Avaliação do teste imunocromatográfico ("ICT card test") no diagnóstico da filariose em estudos populacionais

This study evaluated the whole blood immunochromatographic card test (ICT card test) in a survey performed in Northeastern Brazil. 625 people were examined by the thick blood film (TBF) and ICT card test. Residents of a non-endemic area were also tested by the whole blood card test and Og4C3. The sensitivity of the ICT card test was 94.7% overall, but lower in females than males, based on the reasonable assumption that TBF is 100% specific. However, since TBF and other methods have unknown sensitivity, the true specificity of the card test is unknown. Nevertheless, it is possible to estimate upper and lower limits for the specificity, and relate it to the prevalence of the disease. In the endemic area, the possible range of the specificity was from 72.4% to 100%. 29.6% of the card tests performed in the non-endemic area exhibited faint lines that were interpreted as positives. Characteristics of the method including high sensitivity, promptness and simplicity justify its use for screening of filariasis. However, detailed information about the correct interpretation in case of extremely faint lines is essential. Further studies designed to consider problems arising from imperfect standards are necessary, as is a sounder diagnostic definition for the card test.Este estudo avaliou o teste imunocromatográfico ("ICT card test") em inquérito de filariose realizado no município de Olinda, Brasil. 625 pessoas foram examinadas pela técnica da gota espessa (GE), e "ICT card test" (ICT). Moradores do município de Campina Grande, Paraíba, área não endêmica, foram examinados pelos testes ICT e Og4C3-ELISA, para verificação da especificidade. A sensibilidade do método foi de 94,7%. O desenho do estudo - que envolveu a acurácia do ICT e do teste de referência (GE), em todos os elementos da amostra, - e a especificidade de 100% da GE permitiram o cálculo correto da sensibilidade. Todavia, como a sensibilidade da GE é desconhecida, a especificidade do ICT é ignorada. É possível, contudo, estimar o limite superior e inferior da especificidade e relacioná-la à prevalência de doença. Na área endêmica, a especificidade do teste variou entre 72,4% e 100,0%. 29,6% dos exames pelo ICT, realizados na área não endêmica, exibiram coloração tênue, tendo sido interpretados como positivos. Algumas características do método, incluindo alta sensibilidade, rapidez e simplicidade de execução justificam sua utilização em rastreamento de áreas endêmicas. Todavia, detalhes acerca da correta interpretação dos resultados com coloração extremamente tênue, parecem de importância fundamental

