Are we interconnected? A qualitative study on the role and perception of different actors on malaria social behaviour change interventions in rural Mozambique

Background: Interconnecting institutions (health and education sector) and community (through a network of community structures) in social and behaviour change (SBC) activities can add value in an effort for malaria prevention towards a long-term objective of elimination. This approach has been implemented since 2011 in some rural districts of Mozambique. The objective of this study is to describe the perceptions of community and institutional actors on malaria prevention interventions in rural Mozambique. Methods: A descriptive qualitative study with a constructivist research paradigm was conducted in October 2018 in two rural districts of Zambezia Province with high malaria burden in Mozambique. Key-informant sampling was used to select the study participants from different actors and layers: malaria community volunteers, health professionals, non-governmental actors, and education professionals. In-depth interviews (IDIs) and focus group discussions (FGDs) were used to explore the perceptions of these actors. Classic content analysis looking for themes and semantics was used, and saturation guided the sample size recruitment. Results: A total of 23 institutional actor IDIs took place, and 8 FGDs were held. Four themes emerged from the content analysis: (1) organizational and functional aspects; (2) knowledge about malaria; (3) perception of institutional actors on SBC and community involvement; and, (4) perception of institutional actors on the coordination and leadership on SBC malaria interventions. Community structures were well organized, linked to the health sector and operational, with good knowledge of malaria prevention. Education sector (school teachers) links with the health sector were in some cases good, and in other cases, non-existent. The importance of SBC interventions for malaria control was recognized by health actors, although the activities are delegated to non-governmental institutions. Domestic budgetary allocation constraints, quality of intervention and lack of SBC standard indicators were also identified by health actors as aspects for improvement. Conclusions: Community structures, volunteers and primary school teachers have good knowledge on malaria prevention and regularly sensitize community members and students. Institutional health actors and partners recognize their role on malaria prevention activities, however, more interconnection is needed at different levels.publishersversionpublishe

Hepatite A : contributo para uma melhoria em saúde pública

Trabalho final de mestrado integrado em Medicina àrea científica de Medicina, apresentado á Faculdade de Medicina da Universidade de CoimbraIntrodução: As hepatites víricas, cuja descrição data provavelmente de Hipócrates, constituem ainda hoje um importante problema de saúde pública. A situação geográfica de Portugal, no extremo ocidental da Europa, é uma porta aberta para a aquisição de vírus endémicos noutras regiões do globo. Os novos fluxos migratórios, também têm contribuído bastante para a propagação de infeções virais tendo a Hepatite A assumido um especial relevo. Objetivos: Com esta revisão bibliográfica, pretende-se avaliar o contributo dado pelas técnicas de laboratório, nomeadamente as técnicas imunoenzimáticas, a reação em cadeia polimerase (PCR) em tempo real e sequenciação genómica na pesquisa do ácido ribonucleico (RNA) viral, no diagnóstico de situações a necessitar de esclarecimento e em estudos epidemiológicos. Por outro lado, estimar a importância da prevenção desta infeção viral. Desenvolvimento: A descoberta do vírus da Hepatite A ocorreu em 1975, todavia, na antiguidade já se registavam surtos de doença diagnosticados como “iterícia infeciosa” e eram frequentes em períodos de guerra e de cataclismos. O vírus da Hepatite A (VHA) tem cerca de 27 nm e está incluído na família dos picornaviridae. O seu genoma é construído por um RNA positivo e monocatenário. Está distribuído por todo o mundo, especialmente em lugares e onde as condições de higiene são escassas. Embora atualmente estejam descritas outras vias de contaminação, a principal é oro-fecal, isto é, através de alimentos e águas contaminadas. E de salientar a ocorrência de vários surtos de doença de origem alimentar. O diagnóstico laboratorial, é feito por rotina por deteção da presença serológica de anticorpos do tipo IgM e IgG e também pela enzimologia hepática. A utilização de técnicas de biologia molecular nos estudos epidemiológicos e a presença do RNA viral em alimentos contaminados contribui por certo para o reconhecimento do vírus como um grupo importante de vírus veiculado por alimentos. Estas técnicas assumiram um adicional relevo desde que as investigações da Autoridade de Segurança Alimentar e Económica se tornaram mais rotineiras. Conclusões: Este estudo pretende fazer uma avaliação qualitativa dos métodos de diagnóstico laboratorial e a sua evolução. Calcular o impacto desta infeção na consulta do viajante e contribuir para uma melhoria nas condições de saúde pública em Portuga

Estimating clinically relevant mental disorders in a rural and an urban setting in postconflict Timor Leste.

