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200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

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Abstract 200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

Resumo Duzentos milhões de crianças em idade pré-escolar não estão se desenvolvendo adequadamente. Os atrasos no desenvolvimento estão associados a múltiplos fatores. Este estudo pretende analisar se a suplementação de vitamina A está associada a melhor desenvolvimento e a forma como esse efeito pode ser mediado pelo estado nutricional. Estudo de base populacional com amostra de 8.000 famílias, 1.232 crianças 0-35 meses, no estado do Ceará, Brasil. As variáveis analisadas incluíram desenvolvimento, determinantes nutricionais e fatores de confusão. Os efeitos e as interações foram avaliados utilizando modelos regressivos de Cox. A suplementação de vitamina A foi protetora para atraso no desenvolvimento cognitivo e motor modificado pela interação com o estado nutricional. Crianças suplementadas bem nutridas apresentaram um risco 67% menor de atraso cognitivo (PRR ajustado = 0 33 [0 21-0 53]), já as crianças desnutridas não se beneficiaram (PRR ajustado = 0 97 [0 39-2 40]). A suplementação tem um efeito protetor sobre o desenvolvimento, mas não em crianças desnutridas. Isso sugere que a suplementação é eficaz na promoção do desenvolvimento, especialmente se associada a um esforço para melhorar o estado nutricional infantil, dada a importância desse mediador.

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Measles is a highly contagious disease that can be effectively prevented through vaccination. The recent increase in vaccination coverage was successful in reducing the mortality globally of the disease by 74%. As a whole, the Americas have been considered a disease-free zone. However, it is known that if an immunization programs fails, there will be an accumulation of susceptible people that can lead to disease outbreaks. Recently, both the United States and Brazil faced outbreaks of measles. The present study aims to identify the determining factors of non-vaccination in Brazil in two different vaccination coverage moments, to provide clues as to the causes of current outbreaks. Data were drawn from five population-based cross-sectional studies that surveyed a representative sample of preschool children from 1987 to 2007 (9585 children in total). To assess children's vaccination status, two different information sources were used: information provided by mothers and information from children's health cards. Multivariate analyses with logistic binary regression models were conducted. After adjustment for confounding factors, it was observed that in 1987, with 48.2% vaccination coverage, socioeconomic, maternal, nutritional factors and access to health facilities were important, while in 2007 (96.7% coverage), nutritional and maternal factors were important. Distinct patterns of determinants of non-vaccination were also found. In addition, the low coverage in 1987 resulted in a current pool of adults who were not immunized as children; this may have contributed to the beginning of the current Brazilian outbreak. Globally, there are two standards of vaccination coverage (low and high). Therefore, discussion of the determinants of non-vaccination is important. Our findings suggest vulnerable groups should receive special attention to ensure they are protected. It is also important to consider the possible impact of pools of adults not immunized.

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To describe the experience of Ceará, Northeast of Brazil, state on improving child survival, over a 20 year period, and discuss its contribution to Brazil's progress toward the achievement of MDG 4. Five population-based, statewide household surveys, with children <3 years of age, known as PESMIC (Mother and Child Health Survey of Ceará), were conducted in 1987, 1990, 1994, 2001 and 2007. They aimed to investigate levels and causes of mortality and access to child health services. The cluster sampling of 8,000 households identified 2,000 children on average. They used the same methodological approach and indicators. Important changes occurred in demographic and health indicators in the 20 year period, including 81 % reduction in the infant mortality rate, 43 % increase in breastfeeding rate and the achievement of a 95 % immunization rate. The prevalence of chronic malnutrition declined from 28 to 13 % and acute malnutrition from 13 to 5 %. Diarrheal diseases contributed with 36.6 % to the infant mortality in 1986 and 3.9 % in 2007. The major improvements in child health contributed substantially to the progress on MDG 4 in Brazil. Results of the 5 surveys produced reliable information for planning and evaluation that contributed to the remarkable progress made by the state.

