Abstract Background In sub-Saharan Africa, malaria is the leading cause of morbidity and mortality. An estimated 15 million malaria cases and 40 000 malaria deaths were reported in Kenya. Malaria during pregnancy is associated with adverse health outcomes for both the mother as well as her foetus. The purpose of this study was to examine the relationship between socioeconomic correlates and the uptake of malaria prevention methods during pregnancy. Methodology: Data was drawn from the 2008-2009 Kenya Demographic and Health Survey. A total of 8098 women aged 15-49 were analysed. Stata version 12 was used for the management and analysis of data. Univariate, bivariate and multivariate analysis was carried out to meet the objectives of this study. Results: Forty-eight percent of women made use of Insecticide Treated Net (ITNs), 52 percent were administered with Intermittent Preventative Therapy (IPTp) and 36 percent made use of both measures during pregnancy. Multivariate results indicate that urban women were found to display slightly higher odds of ITN usage (1.13) and the combined usage of ITNs and IPTp (1.22) during pregnancy in comparison to rural women. Women with higher levels of education and women from middle income and rich households displayed higher odds of the uptake of these malaria prevention methods during pregnancy. Conclusion: This study has shown that socioeconomic indicators influence the usage of malaria prevention methods during pregnancy. It is therefore imperative that these factors be considered when designing and implementing policies aimed at improving the uptake of these measures during pregnancy.

MPH, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2010 / INTRODUCTION Although much focus has been placed towards rapid scale-up of antiretroviral treatment programmes and interventions for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV), very little is known about adherence to highly active antiretroviral therapy (HAART) and loss to follow-up of pregnant women in antiretroviral treatment programmes in the developing world. In this retrospective cohort analysis, we described the baseline characteristics of adult women who were pregnant at the time of HAART initiation (pregnant at start) as well as women who became pregnant during follow-up after starting HAART (pregnant after) and women who never had a pregnancy (not pregnant) during the study period. We evaluated the association of pregnancy status with adherence and loss to follow-up in these three groups of women. MATERIALS AND METHODS Themba Lethu Clinic is an urban public-sector antiretroviral rollout facility in Johannesburg, South Africa. A retrospective analysis was conducted of all adult women initiating HAART at this clinic between January 2005 and December 2007. Clinical data from these patients was analysed for differences in rates of loss to follow-up, and measured adherence rates based on CD4 cell count response and virologic suppression. Regression models were performed to determine independent predictors of adherence and loss to follow-up and compared between the three groups. Survival analysis, in the form of Kaplan-Meier plots and log-rank tests, was used to compare the time to becoming lost to follow up. RESULTS Between 1 January 2005 and 31 December 2007, 5129 women initiated HAART at Themba Lethu Clinic, Johannesburg, South Africa. Of these women, 521 (10.0%) were pregnant at the time of HAART initiation (pregnant at start) and 291 (5.6%) became pregnant during follow-up (pregnant after). Women who were pregnant at start (16.6%) of HAART had less-advanced HIV disease than the not pregnant women and pregnant women after HAART initiation 4608 (89.9%). Overall pregnant women were significantly younger than the not pregnant women and fewer pregnant women had a CD4 <100 cells/mm3 and a WHO stage III of HIV disease. There was no significant difference in the CD4 cell count response and virological suppression between the three groups of women based on pregnancy status at 6 months and 12 months (X2=2.1, p=0.347 and X2=4.4, p=0.111 respectively). However, women pregnant at start were more likely to become lost to follow-up (X2=15.8, P=<.0001) during follow up. In the multivariate Cox logistic regression model, independent predictors of loss to follow-up were pregnancy, baseline CD4 cell count and age at initiation. Being pregnant was significantly associated with being loss to follow-up. CONCLUSIONS Pregnancy is significantly associated with defaulting treatment and becoming lost to follow-up from HAART treatment programmes. Together with being pregnant, young age and a low CD4 at baseline are high risk factors for non adherence and loss to follow-up in this sub-group of the population. Early initiation of HAART with adequate pre-treatment counselling and ongoing adherence support could help improve adherence and retention in care for patients in treatment programmes in resource-limited settings. Interventions to trace patients immediately upon missed appointments would help to reduce the number of patients’ loss to follow-up. Moreover, integration of tuberculosis (TB), antenatal care (ANC) and HIV treatment services may maximize the effectiveness of interventions aimed at reducing the loss to follow-up rate. The initiation of HAART in pregnancy requires strengthened antenatal and HIV services that target women with advanced stage disease.

