Prevalence of breastfeeding in the city of São Carlos, São Paulo

OBJECTIVE: To verify the prevalence of breastfeeding in the city of S?o Carlos. METHOD: For the collection and treatment of data regarding prevalence of breastfeeding we used the LACMAT 3.3 program. During Vacination National Day (1998, August 15) 3,326 persons responsible for children 2 years old or younger were interviewed. RESULTS: It was verified that 52.4% of the children under a month old were on exclusive breastfeeding. Out of 532 children under 4 months old, 73.3% were being breast fed: 37.8% exclusively breast fed and 17.3% under predominant breastfeeding. It was observed that 31.7% of the children under 4 months received some other form of nourishment, such as fruit and mush, and on the fifth month, this percentage went to 62.3%. CONCLUSIONS: The results of this study demonstrated that the situation of breastfeeding in S?o Carlos is far from what the WHO recommends, this confirming the need to implement actions of promotion, protection, and support to breastfeeding in the health public services of the municipality.     

Etiologic profile of acute diarrhea in children in São Paulo

OBJECTIVE: To evaluate the etiologic profile of acute diarrhea in socioeconomically deprived children assisted at a regional pediatric emergency care service. METHODS: During two years all children with acute diarrhea assisted at a previously established day and week time schedule were included in the study. Other selective criteria were: a) age less than 5 years; b) nonuse of antibiotics in the previous month; and c) no travel outside the city in the previous month. Stool examination was used for the detection of the following microorganisms: a) rotavirus (immunofluorescence and counterimmunoelectrophoresis); b) bacteria - culture in MacConkey agar, SS agar, Columbia agar, bright green, serotyping, detection of toxins - INV, LT,ST,SLT I, SLT II, Sereny test, detection of virulence factors- EAF, eae, BFP; and c) protozoa (Hoffman and Faust). In the same period, a control group without diarrhea was also evaluated for the same fecal pathogens. RESULTS: Between March 1994 and June 1996, 154 children with acute diarrhea (AD) and 42 control children (WAD), that is, without acute diarrhea, were selected. In the AD group, intestinal pathogens were detected in 112 (72.8%) cases, and in 9 (21.5%) cases in the WAD group. The association of two or more intestinal pathogens occurred in 47 (30.5%) cases in the AD group, and in 3 (7.1%) cases in the WAD group. The pathogens identified in the AD cases were: Rotavirus: 32 (20.8%), bacteria: 53 (34.4%), both: 25 (16.2%), and 2 (1.4%) with Giardia lamblia (in one case associated with Rotavirus and in another one associated with bacteria). In the WAD group, only bacteria were detected in 8 (19.1%) cases, and bacteria associated with Giardia lamblia in 1 (2.4%) case. Altogether, there were 105 bacteria isolated in the AD group: 90 were Escherichia coli (EPEC 27, DAEC 24, ETEC 21, EAEC 18), 12 were Shigella sp, 2 were Salmonella sp, and one was Yersinia sp. Children with mixed infections (viral and bacterial) had increased incidence of severe vomiting, dehydration and hospitalization. CONCLUSIONS: Bacteria were the most frequent pathogens detected in acute diarrhea cases, among which Escherichia coli was highly predominant. The majority of Escherichia coli strains belong to non-EPEC varieties, strains that are not routinely evaluated in clinical laboratories of pathology. Rotavirus was found in a great number of diarrhea cases, often associated with bacteria. Protozoa showed reduced importance.     

Diagnosis and prognosis of wheezing disorders in young children in the city of São Paulo, Southeast Brazil

Three‐hundred‐and‐ninety‐seven children aged 2–59 mo presenting to the paediatric emergency departments of five public hospitals in São Paulo, Brazil, with an acute episode of lower respiratory disease were examined. The children were classified into the following diagnostic categories: acute bronchitis, acute bronchiolitis, pneumonia, asthma, post‐bronchiolitis wheezing and wheezing of uncertain aetiology. Three years after the initial study, the homes of the children diagnosed as asthmatic or as having wheezing of uncertain aetiology were visited to collect information on subsequent episodes of lower respiratory disease. This paper reports the proportional incidence of different categories of lower respiratory disease and the results of an analysis to investigate clinical features that might distinguish wheezing children between those with asthma and those with an infectious disease. The predictions made for children with wheezing of uncertain aetiology were then compared with the follow‐up data. Recurrent wheezing disorders (asthma, post‐bronchiolitis wheezing) were common in the study sample (47% of children). Thirty‐six percent of children with an initial diagnosis of wheezing of uncertain aetiology were diagnosed as asthmatic by another doctor over the next 3 y. We were unable to identify any clinical features that were useful in identifying those children likely to be diagnosed subsequently as asthmatic. Conclusions: The use of a diagnostic category similar to that which we have called “wheezing of uncertain aetiology” might help to alert physicians early to the possibility of asthma without interfering in the management of the illness. Such a classification might also be useful in epidemiological investigations of the aetiology of lower respiratory diseases.     

