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

THE PREVALENCE OF ANEMIA IN RIO GRANDE DO SUL, BRAZIL. . Lucia Mariano da Rocha Silla Head of the Hematology and Bone Marrow Transplantation – HCPA Professor of Hematology at the Federal University of Rio Grande do Sul President of NGO: HEMOAMIGOS-HCPA . 10.582.840 inhabitants.

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

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  1. THE PREVALENCE OF ANEMIA IN RIO GRANDE DO SUL, BRAZIL. Lucia Mariano da Rocha Silla Head of the Hematology and Bone Marrow Transplantation – HCPA Professor of Hematology at the Federal University of Rio Grande do Sul President of NGO: HEMOAMIGOS-HCPA

  2. 10.582.840inhabitants ~ 1.800.000 children < 6 YoA child. mortality rate: 15.4/thousand GOP R$ 144.344 M

  3. HCPA Public Health System (SUS) Federal University of Rio Grande do Sul

  4. ● 750 beds (90% SUS) ● ICU for adults, children and neonates ● ICU for Coronary Disease ● Solid Organ Transplant Program ● Bone Marrow Transplant Programautologous, relate and non-related alogeneic ● Day Care and Out Patient Clinic ● CT scan and MIR ● Basic health Unit HCPA

  5. 12 9 5 2

  6. neonatal screening 2008 sickle cell disease in Brazil MA SS 1:1,400 AS 1:23 PE SS 1:1,400 AS 1:23 BA SS 1:650 AS 1:17 MG SS 1:1,400 AS 1:23 GO SS 1:1,800 AS 1:28 ES SS 1:1,800 AS 1:28 SC SS 1:13,000 SC SS 1:13,000 RJ SS 1:1,200 AS 1:21 SP SS 1:4,000 AS 1:35 RS SS 1:11,000 AS 1:65

  7. 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

  8. Childhood Acute Leukemia Germany cure rate 80% HCPA cure rate 65% 47% advanced disease delay in referral 40% IDA blocking the agenda

  9. Iron Deficiency Anemia • only happens after total iron storage depletion

  10. Gabinete da Primeira Dama Secretaria da Saúde Secretaria da Educação CAIXA RS SESC RS HEMOAMIGOS Pastoral da Criança SIMERS SESI OAB RS FAMED UFRGS HCPA AJERT UNESCO UNESCO ARI Job-Herve comunicações AMRIGS

  11. State Health and Education departments 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

  12. Prevalence 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

  13. 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

  14. The Socioeconomic level distribution urban areas in Brazil

  15. 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

  16. 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

  17. Região Norte Hg inferior a 11 em crianças 40,7% Hg inferior a 12 em mulheres 28,8% Região Nordeste Hg inferior a 11 em crianças 29,1% Hg inferior a 12 em mulheres 19,3% Região Oeste Hg inferior a 11 em crianças 42,0% Hg inferior a 12 em mulheres 40,5% Região Leste Hg inferior a 11 em crianças 42,2% Hg inferior a 12 em mulheres 35,4% Bagé Região Sul Hg inferior a 11 em crianças 68,7% Hg inferior a 12 em mulheres 65,9%

  18. F. Westphalen Rio Grande do Sul Hg inferior a 11 em crianças 44,2% Hg inferior a 12 em mulheres 36,3% Bagé Crianças 2375 Mulheres 1999

  19. Prevalence of anemia in children by socioeconomic class level p < 0,001

  20. Prevalence of anemia in women by socioeconomic class level p = 0,006

  21. age distribution of anemia in children p < 0,001

  22. Prevalence of anemia in children by socioeconomic class level p < 0,001

  23. Prevalence of anemia in women by socioeconomic class level p = 0,006

  24. Diagnosis √ Uncertainties about the definition of 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 is not readily available for practitioners

  25. depressed or low IQ mother low stimulus low socioecomic level high risk

  26. Strategies 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

  27. Startegies 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

  28. Our Startegy age distribution of anemia in children p < 0,001

  29. before being a mother avoid anemia

  30. “before being a mother avoid anemia” 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 enfasis in midle class individuals)

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

  32. “before being a mother avoid anemia” 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

  33. “before being a mother avoid anemia” 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)

  34. 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

  35. Thank you

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