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Pires CDP, Mareto LK, de Medeiros MJ, de Oliveira EF. Associated factors, incidence, and management of gestational and congenital syphilis in a Brazilian state capital: a cross-sectional study. Rev Inst Med Trop Sao Paulo 2024; 66:e21. [PMID: 38656037 PMCID: PMC11027491 DOI: 10.1590/s1678-9946202466021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/22/2024] [Indexed: 04/26/2024] Open
Abstract
Maternal and child health remains an enduring global challenge, having occupied a prominent position on international agendas since the dawn of the 21st century. During pregnancy, syphilis emerges as the second most prevalent cause of stillbirth on a global scale, potentially leading to a range of adverse outcomes. This study aimed to describe the clinical and epidemiological profile of cases of gestational and congenital syphilis and the hospital care provided for newborns in Campo Grande municipality, Mato Grosso do Sul State, Brazil, from 2013 to 2018. This is a cross-sectional study based on data from Brazilian Notifiable Diseases Surveillance System (SINAN) and hospital medical records. Chi-square or Fisher's exact test and logistic regression analysis were used to assess the associations and relationships between the child's clinical outcome at birth and the mother's clinical-obstetric and epidemiological characteristics. Cumulative detection rate of gestational syphilis was 174.3 cases per 1,000 live births and cumulative incidence of congenital syphilis was 47.7 cases per 1,000 live births. Alcoholism, prenatal care, number of prenatal visits, maternal treatment regimen, and timing of maternal diagnosis were associated with child's clinical outcome at birth and considered in the regression model. Prenatal visits showed a protective effect against the signs and symptoms of congenital syphilis (odds ratio = 0.37; 95% confidence interval = 0.17-0.77). Medical assistance was considered inadequate in 62.3% of cases. Prenatal consultations should be encouraged among pregnant women. There is a need for better education of health personnel on the treatment and diagnosis of syphilis.
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Affiliation(s)
- Cássia de Paula Pires
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Pós-Graduação Stricto Sensu em Doenças Infecciosas e Parasitárias, Campo Grande, Mato Grosso do Sul, Brazil
| | - Lisany Krug Mareto
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Pós-Graduação Stricto Sensu em Doenças Infecciosas e Parasitárias, Campo Grande, Mato Grosso do Sul, Brazil
| | - Márcio José de Medeiros
- Universidade Federal do Rio de Janeiro, Campus Macaé, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Everton Falcão de Oliveira
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Programa de Pós-Graduação Stricto Sensu em Doenças Infecciosas e Parasitárias, Campo Grande, Mato Grosso do Sul, Brazil
- Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Campo Grande, Mato Grosso do Sul, Brazil
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Caballe-Climent L. "Beautiful Registrations": Metrics and Prenatal Care in Rural Bahia, Brazil. Med Anthropol 2024; 43:233-246. [PMID: 38206566 DOI: 10.1080/01459740.2023.2301388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
In Brazil, lack of quality in the delivery of prenatal care is a persistent concern. In this study, I analyze the dynamics taking place in the prenatal clinical encounter, and illuminate how the requirement to produce metrics through registration and monitoring endorses a form of bureaucratic care. This form of care develops in a context characterized by scarcity and a lack of medical resources, where healthcare professionals attempt to contain uncertainty. Ruled by notions of risk, centered in measuring practices, and saturated by an overvaluation of technology, bureaucratic care reinforces the disenfranchizement and stigmatization of Black rural women.
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Affiliation(s)
- Laura Caballe-Climent
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Adami ADG, da Motta LR, Sperhacke RD, Kato SK, Pereira GFM, Rahmi RM. Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil. Rev Saude Publica 2023; 57:68. [PMID: 37878854 PMCID: PMC10519679 DOI: 10.11606/s1518-8787.2023057005146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.
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Affiliation(s)
- Aline De Gregori Adami
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Leonardo Rapone da Motta
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Rosa Dea Sperhacke
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Sérgio Kakuta Kato
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto AlegreDepartamento de Saúde ColetivaPorto AlegreRSBrazil Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brazil.
| | - Gerson Fernando Mendes Pereira
- Ministério da SaúdeSecretaria de Vigilância em SaúdeDepartamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente TransmissíveisBrasíliaDFBrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Departamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Brasília, DF, Brazil.
| | - Rosa Maria Rahmi
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
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de Paula M, Höfelmann DA. Quality assessment of prenatal and puerperium care. EINSTEIN-SAO PAULO 2023; 21:eAO0094. [PMID: 37531474 PMCID: PMC10382073 DOI: 10.31744/einstein_journal/2023ao0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/19/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To evaluate prenatal and puerperium care levels received and identify their association with sociodemographic and obstetric characteristics. METHODS This cross-sectional study was conducted from May to December 2020 and included women who gave birth at the Municipal Hospital of Fazenda Rio Grande, Paraná, Brazil. Data were collected through interviews and review of portfolios and medical records. The variables extracted from the prenatal protocols of Paraná and the Ministry of Health were grouped into five compliance indices: CI1 - clinical examination; CI2 - health education; CI3 - queries; CI4 - examinations and vaccines; and CI5 - postpartum appointments. Prenatal care was considered adequate when 80% or more adequacy was obtained. RESULTS A total of 307 women participated in this study. Prenatal compliance was 16.6% considering the entire set of variables. The best performance was for CI4 (54.7%) and the worst for CI5 (13.3%). The lowest adequacy occurred among single women (10.9%) compared to those who lived with a partner (19.9%) (p=0.043) and among women with black/brown skin color (9.5%) compared to those with white/yellow skin color (20.3%) (p=0.016). CONCLUSION Most women did not receive adequate care, with those in situations of greater social vulnerability received worse quality care.
