Characteristics of adolescent pregnancy in São Luís, Maranhão, Brazil

OBJECTIVE: To identify the main socioeconomic, demographic, anthropometric and behavioral characteristics, and pregnancy outcomes of adolescent pregnancy and to assess health services used by pregnant adolescents. METHODS: Data were collected from a cross-section of 2,429 deliveries by women residing in the municipality of S?o Luís, Brazil, of which 94% were hospital births. Women were categorized into six age groups. The two groups of teenagers (under 18 and 18-19 years) were compared to four groups of older women. Comparison was also made between the two teenage groups. The chi-square test was used to compare proportions and prevalence ratio was used as an effect measure. RESULTS: Of 2,429 women, 714 (29.4%) were adolescents. Their specific fertility coefficient was higher than in other regions of the country. Adolescents showed lower socioeconomic and reproductive conditions than older women and a higher proportion of inadequate prenatal care. The majority had no partner. They had the lowest percentages of caesarean section and smokers. CONCLUSIONS: Despite their equally unfavorable socioeconomic situation, 18-19 year-old adolescents had pregnancy outcomes comparable to the age group 25-29, whereas those under 18 had the highest proportions of low birth weight, preterm birth, and infant mortality rate. This suggests that biologic immaturity may be associated with adverse pregnancy outcomes.     

Risk factors for preterm births in São Luís, Maranhão, Brazil

Preterm birth continues to be one of the main causes of neonatal morbidity and mortality. The objective of the present study was to identify risk factors for preterm birth in S?o Luís, Maranh?o, Brazil. The sample consisted of hospital births at 10 public and private hospitals from March 1, 1997 to February 28, 1998. A total of 2,443 live births were randomly selected, excluding multiple deliveries and stillbirths. Preterm birth rate in S?o Luís was 12.7%. Risk factors for preterm delivery were maternal age below 18 years, family income equal to or less than one minimum wage/ month, primiparity, vaginal delivery at a public hospital, single mothers (or living without a partner), and absence of prenatal care. The following factors remained associated with preterm birth after multivariate analysis to control for confounding: maternal age below 18 years (OR=1.9), primiparity (OR=1.5), and failure to appear for scheduled prenatal care visits (OR=1.5).     

Epidemiological characteristics of dengue in the Municipality of São Luís, Maranhão, Brazil, 1997-2002

A total of 12,008 cases of dengue were reported from 1997 to 2002, with peaks in 1997 (35.8%) and 1998 (45.8%). The disease predominated in the 15-49-year age group (72.2%) and during the rainy season (83.3%), showing a positive correlation with the amount of rainfall (r = 0.84) and relative humidity (r = 0.76) and a negative correlation with temperature (r = -0.78). There was no significant difference (chi2 = 2.319; p > 0.05) in the number of cases in males (49%) and females (51%). Dengue was detected in all seven health districts: Tirirical (27%), Coroadinho (17%), Bequimao (16%), Cohab (14%), Itaqui-Bacanga (11%), Centro (8%), and Vila Esperanca (7%). The building infestation rate ranged from 1.01 to 7.15, and the Breteau index ranged from 1.10 to 8.18. The most frequent mosquito breeding sites were metal barrels or similar recipients (80.0%), followed by plant vases (4.7%), bottles, cans, and plastics (3.6%), tires (3.3%), water tanks (2.7%), and others (5.7%). In the case of Aedes aegypti, 134,631 positive water deposits were detected, with a predominance of type B (80.0%), followed by types C (4.7%), E (3.6%), and A (3.3%).     

Asthma and associated factors in students 13 and 14 years of age in São Luís, Maranhão State, Brazil

The aim of this study was to estimate the prevalence of asthma and associated factors among students 13 and 14 years of age in S?o Luís, Maranh?o State, Brazil. A cross-sectional study was conducted using the questionnaire developed by ISAAC (International Study of Asthma and Allergies in Childhood) and an additional questionnaire from July 2008 to May 2009, including 3,069 adolescents. Asthma prevalence (wheezing in the previous 12 months) was 12.7%, lifetime prevalence was 32.4%, 3.9% reported difficulty speaking due to wheezing, and 9.8% reported wheezing after exercise. In the multivariate analysis, factors associated with increased asthma prevalence were family history of asthma, respiratory infection and wheezing in early life, eczema, allergic rhinitis, and passive smoking. Asthma prevalence was lower than for Brazil as a whole. Factors most strongly associated with asthma prevalence in these adolescents were family history of asthma (PR = 3.86), wheezing in early childhood (PR = 4.58), and allergic rhinitis (PR = 3.21).     

