[Maternal conceptions of infantile diarrhea] / Concepções maternas sobre a diarréia infantil.

OBJECTIVE: To understand maternal conceptions of infantile diarrhea, encouraging reflection on the importance of communication between mothers and health services. METHODS: Survey carried out in selected areas of six towns in the state of Pernambuco, all of which participated in the diarrhea control project coordinated by the State Health Secretariat. The information was obtained through interviews with 770 mothers, producing a representative sample of 1,026 children younger than five years. RESULTS: In general, mothers associated the occurrence of diarrhea with some kinds of food (fatty or undercooked). Better educated mothers, regardless of their place of residence, attributed it to improper hygiene and sanitation, whereas illiterate and poorly educated mothers, from the metropolitan region of Recife, blamed it on hot weather, and those living in the countryside believe the occurrence of diarrhea is related to teething. Circa 24.2% (63.4% living in the countryside) do not know how to prevent the disease. The two preventive measures most frequently adopted consist in drinking treated water and cooking food thoroughly. Only 0.5% mentioned breast-feeding. The number of children still alive and their ages influence maternal conceptions. The main sources of information about the prevention of diarrhea are the support network (45.5%), the health sector (35.9%) and the media (33.2%). CONCLUSIONS: The insufficient participation of the health sector in the information network about diarrhea, misinformation, and sharp disagreement over maternal conceptions and technical knowledge, which are the cornerstone of institutional measures, show that it is necessary to value the communicative dimension of the educational approach in child care.

[Organization of health practices and vulnerability to childhood diarrhea] / Organização das práticas de saúde e vulnerabilidade à diarréia infantil.

OBJECTIVES: This study aimed to characterize, the organization of health practices related to the reduction of vulnerability to childhood diarrhoea. METHODS: A longitudinal study was carried out, with two interconnected transversal cuts, in 14 health services (11 health centres and 3 hospitals), located in six municipalities of Pernambuco that participated of the Diarrhoea Control Implementation Project coordinated by the Health State Department. The data collection was performed through observation, interviews with professionals and mothers of the children, and clinic histories revision. RESULTS: Overall, there was a high proportion of patients who either did not get consulted or had to wait for a long time after their arrival at the health service. No orientation was given on the use of oral rehydration salts at home; little advice on the signs and symptoms of an aggravating episode was given, an elevated number of drugs were prescribed to the children with diarrhoea; and there was high degree of omission to record the patients hydration status and the treatment offered. The educational practice is systematic only in 3 services, and only in these services there is delegation of activities to the nursing team and articulation with community health agents. On the 2nd phase of the study, one of the few changes identified was a discrete increase in weight measurement and its recording on a Chart. However, in the intervention period 69.6% of the health team members noticed an improvement on the pediatric assistance. CONCLUSIONS: The results reveal the great deficiency of the evaluated services in operating educational and healing activities related to diarrhoea control. So the observed practices concerning the attention to the children have contributed to increase childhood vulnerability, which shows the need to reorganize disease control actions, among the myriad of other actions related to this social group.

[Early diagnosis of Hansen disease: study of the health services in Recife (Pernambuco), Brazil]. / Diagnóstico precoce da hanseníase: o caso dos serviços de saúde no Recife (Pernambuco), Brasil.

This paper presents the results of a descriptive study carried out in the city of Recife, state of Pernambuco, Brazil, between March and September 1994. The study aimed at health services available for performing early diagnosis of Hansen's disease with emphasis on accessibility and quality of the services provided. The sample consisted of 32 health clinics visited for diagnostic purposes by 183 patients with Hansen's disease. Information on organizational infrastructures was collected by means of interviews with health clinic managers. Information regarding routine procedures in the 32 clinics was collected by observation, with special attention given to archival and inspection activities. A total of 1,998 patients were interviewed to determine accessibility of services. Time spent in consultation with the physician was determined for 1,000 patients who were seen by 123 physicians at the clinics during the interviews. To explore physicians' attitude and knowledge regarding Hansen's disease, 133 were randomly selected from a list of names. The following factors were identified as hindering early diagnosis of Hansen's disease: the large number of people seeking service who could not be seen by a physician on the same day; the long time elapsed between appointment scheduling and the actual visit (for those not seen on the same day); the long wait for the consultation; the brevity of the consultation; the low availability of trained personnel; the low proportion of physicians who examined all body surfaces; difficulties in the clinical recognition of the disease; and physicians not prepared to make a differential diagnosis. These obstacles can precipitate the physical deterioration of Hansen's disease patients and stimulate the persistence of transmissibility; therefore, they need to be overcome if Hansen's disease is to be eliminated.

