Side effects of antimalarial drug can overlap with malaria symptoms. We evaluated 50 patients with vivax malaria in Mâncio Lima, Acre, treated with chloroquine and primaquine. Patients were evaluated for the presence of 21 symptoms before and after treatment and for reported side effects of these drugs after treatment was started. The most frequent symptoms before medication were headache, fever, chills, sweating, arthralgia, back pain, and weakness, which were present in between 40% and 76% of respondents. The treatment reduced the occurrence of these symptoms and reduced the lack of appetite, but gastrointestinal symptoms and choluria increased in frequency. There were no reports of pale stools before medication, but 12% reported the occurrence of this symptom after treatment started. Other symptoms such as blurred vision (54%), pruritus (22%), paresthesia (6%), insomnia (46%), and “stings” into the skin (22%) were reported after chloroquine was taken. The antimalarial drugs used to treat P. vivax malaria reduce much of the systemic and algic symptoms but cause mainly gastrointestinal side effects that may lead to lack of adherence to drug treatment. It is important to guide the patient for the appearance and the transience of such side effects in order to avoid abandoning treatment.

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IntroductionVaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.MethodsA census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.ResultsOnly 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95).ConclusionsThis study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

RESUMOEste estudo descreve o perfil epidemiológico da leishmaniose tegumentar americana (LTA) em Assis Brasil-AC entre 2003 e 2010. As fichas de notificação dos casos confirmados de LTA do município foram revisadas e as frequências foram comparadas utilizando-se o Teste Exato de Fisher ou Qui-quadrado. Foram notificados 579 casos de LTA, com um coeficiente de detecção de 191 e 82 casos por 10.000 habitantes em 2003 e 2010, respectivamente. Os casos ocorreram mais em homens (63,0%), em moradores da zona rural (72,3%) e com ocupação relacionada ao meio ambiente (52,5%). Cerca de 81% dos casos era de moradores de Assis Brasil, 3,6% de outros municípios acreanos, 10,4% do Peru, 1,7% da Bolívia e 3,8% sem informação. Houve predomínio da forma cutânea (53,5%), com poucas recidivas (1,7%). O diagnóstico foi confirmado preferencialmente com o teste intradérmico, sendo o diagnóstico microscópico direto pouco usado (17,4%). Inadequações no tratamento prescrito ocorreram quanto à dose (inadequada em 56,3% dos casos mucosos) e ao tempo de tratamento (3,7% dos casos com tempo insuficiente). Existe aparente deficiência de recursos humanos para executar os testes diagnósticos necessários e fazer o preenchimento da ficha de notificação, portanto melhorias na rede de atenção básica são necessárias para o controle eficiente desta endemia. DESCRITORES: Leishmaniose cutânea; vigilância; saúde na fronteira; tratamento.

BackgroundThe aim of this study was to analyse the prevalence of undernutrition, overweight and associated factors, before and after the implementation of the Interoceanic Highway.MethodsA population-based cross-sectional study on children under 5 years of age was conducted in the municipality of Assis Brasil, AC, Brazil, in 2003 and 2010. Prevalence of undernutrition was observed by using height-for-age Z-scores (HAZ) and adopting a cut-off point equal to or lower than a -2 Z-score. Overweight prevalence was defined by a cut-off point equal to or greater than a +2 Z-score of the WHZ index. Z-scores were calculated relative to WHO 2006 reference data. Semi-structured questionnaires were applied to the children’s guardians, investigating family socio-economic and demographic characteristics, morbidities, access to services and child care. Associated factors were identified by hierarchical multiple logistic regression analysis.ResultsThe prevalence of low HAZ (undernutrition) was 7.0% in 2003 and 12.2% in 2010. The prevalence of high WHZ (overweight) was 1.0% and 6.6% for 2003 and 2010, respectively. It was not possible to adjust the multiple model for the year 2003. The factors associated with low HAZ in 2010 were: wealth index, the situation of living with biological parents, maternal height and presence of open sewage, whereas the factors associated with a high WHZ in the same year were: child’s age, mother’s time of residence in the location, mother’s body mass index.ConclusionsOverweight increase within this undernutrition scenario reveals that the process of nutritional transition began in this Amazonian city only in the last decade, and therefore, it is delayed when compared to overweight in other parts of Brazil. Such nutritional transition in Assis Brasil may have been facilitated by the construction of the Interoceanic Highway.