Prevalence and risk factors associated with wheezing in the first year of life / Prevalência e fatores de risco associados à sibilância no primeiro ano de vida

OBJECTIVE: to investigate the prevalence and risk factors associated with wheezing in infants in the first year of life. METHODS: this was a cross-sectional study, in which a validated questionnaire (Estudio Internacional de Sibilancias en Lactantes - International Study of Wheezing in Infants - EISL) was applied to parents of infants aged between 12 and 15 months treated in 26 of 85 primary health care units in the period between 2006 and 2007. The dependent variable, wheezing, was defined using the following standards: occasional (up to two episodes of wheezing) and recurrent (three or more episodes of wheezing). The independent variables were shown using frequency distribution to compare the groups. Measures of association were based on odds ratio (OR) with a confidence interval of 95% (95% CI), using bivariate analysis, followed by multivariate analysis (adjusted OR [aOR]). RESULTS: a total of 1,029 (37.7%) infants had wheezing episodes in the first 12 months of life; of these, 16.2% had recurrent wheezing. Risk factors for wheezing were family history of asthma (OR = 2.12; 95% CI: 1.76-2.54) and six or more episodes of colds (OR = 2.38; 95% CI: 1.91-2.97) and pneumonia (OR = 3.02; 95% CI: 2.43-3.76). For recurrent wheezing, risk factors were: familial asthma (aOR = 1.73; 95% CI: 1.22-2.46); early onset wheezing (aOR = 1.83; 95% CI: 1.75-3.75); nocturnal symptoms (aOR = 2.56; 95% CI: 1.75-3.75), and more than six colds (aOR = 2.07; 95% CI 1.43- .00). CONCLUSION: the main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies. .

OBJETIVO: verificar a prevalência e fatores de risco associados à sibilância em lactentes no primeiro ano de vida. MÉTODOS: estudo transversal, onde foi aplicado o questionário padronizado e validado (Estudio Internacional de Sibilancias en Lactantes-EISL) aos pais de lactentes com idade entre 12 e 15 meses que procuraram 26 das 85 unidades de atenção básica, no período 2006 a 2007. A variável dependente, sibilância, foi definida utilizando os seguintes padrões: ocasional (até dois episódios de sibilância) e recorrente (três ou mais episódios). As variáveis independentes foram apresentadas usando distribuição de frequências, utilizadas para comparar os grupos. As medidas de associações foram baseadas em razão de chances (odds ratio-OR), com intervalo de confiança de 95% (IC95%), com análise bivariada, seguida de análise multivariada (OR ajustada). RESULTADOS: um total de 1.029 (37,7%) lactentes apresentou sibilância nos primeiros 12 meses de vida e destes, 16,2% tiveram sibilância recorrente. Os principais fatores de risco associados à sibilância foram: história familiar de asma (ORa = 2,12; IC95%: 1,76-2,54); seis ou mais episódios de resfriado (ORa = 2,38; IC95%: 1,91-2,97) e pneumonia (ORa = 3,02; IC95%: 2,43-3,76) e sibilância recorrente foram: asma na família (ORa = 1,73; IC95%: 1,22-2,46); início precoce de sibilância (ORa = 1,83; IC95%: 1,75-3,75); sintomas noturnos (ORa = 2,56; IC95%: 1,75-3,75); mais de 6 resfriados (ORa = 1,83; IC95%: 1,75-3,75) CONCLUSÃO: os principais fatores de risco associados à sibilância foram as infecções respiratórias e história de asma na família. Conhecer os fatores de risco dessa enfermidade deve ser uma prioridade para a saúde pública, que poderá ...

Prevalence and risk factors associated with wheezing in the first year of life.

OBJECTIVE: to investigate the prevalence and risk factors associated with wheezing in infants in the first year of life. METHODS: this was a cross-sectional study, in which a validated questionnaire (Estudio Internacional de Sibilancias en Lactantes--International Study of Wheezing in Infants--EISL) was applied to parents of infants aged between 12 and 15 months treated in 26 of 85 primary health care units in the period between 2006 and 2007. The dependent variable, wheezing, was defined using the following standards: occasional (up to two episodes of wheezing) and recurrent (three or more episodes of wheezing). The independent variables were shown using frequency distribution to compare the groups. Measures of association were based on odds ratio (OR) with a confidence interval of 95% (95% CI), using bivariate analysis, followed by multivariate analysis (adjusted OR [aOR]). RESULTS: a total of 1,029 (37.7%) infants had wheezing episodes in the first 12 months of life; of these, 16.2% had recurrent wheezing. Risk factors for wheezing were family history of asthma (OR=2.12; 95% CI: 1.76-2.54) and six or more episodes of colds (OR=2.38; 95% CI: 1.91-2.97) and pneumonia (OR=3.02; 95% CI: 2.43-3.76). For recurrent wheezing, risk factors were: familial asthma (aOR=1.73; 95% CI 1.22-2.46); early onset wheezing (aOR=1.83; 95% CI: 1.75-3.75); nocturnal symptoms (aOR=2.56; 95% CI: 1.75-3.75), and more than six colds (aOR=2.07; 95% CI 1.43- .00). CONCLUSION: the main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies.

Effectiveness of home-based peer counselling to promote breastfeeding in the northeast of Brazil: a randomized clinical trial.

AIMS: To evaluate the effectiveness of home-based peer counselling to increase breastfeeding rates for unfavourably low birthweight babies. METHODS: Randomized clinical trial carried out in maternity hospitals and households in Fortaleza, one of the regions in Brazil with very low income; 1003 mothers and their newborns were selected in eight maternity hospitals. Newborns needed were healthy and weighed less than 3000 g. INTERVENTION: Breastfeeding counselling, conducted by lay counsellors from the community, during home visits carried out on days 5, 15, 30, 60, 90 and 120 after birth. MAIN OUTCOME MEASURE: Feeding methods in the fourth month of life. RESULTS: The intervention increased exclusive breastfeeding (24.7% vs 19.4%; p=0.044), delayed the introduction of formula and increased the time infants substituted breastfeeding to bottle milk (bottle milk 33.4% in the control group and 20.1% in the intervention group; p=0.00002). When comparing the frequency of artificial breastfeeding versus all other forms of breastfeeding (exclusive+predominant+partial), the intervention increased breastfeeding rates in 39% (RR=0.61; CI 95%: 0.50-0.75); 15% of children were free from artificial feeding (absolute risk reduction). The number of families to be visited to avoid one child receiving artificial feeding (NNT) was 7 (CI 95%: 5-13). CONCLUSIONS: Breastfeeding counselling, promoted by lay counsellors, can impact favourably on exclusive breastfeeding rates and contribute to delaying the utilization of milk formula and weaning. The intervention has great application potential because most cities in the northeast of Brazil count on community health workers that could do the counselling.