BACKGROUND: This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease OBJECTIVE: To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia METHODS: Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012 RESULTS: A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% («=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 -15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment CONCLUSIONS: In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia

Resumen Fundamento: El objetivo de este estudio fue valorar la afectación microangiopática mediante capilaroscopia en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Apenas ha sido estudiada y podría constituir una herramienta de diagnóstico precoz de afectación cardiovascular en estos pacientes. Material y métodos: Estudio transversal que incluyó pacientes mayores de 18 años, diagnosticados de infección por VIH entre 2008 y 2018. Se recogieron variables demográficas (sexo, edad), analíticas (tiempo de infección, CD4, CD4/CD8, coinfección por otros virus), tratamiento antirretroviral y comorbilidades (tabaquismo, enolismo, hipertensión arterial, dislipemia, diabetes, cardiopatía). Se realizó una capilaroscopia y un análisis de sangre en el mismo acto. Las alteraciones capilaroscópicas evaluadas fueron: congestión, tortuosidades, hemorragias, dilataciones, pérdida capilar y megacapilares. Resultados: Se incluyeron 102 pacientes, 73,5% hombres, edad media 40 años (DE: 10) y tiempo medio de infección 4,5 años (DE: 3,1). Al diagnóstico, la media de CD4 fue 408 células/mm3 y la razón CD4/CD8 fue 0,4. El 14,7% presentaban coinfección por el virus de la hepatitis B, el 31,3% tabaquismo y el 13,7% enolismo. El 93,1% de pacientes mostró alguna alteración capilaroscópica. Se observaron, por orden de frecuencia, congestión (78,5%), tortuosidades (77,5%), hemorragias (13,8%), dilataciones (11,8%), pérdida capilar (5%) y megacapilares (1%). Las torutuosidades se asociaron a edad y tabaquismo, y las hemorragias a edad, CD4, tratamiento antirretroviral, e hipertensión. Conclusiones: Los pacientes con infección por VIH presentan una prevalencia importante de alteraciones capilaroscópicas, principalmente tortuosidades y congestión. Es la primera descripción de áreas de congestión como hallazgo capilaroscópico en este grupo de pacientes.

Abstract Background: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. Methodology: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. Results: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuo-sity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. Conclusion: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Journalism has practically become a feminine profession across the world. To understand the root of the flow of women into the Journalism profession it is pertinent to begin at the university education level. Gallagher's 1992 worldwide survey of female students in 83 journalism institutions reveals a significant increase in number of female students. Djerf-Pierre (2007) and others argue along Bourdieu's conception of education as a form of social capital which empowers, enables and enhances women's competitiveness in a pre-dominantly androgynous social arena. The study analyses 16 years of enrolment data of the Academic Affairs Unit of the Ghana Institute of Journalism (GIJ), a leading Journalism, and Communication University in Africa, to understand the growing feminization of the journalism profession in Ghana. To this end the study, employs the UNESCO gender parity index model (GPI) to ascertain the gender parity ratio of male to female students enrolled at the University. Findings indicate a significant shift in the gender parity ratio in favour of women in the journalism education.

BACKGROUND. Although psoriatic arthritis (PsA) is a well-documented clinical entity, epidemiological, clinical and radiological studies of South African (SA) patients are scarce. OBJECTIVES. To assess clinical, biochemical and radiological features in a single-centre SA cohort. METHODS. We conducted a prospective assessment of the clinical, biochemical and radiological features of 384 consecutive patients with PsA seen at the rheumatology clinic at Prince Mshiyeni Memorial Hospital, Durban, SA, between January 2007 and December 2013. Patients were assessed at enrolment and 6 months after enrolment. They were classified into five groups as described by Moll and Wright, being entered into the group that best described the clinical manifestations. Clinicopathological characteristics recorded at enrolment were age at the time of examination, racial background, personal and family medical history, age and symptoms at the onset of PsA, pattern of joint involvement, joint pain, and the relationship between joint pain and the onset of PsA. RESULTS. Of the patients, 59.1% had a polyarticular presentation indistinguishable from rheumatoid arthritis, 19.0% had distal interphalangeal involvement, 9.1% had spondyloarthropathy, 11.9% had oligoarthritis and 0.9% had arthritis mutilans. The epidemiological trends (male/female ratio 1.45:1, mean age at onset of arthritis 50.2 (standard deviation 11.8) years, female preponderance in the polyarticular group and male preponderance in the spondyloarthropathy and oligoarticular groups) were similar to trends published elsewhere. A notable characteristic of our cohort was the complete absence of black South Africans with PsA. CONCLUSIONS. The complete absence of black South Africans with PsA is interesting. We anticipate that our findings will prompt genetic studies to isolate both protective and susceptibility genes for further elucidating PsA.