Perfil epidemiológico e clínico de casos de microcefalia

Objective: To describe the epidemiological and clinical profile of microcephaly cases in Recife, Pernambuco. Method: This was a cross-sectional, quantitative study developed at a reference hospital for cases of microcephaly. Data were collected in August 2016 from the FormSUS system. All confirmed cases of microcephaly in the period from August 2015 to July 2016 were included, making up 180 cases. Data were analyzed using descriptive statistics and the chi-square and Fisher's exact tests. Results: The majority of cases occurred in October and November 2015, with 55 (30.56%) and 52 (28.89%) cases, respectively. Serology for the Zika virus was reagent for 79 (43.89%) of the infants. The most prevalent symptom during gestation was exanthema 105 (57.3%). Furthermore, 150 (83.33%) of the children were born at full term, 78 (43.33%) presented percentiles between 10 and 50 in relation to weight and gestational age and 108 (60%) had -3 standard deviations in the comparison of head circumference with gestational age, thus considered to indicate severe microcephaly. Conclusions: It is necessary to guarantee comprehensive and specialized care for these children. Epidemiological and entomological surveillance and more effective control actions in the fight against the vector are necessary.Objetivo: Describir el perfil epidemiológico y clínico de los casos de microcefalia en Recife, Pernambuco. Método: Estudio transversal, cuantitativo, desarrollado en un hospital de referencia para casos de microcefalia. Los datos se recolectaron en agosto/2016 sobre la base del formulario FormSUS. Se incluyeron todos los casos de microcefalia confirmados de agosto/2015 a julio/2016, totalizando 180 casos. Para analizar los datos, se utilizó la estadística descriptiva y las pruebas de Chi-cuadrado y exacta de Fisher. Resultados: La mayoría de los casos tuvieron lugar en octubre y noviembre de 2015, con 55 (30,6%) y 52 (28,9%), respectivamente. La serología para el virus Zika fue reactiva para 79 (43,9) bebés. El síntoma más prevalente durante el embarazo fue la erupción cutánea, 105 (57,3%). Además, 150 (83,3%) niños nacieron a término, 78 (43,3%) presentaron percentiles entre 10 y 50 en la relación peso y edad gestacional y 108 (60%) tuvieron -3 desviaciones estándar en la comparación del perímetro cefálico con la edad gestacional, considerada como microcefalia grave. Conclusiones: Es necesario garantizar a estos niños una atención integral y especializada. Es imprescindible la vigilancia epidemiológica y entomológica, así como y acciones de control más eficaces en la lucha contra el vector.Objetivo: Descrever o perfil epidemiológico e clínico dos casos de microcefalia em Recife, Pernambuco. Método: Estudo transversal, quantitativo, desenvolvido em hospital de referência para casos de microcefalia. Os dados foram coletados em agosto/2016 a partir do formulário FormSUS. Foram incluídos todos os casos de microcefalia confirmados de agosto/2015 a julho/2016, perfazendo 180 casos. Para análise dos dados utilizou-se a estatística descritiva e os testes do qui-quadrado e exato de Fisher. Resultados: A maioria dos casos ocorreram em outubro e novembro de 2015, com 55 (30,6%) e 52 (28,9%), respectivamente. A sorologia para o vírus Zika foi reagente para 79 (43,9%) dos bebês. O sintoma mais prevalente, durante a gestação, foi o exantema 105 (57,3%). Ademais, 150 (83,3%) crianças nasceram a termo, 78 (43,3%) apresentaram percentis entre 10 e 50 na relação peso e idade gestacional e 108 (60%) possuíam -3 desvios padrões na comparação do perímetro cefálico com a idade gestacional, considerada microcefalia severa. Conclusões: É necessário garantir a essas crianças um atendimento integral e especializado. É imprescindível a vigilância epidemiológica, entomológica e ações de controle mais efetivas no combate ao vetor

Consumo alimentar na gestação e no pós-parto segundo cor da pele no município do Rio de Janeiro

OBJECTIVE: To assess dietary intake during pregnancy and postpartum according to skin color. METHODS: A longitudinal prospective study was carried out comprising 467 postpartum women aged between 15-45 years in the city of Rio de Janeiro, Southeastern Brazil, in 1999-2001. A food frequency questionnaire was administered at two weeks postpartum (intake covering the pregnancy period) and at six months postpartum (intake covering the postpartum period). Analysis of covariance was performed to evaluate differences in food intake among skin color groups, adjusted for educational level. RESULTS: During pregnancy, black and mulatto women had 13.4% and 9.1% higher energy intake (p=0.009 and p=0.028) and 15.1% and 10.5% higher carbohydrate intake (p=0.005 and p=0.014) than white women, respectively. Energy intake of black and white women exceeded the nutritional recommendations by 34% and 20%, respectively (p=0.035). During the postpartum period, black women had 7.7% higher energy intake (p=0.030) and 14.8% higher lipid intake (p=0.008) than white women, as well as 23.8% and 13% higher saturated fatty acids intake than white (p = 0.003) and mulatto (p = 0.046) women, respectively. The adequacy of lipid and saturated fatty acids intake was higher in black (p=0.024) than white women (p=0.011). CONCLUSIONS: The study suggests the need to revise nutritional interventions strategies in the prenatal period, and to implement nutritional guidance programs during the postpartum period in order to adjust food intake to adequate levels, taking into consideration racial differences identified.OBJETIVO: Avaliar o consumo alimentar durante a gestação e pós-parto, segundo cor da pele. MÉTODOS: Estudo longitudinal prospectivo que incluiu 467 mulheres entre 15 e 45 anos no período pós-parto, no município do Rio de Janeiro, entre 1999 e 2001. Foi aplicado um questionário de freqüência de consumo de alimentos aos 15 dias pós-parto (consumo referente ao período da gestação) e aos seis meses (consumo referente ao período pós-parto). Foi utilizada análise de covariância para analisar diferenças no consumo alimentar, segundo cor da pele, controlada pela escolaridade. RESULTADOS: Durante a gestação, pretas e pardas apresentaram consumo de energia 13,4% e 9,1% (p=0,009 e p=0,028) e consumo de carboidrato 15,1% e 10,5% maior que brancas (p=0,005 e p=0,014), respectivamente. Mulheres pretas e brancas apresentaram consumo energético 34% e 20% acima das recomendações nutricionais, respectivamente (p=0,035). Durante o período pós-parto, as pretas apresentaram consumo de energia 7,7% maior e consumo de lipídios 14,8% maior que as brancas; consumo de ácidos graxos saturados 23,8% maior que brancas (p=0,003) e 13% maior que pardas (p=0,046). A adequação de consumo de lipídios e ácidos graxos saturados foi maior em pretas que em brancas (p=0,024 e p=0,011, respectivamente). CONCLUSÕES: Os resultados mostram ser necessário revisar estratégias de intervenção nutricional no pré-natal e implementar assistência nutricional no pós-parto, para ajustar o consumo alimentar a níveis adequados, considerando as diferenças por cor/raça identificadas

