Racial and ethnic disparities in premature births among pregnant women in the NISAMI cohort, Brazil / Disparidades étnicas e raciais nos partos prematuros entre gestantes da coorte NISAMI, Brasil

Abstract The incidence of premature birth has increased worldwide, unequally distributed by race/ethnicity. Racism generates economic inequalities, educational disparities, and differential access to health care, which increases the risk of preterm birth. Thus, this study aimed to evaluate the factors associated with preterm birth and racial and ethnic disparities in premature birth among pregnant women attending prenatal care at the Brazilian Unified Health System health units in the urban area of Santo Antônio de Jesus, Bahia, Brazil. This study used data from 938 pregnant women aged between 18 to 45 years within the NISAMI prospective cohort. Premature birth prevalence was 11.8%, with a higher prevalence among black than non-black women (12.9% versus 6.0%, respectively). Maternal age between 18 and 24 years was the only factor associated with premature birth. A higher risk of premature birth was found among black women than non-black women (RR 3.22; 95%CI 1.42-7.32). These results reveal the existence of racial and social inequalities in the occurrence of premature birth.

Resumo A incidência de parto prematuro tem aumentado em todo o mundo, distribuída de forma desigual por raça/etnia. O racismo gera desigualdades econômicas, disparidades educacionais e acesso diferenciado à saúde, o que aumenta o risco de parto prematuro. Assim, este estudo teve como objetivo avaliar os fatores associados à prematuridade e disparidades raciais e étnicas no parto prematuro entre gestantes atendidas durante o pré-natal em unidades de saúde do Sistema Único de Saúde na zona urbana de Santo Antônio de Jesus, Bahia, Brasil. Este estudo utilizou dados de 938 mulheres grávidas com idade entre 18 e 45 anos dentro da coorte prospectiva do NISAMI. A prevalência de prematuridade foi de 11,8%, sendo maior entre as negras do que entre as não negras (12,9% versus 6,0%, respectivamente). A idade materna entre 18 e 24 anos foi o único fator associado ao parto prematuro. Foi encontrado maior risco de prematuridade entre as mulheres negras do que entre as não negras (RR 3,22; IC95% 1,42-7,32). Esses resultados revelam a existência de desigualdades raciais e sociais na ocorrência do parto prematuro.

Bolsa Familia Program and Perinatal Outcomes: NISAMI Cohort.

This study aimed to assess the impact of the Bolsa Familia Program on perinatal outcomes of pregnant women. A cohort study was conducted with pregnant women supported by prenatal services at 17 Family Health Units in Bahia, Brazil. A previously tested structured questionnaire, which has sociodemographic, economic, prenatal care, lifestyle, and nutritional variables, has been used to collect data. The outcomes included premature birth and low birth weight. A hierarchical conceptual model was constructed, and logistic regression analysis was performed. From a total of 1173 pregnant women, the identified average age was 25.44 years and 34.10% had pre-gestational overweight. The non-beneficiary pregnant women presented a 1.54 (95% CI = 0.46-5.09) times higher chance of giving birth to children with low weight and a 1.03 (95% CI = 95% CI = 0.53-2.00) times chance of premature birth when compared to the beneficiary group. In the multilevel model, some variables were statistically significant, such as age between 18 and 24 years (p = 0.003), age greater than or equal to 35 years (p = 0.025), family income (p = 0.008), employment status (p = 0.010), and maternal height (p = 0.009). The Bolsa Familia Program, as an integrated strategy of social inclusion and economic development, is suggested to exert a protective effect on the health of mother-concept binomial.

Socioeconomic and nutritional aspects of pregnant women assisted by Programa Bolsa Família: cohort NISAMI.

The objective of this study was to evaluate the socioeconomic and nutritional assistance factors of pregnant women who are beneficiaries of the Bolsa Família Program and were attended at a prenatal service in the city of Recôncavo da Bahia. A cohort study was conducted with 250 pregnant women from the prenatal service in 16 Family Health Units from August 2013 to December 2014. A structured and previously tested questionnaire was used to collect data. Socioeconomic and nutritional variables were used. It was identified that the average age was 28.3 years, of these, 85.2% studied until high school, 72.4% of pregnant women reported having income less than or equal to two minimum wages, with a mean of 1,036.3 and 26.8% reported receiving the benefit. It was observed that 40% had a pre-gestational Body Mass Index of overweight, 38% presented adequate weight gain for Gestational Age; 90.57% performed more than 7 consultations and 75.6% reported that they made use of alcoholic beverages or stopped in the gestation. The Bolsa Família Program as an integrated strategy for social inclusion and economic development seems to have a protective effect on the nutritional health of pregnant women in the municipality.