This paper examines regional differentials in pass rates in Primary School Leaving Examination (PSLE) in Mainland Tanzania. In particular, the paper investigates the effects of pupil-teacher ratio (PTR), pupil-latrine ratio (PLR), pupil-classroom ratio (PCR), availability of electricity in schools, and secondary school and above education of women and men aged 15-49 years on the percentage of students passing the PSLE. The paper employs a multilevel framework using aggregate regional data from Basic Education Statistics in Tanzania (BEST) and Tanzania Demographic and Health Survey (TDHS). The results indicate that regional pass rates in PSLE are negatively associated with regional PTR and PLR, and that there are regional differences in these education resources. However, their effects were found to be statistically insignificant. Education of women on the other hand, was positively and significantly related to the pass rate in the PSLE. Accordingly, there is a need for formulating education policies that would promote the enrolment of women in higher education in Tanzania so as to ensure that children achieve progress in education and social economic development later in life. In addition, measures to ensure efficient allocation of resources are needed in order to address apparent regional disparities regarding access to essential education resources.

Introduction: This study describes the frequency of late diagnosis and HIV among children attending a pediatric AIDS clinic. Methods: Cross-sectional study in children exposed to HIV from 2005-2008. A questionnaire was given that included questions on demographics and clinical information. Results: Two-hundred twenty-one (97.8%) children were exposed to HIV during pregnancy/childbirth. A total of 193 (87.3%) children had late enrolment in the service and late access to HIV serology. The frequency of HIV was 21.3% (95% confidence interval [CI] 15.9%-26.7%). Protective factors were earlier diagnosis [odds ratio (OR)=0.17 (0.08-0.37)] and receiving complete prophylaxis [OR=0.29 (0.09-0.97)]; being born by vaginal delivery was a risk factor [OR=4.45 (1.47-13.47)]. Conclusions: There was a high frequency of late diagnosis in this patient cohort. Earlier diagnosis is an important measure for controlling HIV among children.

O uso de serviços de saúde vem aumentando no país, mas permanecem as desigualdades geográficas e sociais, especialmente entre os grupos minoritários. O objetivo deste trabalho foi analisar o uso de serviços de saúde pela população quilombola de Vitória da Conquista, Bahia, Brasil. Trata-se de inquérito de saúde transversal, realizado em 2011, com indivíduos quilombolas > 18 anos. A magnitude das associações entre variáveis explanatórias e o uso de serviços foi estimada pelas razões de prevalência obtidas por regressão de Poisson com intervalo de 95% de confiança. Dos 797 indivíduos entrevistados, 455 (57,1%) usaram algum serviço de saúde nos 12 meses anteriores às entrevistas. Verificou-se maiores prevalências de uso de serviços para os quilombolas do sexo feminino, com companheiros(as), que avaliaram sua saúde como regular, ruim ou muito ruim, cadastrados no Programa Saúde da Família e que fizeram referência a um serviço de saúde de uso regular. Os resultados apontaram subutilização de serviços de saúde pelos quilombolas, demonstrando a necessidade de melhorar a prestação de serviços de saúde a essa população.

Use of health services is increasing in Brazil as a whole, but geographic and social inequalities persist, especially among minority groups. The aim of this study was to analyze the use of health services by members of quilombos (slavedescendant African-Brazilian communities) in Vitória da Conquista, Bahia State, Brazil. This cross-sectional health survey in 2011 focused on 797 adults (> 18 years old) belonging to quilombos. The magnitude of the associations between explanatory variables and use of services was estimated by the prevalence ratio obtained from Poisson regression with 95% confidence interval. Of the total sample, 455 (57.1%) reported having used health services in the 12 months prior to the interview. Higher rates of health services utilization were associated with female gender, non-single conjugal status, fair, poor, or very poor self-rated health, enrolment in the Family Health Program, and referral to a health facility for regular or on-going care. The results showed underutilization of health services by members of quilombos, thus demonstrating the need to improve health services provision for this population group.