Prevention of anemia in the first year of life in health centers of Santo André, São Paulo

The aim of this study was to evaluate the efficacy of an iron prophylactic supplementation program, in three health centers of Santo André, in S?o Paulo state. The prevalence of anemia was identified in a control group consisting of 201 children of 1 year old. The intervention group consisted of 308 children younger than 3 months, but 55% of them gave up during the survey. The mothers were instructed to give them daily prophylactic doses of iron sulfate (6 mg of iron/day) when they were 4 or 6 months old, according to the kind of breast-feeding. The mothers were also instructed about feeding and anemia and its risk to children's health. When the children were 12 months old, the diagnosis of anemia was made through dosage of hemoglobin concentration and the results were compared with those of the control group. It was verified that the 2 groups presented similar prevalences. It is important to realize that children with low frequency of visits to the health centers had prevalence of anemia significantly higher than those with high frequency. Some factors that possibly contributed to the result of the intervention are discussed.     

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo,Brazil

ObjectiveTo analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors.MethodsA cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24 h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers’ and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake.ResultsThe prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08–2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01–2.27]) were factors associated with the consumption of ultra-processed foods.ConclusionsHigh consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.     

Congenital and neonatal measles during an epidemic in São Paulo, Brazil in 1997

During a measles outbreak, 2 mothers with measles gave birth at University Hospital in S?o Paulo City, Brazil. Blood, saliva and urine were collected from the mothers and newborns. Measles virus genome and IgM antibodies against measles were detected. In 1 infant, measles virus genome persisted in peripheral blood mononuclear cells for 157 days after birth.     

Perinatal factors related to the morbidity and mortality of newborns in nine neonatal care units in the city of São Paulo

This study was carried out in nine hospitals in the city of S?o Paulo, in 1991 (between July 1 and November 30), when 10,235 live children were born. The aim of this study was to analyze the characteristics of the 1975 pathologic newborn (PNB) who were put into those neonatal care units (NCU) of the hospitals; besides that, the most common morbidity conditions, breast feeding prevalent and therapies were studied. It was calculated the odds ratio, its confidence interval and the c(2) test in order to evaluate the association between the variables and the death of the PNB. The results have demonstrated that the low weight PNB lethality (especially those with weight <1500 g) was higher than those PNB whose weight was > or = 2500 g. The lethality for both premature PNB and small for gestational age PNB was higher than the other categories of babies. The PNB with hypoxia until the 5th minute had the worst prognostic: their lethality was 10 times higher than the other category. The PNB who had Apgar < or =7 until the 5th minute had twice as much lethality when compared with PNB who had Apgar < or =7 just until the 1st minute. Conventional therapies have been used and only 25.4% have received breast feeding. Several risk factors (maternal, delivery, newborn) were associated with the PNB mortality, as well as most of the morbidity conditions. Those factors reflect the perinatal assistance in our environment.     

Bone mineral density of the lumbar spine in children and adolescents with celiac disease on a gluten-free diet in São Paulo, Brazil

BACKGROUND: To compare bone mineral density (BMD) in children and adolescents with celiac disease (CD) and control subjects and to evaluate diet adequacy and calcium metabolism in patients with CD. METHODS: Thirty patients with asymptomatic CD (17 children, 13 adolescents), on a gluten-free diet, and 23 healthy subjects were studied. BMD of the lumbar spine (dual energy x-ray absorptiometry) was performed on all patients and control subjects. In patients, food diaries for nine nonconsecutive days were obtained and analyzed. In patients, laboratory tests pertaining to calcium balance were obtained. RESULTS: The mean weight and height of the adolescents with CD were lower than those of control subjects (weight: 45.8 +/- 10.5 kg v 55.3 +/- 10.5 kg, P = 0.037; height: 153.0 +/- 11.0 cm v 167 +/- 12.0 cm, P = 0.007). The mean BMD in adolescents with CD was significantly lower than that of the control subjects (0.917 +/- 0.116 g/cm2 v 1.060 +/- 0.158 g/cm2, P = 0.015), whereas no significant difference was found between children with CD and control subjects (P = 0.595). A multiple-regression model shows that increases in BMD relative to height were lower in adolescents with CD than in control subjects. The proportion of adolescents who had started a gluten-free diet after 2 years of age was higher than that of children with CD (P < 0.001). High percentages of magnesium, calcium, and phosphorous deficiencies were present in CD patients' diets. The serum levels of ionized and total calcium and parathormone were normal. CONCLUSIONS: The BMD of adolescents with CD was lower than that of the control subjects, whereas no difference was found between the BMD of children with CD and that of control subjects.     

