram parto normal. Os fatores determinantes para a decisão pelo tipo de parto foram acesso à informação, ter um profissional de confiança que acompanhe a gestação e o parto. Os fatores financeiros, como cobertura assistencial do SUS ou do plano de saúde também foram considerados como definidores do planejamento do parto pelas mulheres. As intervenções de aconselhamento e educação em saúde no pré-natal precisam ofertar instrumentos para que as mulheres possam tomar decisões com autonomia. É preciso ampliar o acesso aos grupos de apoio e a ferramentas para preparação para o parto. Além disso, é preciso que a gestão incentive a organização da rede com cuidado pré-natal seguro e baseado em evidências científicas, para apoiar as mulheres para que elas ampliem sua autonomia na decisão sobre o local de parto mais adequado às suas necessidades e expectativas. Conclusão: Existem incentivos diretos e indiretos para que as mulheres demandem por cesarianas na rede de saúde de Mato Grosso do Sul. Nesta cultura de cesariana, o parto espontâneo é tratado como uma emergência médica para a qual a maioria dos serviços não estaria qualificada para atender. Tal realidade tem implicação nos direitos das mulheres ao cuidado adequado e livre de dano.

Introduction: Actions for promotion of prenatal care of the public health care system must be planned so that pregnant women may take decisions with autonomy relying on infrastructure and professional teams suitable to their needs. Objective: To assess the organization of the delivery-care-network and monitor the determining factors for cesarean section rates to be above the national average in Mato Grosso do Sul and based on the collected data, to develop a childbirth preparation tool oriented to SUS primary care services. Methods: Ecological study with triangulation of qualitative and quantitative techniques of a comprehensive-interpretative and action-oriented nature. The research participative group contributed to the definition of the question, the recruitment of subjects and the discussion of the results. For the quantitative component of the research, epidemiological data related to the type of delivery recorded in the National System of Birth Records (SINASC) were analyzed. After approval by the Research Ethics Committee, women who gave birth in Mato Grosso do Sul in the year 2020 were recruited. They were interviewed virtually through the WhatsApp application following a semi-structured script. Content analysis was performed using the NVivo software. Results: The analysis of epidemiological data from 2009 to 2019 made it possible to identify that the care network is organized to offer cesarean sections. In 15 municipalities, more than 75% of births in the decade were by cesarean section. Among women with previous cesarean section, only 3% had a normal delivery. The determining factors for the decision making on the type of delivery were having access to information, a reliable professional to monitor the pregnancy period and delivery. Financial factors, such as SUS healthcare coverage or having health insurance were also considered as defining factors. Prenatal counseling and health education interventions need to offer instruments so that women can make decisions with autonomy. Access to support groups and tools for childbirth preparation needs to be expanded. In addition, management needs to encourage the organization of the network with safe prenatal care and based on scientific evidence to support women so that they may expand their autonomy on deciding the most appropriate place of delivery according to their needs and expectations. Conclusion: There are direct and indirect motivations for women to demand cesarean sections in the healthcare network of Mato Grosso do Sul. On this cesarean culture, spontaneous delivery is treated as a medical emergency that most services would not be qualified to handle. This reality has implications on women's right to have an adequate and harm-free care.

A meta-analysis of the diagnostic accuracy of chest ultrasound for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma.

BACKGROUND: We performed a systematic review (SR) and meta-analysis (MA) to determine the diagnostic accuracy of chest ultrasound (US) compared with a pericardial window (PW) for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. METHODS: A literature search in five databases identified relevant articles for inclusion in this SR and MA. Studies were eligible if they evaluated the diagnostic accuracy of chest US, compared with a PW, for the diagnosis of occult penetrating cardiac injuries in hemodynamically stable patients presenting with penetrating thoracic trauma. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. Methodological quality was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. We performed a MA of binary diagnostic test accuracy within the bivariate mixed-effects logistic regression modeling framework. RESULTS: We included five studies in our SR and MA. These studies included a total of 556 trauma patients. The MA found that, compared with PW, the US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients. The presence of a concomitant left hemothorax was frequent in patients with false-negative results. CONCLUSION: This SR and MA found that, compared with PW, US was 79% sensitive and 92% specific for detecting occult penetrating cardiac injuries in hemodynamically stable patients with penetrating thoracic trauma. Caution interpretation of pericardial US results is suggested in the presence of left hemothorax. In these cases, a second diagnostic test should be performed. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis, level II.

