OBJETIVO: Em resposta à necessidade sentida por municípios brasileiros de informação referente às práticas de amamentação com vistas ao planejamento em saúde, realizou-se estudo com o objetivo de descrever a situação da amamentação e identificar fatores associados ao desmame nesses municípios. MÉTODOS: De uma convocação aberta a todos os municípios do Estado de São Paulo, 84 aderiram a um treinamento para coleta de dados no Dia Nacional de Vacinação, em 1998. Para cada município, foi desenhada uma amostra compatível com o tamanho de sua população infantil, aplicando-se um questionário padronizado com questões referentes à alimentação da criança nas 24 horas precedentes. Além de estatísticas descritivas sobre a freqüência de amamentação, foram analisados pela regressão logística fatores de risco para interrupção da amamentação exclusiva em menores de quatro meses e para o desmame em menores de um ano. RESULTADOS: O aleitamento exclusivo nos primeiros quatro meses raramente alcançou índices superiores a 30%. Como fatores de risco para essa situação, identificaram-se: baixa escolaridade materna, ausência de programa Hospital Amigo da Criança, primiparidade e maternidade precoce. Com relação aos menores de um ano, a amamentação ficou em torno de 50%. CONCLUSÃO: A ausência do programa Hospital Amigo da Criança, primiparidade, trabalho informal ou desemprego materno foram os fatores de risco para o desmame. As taxas municipais de amamentação diferem amplamente no Estado de São Paulo, o que reforça a importância de diagnósticos locais, rápidos e de fácil apropriação por profissionais de saúde.

There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.

The BFHI has had an impact on several indicators of breast feeding. The authors hope the results of this study will make policy makers and health professionals aware of the importance and potential of this strategy.

Determinantes da amamentação no primeiro ano de vida em Cuiabá, Mato GrossoBreast feeding determinants on the fi rst year of life of children in a city of Midwestern Brazil RESUMO OBJETIVO: Avaliar os fatores de risco para a interrupção de aleitamento materno e desmame em crianças menores de um ano. MÉTODOS:Estudo transversal analítico com crianças menores de um ano de idade que compareceram aos postos de vacinação do município de Cuiabá, Mato Grosso, em 2004, acompanhadas de seus responsáveis. Para defi nição da amostra, foram sorteadas as unidades de vacinação, seguindo-se o sorteio das crianças em cada unidade, de forma sistemática. Para coleta de dados, aplicou-se um questionário semi-estruturado aos acompanhantes das crianças, investigando variáveis características sociodemográfi cas, referentes ao nascimento da criança e maternas, uso de chupeta e alimentação no primeiro dia em casa. Foram realizadas análise descritiva e regressão logística dos fatores de risco para cada faixa etária, apresentadas em odds ratio e intervalos de confi ança. RESULTADOS:No total, 920 crianças menores de um ano foram avaliadas, das quais 205 menores de 120 dias e 275 menores de 180 dias. Verifi cou-se que usar chupeta, tomar chá no primeiro dia em casa, ter mãe com escolaridade até o primeiro ou segundo graus ou primípara, representam maior risco de não estar em amamentação exclusiva aos 120 dias de vida. Tais fatores se mostraram signifi cativos também para menores de 180 dias, com exceção do consumo de chá, que não foi indagado para essa faixa etária. Nos menores de um ano, o uso de chupeta foi a única variável que manteve signifi cância estatística. CONCLUSÕES:Fatores socioculturais mostraram-se determinantes da situação de aleitamento materno. Ressalta-se a importância da instrução e conscientização maternas, que refl etem sobre as práticas que podem prejudicar a amamentação.