The study explores pertinent issues around a comprehensive provision of antiretroviral drugs to HIV positive pregnant women in South Africa from a human rights perspective. Although these drugs have been proven to significantly reduce the transmission of HIV from a pregnant mother to her newborn baby/babies at birth, the South African government for over five years refused to roll them out in the public health sector. Reasons that were provided in this regard were multifaceted and have included claims regarding their alleged toxicity, potential side effects, huge cost, inadequate infrastructure, etc until March 2004 when it announced to start a national rollout program. It is in light of this that the study sets out to explore some of the key positions within the government and amongst activist groups on the health rights of HIV positive pregnant women, and how these different positions have evolved in response to each other. In particular, the paper aims at examining how discourses of human rights were employed, and how they have impacted on the Social Work discipline. It further focuses on developing a Social Work perspective on the human rights of HIV positive pregnant women in South Africa, thereby contributing to the discipline’s professional value base and body of knowledge, which inform, inter alia, its advocacy role and social action approach. The research project was embedded in a theoretical framework often referred to as ‘standpoint research’. An archival study of local and international literature and policy documents was conducted. This was complemented with a limited qualitative study. Semi-structured interviews were conducted with a purposive sample of five interviewees representing a cross-section of positions on the topic. This data was analyzed using a three step coding procedure that allowed for categorizing, connecting, and systematically relating the gathered data to each other and to the reviewed literature. The research findings indicate that the South African government’s absence of consistency and apparent lack of political will to rollout the drugs have contributed to the deterioration of the right of HIV positive pregnant women to access health care services. The role of civil society organizations in helping to realize, promote and protect the health and related human rights of this group is emphasized. It was also found that the different strategies employed to this end speak well to Social Work’s value base, and some of its methods and approaches to practice. Social Work is therefore well placed to join and support those efforts of other segments of civil society that have been investigated in this paper. The paper concludes by making recommendations towards, inter alia, the need for the South African government to adhere to the values enshrined in the country’s Constitution; to work closely and transparently with different organs of civil society; and simultaneously implement the said ARV rollout program while building and strengthening its infrastructural capacity. The various roles Social Work could, and should, assume with regards to improving the human rights of HIV positive pregnant women in this regard are also highlighted.

Com a finalidade de avaliar um conjunto de curvas de ganho de peso de gestantes, foram tomadas, em dois grupos de mulheres, medidas antropométricas maternas como peso, estatura, peso habitual, peso no final da gravidez, perímetro cefálico, perímetro braquial, prega cutânea tricipital, bem como medidas antropométricas do recém-nascido ao nascer (peso, comprimento, perímetro cefálico), além de ter sido realizado estudo da dieta das gestantes. A comparação entre as curvas e as demais variáveis antropométricas, maternas ou fetais, mostrou que os resultados são semelhantes, mesmo em grupos diferentes entre si como os aqui estudados. As gestantes classificadas como desnutridas através das curvas de ganho de peso também o são quando outras técnicas são aplicadas. Os filhos de gestantes desnutridas têm peso, comprimento e perímetro cefálico significantemente menores que os filhos de gestantes normais ou obesas. Verificou-se ainda que não há relação entre a ingestão de calorias, proteínas e ferro e o estado nutricional materno. A estatura e a idade-gestacional maternas não interferiram nesse processo diagnóstico. Os resultados permitiram considerar as curvas estudadas como bons indicadores de desnutrição materna e fetal. / This study has been carried out with the purpose of evaluating curves of weight gain during pregnancy. Two gruups of women were selected and the following values were obtained for each them: maternal prepregnancy weight, weight at the end of pregnancy, height, cephalic circumference, arm circumference and triceps skinfold. Also some anthropometric measurements of tne newborn children were taken, such as weight, lenght and cephalic circumference. A dietary survey was aLso carried out. When the cuRves and the other measurements were compared, it was seen that the results were similar in both of the groups of mothers studied. Pregnant women classified as undernourished in terms of the weight gain curves are also classified in the same way when other tecniques are used. Babies born-to undernourished mothers have an impairment in intra-uterine growth, as compared to babies born to normal or obese mothers. There is no relation between caloric, protein and iron intake and maternal nutrition status. Maternal height and gestational age do not play any part in this diagnostic process. The results permit to consider the curves here studied as good indicators of maternal and fetal malnutrition.