Spatiotemporal Analysis of the Population Risk of Congenital Microcephaly in Pernambuco State, Brazil.

Since an outbreak in Brazil, which started in 2015, Zika has been recognized as an important cause of microcephaly. The highest burden of this outbreak was in northeast Brazil, including the state of Pernambuco. The prevalence of congenital microcephaly in Pernambuco state was estimated from the RESP (Registro de Eventos em Saúde Pública) surveillance system, from August 2015 to August 2016 inclusive. The denominators were estimated at the municipality level from official demographic data. Microcephaly was defined as a neonatal head circumference below the 3rd percentile of the Intergrowth standards. Smoothed maps of the prevalence of microcephaly were obtained from a Bayesian model which was conditional autoregressive (CAR) in space, and first order autoregressive in time. A total of 742 cases were identified. Additionally, high and early occurrences were identified in the Recife Metropolitan Region, on the coast, and in a north-south band about 300 km inland. Over a substantial part of the state, the overall prevalence, aggregating over the study period, was above 0.5%. The reasons for the high occurrence in the inland area remain unclear

Racial, sociodemographic, and prenatal and childbirth care inequalities in Brazil, 1999-2001

OBJECTIVE: To analyze social inequalities and inequalities in access to and utilization of health care services according to skin color in a representative sample of postpartum women receiving hospital childbirth care. METHODS: A cross-sectional study was carried out in a sample of 9,633 postpartum women, of whom 5,002 were white (51.9%), 2,796 mulatto (29.0%), and 1,835 black skin color (19.0%), seen in public maternity hospitals, hospitals contracted out by the Unified National Health System, and private hospitals in the period 1999-2001. Data were collected from medical records and through interviews with the mothers in the immediate postpartum period using standardized questionnaires. Statistical analyses were performed using chi² tests to assess homogeneity of proportions and Student's t-test for comparison of measures. The analysis was stratified by maternal schooling. RESULTS: A persistent unfavorable situation was seen for mulatto and black women as compared to white women. Mulatto and black women had the highest rates of adolescent mothers, low schooling, unpaid occupation, and not having a partner. History of physical violence, smoking, attempts to interrupt pregnancy, and visits to several hospitals before being admitted were more frequent among black women, followed by mulatto and then white women of low schooling. High schooling group of women showed better indicators but the same pattern was seen. This variability is also seen in the opposite direction in terms of the level of satisfaction with prenatal and childbirth care. CONCLUSIONS: It was distinguished two forms of discrimination, by educational level and skin color, in care delivered by health services to postpartum women in Rio de Janeiro.OBJETIVO: Analisar as desigualdades sociais e no acesso e utilização dos serviços de saúde em relação à cor da pele em amostra representativa de puérperas que demandaram atenção hospitalar ao parto. MÉTODOS: Trata-se de estudo transversal, realizado no Município do Rio de Janeiro, no qual foram amostradas 9.633 puérperas, sendo 5.002 brancas (51,9%), 2.796 pardas (29,0%) e 1.835 negras (19,0%), oriundas de maternidades públicas, conveniadas com o Sistema Único de Saúde e particulares no período de 1999 a 2001. Os dados foram coletados de prontuários médicos e por entrevistas com as mães no pós-parto imediato, aplicando questionários padronizados. Foram utilizados os testes de chi² para analisar a homogeneidade das proporções e t de Student para comparação de médias. A análise foi estratificada segundo o grau de instrução materna. RESULTADOS: Observou-se persistente situação desfavorável das mulheres de pele preta e parda em relação às brancas. Nas mulheres pretas e pardas são maiores as proporções de puérperas adolescentes, com baixa escolaridade, sem trabalho remunerado e vivendo sem companheiro. Sofrer agressão física, fumar, tentar interromper a gravidez e peregrinar em busca de atenção médica foram mais freqüentes nas negras seguidas das pardas e das brancas com baixa escolaridade. O grupo de elevado nível de escolaridade tem melhores indicadores, mas repete o mesmo padrão. Esse gradiente se mantém, em sentido inverso, quanto à satisfação com a assistência prestada no pré-natal e no parto. Constata-se a existência de duas formas de discriminação, por nível educacional e cor da pele. CONCLUSÕES: Verificaram-se dois níveis de discriminação, a educacional e a racial, que perpassam a esfera da atenção oferecida pelos serviços de saúde à população de puérperas do Município do Rio de Janeiro

