THE PREVALENCE OF ANEMIA IN RIO GRANDE DO SUL, BRAZIL'

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THE PREVALENCE OF ANEMIA IN RIO GRANDE DO SUL,
BRAZIL.

• Lucia Silla
• 33rd Global Conference of the International
  Council of Social Wellfare
• ICSW
• Tours France
• July 2008

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10.582.840 inhabitants
1.800.000 children lt 6 YoA
child. mortality rate 15.4/thousand
GDP R 144.344 M
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HCPA

• Public Health System
• (SUS)
• Federal University of Rio Grande do Sul

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HCPA

• ? 750 beds (90 SUS)
• ? ICU for adults, children and neonates
• ? ICU for Coronary Disease
• ? Solid Organ Transplant Program
• ? Bone Marrow Transplant Program autologous,
  relate and non-related alogeneic
• ? Day Care and Out Patient Clinic
• ? CT scan and MIR
• ? Basic health Unit

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AGAFAL
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5
2
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2008 sickle cell disease in Brazil
MA SS 11,400 AS 123
PE SS 11,400 AS 123
BA SS 1650 AS 117
MG SS 11,400 AS 123
GO SS 11,800 AS 128
ES SS 11,800 AS 128
SC SS 113,000
SC SS 113,000
RJ SS 11,200 AS 121
SP SS 14,000 AS 135
RS SS 111,000 AS 165
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Hematology and Bone Marrow Transplant

• 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

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Childhood Acute Leukemia

• Germany cure rate 80
• HCPA cure rate 65
• 47 advanced disease
• delay in referral
• 40 IDA blocking the agenda

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Iron Deficiency Anemia

• only happens after total iron storage depletion

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Gabinete da Primeira Dama Secretaria da
Saúde Secretaria da Educação
CAIXA RS
SESC RS
HEMOAMIGOS Pastoral da Criança
SESI
SIMERS
OAB RS
FAMED UFRGS
HCPA
AJERT
UNESCO
UNESCO
ARI
Job-Herve comunicações
AMRIGS
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State Health and Education
Medical and Nurse Schools
Nutrition and Biology Schools
Teaching
Nutricionists and Biologists
MD, nurses, pharmacists, health agents
information
Pre- and Elementary Schools
Basic health facilities
Civil Society
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Prevalence Determination

• Sample for 30 of prevalence 500 children and
  500 women
• children lt 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

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Socioeconomic 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
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The Socioeconomic level distribution urban areas
in Brazil
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Target Population

• Healthy population at their homes
• Pastoral da Criança
• http//www.pastoraldacrianca.org.br/
• SESC-RS workers
• http//www.sesc-rs.com.br/site/home.htm
• Medical Students
• 10 Schools of Medicine in RS

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Results

• 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

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North Children 40,7 Women 28,8
Northeast Children 29,1 Women 19,3
West Children 42,0 Women 40,5
East Children 42,2 Women 35,4
Bagé
South Children 68,7 Women 65,9
Children 2375 Women 1999
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F. Westphalen
Rio Grande do Sul Children 44,2 Women 36,3
Bagé
Children 2375 Women 1999
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Prevalence of anemia in children by socioeconomic
class level
p lt 0,001
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Prevalence of anemia in women by socioeconomic
class level
p 0,006
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Distribuição de crianças com hemoglobina inferior
a 11 segundo a cor referida da pele
p 0,001
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Distribuição de mulheres com hemoglobina inferior
a 12 segundo a cor referida da pele
p 0,01
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age distribution of anemia in children
p lt 0,001
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Prevalence of anemia in children by socioeconomic
class level
p lt 0,001
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Prevalence of anemia in women by socioeconomic
class level
p 0,006
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Iron Deficiency

• 324 children with 1 year of age in
• São Leopoldo RS
• 64 anemic
• 90 with ferritin lt 15 µ/dl

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Diagnosis

• v Uncertainties about the definition of anemia
• v Anemia is asymptomatic, as a consequence,
• physicians dont see the hidden burden
• v Physicians dont know about micronutrients
• deficiencies (physicians are the key health
  professionals in developing countries)
• v Regular Nutritionists lack the knowledge about
  iron-rich food and its absorption
• v WHO literature as well as UNs is not readily
  available for practitioners

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Prevalence of Iron Deficiency in the United
States Looker et al. JAMA 277973, 1997
9 of toddlers aged 1 to 2 years iron
deficient 9 to 11 of adolescent girls and women
of childbearing age were iron deficient 3 of
adolescent girls and 2 to 5 of women of
childbearing age were anemic Among women of
childbearing age, iron deficiency was more likely
in those who are minority, low income, and
multiparous.
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47 trabalhos 28 com desenho razoável
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depressed or low IQ mother low stimulus low
socioecomic level
high risk
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Our Strategy
age distribution of anemia in children
p lt 0,001
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Iron Deficiency Anaemia Assessment,
Prevention and Control. A guide for programme
managers WHO 2001
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before being a mother avoid anemia
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Women in childbearing age
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Ultrasound Obstet Gynecol. Oct30(4)443,2007
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Strategies for solutions

• push health international professionals and
  scholars to settle the issue about anemia
  definition
• push Medical Societies (Hematology, Pediatric,
  Gynecology/Obstetrics), and 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

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before being a mother avoid anemia 12 semanas
246 children SESC-RS
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before being a mother avoid anemia Strategy

• empower Pastoral da Criança
• MESA BRASIL SESC
• civil society (midle class) 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

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before being a mother avoid anemia Strategy

• push the necessary changes in Public Health
  Schools and Social Work Schools
• 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

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Strategies for Solutions

• In all documents about human development,
• health and development MUST be listed BEFORE
  education
• Otherwise, we are enforcing another form of
  power
• TO KNOW BETTER

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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