Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study.

BACKGROUND: This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. METHODS: Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. RESULTS: Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. CONCLUSIONS: Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. METHODS: An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions. RESULTS: Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. CONCLUSIONS: The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Aleitamento materno exclusivo: conhecimentos de puérperas na atenção básica / Exclusive breastfeeding: knowledge of puerperals in primary care / Lactancia materna exclusiva: conocimiento de puérperas en atención primaria

Objetivos: investigar o conhecimento de puérperas acerca da prática do aleitamento materno exclusivo. Método: Pesquisa com abordagem qualitativa realizada no período de dezembro de 2020 a abril de 2021 na Unidade Básica de Saúde Nova Imperatriz em Imperatriz (MA). Foram incluídas puérperas frequentadoras da unidade básica, em processo de amamentação ou desmame, residentes na área de abrangência. Participaram da pesquisa 42 puérperas que foram entrevistadas e responderam a um questionário semi-estruturado. A pesquisa atendeu aos princípios éticos e foi aprovada pelo comitê de Ética em pesquisa da Universidade Federal do Maranhão sob o parecer de número 4.378.168.Resultados: A faixa etária das puérperas variou de 18 a 37 anos, se autodeclararam pardas 76,1%, eram casadas 57%, possuíam o ensino médio completo 47,6%, eram donas de casa 66,7%, com renda familiar de 1 a 2 salários mínimos 38,1%, e sem moradia própria 54,8%. Eram primíparas 52,4%, todas realizaram o pré-natal, tendo a maioria (83,3%) comparecido a mais de seis consultas. Os dados qualitativos foram analisados e emergiram as seguintes categorias: Promoção do aleitamento maternoe aleitamento materno exclusivo; Mitos e tabus sobre o Aleitamento materno; Riscos da interrupção precoce do aleitamento materno exclusivo. Considerações finais: Notou-se que o conhecimento materno acerca do aleitamento ainda é pequeno. As orientações fornecidas nos serviços de saúde foram insuficientes para a adequada compreensão da relevância do aleitamento materno exclusivo, bem como para a sua adesão.

Objectives: to investigate the knowledge of puerperwomen about the practice of exclusive breastfeeding. Method: Research with qualitative approach conducted from December 2020 to April 2021 at the Basic Health Unit Nova Imperatriz in Imperatriz (MA). Postpartum women attending the basic unit, in the process of breastfeeding or weaning, living in the area of coverage were included. Forty-two puerperal women who were interviewed and answered a semi-structured questionnaire participated in the study. The research met ethical principles and was approved by the Research Ethics Committee of the Federal University of Maranhão under the opinion of number 4,378,168. Results: The age group of the puerperum ranged from 18 to 37 years, 76.1% were brown, 57% were married, had completed high school 47.6%, housewives 66.7%, with a family income of 1 to 2 minimum wages 38.1%, and without their own home housing 54.8%. They were primiparous 52.4%, all of them had prenatal care, with the majority (83.3%) showing up for more than six consultations. Qualitative data were analyzed and the following categories emerged: Promotion of breastfeeding and exclusive breastfeeding; Myths and taboos about Breastfeeding; Risks of early interruption of exclusive breastfeeding. Final considerations: It was noticed that maternal knowledge about breastfeeding is still small. The guidelines provided in the health services were insufficient to adequately understand the relevance of exclusive breastfeeding, as well as for its support.

Objetivos: investigar el conocimiento de las puerpermadas sobre la práctica de la lactancia materna exclusiva. Método: Investigación con enfoque cualitativo realizada desde diciembre de 2020 hasta abril de 2021 en la Unidad Básica de Salud Nova Imperatriz en Imperatriz (MA). Se incluyeron las mujeres posparto que asistían a la unidad básica, en proceso de lactancia o destete, que vivían en el área de cobertura. Cuarenta y dos mujeres puerperales fueron entrevistadas y respondieron a un cuestionario semiestructurado participaron en el estudio. La investigación cumplió con los principios éticos y fue aprobada por el Comité de Ética en Investigación de la UniversidadFederal de Maranhão bajo la opinión del número 4.378.168. Resultados: El grupo de edad del puerperum varió de 18 a 37 años, 76.1% eran morenas, 57% estaban casadas, habían completado la escuela secundaria 47.6%, amas de casa 66.7%, con un ingreso familiarde 1 a 2 salarios mínimos 38.1%, y sin vivienda propia 54.8%. Eran primíparas 52,4%, todas ellas con atención prenatal, y la mayoría (83,3%) se presentaba a más de seis consultas. Se analizaron los datos cualitativos y surgieron las siguientes categorías:Promoción de la lactancia materna y lactancia materna exclusiva; Mitos y tabúes sobre la lactancia materna; Riesgos de interrupción temprana de la lactancia materna exclusiva. Consideraciones finales: Se observó que el conocimiento materno sobre la lactancia materna es aún pequeño. Las directrices proporcionadas en los servicios de salud fueron insuficientes para comprender adecuadamente la pertinencia de la lactancia materna exclusiva, así como para su apoyo.