El uso de los servicios de salud está aumentando en el país, pero se mantienen las desigualdades geográficas y sociales, especialmente, en los grupos minoritarios. El objetivo de este estudio fue analizar el uso de los servi-cios de salud por la población quilombola de Vitória da Conquista, en el Estado de Bahía, Brasil. Se trata de una encuesta de salud transversal realizada en 2011, con las personas quilombolas > 18 años. Con la magnitud de las asociaciones entre las variables explicativas y el uso de los servicios se calcularon las razones de prevalencia, obtenidas por regresión de Poisson, con un intervalo de un 95% de confianza. De las 797 personas entrevistadas, 455 (57,1%) habían utilizado los servicios de salud en los 12 meses anteriores a la entrevista. Hubo una mayor prevalencia de uso de los servicios para las mujeres quilombolas con pareja, que calificaron su salud como regular, mala o muy mala, inscritos en el Programa de Salud de la Familia y se designó un servicio de salud de uso regular. Los resultados apuntaron la subutilización de los servicios de salud por los quilombos.

O uso de serviços de saúde vem aumentando no país, mas permanecem as desigualdades geográficas e sociais, especialmente entre os grupos minoritários. O objetivo deste trabalho foi analisar o uso de serviços de saúde pela população quilombola de Vitória da Conquista, Bahia, Brasil. Trata-se de inquérito de saúde transversal, realizado em 2011, com indivíduos quilombolas > 18 anos. A magnitude das associações entre variáveis explanatórias e o uso de serviços foi estimada pelas razões de prevalência obtidas por regressão de Poisson com intervalo de 95% de confiança. Dos 797 indivíduos entrevistados, 455 (57,1%) usaram algum serviço de saúde nos 12 meses anteriores às entrevistas. Verificou-se maiores prevalências de uso de serviços para os quilombolas do sexo feminino, com companheiros(as), que avaliaram sua saúde como regular, ruim ou muito ruim, cadastrados no Programa Saúde da Família e que fizeram referência a um serviço de saúde de uso regular. Os resultados apontaram subutilização de serviços de saúde pelos quilombolas, demonstrando a necessidade de melhorar a prestação de serviços de saúde a essa população.

Use of health services is increasing in Brazil as a whole, but geographic and social inequalities persist, especially among minority groups. The aim of this study was to analyze the use of health services by members of quilombos (slavedescendant African-Brazilian communities) in Vitória da Conquista, Bahia State, Brazil. This cross-sectional health survey in 2011 focused on 797 adults (> 18 years old) belonging to quilombos. The magnitude of the associations between explanatory variables and use of services was estimated by the prevalence ratio obtained from Poisson regression with 95% confidence interval. Of the total sample, 455 (57.1%) reported having used health services in the 12 months prior to the interview. Higher rates of health services utilization were associated with female gender, non-single conjugal status, fair, poor, or very poor self-rated health, enrolment in the Family Health Program, and referral to a health facility for regular or on-going care. The results showed underutilization of health services by members of quilombos, thus demonstrating the need to improve health services provision for this population group.

El uso de los servicios de salud está aumentando en el país, pero se mantienen las desigualdades geográficas y sociales, especialmente, en los grupos minoritarios. El objetivo de este estudio fue analizar el uso de los servi-cios de salud por la población quilombola de Vitória da Conquista, en el Estado de Bahía, Brasil. Se trata de una encuesta de salud transversal realizada en 2011, con las personas quilombolas > 18 años. Con la magnitud de las asociaciones entre las variables explicativas y el uso de los servicios se calcularon las razones de prevalencia, obtenidas por regresión de Poisson, con un intervalo de un 95% de confianza. De las 797 personas entrevistadas, 455 (57,1%) habían utilizado los servicios de salud en los 12 meses anteriores a la entrevista. Hubo una mayor prevalencia de uso de los servicios para las mujeres quilombolas con pareja, que calificaron su salud como regular, mala o muy mala, inscritos en el Programa de Salud de la Familia y se designó un servicio de salud de uso regular. Los resultados apuntaron la subutilización de los servicios de salud por los quilombos.