Alicerçado em trabalhos contidos na literatura internacional sobre a implicação dos micoplasmas nas aIterações do trato geniturinário e sobretudo nas chamadas \"falhas da reprodução\", o presente estudo teve como objetivo, além da introdução de uma tecnologia de pesquisa desses microrganismos acessível ao laboratório clínico de rotina diagnóstica, também determinar as taxas de colonização de Mycoplasma hominis e de Ureaplasma urealyticum em gestantes pertencentes a uma classe de baixo nível sócio-econômico. Estas gestantes, em número de 74 (setenta e quatro), foram divididas em dois grupos: um grupo de 37 (trinta e sete) gestantes que possuía histórico anterior de alterações perigestacionais como: abortos, natimortos, prematuros, etc., e que constituíram o Grupo de Risco; e o outro constituído de 37 (trinta e sete) gestantes com gestações anteriores normais, Grupo Controle. Utilizando-se os materiais e métodos adaptados às condições de nosso meio, foram encontrados os seguintes resultados: a proporção de micoplasmas isolada foi de 94,6% no grupo de risco e de 81,2% no grupo controle. Do grupo de risco, Ureaplasma urealyticum foi isolado de vlnte e um pacientes (56,8%), Mycoplasma hominis de dois (5,4%) e ambos foram encontrados em seis pacientes (16,2%). No grupo controle, Ureaplasma urealyticum foi encontrado em 18 pacientes (48,6%), Mycoplasma hominis não foi isolado de nehuma (0,0%), enquanto que a associação Ureaplasma urealyticum e Mycoplasma hominis foi observado em seis casos (16,2%). Foi ainda verificado que onze (30,5%) gestações terminaram anormalmente no grupo de risco, sendo quatro (11,1%) de pacientes que não possuíam quaisquer alterações clínicas que as justificassem. No grupo controle, nenhuma alteração foi verificada entre os casos notificados. A análise estatística, dos resultados, permitiu verificar que não houve diferenças significantes entre os grupos estudados. / Abstracts Not Available

O magnésio (Mg) é um íon intracelular, co-fator essencial de mais de 300 reações enzimáticas, envolvido principalmente nas reações de geração de energia (ATP). Sua deficiência tem sido associada a complicações durante a gravidez, como préeclâmpsia, eclâmpsia, restrição do crescimento fetal intrauterino e mortalidade fetal. Deste modo, este estudo observacional de corte transversal teve como objetivo avaliar o estado nutricional em Mg de mulheres saudáveis no terceiro trimestre gestacional atendidas no pré-natal do Hospital Universitário da Universidade de São Paulo. A amostra foi composta por 52 gestantes saudáveis, entre a 26ª e 42ª semana gestacional, com média de idade de 28,1 (5,9) anos, que realizavam pré-natal no HU/USP. Elas foram submetidas a avaliação antropométrica (peso e altura), dietética (Mg), por meio do recordatório alimentar de 24 h e registro alimentar de 3 dias, e bioquímica (Mg plasmático, eritrocitário e urinário). Foi observado que todas as gestantes tinham inadequação no consumo alimentar de Mg. Das gestantes, 38,5% apresentaram baixa excreção urinária de Mg, porém a concentração de Mg nos outros parâmetros, plasma e eritrócito, não mostrou deficiência deste mineral. Foram observadas correlações significativas entre a ingestão alimentar de Mg e as seguintes variáveis: pressão arterial sistólica (r = - 0,297; p = 0,032), Mg eritrocitário (r = 0,285; p = 0,041) e tendência a ser significativa com a pressão arterial diastólica (r = -0,247; p = 0,078). As gestantes atendidas no HU/USP apresentaram inapropriado consumo alimentar do Mg, que se refletiu em alterações na excreção urinária deste mineral, porém sem afetar os demais compartimentos biológicos estudados. / Magnesium (Mg) is an intracellular ion, an essential co-factor for over 300 enzymatic reactions, involved mainly in energy (ATP) generation. Its deficiency has been associated to complications during pregnancy such as preeclampsia, eclampsia, restriction to intrauterine fetal growth and fetal mortality. So, this observational cross-section study aimed to evaluate the nutritional status concerning Mg in healthy women in the third trimester of pregnancy received prenatal care at the University Hospital of the University of São