http://repositorio.ufc.br/handle/riufc/57173 Fri, 14 Aug 2026 22:03:16 GMT 2026-08-14T22:03:16Z http://repositorio.ufc.br/handle/riufc/87392 Título: A política de desnutrição infantil no setor autônomo de Guiné-Bissau Autor(es): Bá, Tcherno Amadú Abstract: Introduction. Child malnutrition is a serious public health problem, especially in low-income countries like Guinea-Bissau, where chronic political instability and structural poverty hinder the development of effective child protection policies. Objective. To describe the child nutrition policy in Guinea-Bissau developed between 2020 and 2024. Methodology. This study involved documentary and bibliographic research, analyzing documents regarding health policies in Guinea-Bissau and Brazil, complemented by field notes from the Institute for Early Childhood (IPREDE) in Fortaleza, Ceará. Empirical data collection included semi-structured interviews with families of children being treated for malnutrition, allowing for triangulation between documentary evidence and lived experiences. Results. The analysis identified four thematic categories: the prevalence and epidemiological profile of child malnutrition (showing 28% chronic malnutrition and 6.5% acute malnutrition in Guinea-Bissau); the impact of political instability on the implementation of social programs; the coverage of community health workers and social protection; and a comparative analysis with Brazilian policies, highlighting the effectiveness of the Bolsa Família Program and the Family Health Strategy in reducing this health issue. Final considerations. Child malnutrition remains a significant issue in both countries, requiring the expansion of intersectoral public policies, systematic epidemiological studies, and the strengthening of social protection programs—with particular attention to the context of Guinea-Bissau, where international cooperation is a fundamental pillar in addressing this problem. Tipo: Dissertação Thu, 01 Jan 2026 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/87392 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/87137 Título: Progressos e desafios para alcançar a cobertura universal de saúde no Peru, 2011-2019: um estudo de caso Autor(es): Bonzano, Cesar Manuel Velazco Abstract: The Peruvian health system demonstrated significant fragility during the COVID-19 pandemic, evidenced by the enormous number of deaths associated with the disease, despite health coverage for approximately 90% of the population being reported in the years before the pandemic. In the second decade of the 21st century, Peru conceived and implemented a "new" health reform, led by a government that promised social changes. The reform is based on the Universal Health Insurance model, a mixed insurance model, built during two previous decades — years of hegemonic neoliberal discourse and practices in the health sector. This reform is also framed in the discourse of Universal Health Coverage, hegemonic on regional and global levels, with vague definitions, interpretations and diverse strategies, and involving a dispute between two opposing models of construction of the health system: the market or residual model and the universal or health-directed model. This dissertation describes the health reform process in Peru, from 2011 to 2019, from a historical-contextual perspective, analyzing its trajectory and context, as well as some of the results of its implementation. It uses theoretical references, such as historical institutionalism, to try to understand the changes or continuities in public policies. The research strategy is a case study, mainly employing documentary and bibliographic analysis. After analyzing the health reform package and the changes implemented during the study period, it is evident that the main measures aim to strengthen the mixed health insurance model; This includes things like the separation of functions and the specialization of entities, within a market governance structure. Furthermore, it is noted that there is a lack of emphasis on measures to improve the provision of services and to overcome the fragmentation and segmentation of the health system. Finally, we believe that the opportunity for health reform was brief, given the context, and stressed, among other reasons, by the opposition of professional and civil society associations. Furthermore, it is worth highlighting the significant number of policies that have not been implemented or are only partially implemented, or that may be related to institutional fragility. Tipo: Dissertação Wed, 01 Jan 2025 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/87137 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/87131 