Socioeconomic and nutritional aspects of pregnant women assisted by Programa Bolsa Família: cohort NISAMI / Aspectos socioeconômicos e nutricionais de gestantes do Programa Bolsa Família: coorte NISAMI

Abstract The objective of this study was to evaluate the socioeconomic and nutritional assistance factors of pregnant women who are beneficiaries of the Bolsa Família Program and were attended at a prenatal service in the city of Recôncavo da Bahia. A cohort study was conducted with 250 pregnant women from the prenatal service in 16 Family Health Units from August 2013 to December 2014. A structured and previously tested questionnaire was used to collect data. Socioeconomic and nutritional variables were used. It was identified that the average age was 28.3 years, of these, 85.2% studied until high school, 72.4% of pregnant women reported having income less than or equal to two minimum wages, with a mean of 1,036.3 and 26.8% reported receiving the benefit. It was observed that 40% had a pre-gestational Body Mass Index of overweight, 38% presented adequate weight gain for Gestational Age; 90.57% performed more than 7 consultations and 75.6% reported that they made use of alcoholic beverages or stopped in the gestation. The Bolsa Família Program as an integrated strategy for social inclusion and economic development seems to have a protective effect on the nutritional health of pregnant women in the municipality.

Resumo Objetivou-se avaliar os fatores socioeconômicos e de assistência nutricional de gestantes beneficiárias do Programa Bolsa Família que foram atendidas em serviço de pré-natal em município do Recôncavo da Bahia. Estudo transversal realizado com 250 gestantes do serviço de pré-natal em 16 Unidades de Saúde da Família, de agosto de 2013 a dezembro de 2014. Para a coleta de dados, utilizou-se questionário fechado envolvendo informações socioeconômicas, antropométricas e de saúde da gestante. Identificou-se que a média de idade das gestantes foi de 28,3 anos, das quais 85,2% estudaram até o ensino médio, 72,4% das gestantes afirmaram possuir renda menor ou igual a dois salários mínimos, com uma média de 1.036,3 reais, e 26,8% declararam receber o benefício. Observou-se que 40% encontravam-se com Índice de Massa Corporal pré-gestacional de excesso de peso, 38% apresentaram um ganho de peso adequado para Idade Gestacional; 90,57% realizaram mais de 7 consultas, e 75,6% relataram que fizeram uso de bebida alcoólica ou pararam na gestação. O Programa Bolsa Família, enquanto uma estratégia integrada de inclusão social e de desenvolvimento econômico, parece exercer efeito protetor na saúde nutricional das gestantes do município.

Estado antropométrico pré-gestacional e peso ao nascer: Coorte NISAMI / Pre-gestational anthropometric status and birth weight: NISAMI cohort

objetivo do estudo foi analisar a relação entre o Índice de Massa Corporal pré-gestacional (IMCpg) e peso do recém nascido no município de Santo Antônio de Jesus-BA. Estudo de coorte prospectivo, com 185 gestantes e seus respectivos recém-nascidos, atendidas nas Unidades Básicas de Saúde, de abril de 2012 a novembro de 2013. O IMC pré-gestacional foi realizado com dados do peso referido e estatura aferida no dia da aplicação do questionário. O teste de Kolmogorov–Smirnov foi realizado para análise da normalidade dos dados. Estimou-se a associação entre o estado nutricional pré gestacional e os desfechos perinatais, por meio do Risco Relativo e intervalo de confiança de 95%. Das 185 mulheres, 44,9% iniciaram a gestação com algum desvio ponderal. As mulheres com baixo peso e sobrepeso apresentaram associação positiva para peso insuficiente ao nascer (<3000g), sendo as com baixo peso (RR=2,2; IC95%=0,5-9,5) e sobrepeso (RR=1,1; IC95%=0,5-2,6), enquanto as obesas apresentaram associação negativa (RR=0,8; IC95%=0,3-2,7). Apenas as mulheres com baixo peso apresentaram risco para baixo peso ao nascer (RR=3,1; IC95%=0,3-30,7). Esses dados revelam que o estado antropométrico pré-gestacional influencia no desenvolvimento da gestação e as inadequações nutricionais configuradas em períodos anteriores à concepção são considerados fatores determinantes para o peso da criança. Os desvios ponderais pré gestacionais apresentaram associação positiva com o peso inadequado ao nascer, o que sugere a necessidade de cuidados nutricionais pré-concepcionais. Assistência à saúde a mulheres em idade fértil poderá auxiliar em melhores desfechos gestacionais.(AU)