Paulo (HU/USP). The sampling comprised 52 healthy pregnant women between the 26th and the 42nd week of pregnancy, with a mean age of 28.1 (5.9) years, who received prenatal care at the HU/USP. They were submitted to anthropometric (weight and height), dietary (Mg), through the food recall 24 h and food record of 3 days, and biochemical (plasma, erythrocytic and urinary Mg) evaluations. It was observed that all pregnant women presented an inadequate Mg intake from food. An amount of 38.5% of the pregnant women showed low urinary Mg excretion, but Mg concentrations within the other parameters, that is, plasma and erythrocytic Mg, did not show deficiency of this mineral. Significant correlations were observed between Mg intake from food and the following variables: systolic blood pressure (r = - 0.297; p = 0.032), erythrocytic Mg (r = 0.285; p = 0.041) and a trend to be significant with diastolic blood pressure (r = - 0.247; p = 0.078). The pregnant women assisted at HU/USP presented inadequate intake of Mg from food, which was reflected in alterations in the urinary excretion of this mineral, although it was not affected in the other biological compartments studied.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-02-23T17:40:05Z No. of bitstreams: 1 MARLE ARAÚJO LUZ DE CARVALHO.pdf: 1280783 bytes, checksum: 5a05220787d6bfa01b155b4519142f85 (MD5) / Made available in DSpace on 2017-02-23T17:40:05Z (GMT). No. of bitstreams: 1 MARLE ARAÚJO LUZ DE CARVALHO.pdf: 1280783 bytes, checksum: 5a05220787d6bfa01b155b4519142f85 (MD5) Previous issue date: 2016-08-11 / The objective of this study was to analyze the characteristics and profiles of prenatal care from the perspective of women treated in the primary care network in a city of Piauí semiarid region. This is a descriptive exploratory survey study with a sample of 50 pregnant women, involving six teams of the Family Health Strategy, which data collection was carried out from January to May 2016 through a questionnaire. For statistical analysis we used descriptive statistics and the chi-square test or G when n <20. The results showed that 66% of pregnant women living in urban areas. The service was characterized by single hospital that performed the delivery, which is responsible for hosting 88% of pregnant women, and 56% were treated at one clinic in the city. Access to prenatal 44% of them occurred through referral and consultation schedule in 68% of cases was through the community health worker. The sociodemographic profile was formed by the prevalence of 40% of pregnant women aged 21-30 years old, 68% declared the brown race, 46% with higher education seven years, focusing on the lowest rate in the countryside, 72% They claimed to have stable partner and 74% defined the Catholic religion. The socioeconomic profile demonstrates composed majority of 66% with occupancy of the home, 72% with family income from 0 to 1 minimum wage, 50% dependent on the Bolsa Família, 56% without children, 36% live with their spouse and 44% own their own homes . Although 70% of pregnant women have access to treated water, there are problems related to basic sanitation: 80% do not have sewage system, 88% do not reside in asphalted local, 74% do not live close to the squares and 60% reside in wooded site. Regarding habits 78% do not exercise, 96% do not smoke, do not drink alcohol 100% and 90% did not use other drugs. It was found that 68% had laboratory tests and 62% exams ultrasound properly, 74% had prenatal booklet filled properly, and 82% started the consultation in the first trimester of pregnancy. The satisfaction index regarding professional consulting physician and nursing was high, with 96% and 98% respectively. However, 64% did not participate in educational activities offered by the service, 78% had no suggestions for improvement and 90% said they did not miss any service. It was found that the variable education had an influence only on four criteria: type of delivery, abortion, suggestions and dental care. It was found that the Piauí semiarid region is a very favorable scenario, as a result of health indicators, restricted network services and low population's quality