Objetivou-se apreender os dilemas e conflitos revelados por mulheres que engravidaram na vigência da infecção pelo HIV/Aids. Estudo qualitativo com oito mulheres atendidas em ambulatório em Fortaleza-CE. Mediante entrevistas observou-se que as mulheres gestam com expectativa do resultado da sorologia do concepto; depois de nascidos vivenciam incertezas e mantêm superproteção da criança. Relatam maneiras inadequadas da comunicação do diagnóstico e pouca orientação para gestar em face do HIV. As mulheres transformam o desejo de ser mãe em realidade. Para elas, lidar com uma criança com possibilidade de contrair infecção pelo HIV é algo além de sua capacidade. Conclui-se ser essencial oferecer suporte emocional e social para essas mulheres independente das fases da vida.

OBJETIVOS: abordar percepções e vivências de mulheres que amamentaram exclusivamente por seis meses; retratar suas atitudes e o significado que a amamentação tem para elas, esclarecendo como se originou e se sustentou no grupo a prática da amamentação exclusiva. MÉTODOS: estudo qualitativo de investigação social, com enfoque crítico-interpretativo. A amostra foi composta por 13 lactantes, usuárias da rede de serviços de Fortaleza, Ceará, Brasil. A técnica utilizada foi a entrevista individual em profundidade. RESULTADOS: evidenciou-se a complexidade do ato de amamentar, muitas vezes naturalizado e considerado como possível de ser vivenciado, independentemente do contexto social em que se desenvolve. O papel desempenhado pelos pais e avós mostrou-se um elemento importante no processo da amamentação. Constatou-se, que o sucesso do aleitamento materno teve como origem os significados construídos pelas informantes, ao longo de suas vidas e na própria vivência de lactante, na qual se processaram reinterpretações de concepções prévias às suas experiências com o ato de amamentar.. CONCLUSÕES: as experiências reportam à dimensão concreta da vida, na qual se inserem as relações estabelecidas com os serviços e os profissionais de saúde. A motivação e percepção do processo de amamentar ancoram-se em experiências inseridas em redes sócio-familiares, construtoras de autoconfiança, resultando numa determinação, que superam, os diferentes obstáculos apresentados para a conquista da amamentação.

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.

BackgroundAfter being eliminated during the 1950s, dengue reemerged in Brazil in the 1980s. Since then, incidence of the disease has increased, as serotypes move within and between cities. The co-circulation of multiple serotypes contributes to cycles of epidemic and interepidemic years, and a seasonal pattern of transmission is observed annually. Little is known regarding possible differences in the epidemiology of dengue under epidemic and interepidemic scenarios. This study addresses this gap and aims to assess the epidemiological characteristics and determinants of epidemic and interepidemic dengue transmission, utilizing data from the 5th largest city in Brazil (Fortaleza), at fine spatial and temporal scales.Methods/Principal findingsLongitudinal models of monthly rates of confirmed dengue cases were used to estimate the differential contribution of contextual factors to dengue transmission in Fortaleza between 2011 and 2015. Models were stratified by annual climatological schedules and periods of interepidemic and epidemic transmission, controlling for social, economic, structural, entomological, and environmental factors. Results revealed distinct seasonal patterns between interepidemic and epidemic years, with persistent transmission after June in interepidemic years. Dengue was strongly associated with violence across strata, and with poverty and irregular garbage collection during periods of low transmission, but not with other indicators of public service provision or structural deprivation. Scrapyards and sites associated with tire storage were linked to incidence differentially between seasons, with the strongest associations during transitional precipitation periods. Hierarchical clustering analysis suggests that the dengue burden concentrates in the southern periphery of the city, particularly during periods of minimal transmission.Conclusions/SignificanceOur findings have direct programmatic implications. Vector control operations must be sustained after June even in non-epidemic years. More specifically, scrapyards and sites associated with tires (strongly associated with incidence during periods of minimal transmission), require sustained entomological surveillance, particularly during interepidemic intervals and in the urban periphery. Intersectoral collaborations that address urban violence are critical for facilitating the regular activities of vector control agents.

Objetivou-se descrever a vivência das mães sobre os cuidados prestados aos filhos, bem como a percepção destas em relação à consulta de puericultura. Realizou-se pesquisa-ação com onze mães de crianças menores de dois anos e utilizou-se a entrevista semiestruturada em visita domiciliária às mães, seguidas de consultas mensais de puericultura e estratégias de educação em saúde e de nova entrevista para avaliação da implementação das consultas. Após descrição e análise dos dados, emergiram as categorias: Construção da Competência para ser mãe; Alternativas e Tratamento da Doença; Aprendizado na Puericultura. As consultas favorecem o cuidado das mães ao filho, proporcionando saúde de qualidade, por meio da promoção da saúde e prevenção de doenças.

Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do BrasilPrevalence and determinants of obesity and overweight among reproductive age women living in the semi-arid region of Brazil

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BackgroundTuberculosis (TB) remains a public health problem, despite recent achievements in reducing incidence and mortality rates. In Brazil, these achievements were above the worldwide average, but marked by large regional heterogeneities. In Fortaleza (5th largest city in Brazil), the tuberculosis cure rate has been declining and treatment abandonment has been increasing in the past decade, despite a reduction in incidence and an increase in directly observed therapy (DOT). These trends put efforts to eliminate tuberculosis at risk. We therefore sought to determine social and programmatic determinants of tuberculosis incidence and treatment abandonment in Fortaleza.MethodsWe analyzed sociodemographic and clinical data for all new tuberculosis cases notified in the Notifiable Diseases Information System (SINAN) from Fortaleza between 2007 and 2014. We calculated incidence rates for 117 neighborhoods in Fortaleza, assessed their spatial clustering, and used spatial regression models to quantify associations between neighborhood-level covariates and incidence rates. We used hierarchical logistic regression models to evaluate how individual- and neighborhood-level covariates predicted tuberculosis treatment abandonment.ResultsThere were 12,338 new cases reported during the study period. Case rates across neighborhoods were significantly positively clustered in two low-income areas close to the city center. In an adjusted model, tuberculosis rates were significantly higher in neighborhoods with lower literacy, higher sewerage access and homicide rates, and a greater proportion of self-reported black residents. Treatment was abandoned in 1901 cases (15.4%), a rate that rose by 71% between 2007 and 2014. Abandonment was significantly associated with many individual sociodemographic and clinical factors. Notably, being recommended for DOT was protective for those who completed DOT, but associated with abandonment for those who did not.ConclusionLow socioeconomic status areas have higher tuberculosis rates, and low socioeconomic individuals have higher risk of treatment abandonment, in Fortaleza. Treatment abandonment rates are growing despite the advent of universal DOT recommendations in Brazil. Proactive social policies, and active contact tracing to find missed cases, may help reduce the tuberculosis burden in this setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4435-0) contains supplementary material, which is available to authorized users.