Título: Itinerário terapêutico de mulheres idosas com câncer de colo de útero: perspectivas das usuárias e dos(as) cuidadores(as) Autor(es): Vieira, Gabriela Holanda Abstract: Introduction: Cervical cancer (CC) is emerging as a serious public health problem in Brazil. Older women constitute a highly vulnerable group for this condition, as current guidelines do not provide specific recommendations for screening in postmenopausal women, limiting themselves to evaluating past cytopathological history without establishing inclusion criteria that raise awareness among this group regarding the importance of the Pap test. Consequently, these women become more vulnerable due to gaps in care, the functional decline inherent to aging, and the accumulated disadvantages in their life trajectories. Objective: To understand the therapeutic journey of older women with cervical cancer from the time of diagnosis, from the perspective of the patient and the caregiver. Methodological Approach: A qualitative, exploratory, and descriptive study conducted in Fortaleza, Ceará. Data collection involved documentary research, semi-structured interviews with 6 patients and 3 informal caregivers, as well as the administration of the Zarit Caregiver Burden Scale to the caregivers. The analysis followed the principles of Thematic Content Analysis, supported by the literature on therapeutic pathways. The research was approved by the Research Ethics Committee of the Federal University of Ceará (Opinion No. 7.354.462). Presentation of findings: From an empirical perspective, strengths were identified in Primary Health Care (PHC), such as initial reception, ease in requesting tests, multidisciplinary care, strong patient-provider relationships, and follow-up measures. However, weaknesses in the network emerged, such as: delays in scheduling specialist appointments; failures in referral coordination; prolonged wait times for biopsy results; scarcity of high-tech diagnostic tests; fragmented care; and a lack of information regarding patient flow and prognosis. This situation leads to financial hardship, social isolation, and the invisibility of caregiving work. The results of the Zarit Scale indicated moderate burden for two caregivers (19 and 20 points) and severe burden for the third (over 22 points), confirming the strain resulting from daily caregiving demands. Commuting by public transportation revealed significant geographical barriers, with an estimated average travel time of 35 to 80 minutes to reach specialized oncology centers. It was not possible to conduct a quantitative analysis of SISCAN data due to chronic data entry failures in the SUS information systems. Final considerations: The study revealed a disconnect between the regulatory frameworks advocated by public policies and the actual experiences of service users and caregivers, demonstrating that weaknesses in the healthcare system directly contribute to family burden. In the context of primary health care marked by the coexistence of initial responsiveness and attitudinal barriers, preventive screening was often performed late in women who were already symptomatic, resulting in a diagnosis of cervical cancer predominantly at advanced stages. Tipo: Dissertação Thu, 01 Jan 2026 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/87131 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/87049 Título: Reações hansênicas em pós alta de poliquimioterapia: fatores associados e visão dos usuários numa área endêmica do Brasil Autor(es): Alencar, Maria de Jesus Freitas de Abstract: Introduction: Leprosy reactions are classified as type 1 (reversal reaction - RR), type 2 (Erythema Nodosum Leprosum - ENL) and pure neuritis. These lead to a potential risk of developing disabilities and deformities before and during anti-leprosy treatment as well as after release from treatment (RFT). Reactions must be diagnosed early and treated effectively. This research is justified by the scarcity of studies on the occurrence of reactions, monitoring practices of patients and factors associated with reaction episodes after RFT. We know little about existing diagnostic problems, about case management from the perspective of the affected persons with reactions.Methods: Transversal study design, consisting of a simplifíed neurological examination, a dermato-neurological examination and interviews of the defined target group. Five municipalities were included in the cluster areas: Araguaina (Tocantins), Floriano (Piauí), Bacabal and Caxias (Maranhão) and Marabá (Pará). The target population consisted of all resident individuais with leprosy reactions after being released from multidrug