Determination of potentially novel compensatory mutations in rpoc associated with rifampin resistance and rpob mutations in Mycobacterium tuberculosis Clinical isolates from peru.

Background: Rifampicin (RIF) resistance in Mycobacterium tuberculosis is frequently caused by mutations in the rpoB gene. These mutations are associated with a fitness cost, which can be overcome by compensatory mutations in other genes, among which rpoC may be the most important. We analyzed 469 Peruvian M. tuberculosis clinical isolates to identify compensatory mutations in rpoC/rpoA associated with RIF resistance. Methods: The M. tuberculosis isolates were collected and tested for RIF susceptibility and spoligotyping. Samples were sequenced and aligned to the reference genome to identify mutations. By analyzing the sequences and the metadata, we identified a list of rpoC mutations exclusively associated with RIF resistance and mutations in rpoB. We then evaluated the distribution of these mutations along the protein sequence and tridimensional structure. Results: One hundred and twenty-five strains were RIF susceptible and 346 were resistant. We identified 35 potential new compensatory mutations, some of which were distributed on the interface surface between rpoB and rpoC, arising in clusters and suggesting the presence of hotspots for compensatory mutations. Conclusion: This study identifies 35 putative novel compensatory mutations in the ß' subunit of M. tuberculosis RNApol. Six of these (S428T, L507V, A734V, I997V, and V1252LM) are considered most likely to have a compensatory role, as they fall in the interaction zone of the two subunits and the mutation did not lead to any change in the protein's physical-chemical properties.

Evidence for a Partially Stalled γ Rotor in F1-ATPase from Hydrogen-Deuterium Exchange Experiments and Molecular Dynamics Simulations.

F1-ATPase uses ATP hydrolysis to drive rotation of the γ subunit. The γ C-terminal helix constitutes the rotor tip that is seated in an apical bearing formed by α3ß3. It remains uncertain to what extent the γ conformation during rotation differs from that seen in rigid crystal structures. Existing models assume that the entire γ subunit participates in every rotation. Here we interrogated E. coli F1-ATPase by hydrogen-deuterium exchange (HDX) mass spectrometry. Rotation of γ caused greatly enhanced deuteration in the γ C-terminal helix. The HDX kinetics implied that most F1 complexes operate with an intact rotor at any given time, but that the rotor tip is prone to occasional unfolding. A molecular dynamics (MD) strategy was developed to model the off-axis forces acting on γ. MD runs showed stalling of the rotor tip and unfolding of the γ C-terminal helix. MD-predicted H-bond opening events coincided with experimental HDX patterns. Our data suggest that in vitro operation of F1-ATPase is associated with significant rotational resistance in the apical bearing. These conditions cause the γ C-terminal helix to get "stuck" (and unfold) sporadically while the remainder of γ continues to rotate. This scenario contrasts the traditional "greasy bearing" model that envisions smooth rotation of the γ C-terminal helix. The fragility of the apical rotor tip in F1-ATPase is attributed to the absence of a c10 ring that stabilizes the rotation axis in intact FoF1. Overall, the MD/HDX strategy introduced here appears well suited for interrogating the inner workings of molecular motors.

Feature Binding of Common Everyday Items Is Not Affected by Age.

