Social exclusion and myiasis of the upper lip in a Brazilian rural resident

CONTEXT

People living in rural or remote Brazil, as in other sub-tropical or tropical nations, are vulnerable to infections that would not normally occur in urban areas or wealthier nations. Brazil is a geographically extensive nation, historically marked by vast socioeconomic inequalities. Approximately 16% of the population live in rural areas.

ISSUE

This clinical case report demonstrates the vulnerability of rural residents who are underserved by Brazil's 'universal' public healthcare system, despite social and economic challenges that increase their risk for disease. Myiasis (especially oral myiasis) is a rare health condition in humans caused by fly larvae. Oral myiasis usually appears in periodontal pockets and open wounds, such as after dental extractions. It is associated with poverty, lack of access to health care, and very poor overall health status. While myiasis has a worldwide distribution, it is particularly associated with the tropical and sub-tropical regions of North and South America.

LESSONS LEARNED

This article describes a rare case of myiasis in the upper lip of a rural male patient. The case report demonstrate that rural and remote residents can be socially excluded from the benefits of technology and biomedicine, making them vulnerable to rare infections.

[Postneonatal infant mortality and quality of medical care: a case-control study]

OBJECTIVE: To identify the risk factors for postneonatal infant mortality caused by diarrhea and pneumonia in relation to the quality of medical assistance. METHODS: Population-based case-control study of 277 postneonatal infant deaths caused by diarrhea and pneumonia occurring in the metropolitan area of Belo Horizonte, Brazil, between May/1991 and April/1992. The cases were compared with hospitalized controls, and matched by pathology, age and hospital. Information on cases and controls were collected from medical records and through home interviews. Some variables related to the quality of medical care were analyzed. McNemar test and conditional logistic regression were used to define the risk factors for postneonatal deaths. RESULTS: Multiple logistic regression analysis showed the following factors independently associated with increased risk of postneonatal death induced by diarrhea and pneumonia: delayed immunization (OR = 2.48; 95%CI=1.17-5.23), general status (serious) on hospital admission (OR=10.94; 95%CI=4.91-24.34), unaccomplished hospital procedures (OR=10.08; 95%CI = 3.55-20.59) and malnutrition on hospital admission (OR=3.58; 95%CI=1.42-9.07). CONCLUSIONS: The results indicate the low quality of medical assistance as an important risk factor for avoidable causes of postneonatal deaths. The authors highlight the lack of integration between the outpatient clinic and hospital activities as an important determinant of low quality. It is necessary that the performance of health services and their effect on avoidable infant mortality be widely discussed, also taking into consideration the preponderant role of socioeconomic variables

[Breastfeeding in Montes Claros, Minas Gerais: a representative sample study]

OBJECTIVE: To evaluate the situation of breast-feeding in Montes Claros, among under-two-year-old children, and to determine variables associated to major risk for early weaning. METHODS: In this cross-sectional study interviews were carried out by trained personnel with 602 mothers selected randomly in the urban area of Montes Claros, from September to November, 1996. The survival analysis was the method used to calculate the prevalence and the median duration of breast-feeding. The chi-square test was conducted to compare the proportions, and the level of significance was set at 5%. The prevalence ratio (PR) was used to measure the strength of the associations, with a 95% confidence interval. The logistic regression analysis was used to identify the risk factors for early weaning. RESULTS: The median duration of breast-feeding in general was 8.7 months; however the median duration of exclusive breastfeeding was only 27 days. The risk factors for early weaning were low birth weight (OR=2.65; CI95%=1.10-6.40), mothers with difficulties to breast-feed in the first days (OR=1.86; CI95%=1.21-2.85) and lack of posnatal medical incentive to breast-feed (OR=1.75; CI95%=1.15-2.66). CONCLUSIONS: For breast-feeding in general there is a better situation than that showed by other national reports, but it is still below recommended by WHO. There is a critical exclusive breastfeeding pattern. The factors related with early weaning denote a weak support of the maternal-infant health services to breast-feeding.