The aim of this study was to analyze the relationship between the pre-gestational Body Mass Index (BMIpg) and the newborn's weight in the municipality of Santo Antônio de Jesus, BA. This was a prospective cohort study, with 185 pregnant women and their respective newborns, attended at the Basic Health Units, from April 2012 to November 2013. The pre-gestational BMI was performed with data of their referred weight and height measured on the day of application of the questionnaire. The Kolmogorov – Smirnov test was performed to analyze the normality of the data. The association between pre-pregnancy nutritional status and perinatal outcomes was estimated through the Relative Risk and 95% confidence interval. Of the 185 women, 44.9% started the pregnancy with some weight deviation. Underweight (RR = 2.2; 95% CI = 0.5-9.5) and overweight (RR = 1, 1; 95% CI = 0.5-2.6) women showed a positive association with insufficient birth weight (<3000g), while obese women presented a negative association (RR = 0.8; 95% CI = 0.3-2.7). Only underweight women were at risk for low birth weight (RR = 3.1; 95% CI = 0.3-30.7). These data reveal that the pre-gestational anthropometric status influences the development of pregnancy and the nutritional inadequacies configured in periods prior to conception are considered determining factors for the child's weight. Pre-pregnancy weight deviations were positively associated with inadequate birth weight, which suggests the need for preconception nutritional care. Health care for women of childbearing age may assist in better pregnancy outcomes.(AU)

Food insecurity in pregnant women is associated with social determinants and nutritional outcomes: a systematic review and meta-analysis.

The association between FI, social determinants, and nutritional outcomes for pregnant women are analyzed. A systematic review was conducted through a search of articles in five electronic databases. Social determinants (race, education, participation in social programs) and nutritional status (pre-gestational BMI, gestational weight gain, anemia) were analyzed in relation to the FI situation. For each article, the frequency of food insecurity was collected in order to calculate the summary measure, prevalence ratio (PR). 26 articles were selected. An elevated occurrence of FI was associated with black pregnant women (PR: 1.83, 95% CI 1.08-3.10), participation in social protection programs (PR = 1.43, 1.02-2.01), and with low education levels on the part of pregnant women (PR = 2.73, 1.68-4.43). FI increased the chances of being overweight (PR = 1.57, 95% CI = 1.29-1.91) and obese (PR = 1.47, 95% CI = 1.15-1.87) in pregnant women, as well as excessive weight gain (PR = 1.42, 95% CI = 1.10-1.82) and inadequate weight gain (PR = 1.47; 95% CI = 1.09-1.97) during pregnancy. Anemia was not associated with FI. Social inequities are associated with food and nutritional insecurity in pregnant women.

Food insecurity in pregnant women is associated with social determinants and nutritional outcomes: a systematic review and meta-analysis / Associação entre insegurança alimentar, determinantes sociais e desfechos nutricionais em mulheres grávidas: revisão e metanálise

Abstract The association between FI, social determinants, and nutritional outcomes for pregnant women are analyzed. A systematic review was conducted through a search of articles in five electronic databases. Social determinants (race, education, participation in social programs) and nutritional status (pre-gestational BMI, gestational weight gain, anemia) were analyzed in relation to the FI situation. For each article, the frequency of food insecurity was collected in order to calculate the summary measure, prevalence ratio (PR). 26 articles were selected. An elevated occurrence of FI was associated with black pregnant women (PR: 1.83, 95% CI 1.08-3.10), participation in social protection programs (PR = 1.43, 1.02-2.01), and with low education levels on the part of pregnant women (PR = 2.73, 1.68-4.43). FI increased the chances of being overweight (PR = 1.57, 95% CI = 1.29-1.91) and obese (PR = 1.47, 95% CI = 1.15-1.87) in pregnant women, as well as excessive weight gain (PR = 1.42, 95% CI = 1.10-1.82) and inadequate weight gain (PR = 1.47; 95% CI = 1.09-1.97) during pregnancy. Anemia was not associated with FI. Social inequities are associated with food and nutritional insecurity in pregnant women.

Resumo O estudo objetiva analisar a associação entre insegurança alimentar, determinantes sociais e estado nutricional de mulheres gestantes por meio de uma revisão sistemática e metanálise. As buscas de artigos ocorreram em cinco bases eletrônicas. Determinantes sociais (raça, escolaridade, participação em programa social) e estado nutricional (IMC pré-gestacional, ganho de peso gestacional, anemia) foram analisados em relação à situação de IA. Em cada estudo, a frequência de insegurança alimentar foi coletada para calcular a medida sumário- razão de prevalência (RP) e seu intervalo de confiança de 95%(IC95%). Foram selecionados 26 artigos. Observou-se elevada ocorrência de IA em gestantes pretas (RP:1,83; IC 95% 1,08-3.10), naquelas com participação em programas de proteção social (RP = 1.43; IC 95%= 1.02- 2.01) e com baixo nível de escolaridade (RP = 2.73; IC 95%= 1.68-4.43). O fato de a gestante possuir companheiro protegeu contra IA (RP = 0.61; IC 95%= 0.40-0.95). A experimentação da IA elevou a chance de sobrepeso (RP = 1.57; IC 95% = 1.29-1.91) e de obesidade (RP = 1.47; IC 95% = 1.15-1.87), assim como o ganho excessivo (RP = 1.42; IC 95% = 1.10-1.82) e inadequado (RP = 1.47; IC 95%= 1.09-1.97) de peso na gestação. Iniquidades sociais estão associadas a IA em gestantes.