There is a surge of studies confirming that old age spares the ability to bind in visual working memory (VWM) multiple features within singular object representations. Furthermore, it has been suggested that such ability may also be independent of the cultural background of the assessed individual. However, this evidence has been gathered with tasks that use arbitrary bindings of unfamiliar features. Whether age spares memory binding functions when the memoranda are features of everyday life objects remains less well explored. The present study investigated the influence of age, memory delay, and education, on conjunctive binding functions responsible for representing everyday items in VWM. We asked 32 healthy young and 41 healthy older adults to perform a memory binding task. During the task, participants saw visual arrays of objects, colours, or coloured objects presented for 6 s. Immediately after they were asked either to select the objects or the colours that were presented during the study display from larger sets of objects or colours, or to recombine them by selecting from such sets the objects and their corresponding colours. This procedure was repeated immediately after but this time providing a 30 s unfiled delay. We manipulated familiarity by presenting congruent and incongruent object-colour pairings. The results showed that the ability to bind intrinsic features in VWM does not decline with age even when these features belong to everyday items and form novel or well-known associations. Such preserved memory binding abilities held across memory delays. The impact of feature congruency on item-recognition appears to be greater in older than in younger adults. This suggests that long-term memory (LTM) supports binding functions carried out in VWM for familiar everyday items and older adults still benefit from this LTM support. We have expanded the evidence supporting the lack of age effects on VWM binding functions to new feature and object domains (i.e., everyday items). We have confirmed that education does not negatively impact on such ability at old age. Such results have important implications for the selection of culturally unbiased tests to screen for abnormal ageing trajectories.

Genetic Ancestry and Susceptibility to Late-Onset Alzheimer Disease (LOAD) in the Admixed Colombian Population.

INTRODUCTION: Differences in the prevalence of dementia among populations and in the effect of apolipoprotein E (APOE) on the emergence of Alzheimer disease (AD), which is the main type of dementia, have been reported. METHODS: This study estimated the ancestry of a group of individuals with late-onset Alzheimer disease (LOAD) (N=280) and established whether there were any differences when compared with a control group (N=357) in a sample of the Colombian population. RESULTS: When the analyses were adjusted for known risk factors such as age, sex, presence of APOE[Latin Small Letter Open E]4, socioeconomic status, educational attainment, and place of birth, African ancestry was associated with an increased LOAD risk (odds ratio: 1.55; 95% confidence interval, 1.09-2.03; P=0.029), whereas Native American ancestry was associated with lower risk (odds ratio: 0.75; 95% confidence interval, 0.61-0.98; P=0.046), for every 10% increase in ancestry. In addition, there were significant differences in the proportion of Native American ancestry between carriers and noncarriers of the APOE[Latin Small Letter Open E]4 allele (Mann-Whitney U test, P=0.047), with noncarriers having higher mean Native American ancestry when compared with carriers. CONCLUSIONS: Our results are consistent with the presence of variants of African origin in the genome of the Colombian population and different from APOE[Latin Small Letter Open E]4 that represents a risk factor for the development of LOAD, whereas variants of Native American origin may be conferring protection. However, unknown environmental factors or epigenetic differences among continental groups could also explain the observed associations.

Association of GWAS Top Genes With Late-Onset Alzheimer's Disease in Colombian Population.

OBJECTIVE: The association of variants in CLU, CR1, PICALM, BIN1, ABCA7, and CD33 genes with late-onset Alzheimer's disease (LOAD) was evaluated and confirmed through genome-wide association study. However, it is unknown whether these associations can be replicated in admixed populations. METHODS: The association of 14 single-nucleotide polymorphisms in those genes was evaluated in 280 LOAD cases and 357 controls from the Colombian population. RESULTS: In a multivariate analysis using age, gender, APOE∊4 status, and admixture covariates, significant associations were obtained ( P < .05) for variants in BIN1 (rs744373, odds ratio [OR]: 1.42), CLU (rs11136000, OR: 0.66), PICALM (rs541458, OR: 0.69), ABCA7 (rs3764650, OR: 1.7), and CD33 (rs3865444, OR: 1.12). Likewise, a significant interaction effect was observed between CLU and CR1 variants with APOE. CONCLUSION: This study replicated the associations previously reported in populations of European ancestry and shows that APOE variants have a regulatory role on the effect that variants in other loci have on LOAD, reflecting the importance of gene-gene interactions in the etiology of neurodegenerative diseases.

