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THE PREVALENCE OF ANEMIA IN RIO GRANDE DO
SUL, BRAZIL.
Lucia Mariano da Rocha SillaHead of the Hematology and Bone Marrow
Transplantation – HCPAProfessor of Hematology at the Federal University of
Rio Grande do SulPresident of NGO: HEMOAMIGOS-HCPA
10.582.84010.582.840 inhabitantsinhabitants
~ 1.800.000 ~ 1.800.000 children < 6 YoAchildren < 6 YoA
child. mortality child. mortality rate: 15.4/thousandrate: 15.4/thousand
GOP R$ 144.344 MGOP R$ 144.344 M
Public Health System
(SUS)
Federal University of Rio Grande do Sul
HCPAHCPA
● ● 750 beds (90% SUS)● ● ICU for adults, children and neonates● ● ICU for Coronary Disease● ● Solid Organ Transplant Program● ● Bone Marrow Transplant Program autologous, autologous,
relate and non-related alogeneic relate and non-related alogeneic ● ● Day Care and Out Patient Clinic● ● CT scan and MIR● ● Basic health UnitBasic health Unit
HCPAHCPA
0
10
20
30
40
50
60
70
93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 8
TRIAGEM NEONATAL : Cobertura Rio Grande do Sul - 1997 / 2002
14%
20% 19%
27%
55%
65%
0
20.000
40.000
60.000
80.000
100.000
120.000
140.000
160.000
180.000
200.000
97 98 99 00 01 02
Fonte: Faculdade de Farmácia / UFRGS
Nº
0%
10%
20%
30%
40%
50%
60%
70%
No. Nasc vivos N. Testes Cobertura %
Até abril
5
912
2
MGSS 1:1,400
AS 1:23
RJRJSS 1:1,200SS 1:1,200
AS 1:21AS 1:21
RSRSSS 1:11,000SS 1:11,000
AS 1:65AS 1:65
SPSS 1:4,000
AS 1:35
GO SS 1:1,800
AS 1:28
MASS 1:1,400
AS 1:23
ESSS 1:1,800
AS 1:28
SCSS 1:13,000
PESS 1:1,400
AS 1:23
neonatalscreening
SCSS 1:13,000
BABASS 1:650SS 1:650AS 1:17AS 1:17
2008 sickle cell disease in Brazil2008 sickle cell disease in Brazil
Hematology and Bone Marrow Transplantation
• 29 beds (12 for BMT)
• 850 pts/month
• Clinical Research (Industry)
• Basic Research (Lab cell culture and molecular characterization of stem cells)
• Graduation
• Post-Graduation Program
Childhood Acute Leukemia
Germany cure rate 80%HCPA cure rate 65%
47% advanced diseasedelay in referral
40% IDA blocking the agenda
Iron Deficiency AnemiaIron Deficiency Anemia
• only happens after total iron storage depletion
HEMOAMIGOSHEMOAMIGOS
Pastoral da CriançaPastoral da Criança
Gabinete da Primeira DamaGabinete da Primeira Dama
Secretaria da SaúdeSecretaria da Saúde
Secretaria da EducaçãoSecretaria da EducaçãoCAIXA RSCAIXA RS
SESC RSSESC RS
SESISESI
UNESCOUNESCO
FAMEDFAMED
UFRGSUFRGSHCPAHCPA
SIMERSSIMERS
AJERTAJERTUNESCOUNESCO
OAB RSOAB RS
AMRIGSAMRIGSJob-Herve Job-Herve comunicaçcomunicaç
õesões
ARIARI
TeachingTeaching
Civil Society
Basic health facilities
Pre- and Elementary
Schools
MD, nurses, pharmacists, health agents
Nutricionists and Biologists
Medical and Nurse Schools
Nutrition and Biology Schools
State Health and Education departments
information
Prevalence DeterminationPrevalence Determination
Sample: for 30% of prevalence = 500 children and 500 women
– children < 6 years of age – women from 14 to 30 years of age: non-pregnant,
non-puerperal, non-post-abortion and not related to the tested children
– demografic data– informed consent – socioecomic form– capillary hemoglobin concentration
Socioeconomic classificationSocioeconomic classification
• Brazilian Association of Market Research Agencies
utilized by the government to classify the Brazilian population along 5 levels:
A to E – being A the highest and E the lowest socioeconomic level
http://www.abep.org/codigosguias/ABEP_CCEB.pdf
The Socioeconomic level distribution urban The Socioeconomic level distribution urban areas in Brazilareas in Brazil
Target PopulationTarget Population
“Healthy” population at their homes Pastoral da Criança
http://www.pastoraldacrianca.org.br/
SESC-RS workershttp://www.sesc-rs.com.br/site/home.htm
Medical Students10 Schools of Medicine in RS
ResultsResults
• Over 800 people involved all over the state• 76 lectures for health care personal (6.584)• Printed material distribution• A foam doll called “Fera” (slang for “the best”)• A theater named “Fera does not have anemia”
12 presentations• TV spot (cartoon) and radio talks• 14 public shows involving about 20.000 low
income people (SESC shows) all over the state
Bagé
Região Norte
Hg inferior a 11 em crianças 40,7%
Hg inferior a 12 em mulheres 28,8%
Região Oeste
Hg inferior a 11 em crianças 42,0%
Hg inferior a 12 em mulheres 40,5%
Região Sul
Hg inferior a 11 em crianças 68,7%68,7%
Hg inferior a 12 em mulheres 65,9%65,9%
Região Nordeste
Hg inferior a 11 em crianças 29,1%29,1%
Hg inferior a 12 em mulheres 19,3%19,3%
Região Leste
Hg inferior a 11 em crianças 42,2%
Hg inferior a 12 em mulheres 35,4%
Bagé
Rio Grande do Sul
Hg inferior a 11 em crianças 44,2%44,2%
Hg inferior a 12 em mulheres 36,3%36,3%
F. Westphalen
Crianças