CONTEXT: Epidemiologic studies undertaken in postconflict countries have focused primarily on trauma-related disorders. There is a need to include disabling psychotic disorders in order to plan clinical services in these settings. OBJECTIVES: To estimate the prevalence of key clinical disorders in Timor Leste (East Timor), and to assess cultural factors that may influence help-seeking patterns. DESIGN, SETTING, PARTICIPANTS: A 2-phase total population survey of 1544 adults in an urban and a rural area of Timor Leste. Phase 1 involved a household informant survey using indigenous terms to detect psychosis and a screen of all adults for posttraumatic stress disorder (PTSD) and symptoms of psychologic distress, including depression and anxiety. In phase 2, clinicians interviewed all those identified by household informants and half of those who screened positive in order to assign DSM-IV diagnoses. Disability, explanatory models, and perceived needs were also assessed. MAIN OUTCOME MEASURES: Phase 1: Demographic characteristics; trauma events and PTSD (Harvard Trauma Questionnaire); psychologic distress (Kessler-10 scale). Phase 2: Structured Clinical Interview for relevant DSM-IV diagnoses; the Global Assessment of Functioning Scale and the World Health Organization Disability Assessment Scales; and the modified Short Explanatory Model Interview. RESULTS: The household informant method in phase 1 detected mainly psychotic disorders, and the screen method detected PTSD and depression. Phase 2 yielded a DSM-IV point prevalence estimate of 5.1% (including psychosis, 1.35%; and PTSD, 1.47%). Psychotic disorders were most disabling, primarily attributed to supernatural causes and treated mainly by traditional healers. Those with depression and PTSD experienced substantial disability but had received little treatment. They attributed their mental problems to social and traumatic causes. CONCLUSIONS: Our 2-phase method proved effective for identifying the range of disorders relevant to planning clinical services in postconflict developing countries. The unmet needs of the mentally ill in countries such as Timor Leste pose a major challenge to psychiatry

Associations of socio-demographic factors, trauma, conflict, poverty and injustice with Intermittent Explosive Disorder amongst Timorese women.

1<p>Odds Ratios adjusted for presence of PTSD, psychological distress and all other variables in the model.</p>2<p>3 historical periods: Indonesian occupation; Independence period.</p><p>Model c-statistic (Area Under the Curve)  = 0.799.</p

Practical suggestions women provided to ameliorate or prevent anger.

<p>Practical suggestions women provided to ameliorate or prevent anger.</p

Intermittent explosive disorder amongst women in conflict affected Timor-Leste: associations with human rights trauma, ongoing violence, poverty, and injustice

Women in conflict-affected countries are at risk of mental disorders such as posttraumatic stress disorder and depression. No studies have investigated the association between experiences of abuse and injustice and explosive anger amongst women in these settings, and the impact of anger on women's health, family relationships and ability to participate in development.\ud \ud A mixed methods study including an epidemiological survey (n = 1513, 92.6% response) and qualitative interviews (n = 77) was conducted in Timor-Leste. The indices measured included Intermittent Explosive Disorder, posttraumatic stress disorder; severe distress; days out of role (the number of days that the person was unable to undertake normal activities); gender-specific trauma; conflict/violence; poverty; and preoccupations with injustice.\ud \ud Women with Intermittent Explosive Disorder (n = 184, 12.2%) were more disabled than those without the disorder (for >5 days out of role, 40.8% versus 31.5%, X²₍₂₎ = 12.93 p = 0.0016). Multivariable associations with Intermittent Explosive Disorder, controlling for the presence of PTSD, psychological distress and other predictors in the model, included the sense of being sick (OR 1.73; 95% CI 1.08–2.77); victimization as a result of helping the resistance movement (OR 2.33, 95% CI 1.48–3.68); war-related trauma specific to being a woman (OR 1.95, 95%, CI 1.09–3.50); ongoing family violence and community conflict (OR 1.88, 95% CI 1.27–2.77); extreme poverty (OR 1.23, 95%, CI 1.08–1.39); and distressing preoccupations with injustice (relating to 2/3 historical periods, OR 2.10, 95% CI 1.35–3.28). In the qualitative study, women elaborated on the determinants of anger and its impact on their health, family and community functioning, child-rearing, and capacity to engage in development. Women reflected on the strategies that might help them overcome their anger.\ud \ud Intermittent Explosive Disorder is prevalent and disabling amongst women in conflict-affected Timor-Leste, impacting on their health, child-rearing and ability to participate fully in socio-economic development

Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil Adequacy of prenatal care in the National Health System in the city of Rio de Janeiro, Brazil

A persistência de desfechos perinatais negativos no Município do Rio de Janeiro, Brasil, sugere problemas na qualidade da assistência pré-natal. A última investigação realizada nessa cidade mostrou adequação de apenas 38% dessa assistência. O objetivo deste estudo é avaliar a adequação da assistência pré-natal na rede do SUS do Município do Rio de Janeiro. Foi realizado um estudo transversal, em 2007-2008, por meio de entrevistas com 2.422 gestantes em atendimento nos serviços de pré-natal de baixo risco. Para avaliação da adequação da assistência, foi utilizado o índice PHPN, com as recomendações do Programa de Humanização do Pré-natal e Nascimento, do Ministério da Saúde, e um índice PHPN ampliado, em que foram acrescentados procedimentos clinico-obstétricos, prescrição de sulfato ferroso suplementar e ações educativas. Foi encontrada adequação de 38,5% para o PHPN e 33,3% para o PHPN ampliado. Estratégias de ampliação da captação precoce das gestantes e melhor utilização dos contatos com os serviços para a realização de ações de atenção à saúde são prioritárias para a reversão desse quadro.<br>The persistence of negative perinatal outcomes in Rio de Janeiro suggests problems in the quality of prenatal care. The most recent study in the city showed that only 38% of prenatal care was adequate. This study aimed to evaluate the adequacy of prenatal care under the Brazilian Unified National Health System in the city of Rio de Janeiro. A cross-sectional study in 2007-2008 interviewed 2,422 women receiving prenatal care for low-risk pregnancy. Evaluation of care used the PHPN index, based on guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and an expanded PHPN index, which included clinical-obstetric procedures, prescription of supplementary ferrous sulfate, and educational activities. According to the PHPN index, 38.5% of prenatal care was adequate, as compared to 33.3% based on the expanded PHPN index. Strategies to expand early entry of pregnant women into prenatal care and better use of their contact with the health services in order to promote healthcare measures are essential to correct this situation

Uma história de conceitos na saúde pública: integralidade, coordenação, descentralização, regionalização e universalidade A history of public health concepts: integrity, coordination, decentralization, regionalization, and universality

O Sistema Único de Saúde conferiu visibilidade a uma série de conceitos próprios da organização de sistemas de saúde. Entre eles a integralidade, que delimita fronteiras comuns com quase todos os demais princípios do Sistema, tem sido objeto de ampla literatura no Brasil. Com base em extensa revisão de fontes primárias e secundárias, este artigo apresenta uma recuperação histórica dos conceitos de integralidade, descentralização, regionalização e universalidade - ideias e conceitos que em grande parte se conformam e se interligam no ideário da organização dos serviços sanitários pelo modelo dos Centros de Saúde distritais.<br>Brazil's Unified Health System (Sistema Único de Saúde) has highlighted a series of concepts specific to the organization of healthcare systems. Among these, integrity - which shares boundaries with almost all other System principles - has been the object of much academic production in Brazil. Based on an extensive review of primary and secondary sources, the article offers a historical recovery of the concepts of integrity, decentralization, regionalization, and universality - ideas and concepts that in good measure are shaped by and interlinked with the set of ideals of the organization of sanitary services according to the district health centers model