Assessing morbidity in the paediatric community

Validity of information on atopic disease and other illness in young children reported by parents in a prospective birth cohort study

Background

The longitudinal birth cohort study is the preferred design for studies of childhood health, particularly atopic disease. Still, prospective data collection depends on recollection of the medical history since the previous visit representing a potential recall-bias. We aimed to ascertain the quality of information on atopic disease and other health symptoms reported by parental interview in a closely monitored birth cohort study. Possible bias from symptom severity and socioeconomics were sought.

Methods

Copenhagen study on Asthma in Childhood (COPSAC) is a clinical birth cohort study of 411 children born of asthmatic mothers from 1999 to 2001. Child health is monitored at six-monthly visits with particular emphasis on atopic symptoms and infections. Data from the first three study years on 260 children was compared with records from their family practitioner as an external reference.

Results

A total of 6134 medical events were reported at the COPSAC interviews. Additional 586 medical events were recorded by family practitioners but not reported at the interview. There were no missed events related to asthma, eczema or allergy. Respiratory, infectious and skin related symptoms showed completeness above 90%, other diseases showed lower completeness around 77%. There was no meaningful influence from concurrent asthma or socioeconomics.

Conclusions

The COPSAC study exhibited full sensitivity to the main study objectives, atopic disease, and high sensitivity to respiratory, infectious and skin related illness. Our findings support the validity of parental interviews in longitudinal cohort studies investigating atopic disease and illness in childhood.

Características da utilização de serviços de atenção básica à saúde nas regiões Sul e Nordeste do Brasil: diferenças por modelo de atenção

Considerando o destaque da atenção básica para o sistema de saúde e a consolidação da Estratégia da Saúde da Família, é importante que as informações sobre a demanda atendida sejam atualizadas para apoiar a gestão do SUS. O estudo comparou o perfil da demanda atendida em unidades básicas de saúde (UBS) de dois modelos de atenção (tradicional e saúde da família [PSF]) em 240 UBS de sete estados do Sul e Nordeste. Coletados em formulário próprio, todos os atendimentos de um dia de trabalho foram processados com o aplicativo PACOTAPS. Foram registrados 26.019 atendimentos, 52% no Sul e 48% no Nordeste; um terço em UBS Tradicionais e 67% em UBS do PSF. A maior proporção de atendimentos foi para mulheres entre 15 e 49 anos (36%), com diferenças significativas entre os modelos, sendo maior nas UBS do PSF. A segunda maior proporção foi de pessoas com 50 anos ou mais de idade (30%), significativamente maior nas UBS Tradicionais. Os procedimentos mais registrados foram os atendimentos básicos de enfermagem (33%), com maior proporção nas UBS Tradicionais. A proporção de consultas médicas foi de 22%, sendo duas vezes maior nas UBS Tradicionais. O perfil da demanda refletiu as diferenças entre os modelos de atenção no país e pode subsidiar a organização dos processos de trabalho em atenção básica.

Medicine use from birth to age two years: the 2004 Pelotas (Brazil) Birth Cohort study

OBJECTIVE

To describe medicine use by children at three, 12 and 24 months of age.

METHODS

Cross-sectional study using data from the 2004 Pelotas Birth Cohort (Southern Brazil), including: 3,985 children at three months, 3,907 children at 12 months, and 3,868 children at 24 months of age. The outcome investigated was use of medicine in the 15 days preceding the interview. Information on independent variables (medicine used, who indicated it, how it was obtained, periodicity of use, and therapeutic group) were collected using a standardized questionnaire administered during a home interview with the child's parents.

RESULTS

Prevalence of medicine use at three, 12, and 24 months was 65.0% (95% CI: 63.5;66.5), 64.4% (95% CI: 62.9;65.9), and 54.7% (95% CI: 53.1;56.2), respectively. As age increased, there was a reduction in the total number of medicines used and an increase in self-medicine, which reached 34% at 24 months. Furthermore, frequency of sporadic medicine use increased, while that of continuous use decreased. Medicine was purchased mainly using private resources, with roughly 10% of drugs being purchased through the Brazilian National Health Care System. The profile of medicine types used also changed with age. The type of medicine most frequently used were dermatological products (36%) at three months; respiratory system drugs (24%) at 12 months; and analgesics (26%) at 24 months of age. Compared to three months, medicine use at 24 months was characterized by decreased use of digestive tract and metabolism drugs, drugs for the sensory organs, cardiovascular system drugs, and dermatological products, and an increase in systemic anti-infectious drugs, medicine for the skeletomuscular and respiratory systems, analgesics, insecticides, and repellents.

CONCLUSIONS

Medicine use in this cohort was high and indicates the need for prioritizing rational use of medicine in early life.

Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

OBJECTIVES

To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.

METHODS

HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.

RESULTS

Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% ≥29 (p=0.003). The odds of LRTI in infants with a CD4+ count (cells/mm(3)) <750 at hospital discharge were 16.0 times those of infants with CD4+ ≥750 (p=0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age.