of life, the study of prenatal care characteristics, both the social and economic problems listed, as the old problem involving the climate issue in the region. / O objetivo deste trabalho consistiu em analisar as características e perfis da assistência pré-natal na perspectiva de mulheres atendidas pela rede de atenção básica de um município do semiárido piauiense. Trata-se de um estudo survey descritivo-exploratório, com amostra de 50 gestantes, envolvendo seis equipes da Estratégia Saúde da Família, cuja coleta de dados foi realizada no período de janeiro a maio de 2016, através da aplicação de questionário. Para análise estatística dos dados utilizou-se estatística descritiva, além do teste qui-quadrado ou teste G, quando n<20. Os resultados demonstraram que 66% das gestantes residem na zona urbana. O serviço foi caracterizado por único hospital que realizava o parto, o qual é responsável por acolher 88% das gestantes, sendo que 56% foram atendidas no único ambulatório da cidade. O acesso ao pré-natal de 44% delas ocorreu por meio de encaminhamento e o agendamento da consulta em 68% dos casos foi através do agente comunitário de saúde. O perfil sociodemográfico foi formado pela prevalência de 40% das gestantes na faixa etária de 21 a 30 anos, 68% se declararam da etnia parda, 46% com escolaridade maior de sete anos, concentrando-se o menor índice na zona rural, 72% afirmaram ter parceiro estável e 74% se definiram da religião católica. O perfil socioeconômico demonstra maioria composta de 66% com ocupação do lar, 72% com renda familiar de 0 a 1 salário mínimo, 50% dependentes do Bolsa Família, 56% sem filhos, 36% moram com o cônjuge e 44% possuem casa própria. Embora 70% das gestantes tenham acesso à água tratada, existem problemas relacionados ao saneamento básico: 80% não possuem rede de esgoto, 88% não residem em locais asfaltados, 74% não moram próximas às praças e 60% não residem em local arborizado. Em relação aos hábitos 78% não praticam exercício físico, 96% não fumam, 100% não ingerem álcool e 90% não consomem outras drogas. Identificou-se que 68% realizaram os exames laboratoriais e 62% os exames de ultrassonografia de forma adequada, 74% possuíam o cartão da gestante preenchido adequadamente, sendo que 82% iniciaram a consulta no primeiro trimestre de gestação. O índice de satisfação em relação à consulta do profissional médico e de enfermagem foi alto, sendo de 96% e 98% respectivamente. Porém, 64% não participaram de atividades educativas oferecidas pelo serviço, 78% não apresentaram sugestões de melhoria e 90% afirmaram não faltar nenhum serviço. Verificou-se que a variável escolaridade exerceu influência apenas em quatro quesitos: tipo de parto, aborto, sugestões e atendimento odontológico. Constatou-se que o semiárido piauiense é um cenário bastante propício, em decorrência dos indicadores de saúde, restrita rede de serviços e baixa qualidade de vida da população, ao estudo das características da atenção pré-natal, tanto pelos problemas sociais e econômicos elencados, como pela velha problemática que envolve a questão climática na região.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Com a finalidade de avaliar um conjunto de curvas de ganho de peso de gestantes, foram tomadas, em dois grupos de mulheres, medidas antropométricas maternas como peso, estatura, peso habitual, peso no final da gravidez, perímetro cefálico, perímetro braquial, prega cutânea tricipital, bem como medidas antropométricas do recém-nascido ao nascer (peso, comprimento, perímetro cefálico), além de ter sido realizado estudo da dieta das gestantes. A comparação entre as curvas e as demais variáveis antropométricas, maternas ou fetais, mostrou que os resultados são semelhantes, mesmo em grupos diferentes entre si como os aqui estudados. As gestantes classificadas como desnutridas através das curvas de ganho de peso também o são quando outras técnicas são aplicadas. Os filhos de gestantes desnutridas têm peso, comprimento e perímetro cefálico significantemente menores que os filhos de gestantes normais ou obesas. Verificou-se ainda que não há relação entre a ingestão de calorias, proteínas e ferro e o estado