Anaemia in falciparum malaria is associated with an increased risk of gametocyte carriage, but its effects on transmission have not been extensively evaluated in malarious children. Plasmodium falciparum gametocyte carriage, emergence, clearance, population sex ratios (SR) (defined as the proportion of gametocytes that are male), inbreeding rates and temporal changes in SR were evaluated in 840 malarious children. Gametocyte carriage pre-treatment was at a level of 8.1%. Anaemia at enrolment was an independent risk factor for gametocyte carriage post-treatment. The emergence of gametocytes seven days post-treatment was significantly more frequent in anaemic children (7/106 vs. 10/696, p = 0.002). In the initially detected gametocytes, the proportion of children with a male-biased SR (MBSR) (> 0.5) was significantly higher in anaemic children (6/7 vs. 3/10, p = 0.027). Pre-treatment SR and estimated inbreeding rates (proportion of a mother's daughters fertilised by her sons) were similar in anaemic and non-anaemic children. Pre-treatment SR became more female-biased in non-anaemic children following treatment. However, in anaemic children, SR became male-biased. Anaemia was shown to significantly increase gametocyte emergence and may significantly alter the SR of emerging gametocytes. If MBSR is more infective to mosquitoes at low gametocytaemia, then these findings may have significant implications for malaria control efforts in endemic settings where malaria-associated anaemia is common.

Esse artigo procura investigar os determinantes da matrícula escolar no Brasil, nos ensinos fundamental e médio, combinando duas tradições dos estudos educacionais. A primeira refere-se ao dividendo demográfico e a segunda aos estudos dos determinantes educacionais que utilizam o arcabouço teórico da Função de Produção Educacional. Somado a isso, busca-se incluir a dinâmica espacial na análise educacional, através da construção de uma metodologia alternativa, que combina os modelos hierárquico e espacial. Os principais resultados indicaram que uma menor pressão demográfica constitui um dos fatores contextuais mais importantes para a matrícula no fundamental. Já para o ensino médio, a disponibilidade de oferta educacional, representada pela razão professor/população em idade escolar, é o fator municipal mais relevante. Quando se considera o espaço na análise através do modelo hierárquico-espacial, observa-se que a razão de dependência e as demais variáveis contextuais das cidades vizinhas afetam a matrícula de determinado município.

The aim of this paper is to investigate the determinants of attendance at elementary and secondary schools in Brazil, combining two traditions in educational studies. The first tradition has to do with the demographic dividend and the second with studies on educational determinants based on the theoretical approach of Educational Production Function. This article takes into account spatial dynamics in educational analysis by constructing an alternative methodology that combines spatial and hierarchical models. The main results show that, on the elementary level, lower demographic pressure is among the most important contextual factors that influence enrolment of children in schools. On the other hand, educational supply, represented by the ratio between the number of teachers and the school-age population, is the most important aspect in cities. The hierarchical-spatial model shows that the dependency ratio, together with the additional contextual variables in adjacent cities, has an influence on school enrollment of any given municipality.

Este artículo busca investigar los determinantes de la matrícula escolar en Brasil, en los niveles de enseñanza fundamental y media, combinando dos tradiciones de los estudios educacionales. La primera se refiere al dividendo demográfico y la segunda a los estudios de los determinantes educacionales que utilizan el andamiaje teórico de la Función de Producción Educacional. Sumado a eso, se busca incluir la dinámica espacial en el análisis educacional, a través de la construcción de una metodología alternativa que combina los modelos jerárquico y espacial. Los principales resultados indicaron que una menor presión demográfica constituye uno de los factores contextuales más importantes para la matrícula no fundamental. Por otro lado, para la enseñanza media la disponibilidad de oferta educacional, representada por la razón profesor / población en edad escolar, es el factor municipal más relevante. Cuando se considera el espacio en el análisis a través del modelo jerárquico-espacial, se observa que la razón de dependencia y las demás variables contextuales de las ciudades vecinas afectan la matrícula de determinado municipio.