Representações sociais entre gestantes vivendo com soropositividade para HIV: o discurso do sujeito coletivo / Social representations among pregnant women living with HIV seropositivity: the collective subject's discourse / Representaciones sociales entre mujeres embarazadas que viven con seropositividad del VIH: el discurso del sujeto colectivo

Objetivo: conhecer as representações sociais da gravidez entre gestantes vivendo com HIV positivo. Métodos:estudo qualitativo, fundamentado na Teoria das Representações Sociais. Os dados foram coletados entre março e maio de 2018 através de entrevista semiestruturada iniciada com a questão norteadora da pesquisa: "Fale-me como se sente em relação a sua gestação?" Foram incluídas mulheres comsoropositividade para HIV conhecida antes da atual gravidez, atendidas em maternidade de referência do interior do nordeste do Brasil com idade maior de 18 anos. Para a análise utilizou-se o discurso do Sujeito Coletivo. Resultados:Foram entrevistadas 12 gestantes na faixa etária de 20 a 45 anos e dos discursos emergiram os temas: Descoberta da soropositividade; Motivos da atual gravidez; Percepção quanto a possibilidade da transmissão vertical; Sentimentos quanto ao futuro dos bebês e Fatores facilitadores da adesão terapêutica. Considerações finais:Tornou-se evidente que as gestantes passam por decepção e choque no recebimento do diagnóstico entre outros sentimentos negativos, manifestando-se não apenas ao descobrir-se HIV-positivo, mas em diversas áreas da vida. As gestantes manifestaram boas expectativas quanto ao futuro de seus filhos e conheciam os benefícios da adesão terapêutica.

Objective: to know the social representations of pregnancy among pregnant women living with HIV positive. Methods:qualitative study, based on the Theory of Social Representations. Data were collected between March and May 2018 through a semi-structured interview initiated with the research's guide question: "Tell me how you feel about your pregnancy?" We included women with HIV seropositivity known before the current pregnancy, attended in a reference maternity hospital in the northeast of Brazil aged over 18 years. For the analysis, the collective subject discourse was used. Results:We interviewed 12 pregnant women aged 20 to 45 years and the following themes emerged from the discourses: Discovery of seropositivity; Reasons for the current pregnancy; Perception regarding the possibility of vertical transmission; Feelings about the future of babies and Factors that facilitate therapeutic adherence. Final considerations:It became evident that pregnant women experience disappointment and shock in receiving the diagnosis among other negative feelings, manifesting themselves not only when discovering HIV-positive, but in several areas of life. The pregnant women expressed good expectations about thefuture of their children and knew the benefits of therapeutic adherence.

Objetivo: conocer las representaciones sociales del embarazo en mujeres embarazadas que viven con el VIH. Métodos:estudio cualitativo, basado en la Teoría de las Representaciones Sociales. Los datos se recolectaron entre marzo y mayo de 2018 a través de una entrevista semiestructurada que comenzó con la pregunta guía de la investigación: "¿Dime cómo te sientes acerca de tu embarazo?" Se incluyeron mujeres con seropositividad al VIH conocida antes del embarazo actual, atendidas en una maternidad de referênciaen el interior del noreste de Brasil, mayores de 18 años. Para el análisis se utilizó el discurso del Sujeto Colectivo. Resultados:se entrevistó a 12 gestantes de entre 20 y 45 años y de los discursos surgieron los siguientes temas: Descubrimiento de la seropositividad; Razones del embarazo actual; Percepción de la posibilidad de transmisión vertical; Sentimientos sobre el futuro de los bebés y Factores que facilitan la adherencia terapéutica. Consideraciones finales:Se hizo evidente que las mujeres embarazadas experimentan desilusión y conmoción al recibir el diagnóstico, entre otros sentimientos negativos, manifestándose no solo cuando descubren que son seropositivas, sino en diferentes ámbitos de la vida. Las mujeres embarazadas expresaron buenas expectativas sobre el futuro de sus hijos y fueron conscientes de los beneficios de la adherencia terapéutica.