The Brazilian Ministry of Health launched its Family Health Program (FHP) in 1994 as a new strategy aimed at reorganizing the healthcare system starting from the primary care level. The Program prioritizes delivery of care to groups identified as presenting increased risk, such as diabetic and hypertensive individuals. The objective of this study was to evaluate the care delivered to such patients by professionals in this program in the municipality of Francisco Morato, São Paulo, Brazil. A random cluster-based sample selected 84 patients with diabetes and/or hypertension who answered a questionnaire at home. Seventy-two patients responded. Of these, 19% were diabetic, 41.7% hypertensive, and 38.9% had both diabetes and hypertension. As for the care offered by the FHP, only 35.9% received excellent diagnostic workups and 10.9% excellent physical examinations. Some 20.8% of the patients reported illness-related complications. With the implementation of the FHP, access to care improved for both diabetic and hypertensive patients. The FHP proved to be a valid alternative to increase healthcare access, seeking to achieve greater equity by delivering care in accordance with the population's needs.

ObjectiveAssuming that ethnicity might be a basis for social differentiation and that such differences might represent vulnerability to sickness, this study attempts to verify whether race or ethnic origin have an effect on mortality patterns. MethodsThe Sao Paulo State death register was examined from 1999 to 2001 in a contingence table of causes according to the 10 th ICD and race or skin-color categories (White, Black, Mulatto and others). Chi-square test was used to check the association between skin-color and cause of death; residual analysis was used to elicit statistically significant excessive occurrences when each category of cause of death and skin color was combined; and correspondence analysis was used to examine overall relations among all categories considered. Results A total of 647,321 valid death registers were analyzed, among which 77.7% were of Whites, 5.4% of Blacks, 14.3% of Mulattoes and 2.6% of others. A significant association between skin color or race and cause of death was found. It may be observed that, although Blacks and Mulattoes present a similar death profile, on the contrary of Whites and others, which could be aggregated into a single category, the former appear in distinct positions on the multidimensional map presented. Except for mal defined causes, which characterize only the deaths of Blacks, the other causes of death within this group are common to both Blacks and Mulattoes, varying however, in intensity and as to the order in which they appear death. Conclusions Analysis of mortality according to race or color revealed that death has a color. There is a White death, which has, among its causes, sicknesses, which, although variable, are nothing more than sicknesses. There's a Black death, which is not caused by sicknesses but by external causes, complications in labor and delivery, mental disorders and ill-defined causes.

BackgroundWorldwide, a high proportion of HIV-infected individuals enter into HIV care late. Here, our objective was to estimate the impact that late entry into HIV care has had on AIDS mortality rates in Brazil.Methodology/Principal FindingsWe analyzed data from information systems regarding HIV-infected adults who sought treatment at public health care facilities in Brazil from 2003 to 2006. We initially estimated the prevalence of late entry into HIV care, as well as the probability of death in the first 12 months, the percentage of the risk of death attributable to late entry, and the number of avoidable deaths. We subsequently adjusted the annual AIDS mortality rate by excluding such deaths. Of the 115,369 patients evaluated, 50,358 (43.6%) had entered HIV care late, and 18,002 died in the first 12 months, representing a 16.5% probability of death in the first 12 months (95% CI: 16.3–16.7). By comparing patients who entered HIV care late with those who gained timely access, we found that the risk ratio for death was 49.5 (95% CI: 45.1–54.2). The percentage of the risk of death attributable to late entry was 95.5%, translating to 17,189 potentially avoidable deaths. Averting those deaths would have lowered the 2003–2006 AIDS mortality rate by 39.5%. Including asymptomatic patients with CD4+ T cell counts >200 and ≤350 cells/mm3 in the group who entered HIV care late increased this proportion by 1.8%.Conclusions/SignificanceIn Brazil, antiretroviral drugs reduced AIDS mortality by 43%. Timely entry would reduce that rate by a similar proportion, as well as resulting in a 45.2% increase in the effectiveness of the program for HIV care. The World Health Organization recommendation that asymptomatic patients with CD4+ T cell counts ≤350 cells/mm3 be treated would not have a significant impact on this scenario.

Methods:A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. Results:We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41% (95%CI 39.7-42.4), while the prevalence of BF in children aged 9 to 12 months was 58.7% (95%CI 56.8-60.7). There was an increase of 30.7 days in the median duration of exclusive BF and 45.7 days in the median of BF. Conclusion:There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.