2375
Mulheres
1999
Prevalence of anemia in children by
socioeconomic class level
25
33.340.4
46.6
57.9
0
10
20
30
40
50
60
70
A B C D E
socioeconomic level
Per
cen
tag
e
p < 0,001
Prevalence of anemia in women by socioeconomic class level
p = 0,006
14.3
26.2
35.7 37.8
45.9
05
1015
202530
3540
4550
A B C D E
socioeconomic level
Per
cent
age
age distribution of anemia in children
p < 0,001
77
58
44 4035
28
0
10
20
30
40
50
60
70
80
90
18 a 23meses
24 a 35meses
36 a 47meses
48 a 59meses
60 a 71meses
72 mesesou mais
per
cen
tag
e
Prevalence of anemia in children by
socioeconomic class level
25
33.340.4
46.6
57.9
0
10
20
30
40
50
60
70
A B C D E
socioeconomic level
Per
cen
tag
e
p < 0,001
Prevalence of anemia in women by socioeconomic class level
p = 0,006
14.3
26.2
35.7 37.8
45.9
05
1015
202530
3540
4550
A B C D E
socioeconomic level
Per
cent
age
DiagnosisDiagnosis
√√ Uncertainties about the definition of anemia√√ Anemia Anemia is asymptomatic, as a consequence,
physicians don’t see the hidden burden√√ Physicians don’t know about micronutrients
deficiencies (physicians are the key health professionals in developing countries)
√√ Regular Nutritionists lack the knowledge about iron-rich food and its absorption
√ √ WHO literature as well as UN’s WHO literature as well as UN’s is notis not readily readily available for practitioners available for practitioners
depressed or low IQ motherdepressed or low IQ motherlow stimuluslow stimuluslow socioecomic levellow socioecomic level
high riskhigh risk
Strategies for solutionsStrategies for solutions
• push health international professionals and scholars to settle the issue about anemia definition
• push health authorities in the developing world to better inform basic health physician/professionals about the most prevalent issues
• gather similar information from other studies/countries/professionals
• implement multidisciplinary iniciatives
Startegies for SolutionsStartegies for Solutions
In all documents about human development,
health and development MUSTMUST be listed BEFOREBEFORE education
Otherwise, we are enforcing another form of power
TO KNOW BETTERTO KNOW BETTER
Our StartegyOur Startegy
p < 0,001
77
58
44 4035
28
0
10
20
30
40
50
60
70
80
90
18 a 23meses
24 a 35meses
36 a 47meses
48 a 59meses
60 a 71meses
72 mesesou mais
per
cen
tag
e
age distribution of anemia in children
before being a mother avoid anemiabefore being a mother avoid anemia
““before being a mother avoid before being a mother avoid anemia” Strategyanemia” Strategy
• submitt a paper to a high impact medical journal (and let the brazilians know about that)
• be here and anywhere else where the public health problems are being discussed by authorities in the field (and let everyone know that)
• collect finantial resourses from industries• apply marketing strategies for health professionals
similar to the pharmaceutical companies: personal letters, e-mail marketing, cultural events, published material, etc
• spread the news to the society (with enfasisin midle class individuals)
before being a mother avoid anemia before being a mother avoid anemia 12 semanas 24612 semanas 246 children children SESC-RSSESC-RS
before after
> 11g/dl < 11g/dl > 11g/dl < 11g/dldrop in anemia
%
intervention
Aelca 33/63 30/63 (48% ) 51/63 12/63 (19%) 60%
NSap 28/55 27/55 (49%) 36/55 19/55 (35%) 29%
Perp. Soc 57/66 09/66 (14%) 60/66 06/66 (9%) 36%
TOTAL 118/184 66/184 (36%) 147/184 37/184 (20%) 44%44%
control
Ciranda 14/22 08/22 (36%) 15/22 07/22 (32%) 11%
São José 47/58 11/58 (19%) 49/58 09/58 (16%) 16%
TOTAL 61/80 19/80 (24%) 64/80 16/80 (20%) 16%16%
““before being a mother avoid before being a mother avoid anemia” Strategyanemia” Strategy
• empower Pastoral da Criança • MESA BRASIL SESC• civil society pushing a law for school meals• push local Pediatric and Gynecology/Obstetrics
Societies to implement obligatory blood tests in women at childbearing age and children
• hopefully to be able to show changes in three years, at least in attitude
““before being a mother avoid before being a mother avoid anemia” Strategyanemia” Strategy
• push the necessary changes in Public Health Schools and Social Work Schools (with your help)
• push Federal Health authorities to stablish a minimal training for future public health professionals (public guarantee job)
• push Public Schools of Medicine to teach the basic health problems (with your advice)
Direct Collaborators
Alice Zelmanowicz, Larissa Brouwers, Ingrid Mitto, Ana Maria Moreira, Mariana Michalowski, Liane Daudt, Marta Alves, Denise Leugeur, João Fridrisch, Christina Bittar, Tania Hewlig, Marco Shiling, Gustavo Fischer, Rosane Bittencourt, Laura Fogliatto, Carlos do Bem, Alessandra Paz, Zilda Arns
Thank youThank you