nutricional materno. A estatura e a idade-gestacional maternas não interferiram nesse processo diagnóstico. Os resultados permitiram considerar as curvas estudadas como bons indicadores de desnutrição materna e fetal. / This study has been carried out with the purpose of evaluating curves of weight gain during pregnancy. Two gruups of women were selected and the following values were obtained for each them: maternal prepregnancy weight, weight at the end of pregnancy, height, cephalic circumference, arm circumference and triceps skinfold. Also some anthropometric measurements of tne newborn children were taken, such as weight, lenght and cephalic circumference. A dietary survey was aLso carried out. When the cuRves and the other measurements were compared, it was seen that the results were similar in both of the groups of mothers studied. Pregnant women classified as undernourished in terms of the weight gain curves are also classified in the same way when other tecniques are used. Babies born-to undernourished mothers have an impairment in intra-uterine growth, as compared to babies born to normal or obese mothers. There is no relation between caloric, protein and iron intake and maternal nutrition status. Maternal height and gestational age do not play any part in this diagnostic process. The results permit to consider the curves here studied as good indicators of maternal and fetal malnutrition.

A vacinação contra a rubéola tem como objetivo único, a proteção de futuras gerações de crianças em desenvolver a rubéola congênita. Gregg40, em 1941, levantou a hipótese de a rubéola ser a causa do nascimento de crianças com graves malformações congênitas. A confirmação etiológica só foi possível em 1962, com o isolamento do vírus, o que permitiu o desenvolvimento da vacina. A vacina foi utilizada, a partir de 1969, nos Estados Unidos e na Inglaterra e, atualmente, faz parte dos programas de vacinação de rotina na maioria dos países desenvolvidos. As experiências de mais de duas décadas no uso da vacina nos programas de controle da SÍNDROME DA RUBÉOLA CONGÊNITA (SRC) mostraram que a epidemiologia da rubéola, assim como a operacionalização das metas propostas para a cobertura vacinal são bastante complexas. As características do vírus, na sua interação com a população humana, determinam um padrão de transmissibilidade que propicia a formação de bolsões de indivíduos suscetíveis na idade adulta. Em condições naturais, a rubéola infecta cerca de 80 por cento a 90 por cento das pessoas até os 20 anos de idade, deixando um resíduo de indivíduos suscetíveis a partir desta idade, que, aparentemente, se mantém mesmo com epidemias sucessivas. O nascimento de crianças com SRC está condicionado à infecção rubeólica durante a gestação das mães destas crianças, portanto, a existência de mulheres suscetíveis à rubéola na idade fértil é uma condição fundamental à ocorrência da doença. O óbito de crianças malformadas detectadas em alguns meses do ano de 1986 chamou a atenção dos epidemiologistas do Município de Bauru para uma possível associação com a epidemia de rubéola ocorrida na cidade em 1985. Conhecer a proporção de suscetibilidade à rubéola entre gestantes é uma das maneiras para se estimar o risco de ocorrência de SRC. Em 1987, 689 gestantes residentes no Município de Bauru foram entrevistadas e submetidas a teste de inibição de hemaglutinação para determinação de suscetibilidade à rubéola. Destas gestantes, 66 (9,7 por cento ) foram consideradas suscetíveis à rubeóla. Não houve diferença estatisticamente significante na proporção de suscetibilidade das gestantes em relação à idade, número de gestações, paridade e idade gestacional, o que de certa forma confirma a dificuldade do vírus da rubéola em infectar todas as pessoas até o início da idade adulta, mesmo após uma epidemia. Este resíduo de suscetibilidade dificilmente seria eliminado naturalmente, como mostram as diferentes experiências nos países que iniciaram um programa de controle da SRC. Seria necessária uma alta cobertura vacinal (cerca de 95 por cento ) de todas as coortes de crianças e adolescentes para se conseguir a quebra na cadeia do processo