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Affiliation(s)
- Marcilene de Paula
- Universidade Federal do ParanáCuritibaPRBrazil Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Dantas JDC, Marinho CDSR, Pinheiro YT, da Silva RAR. Temporal Trend of Gestational Syphilis between 2008 and 2018 in Brazil: Association with Socioeconomic and Health Care Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16456. [PMID: 36554342 PMCID: PMC9778377 DOI: 10.3390/ijerph192416456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
The increased number of cases in recent years has turned syphilis into a global public health problem. In 2020, 115,371 cases of acquired syphilis were reported (detection rate of 54.5 cases/100,000 inhabitants) in Brazil. In that same period, the country notified 61,441 cases of gestational syphilis (detection rate of 21.6 per 1000 live births). The number of syphilis cases points to the need to reinforce surveillance, prevention, and infection control actions, which is a worrying scenario for government organizations. This study aims to describe the temporal trend of gestational syphilis from 2008 to 2018 in Brazilian regions and to associate its detection rate with socioeconomic and health care indicators. We conducted an ecological study of temporal trends using secondary data from the Department of Informatics of the Unified Health System. The temporal trend was analyzed using the Joinpoint Regression program. The annual percent change (APC) and 95% confidence intervals (95%CI) were estimated and tested; statistical significance was assessed using the Monte Carlo permutation test. Correlations were assessed using Pearson's correlation coefficient, and statistical significance was calculated using Pearson's product-moment correlation. The gestational syphilis detection rate increased between 2008 and 2018. The South region showed the greatest trend, whereas the Midwest region presented the lowest trend. The following variables were significantly correlated with the gestational syphilis detection rate: Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage, and proportion of doctors, nurses, and basic health units per inhabitant. Health policies are needed to mitigate social vulnerabilities and strengthen primary health care.
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Affiliation(s)
- Janmilli da Costa Dantas
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | | | - Yago Tavares Pinheiro
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
| | - Richardson Augusto Rosendo da Silva
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal 59064-630, Brazil
- Center of Health Sciences, Department of Nursing, Federal University of Rio Grande do Norte, Natal 59078-900, Brazil
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De Oliveira H, Wendland E. Changes in the Infant Mortality Rate in Twin Towns of Brazil: An Ecological Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1662. [PMID: 36360390 PMCID: PMC9688833 DOI: 10.3390/children9111662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 09/19/2023]
Abstract
BACKGROUND The infant mortality rate (IMR) is a proxy of the living and health conditions of a given population, which allows us to assess the risk of death for children under one year. Although there is, in general, a reduction in infant mortality in Brazil little is known about this indicator in the regions and cities located on the international borders of the Brazilian territory and the changes that occurred in the face of the migratory impact of the Americas in the period from 1996 to 2020. The objectives of this study are to assess IMR in Brazilian Twin Cities (municipalities that are located on the border with a large influx of people) and its social determinants over time. METHODS This is an ecological study, whose units of analysis were the Brazilian Twin Cities, between 1996 and 2020, based on data on births and deaths in children under one year, available in the public vital information system in Brazil. Data were identified by the city in which the infant death occurred in addition to the mother's primary city of residence. Correlation measurements were performed to test the associations of the IMR means between the independent variables. RESULTS The Twin Cities (Bonfim, Tabatinga, Pacaraima, Porto Murtinho, Cáceres, Foz do Iguaçu, Santo Antônio do Sudoeste e Dionísio Cerqueira) had higher numbers of infant deaths per place of occurrence than the number of deaths per place of maternal residence. The Northern Twin Cities exhibited the highest IMRs. Cities in the Midwest region showed variability. In the South region, most cities showed low rates. A positive correlation was identified with the Gini index with r = 0.67 and a negative correlation with the Municipal Human Development Index indicator of r= -0.70. CONCLUSIONS The averages of IMRs in the Twin Cities were higher than in their States. In recent years, there has been an upward trend in infant mortality in these cities.
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Affiliation(s)
- Heluza De Oliveira
- Post-Graduate Program in Pediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre 90050-170, Brazil
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Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, Thumé E, Facchini LA. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve? PLoS One 2022; 17:e0262217. [PMID: 35041716 PMCID: PMC8765636 DOI: 10.1371/journal.pone.0262217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.