Association between gestational weight gain and birth weight: NISAMI Cohort / Associação entre ganho ponderal na gestação e peso ao nascer: Coorte NISAMI

Abstract Objectives: this study aims to evaluate the association between gestational weight gain and the weight of newborns from one municipality in Recôncavo Baiano region. Methods: this is a prospective cohort (NISAMI Cohort), conducted with 185 pregnant women living in the urban area of the municipality of Santo Antônio de Jesus, using the prenatal service of the Family Health Units, between April 2012 and June 2013. The pregestationalBMI and the third trimester of pregnancy were used to assess maternal anthropometric status.Birth weight data were collected from the Epidemiological Surveillance of the municipality. Stata 12.0 software was used for statistical analysis. Logistic regression analysis was used to evaluate to assess the association. Results: among the 185 women evaluated, 33.5% presented inadequate weight gain during pregnancy. The prevalence of inadequate birth weight was 20% (birth weight ≤ 2.999g and ≥ 4.000 g). It was observed that inadequate weight gain during pregnancy is considered an embarrassing factor for birth weight (OR= 2.6; CI95%= 1.5-3.5); adjusted for the following variables: alcohol consumption, duration of pregnancy, and gestational complications. Conclusion: the research results suggest that weight gain throughout pregnancy influences the weight of the conceptus, indicating the need for nutritional interventions in all trimesters of pregnancy, promoting a healthy weight gain throughout the gestational cycle.

Resumo Objetivos: avaliar a associação entre ganho ponderal na gestação e o peso de recém-nascidos em um município do Recôncavo Baiano. Métodos: trata-se de uma coorte prospectiva (Coorte NISAMI), conduzida com 185 gestantes residentes na zona urbana do município de Santo Antônio de Jesus, captadas no serviço de pré-natal das Unidades de Saúde da Família, entre abril de 2012 a junho de 2013. O IMC pré-gestacional e do terceiro trimestre da gestação foram utilizados para avaliar o estado antropométrico materno. Os dados de peso ao nascer foram coletados da Vigilância Epidemiológica do município. Utilizou-se o software Stata 12.0 para as análises estatísticas. Empregou-se análise de regressão logística para avaliar a associação. Resultados: das 185 mulheres, 33,5% apresentaram ganho ponderal inadequado ao longo da gestação. A prevalência de peso inadequado ao nascer foi de 20% (peso ao nascer ≤2.999g e ≥ 4.000 g). Observou-se que o ganho de peso inadequado no período gestacional é considerado fator constrangedor do peso ao nascer (OR= 2,6; IC95%= 1,5-3,5; ajustado pelas variáveis: consumo de bebida alcoólica, duração da gestação e intercorrências gestacionais. Conclusão: o resultado desta investigação sugere que o ganho de peso ao longo da gestação exerce influência no peso do concepto indicando necessidade de intervenções nutricionais em todos os trimestres da gestação, promovendo um ganho ponderal saudável em todo ciclo gestacional.

Off-label use of drugs by age in Brazilian children: a population study. / Uso off-label de medicamentos segundo a idade em crianças brasileiras: um estudo populacional.

OBJECTIVE: To estimate the prevalence of off-label drug use by age in children 12 years old and younger in Brazil. METHOD: Population-based cross-sectional study (National Survey on Access, Use and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children aged 12 years or younger. Face-to-face interviews were used to collect the data in the domiciles. The age-related off-label classification was carried out using the electronic medication compendium of National Agency of Sanitary Surveillance (ANVISA). Sociodemographic characteristics, presence of chronic disease, use of health services and characteristics of the informant were collected. Data were expressed by relative frequencies and 95% confidence intervals. Pearson's chi-square test was used to evaluate the statistical significance of the differences between the groups, with a significance level of 5%. Main outcome measure was the prevalence of off-label use. RESULTS: The prevalence of off-label use by age was 18.7% (95%CI 16.4 - 21.3). Children younger than 2 years old presented the highest prevalence of off-label use. The most frequently used off-label drugs by age were amoxicillin, nimesulide and the combination of phenylephrine and brompheniramine. CONCLUSION: The off-label use of drugs by age is common in the Brazilian pediatric population, especially among children under two years old.

