Avaliação da terceira etapa do método canguru na atenção primária a saúde / Evaluation of the third stage of the kangaroo method in primary health care / Evaluación de la tercera etapa del método canguro en atención primaria de salud

Objetivo: avaliar a assistência prestada às crianças pela Atenção Primária à Saúde na terceira etapa do método canguru. Métodos: estudo transversal com 156 crianças pré-termo no período de janeiro a junho de 2020. Utilizou-se questionário contendo variáveis sócio-demográficas, clínicas e relacionadas à assistência prestada. Resultados: Dentre as crianças: 54,5% tinham idade acima de seis meses; 51,9% eram do interior ou de outras localidades; 94,9% eram de baixa renda; 39,1% tiveram peso menor que 1500g; 62,2% e 12,2% nasceram com idade gestacional entre 28 a 33 semanas e inferior a 28 semanas, respectivamente. Quanto à assistência prestada: 74,4% das crianças não realizaram consultas na atenção primária e dentre as atendidas, 78,2% classificaram como ruim/regular; 59,6% não receberam visita domiciliar. Conclusão: a avaliação da terceira etapa do método canguru na atenção primária, sob o olhar de mães, apontou fragilidades na qualificação, integralidade da assistência, redesenho/discussão da rede, na referência e contra-referência.

Objective: to evaluate the assistance provided to children by Primary Health Care in the third stage of the kangaroo method. Methods: cross-sectional study with 156 preterm children from January to June 2020. A questionnaire was used containing socio-demographic, clinical and care-related variables. Results: Among the children: 54.5% were over six months old; 51.9% were from the countryside or other locations; 94.9% were low-income; 39.1% weighed less than 1500g; 62.2% and 12.2% were born with gestational age between 28 and 33 weeks and less than 28 weeks, respectively. As for the assistance provided: 74.4% of the children did not undergo consultations in primary care and among those attended, 78.2% classified it as poor/fair; 59.6% did not receive a home visit. Conclusion: the evaluation of the third stage of the kangaroo method in primary care, from the perspective of mothers, pointed out weaknesses in qualification, comprehensiveness of care, network redesign/discussion, in reference and counter-reference.

Objetivo: evaluar la asistencia brindada a los niños por la Atención Primaria de Salud en la tercera etapa del método canguro. Métodos: estudio transversal con 156 niños prematuros de enero a junio de 2020. Se utilizó un cuestionario con variables sociodemográficas, clínicas y asistenciales. Resultados: Entre los niños: 54,5% tenían más de seis meses; El 51,9% eran del campo u otras localidades; 94,9% eran de bajos ingresos; El 39,1% pesaba menos de 1500 g; El 62,2% y el 12,2% nacieron con edades gestacionales entre 28 y 33 semanas y menos de 28 semanas, respectivamente. En cuanto a la asistencia brindada: el 74,4% de los niños no acudió a consultas en atención primaria y entre los atendidos, el 78,2% la clasificó como mala / regular; El 59,6% no recibió visita domiciliaria. Conclusión: la evaluación de la tercera etapa del método canguro en atención primaria, desde la perspectiva de las madres, señaló debilidades en la calificación, integralidad de la atención, rediseño / discusión de la red, en referencia y contrarreferencia.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-20166 / Aspectos clínicos e epidemiológicos da microcefalia no Estado do Piauí, Nordeste do Brasil, 2015-2016

Abstract Objectives: To describe aspects of the microcephaly epidemic in the state of Piauí. Methods: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n = 100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n = 63) were used as a comparison group. Results: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p < 0.001); 33 confirmed cases (35.9%) had a head circumference z-score between −2 and −3, 23 (25%) between −3 and −4, and 8 (8.7%) had a z-score of less than −4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. Conclusions: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.

Resumo Objetivos: Descrever os aspectos da epidemia de microcefalia no Estado do Piauí. Métodos: Foram incluídos todos os casos de microcefalia congênita confirmados no estado entre 2015-2016 (n = 100). Os formulários de investigação do Centro Regional de Referência em Microcefalia foram analisados. Os casos descartados (n = 63) foram usados como grupo de comparação. Resultados: Em outubro, novembro e dezembro de 2015, as taxas de incidência atingiram 4,46, 6,33 e 3,86/1.000 nascidos vivos, respectivamente; 44 casos foram relatados na capital do estado. Entre as mães de casos confirmados e descartados, a frequência de erupção cutânea durante a gravidez foi 50/97 (51,5%) e 8/51 (15,7%), respectivamente (p < 0,001); 33 casos confirmados (35,9%) apresentaram um escore z de perímetro cefálico entre -2 e -3, 23 (25%) entre -3 e -4 e 8 (8,7%) apresentaram escore z inferior a -4. As tomografias computadorizadas cerebrais revelaram calcificações em 78/95 (82,1%) dos casos. Lisencefalia, hidrocefalia e agenesia do corpo caloso também foram observadas com mais frequência. Os achados oftalmológicos incluíram rarefação e atrofia do epitélio pigmentar da retina. Foram observadas ausência de emissões otoacústicas em 21/70 casos. Um recém-nascido também apresentou atrofia muscular dos membros inferiores. Não houve diferenças significativas nas taxas de vacinação para gripe, vacina difteria tétano e coqueluche acelular e hepatite B em qualquer grupo. Conclusões: O Estado do Piauí, como outros na região Nordeste, enfrentou, entre 2015 e 2016, uma epidemia de microcefalia congênita, supostamente relacionada à infecção congênita pelo vírus Zika, mais intensa na capital. Os desafios atuais incluem melhora do controle de vetores, pesquisa básica, ampliação de ferramentas de diagnóstico para exame pré-natal do vírus Zika, vacinas e cuidados de saúde para crianças afetadas.

Clinical and epidemiological aspects of microcephaly in the state of Piauí, northeastern Brazil, 2015-2016.

OBJECTIVES: To describe aspects of the microcephaly epidemic in the state of Piauí. METHODS: All cases of congenital microcephaly confirmed in the state between 2015 and 2016 were included (n=100). Investigation forms of the Regional Reference Center for Microcephaly were reviewed. Discarded cases (n=63) were used as a comparison group. RESULTS: In October, November, and December 2015 incidence rates reached 4.46, 6.33 and 3.86/1000 live births, respectively; 44 cases were reported in the state capital. Among the mothers of confirmed and discarded cases, the frequency of skin rash during pregnancy was 50/97 (51.5%) and 8/51 (15.7%), respectively (p<0.001); 33 confirmed cases (35.9%) had a head circumference z-score between -2 and -3, 23 (25%) between -3 and -4, and 8 (8.7%) had a z-score of less than -4. Head computer tomography scans revealed calcifications in 78/95 (82.1%) cases. Lissencephaly, hydrocephalus and agenesis of the corpus callosum were also frequently observed. Ophthalmic findings included retinal pigment epithelium rarefaction and atrophy. Absence of otoacoustic emissions was observed in 21/70 cases. One newborn also presented lower limb muscle atrophy. There were no significant differences in vaccination rates for influenza, diphtheria-tetanus-acellular pertussis, and hepatitis B in either group. CONCLUSIONS: The state of Piauí, like others in the northeastern region, faced an epidemic of congenital microcephaly between 2015 and 2016, presumably related to congenital Zika virus infection, more intense in the capital. Current challenges include the improvement of vector control, basic research, scaling-up of diagnostic tools for pre-natal screening of Zika virus, vaccines, and health care for affected children.