CONCLUSIONS

Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.

Morbidade referida e seus condicionantes em crianças de 5 a 9 anos em Sobral, CE, Brasil

OBJETIVO: Descrever a morbidade referida em crianças de 5 a 9 anos e analisar seus possíveis condicionantes. METODOLOGIA: Corte de base populacional com amostra aleatória e representativa em crianças de 5 a 9 anos da zona urbana de Sobral - CE, Brasil. Entrevistas domiciliares com 3.276 crianças e exame clínico em 2.594. A morbidade referida foi classificada segundo a CID-10. O desfecho analisado foi morbidade referida nos últimos 15 dias, utilizando Stata 7.0. RESULTADOS: 43,9% das crianças apresentaram morbidade referida: Doenças do Aparelho Respiratório (DAR), 28,7%; doenças da pele, 3,4%; doenças infecciosas, 2,2%. Daquelas que adoeceram, 41,5% procuraram atendimento. Dessas, 77,4% em Unidades de Saúde Familiar. Apresentaram maiores chances de DAR as crianças com as seguintes características: residir no núcleo urbano principal do município, ter antecedente de desnutrição e frequentar escola, com um valor de ODDS Ratio, respectivamente de 1,48 (IC95%1,10-1,99), 1,30 (IC95%1,05-1,60) e 1,54 (IC95%1,02-2,32). DISCUSSÃO: Chamou a atenção a elevada prevalência de DAR em crianças do núcleo urbano principal, cerca de duas vezes maior que a observada em outros estudos de metodologia similar, levantando hipóteses de sobrerelato ou poluição ambiental. A maioria das crianças apresentou problemas de saúde de menor gravidade e teve acesso facilitado aos serviços de saúde, principalmente ao PSF. CONCLUSÕES: Serão necessários novos estudos para identificar possíveis causas da elevada prevalência de DAR em crianças do núcleo urbano principal do município. As ocasiões em que as crianças demandam os serviços de saúde da família por doenças de baixa gravidade podem ser aproveitadas para medidas de prevenção e promoção da saúde.

Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study

OBJECTIVE

The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1-exposed but uninfected infants.

METHODS

The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow-up data through the 6-month study visit. Definitive and presumed infections were recorded at study visits (birth, 6-12 weeks, and 6 months).

RESULTS

Of 462 HIV-1-uninfected infants with 11,644 child-weeks of observation, 283 experienced > or = 1 infection. These 283 infants experienced 522 infections (1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child-weeks of observation. Overall, the most common infections were skin or mucous membrane infections (1.9 cases per 100 child-weeks) and respiratory tract infections (1.7 cases per 100 child-weeks). Thirty-six percent of infants had > 1 respiratory tract infection (1.8 cases per 100 child-weeks). Incidence rates of upper and lower respiratory tract infections were similar (0.89 cases per 100 child-weeks and 0.9 cases per 100 child-weeks, respectively). Cutaneous and/or oral candidiasis occurred in 48 neonates (10.3%) and 92 older infants (19.3%). Early neonatal sepsis was diagnosed in 12 infants (26.0 cases per 1000 infants). Overall, 81 of 462 (17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently (40.7%). The occurrence of > or = 1 neonatal infection was associated with more-advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4+ cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections.

CONCLUSIONS

Close monitoring of HIV-1-exposed infants, especially those who are anemic at birth or whose mothers have more-advanced HIV-1 disease or who smoked during pregnancy, remains important.

Aplicativo para sistematizar informações no planejamento de ações de saúde pública

OBJETIVO: Apresentar e avaliar aplicativo para subsidiar gestores e equipes de saúde com informações de serviços que prestam atenção primária à população. MÉTODOS: Descrever o aplicativo PACOTAPS (Aplicativo para atenção primária em saúde) desenvolvido em linguagem Visual Basic 5.0, cujos módulos dados secundários e demanda ambulatorial foram testados em unidade básica de saúde de Pelotas, RS. Por meio dos dados secundários obteve-se a estrutura por idade e sexo da população de referência, e pela demanda ambulatorial foram caracterizados todos os atendimentos realizados durante um mês em duas unidades básicas de saúde pelo processamento das fichas de atendimento ambulatorial. RESULTADOS: Identificaram-se a distribuição etária e o sexo de todos os usuários atendidos nas unidades básicas de saúde e os principais diagnósticos e encaminhamentos. Foi possível detectar diferenças entre as unidades, tanto devidas a estruturas e modelos assistenciais diversos, quanto indicativas de necessidades concretas de melhorias nos sistemas de registro dos atendimentos. CONCLUSÕES: O PACOTAPS é um aplicativo de fácil operação, podendo contribuir para a avaliação da gestão de unidades básicas de saúde, no âmbito do Sistema Único de Saúde. Ao dispor dessa ferramenta eletrônica que conjugue esses recursos, a tomada de decisões no âmbito do serviço de saúde e, até mesmo, da política de saúde do município poderá ser feita em bases mais adequadas e eficientes.