Uso off-label de medicamentos segundo a idade em crianças brasileiras: um estudo populacional / Off-label use of drugs by age in Brazilian children: a population study

RESUMO: Objetivo: Estimar a prevalência de uso off-label de medicamentos segundo a idade em crianças de 0 a 12 anos no Brasil. Métodos: Estudo transversal de base populacional (Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - PNAUM), incluindo 7.528 crianças de 0 a 12 anos de idade. Entrevistas individuais face a face foram utilizadas para coletar os dados nos domicílios. A classificação off-label segundo a idade foi realizada por meio de consulta ao compêndio eletrônico da Agência Nacional de Vigilância Sanitária (ANVISA). Características sociodemográficas, presença de doença crônica, uso de serviços de saúde e características do informante foram coletadas. Os dados foram expressos por frequências relativas e intervalos de confiança de 95% (IC95%). O teste do χ2 de Pearson foi usado para avaliar a significância estatística das diferenças entre os grupos, com um nível de significância de 5%. A principal medida de desfecho foi a prevalência de uso off-label segundo a idade. Resultados: A prevalência de uso off label por idade foi de 18,7% (IC95% 16,4 - 21,3). Crianças com menos de 2 anos apresentaram maior prevalência desse uso em relação às mais velhas. Os medicamentos com maior frequência de uso off-label segundo a idade foram amoxicilina, nimesulida e a combinação de fenilefrina com bronfeniramina. Conclusão: O uso off-label de medicamentos segundo a idade é comum na população pediátrica brasileira, especialmente nas crianças menores de 2 anos de idade.

Abstract: Objective: To estimate the prevalence of off-label drug use by age in children 12 years old and younger in Brazil. Method: Population-based cross-sectional study (National Survey on Access, Use and Promotion of Rational Use of Medicines - PNAUM), including 7,528 children aged 12 years or younger. Face-to-face interviews were used to collect the data in the domiciles. The age-related off-label classification was carried out using the electronic medication compendium of National Agency of Sanitary Surveillance (ANVISA). Sociodemographic characteristics, presence of chronic disease, use of health services and characteristics of the informant were collected. Data were expressed by relative frequencies and 95% confidence intervals. Pearson's chi-square test was used to evaluate the statistical significance of the differences between the groups, with a significance level of 5%. Main outcome measure was the prevalence of off-label use. Results: The prevalence of off-label use by age was 18.7% (95%CI 16.4 - 21.3). Children younger than 2 years old presented the highest prevalence of off-label use. The most frequently used off-label drugs by age were amoxicillin, nimesulide and the combination of phenylephrine and brompheniramine. Conclusion: The off-label use of drugs by age is common in the Brazilian pediatric population, especially among children under two years old.

Avaliação das práticas seguras em hospital público do nordeste brasileiro / Evaluation of safe practices in a public hospital in the northeast of Brazil / Evaluación de prácticas seguras en un hospital público en el noreste de Brasil

Objetivo: avaliar instituição hospitalar quanto à implantação das práticas seguras. Método: estudo descritivo e observacional, realizado em 2019, em hospital público do nordeste do Brasil. Utilizou-se o questionário Avaliação da Gestão de Riscos Assistenciais em Serviços de Saúde (AGRASS), com 40 itens, e roteiro para a observação não participante. Amostra foi constituída por um gestor de risco, três farmacêuticos, quatro enfermeiros, nove técnicos de enfermagem e dois de farmácia. Resultados: na avaliação do grau de implantação da gestão de riscos, foi obtido um total de 22 itens com respostas positivas, indicando a completa adesão desta prática em mais de 50%. Na observação de campo, encontraram-se fragilidades na maioria dos achados, destacando-se a higienização das mãos e prescrição, uso e administração de medicamentos. Conclusão: as potencialidades e fragilidades referentes às práticas observadas exigem ações educativas contínuas e melhoria da gestão de riscos para alcance pleno da cultura de segurança.

Objective: to evaluate a hospital institution regarding the implementation of safe practices. Method: descriptive and observational study, conducted in 2019, in a public hospital in northeastern Brazil. A 40-item Health Care Risk Management Assessment (AGRASS) questionnaire was used and a script for non-participant observation. Sample consisted of one risk manager, three pharmacists, four nurses, nine nursing technicians and two pharmacy technicians. Results: in the assessment of the degree of implementation of risk management, a total of 22 items with positive answers were obtained, indicating the complete adherence of this practice by more than 50%. In the field observation, weaknesses were found in most findings, especially hand hygiene and prescription, use and administration of medications. Conclusion: the potentialities and weaknesses regarding the observed practices require continuous educational actions and improvement of risk management to fully reach the safety culture.

Objetivo: evaluar una institución hospitalaria con respecto a la implementación de prácticas seguras. Método: estudio descriptivo y observacional, realizado en 2019, en un hospital público del noreste de Brasil. Se utilizó un cuestionario de evaluación de gestión de riesgos de atención médica (AGRASS) de 40 ítems y un guión para la observación no participante. La muestra consistió en un gerente de riesgos, tres farmacéuticos, cuatro enfermeras, nueve técnicos de enfermería y dos técnicos de farmacia. Resultados: en la evaluación del grado de implementación de la gestión de riesgos, se obtuvieron un total de 22 ítems con respuestas positivas, lo que indica la adherencia completa de esta práctica en más del 50%. En la observación de campo, se encontraron debilidades en la mayoría de los hallazgos, especialmente la higiene de manos y la prescripción, el uso y la administración de medicamentos. Conclusión: las potencialidades y debilidades con respecto a las prácticas observadas requieren acciones educativas continuas y la mejora de la gestión de riesgos para alcanzar plenamente la cultura de seguridad.