therapy, who presented themselves to the health Services in the period 2007 to 2009, regardless of the date of start of treatment. We compared the EHF (eye- hand-foot) scores at diagnosis and during the respondents’ examinations. In another analysis we compared the presence of disability scores (0-1) to the current EHF scores. In the analysis we used the Chi square test and for those associations where the expected value was less than 5 we used Fischer’s exact test. Results: A total of 280 patients were included in the study. Of those, 190 (67.9%) were male. The ages ranged from 8 to 85 years, with a mean of 46.5 years. Six patients were under 15 years and five aged between 15 and 17 years. The average monthly income of the respondents was R$ 1,077.00 (around €400) with values between R$ 60 (€22) and R$ 6,000 (€2200). More than ninety per cent lived in urban areas. As for education, 53 persons (18.9%) were illiterate and 53.6% had an incomplete primary education. In total 45 patients (16.1%) were classified as PB and 232 (83.7%) were classified as MB. The predominant clinicai form (Madrid classification) was dimorphous in 115 (41.1%) cases, followed by 82 lepromatous forms (29.6%). Type 1 reaction was present in 104 patients (37.1%), type 2 reactions in 18.6% of cases and pure neuritis in 13.9%. An associated neuritis was found in 51.9% of patients with type 2 reactions. The frequency of reaction episodes ranged from one to six. One episode only was developed by 215 patients (77.3%). The first episode occurred during anti-leprosy treatment for 121 patients (43.2%), followed in frequency of occurrence by patients after RFT. The EHF score at the time of diagnosis ranged from 0 to 11. At the time of the examination the EHF score range was 0-10, with a predominance of scores between 1 and 4. In 88 out of 198 patients (44.4%) their scores worsened. The risk of worsening was associated with the following socio-demographic variables: being illiterate (PR = 1.64, 95% Cl: 1.21 - 2.21, p = 0.003), being widower (PR = 1.98, 95% Cl: 1.20 - 3.96, p = 0.013). A protective factor was found: having completed secondary school education (PR = 0.4, 95% Cl: 0.23 - 0.71 p = 0.000). Worsening of the EHF scores was associated with borderline leprosy (PR = 3.71, 95% Cl: 1.00 - 13.70, p = 0.009), having had a reaction during MDT (PR = 1, 70; 95% Cl 1.13 to 2.54 P = 0.004), and the presence of a thickened nerve (PR = 1, 78, 95% Cl: 1.30 - 3.08 p = 0.024). In the patients’ health seeking behaviour towards diagnosis, self-perception of symptoms was reported by 240 respondents (85.8%). Dermatological symptoms were the main complaint, in 176 (62.9%) cases. Primary health care Services were the First point of entry for 95 patients (34%). The main reaction symptoms mentioned were of dermatological nature, in 115 (42%) cases Neurological complaints were mentioned by 97 (35.4%) respondents. In total, 206 out of the 280 patients (73, 5%) responded that leprosy brought about changes, problems and troubles in their lives. Among the intrapersonal changes, physical changes played an important role for 129 (62.6%) participants. These changes led to limitations in work performance and income, as well as causing restrictions in activities of daily living. Conclusions: Episodes of reactions worsen physical and psycho-social impairments, reduce social participation, cause problems at work and hamper activities of daily living. It is necessary to focus on the quality of life of individuais after RFT, especially among those with already established physical disabilities. The EHF score is an important tool to detect the progression of physical disability. The tool should be used in the diagnostic procedure, at the time of RFT and during reactions for all patients. Primary health care Services and reference centres in the municipalities involved need to improve monitoring persons after RFT. Improved monitoring is needed not just in those patients with existing disabilities (DG1 and DG2), but also for those without disability present at discharge. Evidence indicates the need for empowerment of people affected by leprosy to deal effectively with the signs and symptoms of reaction after MDT. It is suggested to establish a system for monitoring and surveillance of reactions for a period of minimally six months up to five years after RFT. This surveillance is especially important considering that patients may develop neurological impairment gradually and without presenting symptoms, with the subsequent possibility of physical and psycho-social harm. Tipo: Tese Sun, 01 Jan 2012 00:00:00 GMT http://repositorio.ufc.br/handle/riufc/87049 2012-01-01T00:00:00Z