Profile of public dental care for children and adolescents in São Luís, Maranhão State

This profile of public dental care for children/adolescents in S?o Luís, Maranh?o State, Brazil, is based on a survey conducted through interviews, designed to identify these services and help upgrade Health Services available in this city. It describes the pediatric dental care available and the age groups attended, the qualifications of the practitioners involved, the types of treatment for primary and permanent teeth and oral health education programs run at the Municipal Healthcare Units with dental facilities, analyzed through visits and structured interviews. The findings show that dental care was available for children/adolescents (mainly between 6 and 12 years old) at 91.1% of the Healthcare Units offering daily and universal care (65.75%), as well as at those whose services are limited to certain specialties and/or specific days (34.15%). All the public Healthcare Units offered surgical treatment for permanent teeth. Fillings are used more for permanent teeth than primary teeth. Among the public Healthcare Units, 25 (55.5%) did not offer or run oral health programs. At most (75.5%) of the Units visited, dental treatment for children and adolescents is limited to basic care and directed mainly to permanent teeth. The traditional welfare model of providing care as freely demanded remains in place.     

Public knowledge and attitudes concerning dengue in the Municipality of São Luís, Maranhão, Brasil, 2004

A sample survey with 843 interviews in S?o Luís, Maranh?o State, Brazil was conducted to assess community knowledge and concepts regarding dengue. The population's understanding and its socioeconomic, health, and environmental conditions were evaluated. Potential vector breeding sites were found in all the areas surveyed. Media (TV, radio, etc.) were the most important source of public information on the disease. However, a gap was observed between knowledge and attitudes towards vector prevention. Strategies are also needed to involve the population in more effective prevention of vector proliferation, thus helping control the disease in S?o Luís.     

Hourly frequency and seasonality of Lutzomyia longipalpis (Diptera: Psychodidae: Phlebotominae) on São Luís Island, Maranhão, Brazil

This article presents the hourly and seasonal distribution of the Lutzomyia longipalpis sand fly captured on S?o Luís Island, Maranh?o State. A total of 11,200 specimens were captured during monthly use of CDC light traps indoors and in animal sheds, between 6:00 PM and 6:00 AM, in 1996 and 1997. The sand fly behaved as an annual species, with a high frequency year-round, while it was most abundant during the rainy season (57.2%) as compared to the dry season (42.8%). The highest frequencies during the rainy season occurred in January and April and in the dry season in July and November. The species was found all night long, mainly between 6:00 PM and 10:00 PM in animal sheds and between 8:00 PM and 2:00 AM indoors.     

Perinatal health and mother-child health care in the municipality of S?o Luís, Maranh?o State, Brazil.

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in S?o Luís, Maranh?o State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.     

Asthma mortality in the city of São Paulo,Brazil

OBJECTIVE: To quantify and compare asthma mortality rates as the main cause of death, taking into consideration the following variables: sex, age and seasonality. METHODS: Data was collected from all death certificates coded 493 of people aged 5 to 34 years in the periods of 1983-5 and 1993-5 in the city of S?o Paulo, SP, Brazil. Data analysis was performed by directly comparing death rates and identifying the odds ratio trend and directly comparing the numbers of asthma deaths. RESULTS: There was no increase in asthma mortality rates for the study periods. There was no difference between men and women. A greater number of deaths in the age group 20 to 34 years were observed. Seasonality was more evident in the first period studied. CONCLUSIONS: Differing from reports in other countries, the results did not show any increase in asthma mortality rates, The variable sex didn't seem to interfere with mortality. Deaths are more frequent among young adults, and their risk may be 9 times greater than that of young children. Deterioration of social and economic issues and health care services and even climatic changes may have been implicated in the absence of seasonality as a risk factor for asthma mortality. The disease by itself is not considered by many health professionals as critical in order to explain the chain of events that lead to death.     