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Descrever os métodos utilizados nas Pesquisas de Saúde Materno-Infantil (PESMIC) no Ceará, durante 20 anos. Métodos: a série de inquéritos realizados no período de 20 anos foi analisada nos seguintes aspectos: a) Estudos transversais em série de base populacional, com amostra representativa de 8000 famílias; b) Utilizou-se questionários e medições antropométricas, estudando-se níveis e causas de mortalidade infantil, prevalência de desnutrição da mãe e da criança, duração da amamentação, cobertura vacinal, prevalência e manejo da diarreia e acesso aos serviços de saúde materno-infantil; c) Obteve-se como resultado as variáveis desfechos (principal mortalidade infantil) e diversos determinantes materno-infantis e socioeconómicos. Resultados: o índice de resposta foi de quase 100 por cento nos cinco inquéritos realizados (1986-2007), e ocorreram importantes mudanças nos indicadores sociodemográficos e de saúde; redução de 81 por cento da taxa de mortalidade infantil, aumento de 43 por cento da taxa de amamentação; índice de imunização de 95 por cento. Observou-se aumento de 243 por cento do índice de sobrepeso. Foram entrevistados no total somado dos cinco estudos: 177.132 residentes, sendo 47.508 mulheres e 13.049 crianças. Conclusões: recomenda-se a continuidade desses estudos utilizando-se a mesma metodologia, possibilitando analises de variações temporais...

Describe the methods used in mother-child health studies (PESMIC), over a period of 20 years in Ceará. Methods: a series of studies carried out over a twenty-year period were examined with regard to the following aspects: a) population-based cross-sectional series studies, with a representative sample of 8000 families; b) questionnaires and anthropo-metric measurements were used, studying the levels and causes of infant mortality, the prevalence of mother and child malnutrition, the duration of breastfeeding, vaccination coverage, the prevalence and management of diarrhea and access to mother-child health services; c) the results obtained were outcome variables (mainly infant mortality) and various determining factors relating to the child and the mother and social and economic conditions. Results: the response rate was nearly 100 percent for the five studies (1986-2007) and there were important changes in socio-demographic and health indicators, an 81 percent reduction in the infant mortality rate, a 43 percent increase in breastfeeding an immunization rate of 95 percent. There was also a 243 percent increase in overweight. In total the five studies covered 177,132 residents, 47,508 women and 13,049 children. Conclusion: it is recommended that these studies should be continued using the same methodology, making it possible to analyze variations over time...

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O estudo estimou a prevalência e identificou fatores determinantes do sobrepeso e obesidade em mulheres em idade fértil na região semiárida do Brasil. Na amostra por conglomerados de oito mil domicílios do estado do Ceará, foram pesquisadas 6.845 mulheres. Sobrepeso e obesidade foram medidos pelo Índice de Massa Corporal, utilizando-se a análise multivariada para a identificação dos fatores determinantes. As prevalências de sobrepeso e obesidade foram de 32,6 por cento e 16,1 por cento, respectivamente. Na análise ajustada, a obesidade esteve positivamente associada a: idade >30 anos (RP=1,55), estado civil casada (RP=1,36), escolaridade fundamental (RP=1,40), idade na menarca <12 anos (RP=1,59), ter tido >1 filho (RP=1,65), uso de contraceptivos (RP=1,31). Os fatores relacionados à saúde e à nutrição, referentes à obesidade mórbida, foram: hipertensão arterial (RP=3,11), diabetes (RP=2,08), insatisfação com a imagem corporal (RP=4,26) e procedimentos para perder peso (RP=2,73). Sobrepeso e obesidade são altamente prevalentes na região semiárida. A educação foi o único fator socioeconômico passível de ser modificado. Os fatores reprodutivos identificados apontam para a necessidade de mobilização dos serviços de pré-natal, pós-parto e planejamento familiar na prevenção e no controle da obesidade.