Óbito neonatal em maternidade pública de referência: fatores associados / Neonatal death in public maternity of reference: associated factors / Muerte neonatal en maternidad pública de referencia: factores asociados

Objetivo: investigar os fatores maternos e neonatais associados aos óbitos neonatais em maternidade de referência no sudoeste maranhense. Metodologia: estudo retrospectivo observacional, quantitativo, com análise documental em prontuários. Brasil. Selecionaram-se prontuários de 677 neonatos nascidos no próprio estabelecimento hospitalar no ano de 2016. Resultados: dos 677 prontuários de recém-nascidos admitidos, ocorreram 14,2% de óbitos e 85,8% de altas, a prematuridade foi o diagnóstico entre 42,4%, seguido de 41,9% de distúrbios respiratórios. A análise ajustada do modelo apontou que o óbito neonatal esteve associado a estatura <35cm (OR: 38,40; p<0,001) e de 35- 39cm (OR: 6,65, p<0,002), perímetro cefálico <22 cm (OR: 38,58; p<0,002) e Apgar no 5º. minuto <3 (OR: 5,91; p<0,001). Conclusão: a prematuridade e os distúrbios respiratórios foram as principais causas de internação. Há necessidade de rever o acesso aos serviços de saúde, assim como a implementação de intervenções qualificadas no pré-natal, parto e nascimento

Objective: to investigate maternal and neonatal factors associated with neonatal deaths in a reference maternity hospital in southwestern Maranhão. Method: quantitative, observational retrospective study, with documental analysis in medical records. Medical records of 677 neonates born in a hospital in southwest Maranhão, in 2016 were selected. Results: of the 677 medical records of admitted newborns, there were 14.2% of deaths and 85.8% of discharges, prematurity was the diagnosis among 42.4%, followed by 41.9% of respiratory disorders. The adjusted analysis of the model showed that neonatal death was associated with height <35cm (OR: 38.40; p<0.001) and 35-39cm (OR: 6.65, p<0.002), head circumference <22 cm (OR: 38.58; p<0.002) and Apgar in the 5th. minute <3 (OR: 5.91; p<0.001). Results: Of the 677 medical records of newborns admitted, there were 96 deaths (14.2%) and 581 discharges (85.8%), with prematurity being the most frequent diagnosis 287 (42.4%), followed by respiratory disorders 284 (41 , 9%). The adjusted analysis of the model showed that neonatal death was associated with height <35cm (OR: 38.40; p <0.001), height of 35-39cm (OR: 6.65, p <0.002), head circumference <22 cm (OR: 38.58; p <0.002) and Apgar in the 5th. minute <3 (OR: 5.91; p <0.001). Conclusion: prematurity and respiratory disorders were the main causes of hospitalization. There is a need to review access to health services, as well as the implementation of qualified interventions in prenatal care, childbirth and birth

Access to Health Services and Assistance Offered to the Afro-Descendant Communities in Northern Brazil: A Qualitative Study.

The remnants of quilombos, individuals of African descent, have faced several barriers throughout its history, either due to prejudice imposed by society, or the non-fulfillment of their rights guaranteed in the 1988 Constitution, such as access to health services. Thus, this study aims to evaluate the health care offered to quilombo communities in the northern region of Tocantins. This is an exploratory, descriptive study with a qualitative approach, including field research and focus group, carried out with 58 quilombo remnants people from communities in the northern region of Tocantins. Data collection was carried out between from October 2017 to July 2018, through semi-structured interviews. We found that these communities have limited access to health services, in addition to a negative perception of the assistance offered to the health of their population and the commitment of managers. Therefore, access to health and assistance received by the studied communities required to be prioritized since the care provided is not unique and has not met the health demands and needs of the remaining quilombos in northern Tocantins, Brazil.

Prevenção do câncer de mama em mulheres atendidas em Unidade Básica de Saúde / Breast cancer prevention in women treated at Primary Care Unit

Descrever o perfil de mulheres atendidas em Unidade Básica de Saúde e identificar as atitudes relacionadas à detecção precoce do câncer de mama. Métodos: pesquisa exploratória e descritiva, realizada com 40 mulheres com idade acima de 20 anos, após a consulta de enfermagem. Resultados: evidenciaram que parcela das participantes possuía fatores de risco para o câncer de mama, principalmente menarca antes dos 12 anos 57% (n=23), em 70% (n=28) as mamas não foram examinadas no momento da consulta e 57,5% (n=23) informaram nunca o ter realizado. Sobre a realização do autoexame, 80% (n=32) das mulheres disseram saber fazer, dessas 65,5% afirmaram realizá-lo mensalmente, 12,5% nunca o ter realizado e 23% das mulheres acima de 40 anos não realizaram mamografia. Conclusão: destaca-se a necessidade do desenvolvimento de intervenções educativas efetivas direcionadas aos fatores de riscos e detecção precoce do câncer de mama nos serviços de saúde...