Clinical manifestations of colorectal cancer patients from a large multicenter study in Colombia.

Colorectal cancer (CRC) is a major public health problem, and its incidence is rising in developing countries. However, studies characterizing CRC clinicopathological features in cases from developing countries are still lacking. The goal of this study was to evaluate clinicopathological and demographic features in one of the largest CRC studies in Latin America.The study involved over 1525 CRC cases recruited in a multicenter study in Colombia between 2005 and 2014 as part of ongoing genetic and epidemiological studies. We gathered clinicopathological data such as age at diagnosis, sex, body mass index, tobacco and alcohol consumption, family history of cancer, and tumor features including location, histological type, and stage. Statistical analyses were performed to test the association between age of onset, sex, and clinical manifestations.The average age at CRC diagnosis was 57.4 years, with 26.5% of cases having early-onset CRC (diagnosed by age 50 years). Most cases were women (53.2%; P = 0.009), 49.2% were overweight or obese, 49.1% were regular alcohol drinkers, 52% were smokers/former smokers, and 12.2% reported relatives with cancer. Most tumors in the study were located in the rectum (42.7%), were adenocarcinomas (91.5%), and had advanced stage (T3-T4, 79.8%). Comparisons by sex found that male cases were more likely to be obese (36.5% vs 31.1%; P = 0.001), less likely to have a family history of cancer (9.7% vs 15.3%; P = 0.016), and more likely to have advanced-stage tumors (83.9% vs 76.1%; P = 0.036). Comparisons by age of onset found that early-onset cases were more likely to be women (59.3% vs 51.0%; P = 0.005) and report a family history of cancer (17.4% vs 10.2%; P = 0.001).To our knowledge, our study is the largest report of clinicopathological characterization of Hispanic CRC cases, and we suggest that further studies are needed to understand CRC etiology in diverse Hispanic populations.

Síntomas laringofaríngeos posoperatorios en cirugía electiva. Incidencia y factores asociados / Postoperative laringo-pharyngeal symptoms in elective surgery - Incidence and related factors

Introducción: Los síntomas laringofaríngeos (SLF) son comunes en anestesia. La incidencia de morbilidad laringofaríngea varía en la literatura. Objetivos: Determinar la incidencia de SLF al usar máscara laríngea y tubo endotraqueal en la primera y a las 24h posoperatorias y estimar la asociación de factores de riesgo. Métodos: Estudio de cohorte cerrada que incluyó 451 pacientes. Se indagó la presencia de odinofagia, disfonía y disfagia. Se utilizaron modelos marginales para estimar asociación con variables en estudio. Resultados: La incidencia de SLF durante la primera y 24h posoperatorias fue del 26 y del 13%, respectivamente. A las 24 h, la incidencia disminuyó significativamente. Conclusiones: La incidencia en un centro hospitalario colombiano de SLF en cirugía ambulatoria es importante. Existen diferencias en la reducción con el tubo endotraqueal y la máscara laríngea en el tiempo.