Access to medicines: relations with the institutionalization of pharmaceutical services.

OBJETIVE: To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS: This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS: Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS: Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.

Access to medicines: relations with the institutionalization of pharmaceutical services / Acesso a medicamentos: relações com a institucionalização da assistência farmacêutica

ABSTRACT OBJETIVE To analyze the relationship between access to medicines by the population and the institutionalization of pharmaceutical services in Brazilian primary health care. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services 2015), a cross-sectional, exploratory, and evaluative study composed of an information survey in a representative sample of cities, stratified by Brazilian regions. Access was defined based on the acquisition of medicines reported by the patient, ranging between: total, partial, or null. The institutionalization of pharmaceutical services was analyzed based on information provided by pharmaceutical services providers and by those responsible for medicines delivery. Chi-square test and multinomial logistic regression were used in the statistical analysis. RESULTS Full access to medicines was greater when professionals affirmed there were the following aspects of the dimensions: "management tools," "participation and social control," "financing," and "personnel structure," with significant associations in the bivariate analysis. The "pharmaceutical care" dimension did not achieve such an association. After multinomial logistic regression, full access was more prevalent when those in charge of pharmaceutical services stated that: they always or repeatedly attend meetings of the Municipal Health Council, OR = 3.3 (95%CI 1.5-7.3); there are protocols for medicines delivery, OR = 2.7 (95%CI 1.2-6.1); there is computerized system for managing pharmaceutical services, OR = 3.9 (95%CI 1.9-8.0); those responsible for medicines delivery reported having participated in a course or training for professionals in the past two years, OR = 2.0 (95%CI 1.1-3.5); there is computerized system for pharmaceutical services management, OR = 4.3 (95%CI 2.4-7.5). CONCLUSIONS Aspects related to the institutionalization of pharmaceutical services have been strongly related to access to medicines. Our results indicate the need to prioritize its implementation, contributing to its consolidation in Brazil and to the effectiveness of health services regarding the purposes of pharmaceutical services policies.

RESUMO OBJETIVO Analisar as relações entre o acesso a medicamentos pela população e a institucionalização da assistência farmacêutica, na atenção básica. MÉTODOS Este artigo integra a Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços 2015, estudo transversal, exploratório, de natureza avaliativa, composto por um levantamento de informações em amostra representativa de municípios, estratificada pelas regiões do Brasil. O acesso a medicamentos foi definido a partir do referencial de obtenção pelo usuário, variando entre: total, parcial ou nulo. A institucionalização da assistência farmacêutica foi analisada a partir das informações prestadas por responsáveis pela assistência farmacêutica e por responsáveis pela entrega de medicamentos. Na análise estatística foram utilizados o teste Qui-quadrado e regressão logística multinomial. RESULTADOS O acesso total a medicamentos foi maior quando os profissionais afirmaram haver aspectos das dimensões: "ferramentas de gestão", "participação e controle social", "financiamento" e "estrutura de pessoal", constatando-se associações significantes na análise bivariada. A dimensão "atenção farmacêutica" não obteve tal associação. Após regressão logística multinomial, o acesso total foi mais prevalente quando responsáveis pela assistência farmacêutica afirmaram: participar sempre ou repetidamente das reuniões do Conselho Municipal de Saúde, RP= 3,3 (IC95% 1,5-7,3); existir protocolos para a entrega de medicamentos, RP= 2,7 (IC95% 1,2-6,1); existir sistema informatizado para gestão da assistência farmacêutica, RP= 3,9 (IC95% 1,9-8,0); e quando responsáveis pela entrega de medicamentos afirmaram ter participado de curso ou capacitação para profissionais nos últimos dois anos, RP= 2,0 (IC95% 1,1-3,5) e haver sistema informatizado para gestão da assistência farmacêutica, RP= 4,3 (IC95% 2,4-7,5). CONCLUSÕES Aspectos relacionados com a institucionalização da assistência farmacêutica se mostraram fortemente relacionados com o acesso a medicamentos. Os resultados indicam a necessidade de priorizar a sua implementação, contribuindo para sua consolidação no Brasil e efetividade dos serviços de saúde quanto às finalidades das políticas de assistência farmacêutica.

