Objectives. To explore some of the demographic risk factors that are associated with the risk of behavioral or emotional problems in children, and to examine the possibility of an association between psychological stress in the parents and psychological problems in their children. Methods. In this study, the presence of psychological stress in the parents and certain psychosocial characteristics that increase the risk of mental problems in childhood were examined in a sample of Uruguayan children from three communities, two urban and one rural. The study, which was carried out in Ciudad Vieja and Barrio Sur, in the city of Montevideo, and in Colonia de Sacramento, a rural town, comprised 115 children between the ages of 5 and 15. Mothers answered the Child Psychiatric Morbidity Questionnaire (QMPI), an instrument for the detection of behaviors pointing to the presence of emotional problems in children. Both parents also supplied the demographic information requested in the Psychiatric Epidemiology Research Interview Demoralization Scale; they answered the CAGE questionnaire, a screening tool for alcoholism; they responded to the Social Support Network Inventory; and they answered questions about their self-perceived mental health. Results. Fifty-three percent of the children had scores greater than 6 on the QMPI, which indicates the possible presence of behavioral or emotional problems. Fathers' self-perception of emotional problems and mothers' feeling of being demoralized showed a statistically significant association with a greater risk of behavioral or emotional problems in their children. Conclusions. In light of our results, mental health in childhood is a social and public health problem that warrants further epidemiologic study in Uruguay.
Objetivos. Explorar algunos de los factores de riesgo demográficos que se asocian con la presencia de problemas conductuales o emocionales en los niños, y examinar la posibilidad de una relación entre el estrés psicológico en los padres y trastornos psicológicos en los hijos. Materiales y métodos. En el presente estudio la presencia de estrés psicológico en los padres y ciertas características psicosociales que aumentan el riesgo de sufrir trastornos mentales en la niñez fueron examinados en una muestra de niños uruguayos de dos comunidades urbanas y una rural. La investigación, que se llevó a cabo en Ciudad Vieja y Barrio Sur, en Montevideo, y en el pueblo de Colonia de Sacramento, abarcó a 115 niños entre las edades de 5 y 15 años. Las madres contestaron por sus hijos el Cuestionario de Morbilidad Psiquiátrica Infantil (QMPI), instrumento para la detección de problemas conductuales que podrían ser indicio de trastornos emocionales en los niños. Adicionalmente, ambos padres proporcionaron la información demográfica solicitada en la Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D) [Escala de Desmoralización para la Investigación Epidemiológica en Psiquiatría]; contestaron el cuestionario CAGE5 para el tamizaje del alcoholismo; se sometieron al Social Support Network Inventory [Inventario de la Red de Apoyo Social], y respondieron preguntas sobre su propio estado de salud mental. Resultados. Cincuenta y tres por ciento de los niños tuvieron puntajes mayores de 6 en el QMPI, resultado que señala la presencia de problemas conductuales o emocionales. La autopercepción de un trastorno emocional y de desmoralización en las madres mostró una asociación significativa con un mayor riesgo de problemas conductuales o emocionales en los hijos. Discusión. A juzgar por nuestros resultados, la salud mental del niño es un problema social y sanitario cuya epidemiología debe explorarse más a fondo en el Uruguay.
Between 1979 and 1994, epidemiological surveillance of meningitides in Uruguay showed a progressive increase in suppurative meningitides due mainly to Neisseria meningitidis and Haemophilus influenzae type b (Hib). The cases were concentrated in children under 5; however, among the cases caused by Hib, 70% affected children from 1 to 11 months old. Facing this situation, the Ministry of Public Health resolved, as of August 1994, to include the Hib vaccine in the country's Expanded Program on Immunization, which has been in place since 1982. The Hib vaccination is done without charge and is obligatory for all children under 5 years of age. It is done using the following series of vaccinations: a) three doses, given at 2, 4, and 6 months, with a booster dose at age 1; b) children from 7 to 11 months old receive two doses two months apart and a booster dose a year later; and c) a single dose for children 12 months to 4 years old. Between August and December 1994 a coverage rate of 76.6% was reached among children between 2 months and 4 years old, and the coverage has remained above 80% in the new cohorts. In Uruguay, this vaccination strategy had a spectacular impact on morbidity and mortality due to meningitides caused by Hib. One of the results was that the incidence of 15.6 per 100000 registered in children under 5 in the prevaccination years declined to 0.03 per 100000 in 1996.
In some countries, the invasive disease caused by Haemophilus influenzae type b (Hib) has been practically eliminated thanks to vaccination. However, in much of the developing world, meningitides and pneumonias caused by these bacteria continue to be a major cause of childhood morbidity and mortality, as well as high hospitalization costs. Because safe and effective conjugate vaccines are now available, the Special Program for Vaccines and Immunization of the Pan American Health Organization has recommended introducing them into the regular vaccination regimen of as many countries as possible. This has been done in Chile and Uruguay, where the Hib vaccine now forms part of the regular vaccination routine. When the vaccine was being introduced, both countries had difficulties they could have avoided if they had known of the experiences of other nations. Therefore, these two countries now offer the lessons they learned to other nations considering introducing the vaccine into their immunization programs. The most important lessons were to: strengthen the epidemiological surveillance system sufficiently in advance of introducing the vaccine; with th support of sicentific societies, present the technical information that justifies introducing the vaccine; seek community backing and acceptance; precisely establish in advance the presentation and dosage of the vaccine that is most appropriate for the country; and be certain to have the political and legal decisions needed to ensure the continuity of Hib vaccination in the future.