Schistosomiasis mansoni in Maranhão State, Brazil, 1997-2003

The aim of this study was to assess the prevalence of schistosomiasis mansoni in Maranh?o State, Brazil, from 1997 to 2003, based on data from the regional health offices included in the Schistosomiasis Control Program. The statistical method was polynomial regression. The municipalities (counties) of Bacabal and S?o Luís showed a constantly downward trend throughout the time series. Colinas showed an increase in prevalence until 2002, followed by a downward trend. Imperatriz witnessed a constant upward trend. Socioeconomic factors are highly significant for schistosomiasis prevalence in Maranh?o, which helps explain the results. The recording of data for the regional health offices is believed to have been affected by changes resulting from decentralization of the Schistosomiasis Control Program. The study's results highlight issues that extend beyond analysis of the pattern of occurrence of schistosomiasis mansoni cases in the State of Maranh?o, particularly demonstrating the need for improvements in the population's living conditions.     

Ischemic heart disease: mortality in natives and migrants, São Paulo, Brazil, 1979-1998

OBJECTIVE: The State of S o Paulo has been a major center of attraction for foreign and Brazilian migrants since the 19th century. The pattern of mortality due to ischemic heart disease according to place of birth is, however, unknown. Thus, the objective of the study was to identify differences in mortality due to ischemic heart disease among residents of the State of S o Paulo according to their place of birth. METHODS: Analytical time series study based on secondary data. Rates were not calculated due to lack of denominators. Instead, non-census indicators (proportional mortality and standardized mortality ratio weighted for years of potential life lost before the age of 100 years) and medians were utilized. Temporal trends were analyzed by means of simple linear regression. RESULTS: In the State of S o Paulo, about 40% of deaths due to ischemic heart disease occurred among migrants. The trend was negative for foreigners and positive for Brazilian migrants. Those born in northeastern Brazil, who presented the highest percentage of deaths in hospitals, had the worst performance: their proportional mortality due to ischemic heart disease remained unchanged throughout the study period (while this clearly declined for all other groups) and they died at younger ages. CONCLUSIONS: Migrants' share of total deaths due to ischemic heart disease in the State of S o Paulo is very high. While there is a declining trend for foreigners, it is growing among Brazilian migrants. Among the compared groups, mortality due to ischemic heart disease in the State of S o Paulo is most prominent for those born in northeastern Brazil.     

Pediatric care and associated factors in S?o Luís (Maranh?o) Brasil]

Pediatric care is fundamental to preventing several diseases during the early years of childhood. Early medical care and having at least nine checkups in the first year of life are the ideal in pediatric care. It is essential to periodically assess whether or not these goals are being met. In 1994, a cross-sectional study was carried out using three-stage cluster sampling to measure coverage of pediatric care and factors associated with that care among children in the city of S?o Luís, in the state of Maranh?o, Brazil. For data collection, a standardized questionnaire was used with the mother of the child or another person responsible for the child. The percentage of those refusing to participate or who were absent was 7%. This work analyzes data concerning 290 children between 1 and 23 months of age. The coverage estimates and 95% confidence intervals took into consideration possible effects of the study design. Cox's regression, modified for cross-sectional studies, was used to estimate adjusted relative risks. Pediatric care coverage for the population studied was 80%. The children had an average of 7.8 checkups in the first year; 44% of the children had six or fewer checkups during the first year of life, well below the recommended number. Eighty-one percent of the children were seen in the Brazilian public health care system (Sistema Unico de Saúde, SUS), and only 15% used health insurance. After adjusting for confounding factors, the factors "greater number of siblings at home" and "father with four or fewer years of schooling" were associated with not having checkups. After adjustment, family income was not associated with the number of checkups. Encouraging educational activities and perhaps also family planning programs are important strategies for increasing the coverage of pediatric care in the city of S?o Luís.