Article

Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators.

Laboratório de Informações em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Avenida Brasil 4365-Manguinhos, Rio de Janeiro, RJ, Brazil. xris@fi ocruz.br
Revista de saude publica (Impact Factor: 1.22). 12/2009; 43(6):1006-14. DOI: 10.1590/S0034-89102009005000070
Source: PubMed

ABSTRACT To identify clustering areas of infants exposed to HIV during pregnancy and their association with indicators of primary care coverage and socioeconomic condition.
Ecological study where the unit of analysis was primary care coverage areas in the city of Porto Alegre, Southern Brazil, in 2003. Geographical Information System and spatial analysis tools were used to describe indicators of primary care coverage areas and socioeconomic condition, and estimate the prevalence of liveborn infants exposed to HIV during pregnancy and delivery. Data was obtained from Brazilian national databases. The association between different indicators was assessed using Spearman's nonparametric test.
There was found an association between HIV infection and high birth rates (r=0.22, p<0.01) and lack of prenatal care (r=0.15, p<0.05). The highest HIV infection rates were seen in areas with poor socioeconomic conditions and difficult access to health services (r=0.28, p<0.01). The association found between higher rate of prenatal care among HIV-infected women and adequate immunization coverage (r=0.35, p<0.01) indicates that early detection of HIV infection is effective in those areas with better primary care services.
Urban poverty is a strong determinant of mother-to-child HIV transmission but this trend can be fought with health surveillance at the primary care level.

Download full-text

Full-text

Available from: Lisiane Acosta, Jun 05, 2014
2 Followers
 · 
140 Views
  • Source
    • "b) social and economic issues: unemployment, poverty, difficult access to health services and education, and the number of people living in the house are factors that may contribute to characterize economic difficulties. Barcellos et al., (2009) [37] mention that urban poverty represents a strong conditioning factor for vertical transmission of HIV. However, the action of health surveillance services in association with the basic attention can overcome this tendency. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV). Thirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Center, in Sao Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization. Out of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS. This study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.
    International Archives of Medicine 10/2013; 6(1):45. DOI:10.1186/1755-7682-6-45 · 1.08 Impact Factor
  • Source
    • "In Brazil, there is a disparity between the existence of internationally recognised protocols to reduce MTCT and the inability to fully apply them in certain parts of the country, especially in the north-east, where coverage of health services is poor (Brazilian Ministry of Health 2010). Poverty, especially in a heterogeneous country such as Brazil, seems to be a strong determinant of MTCT, as it is associated with inadequate care during pregnancy (Barcellos et al. 2009). These situations represent an incomplete process of epidemiological and demographic transition, with the coexistence of old and new clinical and epidemiological challenges (Ramos et al. 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. METHODS: Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2 months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. RESULTS: The transmission rate was 9.16% (95% CI: 7.4-10.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.1-15); vaginal delivery (OR: 2.02; 95% CI: 1.2-3.4); prematurity (OR: 2.5; 95% CI: 1.3-4.7); and breastfeeding (OR: 2.6; 95% CI: 1.4-4.6). CONCLUSIONS: This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.
    Tropical Medicine & International Health 12/2012; 18(3). DOI:10.1111/tmi.12042 · 2.30 Impact Factor
  • Source
    • "Expanded further actions for the prevention of MTCT have occurred since 1999 [6]. Despite these advances in national policy for control of HIV [13,30], there are indications of operational failures in these procedures [30-32]. Additionally, regional differences are important factors that contribute in Brazil to sustain a non-favorable outcome [16,17,30]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: HAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil. This study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed. In total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001). Despite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.
    AIDS Research and Therapy 07/2011; 8:23. DOI:10.1186/1742-6405-8-23 · 1.84 Impact Factor
Show more