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS - but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrolment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.

OBJECTIVE: The aim of this study was to estimate the field efficacy of the first routine programme for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) initiated in South Africa, in the subdistrict of Khayelitsha. METHODS: A consecutive sample of 658 mother-infant pairs, identified from the PMTCT register from 1 March to 30 November 2003, were identified for enrolment in this study. Details of the regimen received were established and HIV status of the infants at between 6 and 10 weeks of age was determined by qualitative DNA polymerase chain reaction. Zidovudine (AZT) was provided antenatally from week 34 of gestation and during labour. Infant formula milk was offered to mothers who chose not to breastfeed. The protocol was amended in July 2003 such that women who had received < 2 weeks of treatment with AZT were given a single dose of nevirapine (NVP) at the onset of labour, and the infant received a weight-adjusted dose of NVP within 72 h of delivery. RESULTS: Of the 535 mother-infant pairs (81%) eventually included in the study, 410 (77%) received an effective PMTCT intervention according to the protocol. The rate of transmission of HIV from mother to child was 8.8% (95% confidence interval (CI), 6.2-10.9). A maternal age of > 25 years was the only significant independent risk factor for transmission (odds ratio, 2.12; 95% CI, 1.14-4.07). CONCLUSION: The results of this study demonstrate the feasibility and effectiveness of a large-scale PMTCT programme in an urban public-sector setting.

OBJETIVO: Estimar la eficacia sobre el terreno del primer programa sistemático de prevención de la transmisión de la madre al niño (PTMN) del virus de la inmunodeficiencia humana (VIH) iniciado en Sudáfrica, en el subdistrito de Khayelitsha. MÉTODOS: Se reclutó para el estudio a una serie consecutiva de 658 pares de madre y lactante, identificados mediante el registro de PTMN entre el 1 de marzo y el 30 de noviembre de 2003. Se establecieron los detalles del tratamiento administrado y se utilizó la PCR (reacción en cadena de la ADN-polimerasa) cualitativa para determinar la serología VIH de los lactantes entre las 6 y las 10 semanas de edad. Se proporcionó zidovudina (AZT) prenatal a partir de la 34 semana de gestación y durante el parto. A las madres que decidieron no dar de mamar se les ofreció leche maternizada. El protocolo se modificó en julio de 2003 de manera que a las mujeres tratadas con AZT durante menos de 2 semanas se les administró una dosis única de nevirapina (NVP) al comienzo del parto, y el lactante recibía una dosis de NVP ajustada a su peso dentro de las primeras 72 horas tras el parto. RESULTADOS: De los 535 pares de madre y lactante (81%) finalmente incluidos en el estudio, 410 (77%) recibieron una intervención eficaz de PTMN según el protocolo. La tasa de transmisión del VIH de madre a hijo fue del 8,8% (intervalo de confianza (IC) del 95%: 6,2-10,9). Una edad materna superior a 25 años fue el único factor de riesgo de transmisión independiente y significativo (OR: 2,12; IC95%: 1,14-4,07). CONCLUSIÓN: Los resultados de este estudio demuestran la viabilidad y la eficacia de un programa de PTMN a gran escala en un entorno urbano del sector público.