Introduction: To determine cumulative incidence of sore throat complaints (STCs) which occur with the insertion of the laryngeal mask (LM) and endotracheal tube (ETT) during the first hour and 24 hours after elective surgery. In addition, to establish risk factors associated with its occurrence. Methods: In a cohort study, a total of 451 patients scheduled for elective non-cardiac surgery were included consecutively for 6 months (ASA I-II-III, >18 years old) who underwent LM or ETT airway management for general anesthesia. Through a questionnaire with indirect and direct questions the presence of sore throat, hoarseness, dysphagia and the composite endpoint STCs were assessed one and 24 hours after surgery. Marginal models were used to identify risk factors. Results:We found an incidence of STCs of 26.8% and 13.5% at first and 24 postoperative hours respectively. At first hour, they were classified as sore throat (23.9%), hoarseness (6.7%) and dysphagia (6.4%). Each compound was not mutually exclusive. At 24 hours of follow up, incidence of STCs and its compounds decreases significantly but differently to ETT and LM. STCs were associated with female gender (OR=1.53 95%CI 1.00-2.37, p=0.05), ETT intubation (OR=4.20 95%CI 2.19-8.04, p<0.01) and bloodstain on airway device at extubation (OR=2.00 95%CI 1.18-3.36, p<0.01). Conclusions: The incidence of STCs remains important. There are differences in the pattern of reduction between ETT and LM over time and this study confirms risk factors for postoperative STCs like use of ETT, presence of blood during the airway device extraction and female gender.

Bloqueo supraclavicular bilateral con ecografía / Bilateral supraclavicular blockade with ultrasound

El manejo analgésico de los pacientes con trauma bilateral de hombro o tercio proximal del brazo es difícil. La estrategia multimodal basada en administración de anestésicos locales en el plexo braquial parece ser la más efectiva, pero hacer bloqueos bilaterales tiene riesgos asociados, como son: la parálisis del nervio frénico, la toxicidad por anestésicos locales y el neumotórax bilateral. Estos pueden ser disminuidos con una aproximación supraclavicular al plexo braquial y el uso de ultrasonografía. Describimos el manejo de un paciente con trauma bilateral de hombro y tercio proximal de húmero, quien es llevado a cirugía de osteosíntesis bilateral de húmero y presenta dolor postoperatorio severo que no responde a dosis altas de opiáceos y antiinflamatorios. Es manejado inicialmente con bloqueo supraclavicular bilateral guiado por ecografía con volumen bajo de anestésico local y posteriormente administración continua de bupivacaína, con una valoración del dolor de 2/10 a las 24 h y 3/10 a las 48 h. Concluimos que el bloqueo supraclavicular bilateral es una opción para el manejo del dolor agudo en cirugía de hombro y tercio proximal de húmero. La administración continua de anestésicos locales al plexo braquial contribuye a mantener la respuesta analgésica.

Analgesic management in patients with bilateral trauma to the shoulder or the proximal third of the arm is difficult. The multimodal strategy based on the administration of local analgesics to the brachial plexus appears to be the most effective; however, there are risks associated with bilateral blocks, including phrenic nerve palsy, toxicity due to local anesthetics, and bilateral pneumothorax. These risks may be diminished using an ultrasound-guided supraclavicular approach to the brachial plexus. This paper describes the management of a patient with bilateral injury to the shoulder and the proximal third of the humerus. The patient is taken to bilateral humeral fixation surgery and develops severe post-operative pain which does not respond to high-dose opioids and anti-inflammatory agents. He is managed initially with bilateral ultrasound-guided supraclavicular block using a low volume of a local anesthetic followed by continuous administration of bupivacaine. Pain assessment was 2/10 at 24 hours and 3/10 at 48 hours. We concluded that bilateral supraclavicular blockade is an option in the acute management of pain after surgery to the shoulder and the proximal third of the humerus. Continuous administration of local anesthetics to the brachial plexus helps maintain the analgesic response.

The help-seeking by women with urinary incontinence in Brazil.

INTRODUCTION AND HYPOTHESIS: Lower tract urinary symptoms are underestimated by women as well as health professionals. The objective of this study was to evaluate the behavior of adult women with urinary incontinence and overactive bladder symptoms in seeking medical treatment. METHODS: Two hundred ninety-two women between 20 and 82 years old were interviewed. Urinary symptoms, epidemiologic, and quality of life (ICQ-SF) were related to the procurement of medical assistance. The Shapiro-Wilk, Mann-Whitney, and chi-square tests were used. RESULTS: The impact of the symptoms on quality of life was greater in younger women. Twenty-two percent of the participants, mainly the younger ones, reported seeking medical services due to several associated symptoms and quality of life impact. CONCLUSION: Younger women, association of several urinary symptoms, symptoms of urinary loss, and longer time since symptom onset were determining factors for seeking medical treatment.