Consumo alimentar de gestantes atendidas em Unidades de Saúde / Food consumption of pregnant women assisted in Health Units

A alimentação exerce função indispensável para a saúde das gestantes. Devido ao período intenso de metabolismofaz-se necessário um consumo alimentar saudável que favoreça o desenvolvimento de uma gestação adequada.Diante dessas informações, o objetivo deste estudo foi analisar a adequação dos grupos alimentares consumidos pelasgestantes atendidas em consultas de pré-natal nas unidades de Saúde de um município do Recôncavo da Bahia. Trata-sede um estudo transversal, envolvendo gestantes atendidas no serviço de pré-natal da rede pública do ano 2010, 2011 e2012. Foi utilizado questionário estruturado com informações, obstétricas e de saúde. Para avaliar o consumo alimentarutilizou-se o Questionário de Frequência de Consumo de Alimentos (QFCA). As porções dos grupos alimentares foramdeterminadas e em seguida analisadas segundo a pirâmide alimentar adaptada para população brasileira. Analisaramsetambém as características socioeconômicas da amostra. Foram entrevistadas 70 gestantes, com idade de 20 a 45anos. Destas, 75,8% eram casadas ou com união estável, 78,6% com nível médio de escolaridade, 36,2% apresentaramrenda familiar menor que um salário mínimo e 41,5% autodeclaram-se negras. Observou-se que as característicassocioeconômicas podem influenciar diretamente no consumo alimentar das gestantes. Na análise dos grupos alimentaresnotou-se consumo insuficiente de leguminosas, leite e produtos lácteos, e consumo excessivo do grupo de açúcares/doces e carnes e ovos. Observou-se consumo alimentar inadequado em termos qualitativos (grupos alimentares),não atendendo às necessidades específicas do ciclo gestacional, podendo implicar em risco nutricional para mãe e oconcepto.(AU)

Food plays essential role for the health of pregnant women. Due to the intense metabolism period, it is necessaryhealthy food consumption which ensures the development of an adequate pregnancy. Due to this information, the aimof this study is to analyze the adequacy of food groups consumed by pregnant women attending prenatal consultationsin the health units of the municipality Reconcavo in Bahia. It is a cross sectional study involving pregnant women inprenatal service of the public network over the years 2010, 2011 and 2012. It was used structured questionnaire withsocio-demographic information, obstetric and health. To assess food consumption it was used the Survey of FoodConsumption Frequency (FFQ). The portions of the food groups were determined then analyzed according to the foodpyramid adapted to the Brazilian population. It was also analyzed the socioeconomic characteristics of the sample. Theyinterviewed 70 pregnant women aged between 20 and 45 years. Among these women, 75.8% were married or in astable relationship, 78.6% with high school degree, 36.2% had family income lower than the minimum wage and 41.5%declare themselves as black. It was observed that the socioeconomic characteristics can influence directly on the diet ofpregnant women. In the analysis of food groups was noted insufficient intake of legumes, milk and dairy products, andexcessive consumption of the group of sugar/sweets and meats and eggs. There was inadequate food consumption interms of qualitative (food groups), not taking into account the specific needs of the gestational cycle, which may resultin nutritional risk to mother and fetus.(AU)

Amamentação: conhecimento e prática de gestantes / Breast Feeding: knowledge and practice of pregnancy

O leite materno contribui positivamente para o crescimento e desenvolvimento da criança e apresenta vantagens imunológicas,psicológicas e nutricionais. Adicionalmente, leva a considerável redução na mortalidade infantil por todas ascausas e também é importante para a saúde da mulher. Considerando as informações apresentadas, o objetivo do presenteestudo foi identificar os conhecimentos e a prática do aleitamento materno de gestantes atendidas em unidades de saúdeem um município do Recôncavo Baiano. Estudo transversal, envolvendo gestantes atendidas em pré-natal em unidades desaúde em município do Recôncavo da Bahia, de Outubro de 2010 a Maio de 2011. Foram excluídas do estudo gestantescom HIV/AIDS ou que se recusaram a participar. Foi utilizado um questionário estruturado sobre aleitamento materno etécnica da mamada, contendo 34 questões, sendo 19 destinadas às multíparas, sobre a experiência prévia com amamentação.Foram entrevistadas 50 gestantes, sendo 68% primigestas. Cerca de 76% das mulheres consideraram que as criançasdeveriam mamar exclusivamente ao seio até os 6 meses, e 80% consideraram o leite materno forte. No que tange aosbenefícios do aleitamento materno para a saúde da mulher, 88% reconheceram a importância dessa prática e apontaramcomo principal benefício a redução do câncer de mama (68%). Apesar da maioria das mães apresentarem conhecimentosobre a importância do aleitamento materno, este ainda não é aplicado satisfatoriamente na prática da amamentação.Deve-se salientar a importância de ações de educação e apoio à amamentação desde o pré-natal até a fase de introduçãode novos alimentos para otimização da prática do aleitamento materno.(AU)