OBJECTIF: La présente étude vise à évaluer l'efficacité sur le terrain du premier programme de prévention systématique de la transmission de la mère à l'enfant (PTME) du virus de l'immunodéficience humaine, lancé dans le sous-district de Khayelitsha, en Afrique du Sud. MÉTHODES: Un échantillon consécutif de 658 couples mère-nourrisson a été constitué à partir de l'analyse du registre de PTME du 1er mars au 30 novembre 2003, pour servir de support à l'étude. Les enquêteurs ont déterminé de manière précise l'alimentation reçue par le nourrisson et le statut VIH de celui-ci entre 6 et 10 semaines par une recherche qualitative de l'ADN par PCR. Les mères ont reçu de la Zidovudine (AZT) pendant la période anténatale, à partir de la 34e semaine de grossesse et pendant le travail. Des préparations pour nourrissons ont été proposées aux mères ayant choisi de ne pas allaiter. En juillet 2003, les enquêteurs ont apporté au protocole une modification prévoyant l'administration au début du travail d'une dose unique de névirapine (NVP) aux femmes traitées pendant moins de 2 semaines à l'AZT et d'une dose de NVP déterminée en fonction du poids au nourrisson dans les 72 heures suivant l'accouchement. RÉSULTATS: Parmi les 535 couples mère-nourrisson (81 %) inclus en fin de compte dans l'étude, 410 (77 %) ont effectivement bénéficié d'une intervention de PTME conforme au protocole. Le taux de transmission du VIH de la mère à l'enfant était de 8,8 % [intervalle de confiance à 95 % (IC) : 6,2 - 10,9]. Le seul facteur de risque indépendant jouant un rôle important dans la transmission était un âge maternel supérieur à 25 ans (odds ratio : 2,12, intervalle de confiance à 95 % : 1,14 - 4,07). CONCLUSION: Les résultats de cette étude démontrent la faisabilité et l'efficacité d'un programme de PTME à grande échelle dans un centre de soins public et urbain.

Este trabalho, elaborado com base nos indicadores da educação superior produzidos pelo INEP, IBGE e UNESCO, analisa a situação do acesso à educação superior no Brasil nos últimos 40 anos, considerando as diferenças nas matrículas e oferta de vagas entre as dependências administrativas e os cursos, o perfil dos concluíntes e a qualificação dos docentes. Comparam-se também os indicadores de taxa de escolarização e grau de privatização do setor no Brasil com os de outros países da América Latina e do mundo. Por fim, é feita uma breve discussão sobre as últimas ações do MEC (gestão Tarso Genro), com vistas a ampliar a oferta e democratizar o acesso. O que os dados apresentados mostram é que, muito embora desde a década de 1960 a política do governo federal para o setor tem sido a ampliação de vagas via privatização, a Taxa de Escolarização Bruta na Educação Superior do país ainda é uma das mais baixas da América Latina, embora o grau de privatização seja um dos mais altos do mundo. O resultado deste processo foi uma grande elitização do perfil dos alunos, em especial nos cursos mais concorridos e nas instituições privadas, onde é muito pequena a presença de afrodescendentes e de pobres. As propostas apresentadas até o momento pelo MEC norteiam-se pelo princípio de expansão de vagas, sem recursos adicionais, no setor público, e subsídios ao setor privado, em troca de bolsas de estudo. Para democratizar o perfil dos alunos propõem-se quotas, tanto no setor público quanto no privado. Trata-se de medidas paliativas, que não enfrentam a questão central que é a expansão do setor público sem perda de qualidade, o que implica sair do atual 0,8% do PIB gasto com o ensino de graduação para um patamar de cerca de 1,4% do PIB.

Based on higher education indicators produced by the INEP, IBGE and UNESCO, this study analyzes the problem of access to higher education in Brazil these last 40 years, considering the differences in admission and enrollment according to the administrative regions and fields of study, graduates profiles and teacher qualifications. The gross enrolment ratio and level of privatization indicators for this sector in Brazil are also compared to those of other countries in Latin America and the world. Lastly, the latest actions of the Ministry of Education and Culture (MEC - Tarso Genro administration), aimed at increasing supply and democratizing access are briefly discussed. The data show that, although the federal government policy for this sector since the 1960s has been to increase enrollment via privatization, Brazil's Gross Schooling Rate for Higher Education is still one of the lowest in Latin America, while its level of privatization is one of the highest in the world. This process has resulted in an overall elitization of the profile of students, especially in the fields with the highest demand and in private institutions, where the presence of African-descendant or poor students is still very low. The proposals presented thus far by the MEC reflect a guiding principle oriented toward an increase in enrollment without additional resources for the public sector, and the granting of subsidies to the private sector in exchange for scholarships, as well as quotas, in both the public and private sectors. These are palliative measures that do not address the main point: expanding the public sector without losing quality. This would mean an increase in higher education expenditures, from the current 0.8% of GDP to about 1.4% of GDP.