[Perceptions regarding leprosy and resulting handicaps prior to diagnosis in Recife, Brazil]. / Percepción de la lepra y las discapacidades antes del diagnóstico en Recife, Brasil.

This article reports on a case-control study conducted in Recife, Brazil, between November 1993 and July 1994, to determine how leprosy patients' perceptions and notions influence disease management and use of health services. The sample was composed of 183 residents of Recife between the ages of 20 and 70 years who sought diagnostic services in the dermatology clinics of two referral centers situated in the third, fourth, and sixth political and administrative regions. Sixty-four patients having handicaps or their precursor lesions were classified as cases; the remaining 119 were used as controls. All were diagnosed during the study period. For the analysis, adjustments were made for sex, age, schooling, and a previous history of Hansen's disease among patients. The study revealed the simultaneous presence of two types of "invisibility" of the disease in an area where endemicity is increasing: 1) for patients in both groups, the low frequency of spontaneous explanatory models related to the illness, even in the presence of disease, and 2) for health professionals, the limitations of detection methods. Since such deficiencies affect decisions bearing on individual and collective disease management, they are a risk factor in and of themselves and stand in the way of eliminating leprosy as a public health problem.

[Are mothers encouraged to identify the risk signs of diarrhea?] / As mães são estimuladas a valorizar os sinais de risco da diarréia?

OBJECTIVES: To acknowledge the mothers' perception of the diarrhea episode and their ability in identifying the signs of risk; to characterize, in the health services, at ambulatory level, the activities that stimulate a timely attention to the disease.METHODS: An inquiry was applied to a representative sample of 1026 children under 5 years old who live in the pilot areas of Pernambuco selected to receive interference concerning diarrhea, and an interconnected transversal study in 14 health services: 11 health centres and 3 hospitals.RESULTS: A high proportion of the mothers of children with diarrhea give importance clinical manifestations that do not allow an early identification of dehydration. Only one fourth of them mentions dehydration as a complication. The mothers perception of the episode has a striking influence on the adopted conduct, particularly in the Metropolitan Area, in which, in the absence of preoccupation, no children were taken to the physician and a significant smaller proportion received care to hydration. In the health services, in general, collective educational programs are not the routine, the consult with the physician is limited to the main complaint, there is no post-consult with the nurses nor articulation with community health agents. Besides that, half of the mothers did not know the signs of dehydration.CONCLUSIONS: The findings of both the inquiry and the evaluation of the health services showed a quite critical situation: mother's little perception of the mothers of diarrhea worsening signs, as well as the insufficiency of these services concerning educational activities towards stimulating mothers to recognize and valorize them.

[Opinions about disease among members of the social network of patients with Hansen's disease in Recife]. / Opiniões sobre a doença entre membros da rede social de pacientes de hanseníase no Recife.

This article describes a study done in Recife, Brazil, between November 1993 and July 1994 to explore the opinions of the members of the social network (for example, family members, friends, and neighbors) of carriers of Hansen's disease regarding their estimation, interpretation, and management of physical manifestations of the disease in the time leading up to diagnosis. The sample consisted of 93 members of the social network, ranging in age between 20 and 70 years, who supported the course of action of 83 patients diagnosed in the study period. The analysis sought to detect differing capacities among the members of the patients' social network to discriminate between persons classified as cases (presence of disabilities or precursor lesions) or controls. The study found a lack of information about transmission of Hansen's disease and revealed a transitional phase in which there was expectation of cure along with a stigmatizing view of the consequences of the disease. Only one-quarter of the study subjects suspected prior to diagnosis that the patient had Hansen's disease, which suggests low perception of the risk represented by the disease and reinforces the idea that its physical manifestations can be invisible. The results reveal a profile of perception and management of Hansen's disease that favors its propagation and the development or worsening of its physical and social consequences.

Desnutricao e hospital. III - Custos do tratamento do desnutrido grave a nivel hospitalar. / Malnutrition and hospital.III - Treatment costs of the severe malnourished infant in the hospital

Valendo-se da experiencia adquirida com o tratamento de 200 criancas portadoras de Desnutricao Proteico Calorica (DPC); os autores fazem uma estimativa dos custos da hospitalizacao e tentam extrapolar os resultados para a possibilidade de cobertura da populacao desnutrida da cidade do Recife. O numero reduzido de leitos, o longo tempo de permanencia exigido para recuperacao dos pacientes, levando a um baixo rendimento e custo muito elevados dos leitos, torna impossivel este tipo de assistencia e fortalece a ideia de que a solucao so podera ser encontrada em programas extra-hospitalares