Conocimientos maternos sobre signos de peligro en diarrea aguda en el marco de la estrategia AIEPI / Maternal knowledge about children’s danger signs in acute diarrhoea in an IMCI’s frame

Antecedentes: La Atención Integrada de las Enfermedades Prevalentes en la Infancia (AIEPI) es una estrategia que busca disminuir la mortalidad por enfermedades prevalentes en menores de cinco años. En la enfermedad diarreica aguda (EDA), una de sus actividades es promocionar los conocimientos maternos sobre signos de peligro, la búsqueda oportuna de atención y las prácticas adecuadas de hidratación. Objetivo: Establecer los conocimientos maternos sobre signos de peligro en EDA en menores de 5 años y determinar prácticas de hidratación. Métodos: Estudio descriptivo por medio de una encuesta. Se aplicó un instrumento de investigaciones operativas de AIEPI, a 204 cuidadores elegidos consecutivamente que asistieron por primera vez a la consulta de crecimiento y desarrollo de un hospital de nivel I en Popayán, Colombia. Se midieron variables: edad materna, sexo, edad del niño, área (rural-urbana), estrato socioeconómico, vínculo al Sistema Nacional de Seguridad Social en Colombia, escolaridad, número de hijos, convivencia con compañero, convivencia con abuela del menor. La variable conocimientos se determinó de una manera dicotómica: la madre conocía si sabía por lo menos dos signos de peligro en EDA. Se establecieron proporciones y medias para caracterizar la población. Resultados: Del total de las madres, 54% conocen como mínimo dos signos de peligro en EDA. En caso de EDA se emplean líquidos caseros 49%, SRO 49%, suero casero 23%. El convivir con la abuela del niño se asoció significativamente con los conocimientos maternos (p <0.05). Conclusión: La mitad de las madres no conocen signos de peligro y esto hace necesario intervenciones educativas en EDA y difundir la estrategia AIEPI. En estas intervenciones es necesario incluir a las abuelas y a las madres que no conviven con ellas.

Background: IMCI ( Integrated Management Childhood Illness) is a sort of strategy for childhood attention that aims to reduce mortality by prevalent diseases in population below 5 years old. In acute diarrhoea the IMCI’s preventive activities are to promote the maternal knowledge about danger signs, to look for opportune care and to improve oral hydration therapy (ORT). Objectives: To establish maternal knowledge about children’s danger signs in acute diarrhoea below 5 years old. To determine hydration practices in acute diarrhoea. Methods: A descriptive study was carried out in Hospital del Norte of Popayán, Colombia, first level of attention health centre for establishing mother’s knowledge of danger signs in acute diarrhoea. A survey based of an instrument from IMCI to 204 mothers chosen consecutively was applied. Variables measured were: maternal age, sex, child age, region (urban-rural), socioeconomic status, bond to the Colombian Social Security National System, scholarship, number of sons, coexistence with partner, coexistence with child’s grandmother. The knowledge variable was determined from a dichotomy way. The mother’s knowledge was established if she knew 2 or more danger signs in acute diarrhoea. Results: Only 54% of mothers knew at least 2 danger signs in diarrhoea. Mothers used: Homemade liquids, 49%; commercial ORT, 49%; homemade serum, 23%. The fact of living with the grandmother was independent associated with an increase in maternal knowledge (p<0.05). Conclusion: Since nearly half of the mothers don’t know a danger sign makes necessary an educational intervention in acute diarrhoea and to divulge IMCI’s recommendations. In this intervention grandmothers must be included.