infeccioso. Concomitantemente, é decisiva a proteção de todas as mulheres em idade fértil até que, estas coortes de indivíduos bem imunizados atinjam a idade fértil. Uma intervenção desta natureza não poderia ser implementada sem o respaldo de um sistema de vigilância epidemiológica fortalecido e atuante, capaz de monitorar não apenas o andamento do programa, mas, fundamentalmente, medir o impacto desta intervenção em termos de incidência de SRC. Considerando as características de polimorfismo da SRC e as dificuldades em se medir a magnitude da infecção congênita, a avaliação de um programa que envolve pelo menos duas gerações de indivíduos é um grande desafio para os administradores de saúde, principalmente, nos países em desenvolvimento. / The vaccination against rubella has as the only objectif to protect the future generations of children from the congenital rubella. Gregg, in 1941, supposed that the rubella should be the cause of birth of children with serious congenital abnormalities. The etiologial confirmation was only possible in 1962, by the isolation of virus, which allowed the development of vaccine. Firstly, utilized in the United States and Great Britain, in 1969, nowadays the vaccine is used in most developed countries. Experiences performed during more than two decades in usage of the vaccines during the Congenital Rubella Syndrome Control Program, showed that the epidemiology of the rubella, as well as, the exequibility of proposed aims for the vaccinal coverture are quite complex. The virus characteristics and its interactions with the population, determine a transmissibility pattern, which provides the formation of susceptible \"cluster\" in the adult age. In natural conditions, the rubella infects about 80 per cent to 90 per cent of people up to the age of twenty, leaving a susceptible remains after this age, which, apparently, it is maintained even with continuous epidemics. As the CRS children birth is connected to the rubella infection during the gestacional age of those mothers, the existence of susceptible childbearing age women is the most important condition for the disease to break out. In 1985, in the City of Bauru (São Paulo), abnormal number of death of congenital abnormalities children was focused by local epidemilogists. This fact was supposed, by the epidemiologists, being associated to a rubella epidemic in the year before. One of the ways to estimate the risk of occurance of RCS is to know the level of susceptibility among pregnant women. In 1987, 689 pregnant women, dwelling in the City of Bauru, were interviewed and went through a haemagglutination-inibition test in order to determine the susceptibility to rubella. Sixty-six out of these pregnant women was considered susceptible to rubella. There was not any difference statistically significant in the susceptible proportion of the pregnant women related to age, number of pregnancies, number of deliveries and gestacional age which somehow confirm the difficult of the rubella virus to infect all people up the beginning of the adult age, even after an epidemic. This susceptible remains would hardly ever be eliminated naturaly, as it is shown in the different experiences in countries, which began the RCS Control Program. The experiences showed that it would possibly, be necessary a high vaccinal coverture (about 95 per cent ) of all generations of children and adolescents in order to get the break of the infection process chain. Concomitantly, the protection of all women in childbearing age is important, until these generations of well vaccinated individuais reach the childbearing age. Such intervention should not be implemented without the agreement of an epidemiological surveillance system, both dynamic and strong, in order to monitore not only, the follow up of the program, but also, to measure the impact of this intervention in terms of RCS incidence. Considering the RCS characterists of polimorfism and the difficulties to evaluate the magnitude of congenital infection, the evaluation of a program that involves, at least, two generations of individuais, is a great challenge for the health administars, specially, in developing countries.