BackgroundCaesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction.MethodsNationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design.DiscussionThis study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it’s consequences on postnatal health.
(OR = 0.23;, time spent from home to the hospital ≥ 30 minutes (OR = 3.12; (OR = 14.75; prematurity (OR = 3.41; IntroduçãoA partir da década de 90, em virtude da redução do componente pós-neonatal da mortalidade infantil, aumentou o peso relativo às mortes ocorridas no período neonatal. Na segunda metade da década de 90, a taxa de mortalidade neonatal, em torno de 20 óbitos por mil nascidos vivos, passou a representar mais de 60% da mortalidade infantil 1,2,3 . Percebeu-se uma maior concentração desses óbitos nos primeiros dias de vida, refletindo a relação entre a assistência de saúde prestada à gestante nos períodos pré-parto e parto como também ao recém-nascido imediatamente após o nascimento na sala de parto e nas unidades neonatais 1,4 .Em relação à mortalidade neonatal precoce em crianças com peso inferior a 2.000g, apresenta valores 10 a 20 vezes maiores em estudos brasileiros, quando comparada a países desenvolvidos como a Inglaterra. Esses dados indicam uma maior dificuldade de acesso a leitos de berçários de risco ou tratamento intensivo neonatal, ou mesmo a insatisfatória qualidade da assistên-cia 1 . Vários estudos descreveram os determinantes associados à morte neonatal precoce, como prematuridade, baixo peso ao nascer e intercorrências na gestação e parto, porém estes fatores se articulam de forma complexa, sendo influenciados pelas características biológicas materna e do recém-nascido, condições sociais e da atenção ofertada pelos serviços de saúde 5,6,7,8,9 .ARTIGO ARTICLE Nascimento RM et al.
The pediatrician, together with other professionals, can act by promoting actions emphasizing the concept of the first 1000 days to ensure healthy nutrition and development. Focusing on actions in this period may increase the child's chance of having a healthy and productive life in the future, strengthening family and community ties, helping to break the intergenerational cycle of poverty.
Este estudo pretendeu determinar os fatores associados à mortalidade intra-hospitalar, utilizando como variáveis explicativas as características individuais da mãe, da assistência ao pré-natal, parto e período neonatal e dos recém-nascidos internados em Unidades Neonatais de Alto Risco (UTIN) integrantes da Rede Norte-Nordeste de Saúde Perinatal no Nordeste do Brasil. Foi realizado estudo longitudinal, multicêntrico de base hospitalar. A população do estudo compreendeu 3.623 nascidos vivos internados em 34 UTIN. Após o ajuste para os três níveis hierárquicos do modelo de determinação do óbito em UTIN até o 27 o dia de vida, associaram-se: tipo de parto – cesariana (OR = 0,72; IC95%: 0,56-0,95); não uso de corticoide antenatal (OR = 1,51; IC95%: 1,01-2,25); pré-eclâmpsia (OR = 0,73; IC95%: 0,56-0,95); oligodramnia (OR = 1,57; IC95%: 1,17-2,10); peso ao nascer < 2.500g (OR = 1,40; IC95%: 1,03-1,90); escore de Apgar 5 o minuto < 7 (OR = 2,63; IC95%: 2,21-3,14); uso de tubo endotraqueal (OR = 1,95; IC95%: 1,31-2,91); não uso de surfactante (OR = 0,54; IC95%: 0,43-0,69). O óbito em UTIN é determinado pelas condições assistenciais à gestação, parto e recém-nato.
A multi-country evaluation is being carried out in Brazil and four other countries to determine the effectiveness, cost, and impact of the Integrated Management of Childhood Illness (IMCI). We examine the effect of IMCI on the quality of health care provided to children under five visiting health facilities. A health facility survey was conducted at 24 facilities (12 with IMCI) in each of four States in the Northeast. We assessed the quality of care provided to children between 2 months and 5 years attending the facilities. Health workers trained in IMCI provided significantly better care than those not trained. Significant differences between health workers who were trained or not trained in IMCI were found in the assessment of the child, disease classification, treatment, and caretaker communication. Nurses trained in IMCI performed as well as, and sometimes better than, medical officers trained in IMCI. We conclude that while there is room for further improvement, IMCI case management training significantly improves health worker performance, and that parts of Brazil that have not yet introduced IMCI should be encouraged to do so.
OBJECTIVETo analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil.METHODSData were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model.RESULTSA sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting.CONCLUSIONSSocioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.
Objectives: to determine overweight and obesity prevalence in adolescent students in the Municipality of Fortaleza, Brazil and to estimate prevalence rates of public and private schools according to gender and age group (early and late adolescence).
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