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Affiliation(s)
- Elaine Tomasi
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Denise Silva da Silveira
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Everton Fantinel
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
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Potet J, Beran D, Ray N, Alcoba G, Habib AG, Iliyasu G, Waldmann B, Ralph R, Faiz MA, Monteiro WM, de Almeida Gonçalves Sachett J, di Fabio JL, Cortés MDLÁ, Brown NI, Williams DJ. Access to antivenoms in the developing world: A multidisciplinary analysis. Toxicon X 2021; 12:100086. [PMID: 34786555 PMCID: PMC8578041 DOI: 10.1016/j.toxcx.2021.100086] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022] Open
Abstract
Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.
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Affiliation(s)
- Julien Potet
- Médecins Sans Frontières Access Campaign, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Médecins Sans Frontières, Medical Department, Operational Center Geneva, Geneva, Switzerland
| | - Abdulrazaq Garba Habib
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Science, Bayero University Kano, Nigeria
| | - Garba Iliyasu
- Infectious Disease and Tropical Medicine Unit, Department of Medicine, College of Health Science, Bayero University Kano, Nigeria
| | | | - Ravikar Ralph
- Department of Internal Medicine & Poisons Information Center, Christian Medical College, Vellore, 632004, Tamil Nadu, India
| | | | - Wuelton Marcelo Monteiro
- Department of Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
| | | | | | | | - Nicholas I. Brown
- Global Snakebite Initiative, 19 Haig Street, Ashgrove, Qld, 4060, Australia
- University of Queensland, Australia
| | - David J. Williams
- Global Snakebite Initiative, 19 Haig Street, Ashgrove, Qld, 4060, Australia
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Cristino JS, Salazar GM, Machado VA, Honorato E, Farias AS, Vissoci JRN, Silva Neto AV, Lacerda M, Wen FH, Monteiro WM, Sachett JAG. A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study). PLoS Negl Trop Dis 2021; 15:e0009245. [PMID: 33661895 PMCID: PMC7963098 DOI: 10.1371/journal.pntd.0009245] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/16/2021] [Accepted: 02/15/2021] [Indexed: 12/05/2022] Open
Abstract
Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.
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Affiliation(s)
- Joseir Saturnino Cristino
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Guilherme Maciel Salazar
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Vinícius Azevedo Machado
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Eduardo Honorato
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
| | - Altair Seabra Farias
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery and Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Alexandre Vilhena Silva Neto
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Marcus Lacerda
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Fan Hui Wen
- Bioindustrial Centre, Butantan Institute, São Paulo, Brazil
| | - Wuelton Marcelo Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, Brazil
| | - Jacqueline Almeida Gonçalves Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus, Brazil
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus, Brazil
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Garnelo L, Parente RCP, Puchiarelli MLR, Correia PC, Torres MV, Herkrath FJ. Barriers to access and organization of primary health care services for rural riverside populations in the Amazon. Int J Equity Health 2020; 19:54. [PMID: 32731874 PMCID: PMC7394681 DOI: 10.1186/s12939-020-01171-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.
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Affiliation(s)
- Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Rosana Cristina Pereira Parente
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Maria Laura Rezende Puchiarelli
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Priscilla Cabral Correia
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Matheus Vasconcelos Torres
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
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do Nascimento DDG, de Moraes SHM, Santos CADST, de Souza AS, Bomfim RA, De Carli AD, Kodjaoglanian VL, dos Santos MLDM, Zafalon EJ. Impact of continuing education on maternal and child health indicators. PLoS One 2020; 15:e0235258. [PMID: 32589647 PMCID: PMC7319283 DOI: 10.1371/journal.pone.0235258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study investigated whether the presence of care workers who completed a specialization course on family health was associated with improved care and maternal and child health indicators in municipalities in the state of Mato Grosso do Sul, Brazil. METHODS Negative binomial regression models with fixed effects were used for the 79 municipalities in the state of Mato Grosso do Sul, with repeated observations for the period 2009-2015. For our reference, the parameter "number of professionals who completed the course" calculated the proportion of professionals who completed the course, and was divided by the total number of primary health care professionals in the municipality to create a ratio. The cutoff points used represented tertile distribution: T3: high (0.35-1.00), T2: intermediate (0.02-0.33) and T1: low (0.00-0.01); to avoid biased results, the analysis was also performed for the years prior to the beginning of the course in question (2009 and 2010). RESULTS During the study period, enrollment of pregnant women, exclusive breastfeeding for children under 4 months, and up-to-date vaccinations in children younger than 1 year to 23 months increased (high to intermediate categories) in municipalities where professionals who completed the specialization course worked. Growth in the intermediate ratio was also observed in indicators related to cervical cancer screening and new diagnoses of congenital syphilis in infants under one year of age. CONCLUSIONS The presence of care workers who completed a specialization course on family health was seen to be associated with improved care and indicators for maternal and child health in municipalities in the state of Mato Grosso do Sul, Brazil. These findings reaffirm the importance and effectiveness of policies on training and continuing education for the Brazilian Unified Health System.
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Affiliation(s)
| | | | | | - Albert Schiaveto de Souza
- Biosciences Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Rafael Aiello Bomfim
- Post-doctoral Researcher at The School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Alessandro Diogo De Carli
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | - Edilson José Zafalon
- Faculty of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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