Desigualdades sociodemográficas e suas conseqüências sobre o peso do recém-nascido

OBJECTIVE: To analyze sociodemographic inequalities in prenatal and childbirth care and their consequences on birth weight. METHODS: The study was based on a sample of 10,072 postpartum women treated at public (those outsourced by the National Health System) and private maternity hospitals in Rio de Janeiro, Brazil, from 1999 to 2001. To test the association between birth weight and maternal sociodemographic and biological characteristics and prenatal care (modified Kotelchuck index), postpartum women were stratified by level of schooling and two multiple linear regressions were performed. The bootstrap technique was used in addition to accurate confidence intervals for the estimated effects. RESULTS: For nearly all of the variables analyzed in the bivariate analysis, birth weight was lower among children of mothers with low schooling. In the multivariate analysis, among women with low schooling, there was a direct association between birth weight and the modified Kotelchuck index and gestational age. The variables black skin color, smoking, and history of premature birth were negatively associated with birth weight, while maternal age and parity showed distinct behaviors from the central range of data at the extremes. In the group with high schooling, only parity, gestational age, and modified Kotelchuck index were significant and directly associated with birth weight. The protective effect of prenatal care was observed, as well as the negative effect of smoking, regardless of the mother's level of schooling. CONCLUSIONS: The variables associated with neonates' birth weight of mothers with high schooling in Rio de Janeiro were biological, in contrast to the social determinants in the group with low schooling.OBJETIVO: Analisar as desigualdades sociodemográficas, na assistência pré-natal e ao parto e suas conseqüências sobre o peso ao nascer. MÉTODOS: Estudo realizado em amostra de 10.072 puérperas atendidas em maternidades públicas, conveniadas com o Sistema Único de Saúde, e particulares do Município do Rio de Janeiro, no período de 1999-2001. Para verificar a associação entre peso ao nascer e características maternas, sociodemográficas, biológicas e da assistência pré-natal (índice de Kotelchuck modificado), realizaram-se regressões lineares múltiplas, estratificando as puérperas segundo nível de instrução. Foi utilizada a técnica de bootstrap com intervalos de confiança acurados para as estimativas dos efeitos. RESULTADOS: Na análise bivariada, para quase todas as variáveis estudadas, as médias de peso ao nascer foram menores entre as mães de escolaridade mais baixa. Na análise da regressão múltipla para o grupo de baixa escolaridade, o peso ao nascer associou-se diretamente com o índice de Kotelchuck modificado e a idade gestacional, e inversamente com as variáveis cor da pele preta, hábito de fumar e a experiência de filhos prematuros anteriores. Idade materna e paridade tiveram comportamentos distintos nos extremos e na faixa central dos dados. No grupo de maior escolaridade somente a paridade, a idade gestacional e o índice de Kotelchuck modificado foram significativos e se associaram diretamente com o peso ao nascer. Verificou-se o papel protetor da assistência pré-natal, assim como o efeito negativo do hábito de fumar independente do nível de escolaridade das mães. CONCLUSÕES: As variáveis que explicaram o peso ao nascer dos neonatos de mães com elevada escolaridade foram de natureza biológica, em contraste com os determinantes sociais encontrados no grupo de baixa escolaridade

