Cubas Strategy for Childhood Tuberculosis Control, 1995-2005

INTRODUCTION Following a tripling of tuberculosis incidence in Cuba between 1991 and 1994 (from 4.7 to 14.7 per 100,000), the National TB Control Program was revamped in 1995 and the National Reference Center for Childhood TB and Provincial Childhood TB Commissions were created as a strategy for addressing this emerging health problem. OBJECTIVES Assess the impact of Cuba’s new strategy for TB control in children aged <15 years during the period 1995–2005. METHODS A descriptive review of health services and systems was conducted in Cuba, examining 157 cases of TB diagnosed in children aged <15 years during the period 1995–2005 and comparing impact and process indicators for selected years (1995, 2000, and 2005). Impact indicators included reduction in: a) incidence; b) serious forms (peritoneal, meningeal, miliary, combined); c) mortality; and d) case outcomes (cure, death, treatment drop-out, treatment failure). Process indicators were proportion of cases with: a) microbiological tests; b) knowledge of infection source; c) diagnoses obtained through adult case contact tracing; d) time to diagnosis <60 days; and e) post-mortem diagnoses. RESULTS During the period 1995–2005, TB rates in children aged <15 years fell by 50 por ciento (from 1.0 to 0.5 per 100,000), more evident in children <10 years. The Havana rate was three times the national rate. Diagnosis was post-mortem in three serious cases (1.9 por ciento); there were four deaths (2.5 por ciento), none after 2000(AU)

Hipercalciuria idiopática / Idiopathic hypercalciuria

Se realiza un estudio prospectivo para valorar la frecuencia de la Hipercalciuria Idiopática en nuestro servicio. Se determinó la excreción urinaria de calcio en 205 pacientes con edades comprendidas entre 3 y 14 años. La hipercalciuria se definió como la excreción urinaria de calcio mayor de 4 mg/kg/día y fue identificada en 163 casos (79,5 por ciento) de los cuales 144 eran varones (70,2 por ciento), la hematuria macroscópica recurrente fue la forma de presentación más frecuente, el 83 por ciento tenía historia familiar de urolitiasis, en el 25 por ciento de los casos se detectó litiasis renal en el estudio ultrasonográfico. Todo los casos de hipercalciuria mantuvieron durante 3 meses una dieta normocálcica, pobre en sodio y con alto aporte de agua, respondiendo con una normalización de calciuria 134 casos (65,4 por ciento)(AU)

A prospective research has been carried out to evaluate the frequency of the Idiopathic Hypercalciuria in our service. We determined the urinary excretion of calcium in 205 patients between 3 and 14 years old. Hypercalciuria was defined as the urinary excretion of calcium of more than 4 mg/kg/ per day, and it was identified in 163 cases (79,5 percent), 144 of which were male (70,2 percent); the most frequent form of presentation was the recurrent macroscopic hematuria; 83 percent of them had familiar history of urolithiasis. In 25 percent of the cases, the ultrasonographic study showed renal lithiasis. All the cases of hypercalciuria followed a normocalcium, low in calcium and high water intake diet, during three months. 134 cases (65,4 percent) answered with a calciuric normalization(AU)

Determinación de factores de riesgo asociados al abandono precoz de la lactancia materna exclusiva en lactantes menores de 6 meses / Determining the risk facts associated to the precocious giving up of the exclusive maternal breastfeeding in infants less than 6 months old

En la actualidad, la lactancia materna exclusiva como principal forma de alimentación del recién nacido y lactante, se ha visto afectada por varias razones, entre las que se destacan cambios en los patrones sociales de vida, la introducción de excelentes sustitutos de la lactancia materna en el mercado y el desconocimiento acerca de sus ventajas para la madre y el niño. Se realiza estudio prospectivo, sobre la utilización de lactancia materna exclusiva en lactantes menores de 6 meses ingresados en el Hospital Pediátrico Universitario de Matanzas Eliseo Noel Caamaño durante el año 2007, se obtienen los principales factores de riesgo que influyen en el destete precoz (juveniles, familia inestable, trabajadoras o estudiantes, hipogalactia subjetiva, nacidos por cesárea, desinformación sobre lactancia materna y ausencia de Puericultura prenatal). Se concluye que el primer mes fue el momento de mayor deserción (63 por ciento), donde la edad materna que más influyó fue las menores de 20 años (80 por ciento) y las mayores de 30 años (100 por ciento), así como las estudiantes (100 por ciento) y las trabajadoras (67 por ciento), la negativa materna y la hipogalactia subjetiva fueron las primeras causas de abandono y donde más de la mitad de las madres que refieren haber recibido información previa, abandona la lactancia en el primer mes posterior al parto. Se comprueba que no existen estrategias locales establecidas (a nivel de área o consultorio médico), ni se conocen los factores de riesgo en su población, mucho menos las estrategias nacionales devenidas de programas Internacionales promovidos por la OMS y la UNICEF...(AU)

Nowadays, exclusive maternal breastfeeding as main form of feeding the newborn and infant, has been affected by several reasons, the main of which are changes in the social patterns of life, the introduction of excellent substitutes of maternal breastfeeding in the market, and the lack of knowledge about the advantages of maternal breastfeeding for both, the mother and the child. A prospective study was carried out, about the usage of exclusive maternal breastfeeding in infants less than 6 months old entering the University Pediatric Hospital Eliseo Noel Caamaño of Matanzas in 2007. The main risk facts of precocious weaning are young mothers, unstable families, mothers that work or study, subjective lactation disorders, children born by caesarean operation, disinformation about maternal breastfeeding and lack of prenatal child care. We concluded that the first month was the moment of the biggest desertion (63 percent); maternal age groups with higher incidence were the group of less than 20 years old (80 percent) and the group of more than 30 years old (100 percent); the main causes of breastfeeding abandoning were mothers who are students (100 percent) or workers (67 percent), maternal negative and subjective lactation disorders. More than half of mothers referring previous information abandoned breastfeeding during the first month after birth. We proved that there are not established local strategies (at the level of Health Areas or Medical Office), nor knowledge about risk facts among the population, or about the national strategies developed on the bases of International programs promoted by the World Health Organization and the United Nations Children's Fund...(AU)