No evidence of vertical transmission of HTLV-I and HTLV-II in children at high risk for HIV-1 infection from São Paulo, Brazil

One hundred and seven plasma specimens obtained from children born to HIV-1 infected mothers were tested for the presence of antibody to human T-cell lymphotropic virus types I and II (HTLV-I and -II) to determine perinatal transmission of these agents. None of the children in this study were breastfed. Fifty-five specimens were from HIV-1 infected children, 28 from HIV-1 non-infected children, and in 24 cases the HIV-1 status could not be defined. In these series, when ELISA screening tests were employed, HTLV antibodies were detected in 54.5, 17.9, and 37.5 per cent of cases, respectively, given an overall ratio of 41.1 per cent. Western blot analysis disclosed 17 specimens with some HTLV reactivity: three were classified as HTLV-I/II, two confirmed as having a HTLV-I Western blot profile, and the last 12 samples showed reactivity to only one of the protein (gag or env) components. In 11 out of 17 cases molecular approaches were used to confirm HTLV infection in children; no case of HTLV-I or -II was detected. In contrast, when 13 specimens of mother-child pairs were analysed, three mothers' plasma samples which were seropositive were confirmed to have HTLV infection by PCR analysis; one case of HTLV-I and two cases of HTLV-II infections were detected. Taking into account the age of the children and their Western blot profiles, passive maternal antibodies could be detected until the age of 15 months. Indeed, after the age of 18 months seroreactivity amongst the children, with ELISA and Western blot assays, suggests the presence of maternal antibodies that resist degradation and/or antibodies that cross-react with rgp21 or p19 antigens from HTLV, or alternatively, with components of the HIV-1. These results emphasize the lack of HTLV-I and -II vertical transmission in children at high risk who are not breastfed.     

Sanitary measures to contain COVID-19 spread decreased pediatric hospitalizations due to other respiratory infections in São Paulo,Brazil

ObjectiveAfter the Covid-19 pandemics hit Brazil and sanitary measures were adopted to contain its dissemination, pediatric hospital admissions were apparently fewer than usual. The authors aimed to describe the time trends of public hospital admissions of children and adolescents due to respiratory infections (RIs) in São Paulo State, Brazil, before and after the adoption of sanitary measures to contain the dissemination of Covid-19.MethodsEcological, time-series study on the monthly average number of admissions per day of children and adolescents (< 16 years) admitted to public hospitals of São Paulo due to acute RIs between January 2008 and March 2021. Data from 2008 to 2019 were used to adjust the statistical model, while data from 2020 and 2021 were compared to the values predicted by the model.ResultsIn 2020 and 2021, the number of hospital admissions was significantly lower than predicted by the time series. However, lethality was three times higher in these years, compared to the previous, and six times higher in patients with Covid-19, compared to those without the disease. Hospitalization costs in 2020 and 2021 were lower than in previous years.ConclusionsThese findings suggest that the sanitary measures adopted to contain the dissemination of Covid-19 also effectively reduce the transmission of other respiratory viruses. Policymakers and administrators can use this knowledge as a guide to planning preventative interventions that could decrease the number and severity of RIs and related hospital admissions in children and adolescents, decreasing the burden on the public health system.     

Use of V3 loop peptide-specific antibody evaluation for subtyping HIV-1: results of a vertical transmission study from São Paulo, Brazil

Plasma samples obtained from 97 children enrolled in a longitudinal study of HIV-1 perinatal transmission in S?o Paulo, Brazil, were tested for the presence of specific V3-loop antibodies in order to determine the HIV-1 subtype circulating among them. A set of seven synthetic peptides representative of the predominant HIV-1 subtypes detected in Brazil was employed in an in-house enzyme immunoassay (EIA) using two different protocols, one of which permits identification of high avidity antibodies (HAAb). Using these approaches we were able to detect antibodies in 64 out of 97 children, independently of the HIV-1 infection status, indicating the presence of subtype B in all cases, except one, which could be considered to be of subtype F. Among subtype B cases, half of the samples reacted with the GWGR motif (type W is representative of Brazilian B strains). In the main, concordant results were obtained between peptide-EIA and HIV-1 status among infants, although in several cases of truly HIV-1 infected children, negative results could be observed. Thirteen mother-child pairs and four fathers were also evaluated, and the results confirmed subtype B to be the prevalent one among them, showing similar proportions of P and W types. Taken together, the results obtained identified subtype B (W and P) uniformly among adults and HIV-1 infected children from S?o Paulo, Brazil, and confirm vertical and sexual transmission of the predominant strains.     

Growth analysis of 566 children from the fourteen day care centers of Paulínia (São Paulo, Brazil), with ages ranging from 3 months to 3 years

To study the growth of 566 children (273 males and 293 females) from fourteen day care centers of Paulínia (S?o Paulo, Brazil), with ages ranging from 3 months to 3 years, admitted from March 1st to May 31st, 1993, the authors analyzed the z-score distribution of height for age and weight for height in relation to age group, per capita family income, social class levels, mothers education level and child birth weight. The Kruskal-Wallis test and the Multiple Comparison test were used in the statistical analysis. The children with less than 24 months or with birth weight less than 3000 g as the children with mothers education level less than four years, presented left deviated distribution in the height for age z-score. The weight for height score was less satisfactory in the group with per capita income less than one salary, in the group with birth weight less than 3000 g, and in the group with ages superior to 18 months.Therefore, institutional actions concerning the children and their parents are recommended in order to attenuate these factors.