The study estimated the prevalence and determinants of overweight and obesity in women of reproductive age in the Semi-Arid Region of Brazil. In the cluster sampling of 8,000 households of the state of Ceará, 6,845 women were surveyed. Overweight and obesity were measured by the body mass index and risk factors identified by multivariate analysis. The prevalences of overweight and obesity were 32.6 percent and 16.1 percent, respectively. After adjusted analysis, obesity was positively associated with age >30 years (PR = 1.55), marital status, married (PR = 1.36), elementary education (PR = 1.40), age at menarche <12 years (OR = 1.59), having >1 child (PR = 1.65) and contraceptive use (PR = 1.31). Specific health and nutritional conditions were identified as highly associated to morbid obesity: hypertension (PR = 3.11), diabetes (PR = 2.08), dissatisfaction with body image (PR = 4.26) and procedures for weight loss (PR = 2.73). The study concluded that overweight and obesity are highly prevalent in the Semi-Arid Region of Brazil. Education was the only socioeconomic determinant considered as amenable to change. The reproductive risk factors identified enforce the need to mobilize the services of prenatal and postpartum care and family planning to prevent and control obesity.

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The study estimated the prevalence and determinants of overweight and obesity in women of reproductive age in the Semi-Arid Region of Brazil. In the cluster sampling of 8,000 households of the state of Ceará, 6,845 women were surveyed. Overweight and obesity were measured by the body mass index and risk factors identified by multivariate analysis. The prevalences of overweight and obesity were 32.6% and 16.1%, respectively. After adjusted analysis, obesity was positively associated with age>30 years (PR=1.55), marital status, married (PR=1.36), elementary education (PR=1.40), age at menarche<12 years (OR=1.59), having >1 child (PR=1.65) and contraceptive use (PR=1.31). Specific health and nutritional conditions were identified as highly associated to morbid obesity: hypertension (PR=3.11), diabetes (PR=2.08), dissatisfaction with body image (PR=4.26) and procedures for weight loss (PR=2.73). The study concluded that overweight and obesity are highly prevalent in the Semi-Arid Region of Brazil. Education was the only socioeconomic determinant considered as amenable to change. The reproductive risk factors identified enforce the need to mobilize the services of prenatal and postpartum care and family planning to prevent and control obesity.

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O uso de aspiraçäo a vácuo (AV) no tratamento do aborto incompleto é prática bastante difundida em países desenvolvidos. Vários estudos nesses países indicam que o uso da técnica de aspiraçäo manual a vácuo (AMV) pode conservar recursos do sistema de saúde e melhorar a qualidade do tratamento do aborto. No Brasil, o uso da AMV é procedimento de rotina nos hospitais e clínicas privados. Entretanto, na maioria dos hospitais da rede pública é utilizada somente a técnica de dilataçäo e curetagem (D&C). Foram utilizados métodos de avaliaçäo rápida para estimar a variaçäo do custo médio do tratamento e duraçäo da estadia hospitalar, em um grupo de 30 pacientes admitidas com aborto incompleto em hospital público de Fortaleza, CE (Brasil). Participantes foram alocadas, randomicamente, em um dos dois grupos de tratamento investigados (AMV ou D&C). Os resultados sugerem que o uso da AMV, em substituiçäo a D&C, no tratamento do aborto incompleto, pode reduzir em até 41 por cento o custo médio do tratamento e em 77 por cento o tempo médio de hospitalizaçäo. Recomenda-se a realizaçäo de estudos confirmatórios, como também que se aprofunde os conhecimentos sobre a percepçäo do aborto e seu tratamento por parte do pessoal de saúde e da populaçäo feminina

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Proposta de cooperacao tecnica com a organizacao Panamericana de Saude para apoiar o processo de distritalizacao no municipio de Fortaleza - Ceara. Modelo assistencial previsto: principios e caracterizacao da rede de servicos de saude. Estrategias e areas de cooperacao, cronograma de atividades e previsao de custos

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