Breastfeeding contributes positively to the growth and development of children and presents advantages immunological,psychological and nutritional. Additionally, it leads to considerable reduction in mortality from all causes and is alsoimportant for women’s health. Considering the information presented, there is the objective of this study was to identifythe knowledge and practice of breast-feeding of pregnant women attending health facilities in one district of ReconcavoBaiano. It is a cross-sectional study involving pregnant women attending antenatal care in health facilities in the municipalityReconcavo of Bahia, October/2010 to May/2011. The study excluded women with HIV / AIDS or who refused toparticipate. We used a structured questionnaire on breastfeeding and breastfeeding technique, containing 34 questions,19 aimed at multiparous on previous experience with breastfeeding. We interviewed 50 pregnant women, 68% primiparous.About 76% of women felt that children should breastfeed exclusively breastfed until 6 months, and 80% consideredstrong breast milk. Regarding the benefits of breastfeeding for the health of women, 88% recognized the importance ofthis practice and pointed as the main benefit to reducing breast cancer (68%). Although most mothers present knowledgeabout the importance of breastfeeding, it is not yet satisfactorily applied in the practice of breastfeeding. Must stress theimportance of education initiatives and support breastfeeding from antenatal and even the phase of introduction of newfoods for optimal breastfeeding.(AU)

Use of prescribed and non-prescribed medications among children living in poor areas in the city of Salvador, Bahia State, Brazil.

A cross-sectional study of children living in poor areas in the city of Salvador, Bahia State, Brazil, was carried out in 2006 to investigate the prevalence of use of prescribed and non-prescribed medication. This population-based study included 1,382 children aged 4-11 years. The use prescribed and non-prescribed medication during the 15 day period preceding the interview was adopted as the dependent variable. Of the 1,382 children, 663 (48%) had used at least one type of medication in the 15 days prior to the interview: in 267 cases (40.3%), mothers reported that the child had taken prescribed medication, while in 396 cases (59.7%), the child had taken medication that had not been prescribed by a physician. The most commonly prescribed drugs were analgesics (42.3%), systemic antibiotics (21.3%) and antiasthmatic (16.5%). With respect to non-prescribed drugs, the most common were analgesics (65.2%), antitussives (15.7%) and vitamins (9.3%). The results show a high prevalence of the use of non-prescription drugs among poor children, and large drug purchases of drugs by the head of household, highlighting deficiencies in coverage of the health system.

Use of prescribed and non-prescribed medications among children living in poor areas in the city of Salvador, Bahia State, Brazil / Consumo de medicamentos prescritos e não prescritos entre crianças residentes em áreas pobres de Salvador, Bahia, Brasil

A cross-sectional study of children living in poor areas in the city of Salvador, Bahia State, Brazil, was carried out in 2006 to investigate the prevalence of use of prescribed and non-prescribed medication. This population-based study included 1,382 children aged 4-11 years. The use prescribed and non-prescribed medication during the 15 day period preceding the interview was adopted as the dependent variable. Of the 1,382 children, 663 (48 percent) had used at least one type of medication in the 15 days prior to the interview: in 267 cases (40.3 percent), mothers reported that the child had taken prescribed medication, while in 396 cases (59.7 percent), the child had taken medication that had not been prescribed by a physician. The most commonly prescribed drugs were analgesics (42.3 percent), systemic antibiotics (21.3 percent) and antiasthmatic (16.5 percent). With respect to non-prescribed drugs, the most common were analgesics (65.2 percent), antitussives (15.7 percent) and vitamins (9.3 percent). The results show a high prevalence of the use of non-prescription drugs among poor children, and large drug purchases of drugs by the head of household, highlighting deficiencies in coverage of the health system.

A prevalência de uso de medicamentos prescritos e não prescritos foi investigada por intermédio dum estudo transversal, em crianças que vivem em áreas pobres da cidade de Salvador, Bahia, Brasil, em 2006. Estudo de base populacional que incluiu 1.382 crianças entre 4 e 11 anos de idade. O consumo de medicamentos prescritos e não prescritos nos 15 dias anteriores à entrevista foi considerado a variável dependente. Das 1.382 crianças, 663 (48 por cento) haviam consumido ao menos um medicamento nos últimos 15 dias: 267 (40,3 por cento) referidas pela mãe haviam consumido medicamentos prescritos e 396 (59,7 por cento) consumiram medicamentos não prescritos. Os grupos farmacológicos prescritos mais consumidos foram analgésicos (42,3 por cento), antibacterianos sistêmicos (21,3 por cento) e antiasmáticos (16,5 por cento). Os grupos farmacológicos não prescritos mais consumidos foram analgésicos (65,2 por cento), antitussígenos (15,7 por cento) e vitaminas (9,3 por cento). Os resultados mostram uma alta prevalência do uso de medicamentos sem prescrição em crianças pobres, bem como elevada compra de medicamentos pelas famílias, evidenciando deficiências de cobertura do sistema de saúde.