Evaluation of diagnostic tests for Wuchereria bancrofti infection in Brazilian schoolchildren.

INTRODUCTION: Since the launch of the Global Programme to Eliminate Lymphatic Filariasis, more than 70% of the endemic countries have implemented mass drug administration (MDA) to interrupt disease transmission. The monitoring of filarial infection in sentinel populations, particularly schoolchildren, is recommended to assess the impact of MDA. A key issue is choosing the appropriate tools for these initial assessments (to define the best intervention) and for monitoring transmission. METHODS: This study compared the pre-MDA performance of five diagnostic methods, namely, thick film test, Knott's technique, filtration, Og4C3-ELISA, and the AD12-ICT card test, in schoolchildren from Brazil. Venous and capillary blood samples were collected between 11 pm and 1 am. The microfilarial loads were analyzed with a negative binomial regression, and the prevalence and associated 95% confidence intervals were estimated for all methods. The accuracies of the AD12-ICT card and Og4C3-ELISA tests were assessed against the combination of parasitological test results. RESULTS: A total of 805 schoolchildren were examined. The overall and stratified prevalence by age group and gender detected by Og4C3-ELISA and AD12-ICT were markedly higher than the prevalence estimated by the parasitological methods. The sensitivity of the AD12-ICT card and Og4C3-ELISA tests was approximately 100%, and the positive likelihood ratios were above 6. The specificity of the Og4C3-ELISA was higher than that of the AD12-ICT at different prevalence levels. CONCLUSIONS: The ICT card test should be the recommended tool for monitoring school-age populations living in areas with ongoing or completed MDA

Prevalence of hepatitis A in the capitals of the States of North, Southeast and South regions of Brazil: decrease in prevalence and some consequences

Hepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection

Effectiveness of screening for tuberculosis in HIV: a pragmatic clinical trial

OBJECTIVE: To verify the effectiveness of screening for tuberculosis (TB) on all-cause mortality and tuberculosis cases in newly diagnosed HIV-infected patients through a clinical algorithm based on recommendations of the World Health Organization. METHODS: From March 2014 to April 2016, a pragmatic randomized clinical trial was conducted with newly diagnosed and TB-free HIV-infected adults undergoing antiretroviral therapy for up to one month at a major tertiary hospital for HIV in the state of Pernambuco, Brazil. Participants were randomized into intervention and control groups using an automatically-generated random list, and followed-up for at least 6 months. The intervention group was screened for TB at hospital admission and at every follow-up visit through a series of questions addressing TB-related symptoms (cough, fever, night sweating, and weight loss). Patients presenting with any of these symptoms were referred to a pulmonologist and underwent sputum smear microscopy, sputum culture, and rapid molecular testing (GeneXpert). When at least one test result came back positive, TB treatment was initiated. In turn, if patients tested negative but presented with severe clinal symptoms, TB preventive treatment was initiated. Screening for TB was not performed systematically in the control group. The primary outcome assessed in this study was death from all causes, and secondary outcomes included sensitivity and specificity of this screening test, as well as its detection time. RESULTS: This study evaluated 581 patients, 377 in the intervention group (64.9%) and 204 in the control group (35.1%). In total, 36 patients died during the follow-up period. Of these, 26 (6.9%) were from the intervention group, reaching a cumulative mortality coefficient of 69 per 1,000 inhabitants, and 10 (4.9%) from the control group (p = 0.341), with a cumulative mortality coefficient of 49 per 1,000 inhabitants (p = 0.341)