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Project "Smile Maré"

Integral health as a component of basic health activity carried out by health promoters

Dr. Andréa Soares Quirino da Silva, Odontopediatra, Federal University of Rio de Janeiro
Dr. Vanessa Maria de Souza e Silva, Master in Social and Preventive Odontology / Federal University of Rio de Janeiro
Dr. Ana Lúcia Ferreira, Pediatrist, Federal University of Rio de Janeiro


Introduction This is a community project sponsored by the W. F. Kellogg Foundation whose purposes are: to give priority to prevention efforts specially through self care, the development of the community participation in the oral health care programs together with the general health care programs and the strengthening of the community through self care. It began in September 1991 in four of the twelve communities of the Complexo da Maré: Baixa do Sapateiro, Parque Maré, Timbau e Vila João, located near the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. The activities are ministered by eight Health Promoters inhabitants of those communities, under the supervision of a multiprofessional team of experts of three units of UFRJ: Faculty of Odontology, Institute of Child Care and Pediatrics Martagão Gesteira and Hospital-School São Francisco de Assis. The Presidents of the Neighbors Associations in the communities are partners in the management of the project.

The Health Promoters through home visits give orientation in the five basic health actions of the Program for the Children of Health Ministry (Breast-feeding, Growth, Development, Diarrhoea and Therapeutics of Oral Re-hydration - TOR, Severe Respiratory Infection - SRI, Immunizations) and Oral Health. Also they develop group activities in the communities to reinforce some points seem more in need according to the benefits and results of the home visits.

Historical For the implementation of the Smile Maré Project extensive discussions took place with the Representative of the communities, Presidents of the Neighbours Associations of the twelve units of Complexo Maré, Director of Units of UFRJ, all involved in the Project and also with members of the technical executive team during a period of six months. It was elaborated a letter-compromise among the members of the Institutions and of the Presidents of the Neighbours Associations by which document all agreed to be responsible for the planning and development of the project as well as for the selection of the four communities where the Project would be initiated.

The beginning of the Project activities took place in September 1991 through an event organized by the Neighbours Associations with the participation of members of the communities and also of members of the Board of Directors and representatives of all said associations.

During the first phase of the activities we made some adaptations in the instruments of investigation (register of data information) and we detected problems outside our field , like alcoholism, hanseiase and other specific pathologies. Also we were aware of the fragility of our system of medical and dental reference.

Our Project saw in its second year of development the landmark of reality through the perception of our deficiencies and capacities, of the necessity of definition of a political guide, of the identification of a model development, of the health promoters as a person with yearnings and needs and the extent of our purposes. The double management (technical team and presidents of neighbours associations) didn't happen due to the withdraw of the community leadership in the process of execution. The third year was marked by the strengthening of the technical team and the better understanding of the community.

Conclusion During these three years we visited 6,537 children in their houses. We acted in 16 day-nurseries and schools. We gave around 63 talks on the basic health actions and oral health, and other talks on: cholera, dengue, hepatitis, meningitis, AIDS, and first-aids, all by their request. We promoted meetings with groups of people in action in the community like "Breast Friends", "Health and Child Movement", "Health Agent of Social Environment Secretariat, Rio de Janeiro", and other groups working on the AIDS subject. We also participated in the campaigns for inoculation, fluorescence, workshops and communal works.

Today we know the health profile of children from 0 to 5 years old from each one of those communities.

* The survey on pregnant women attendance was of 91.4% with no difference among the four communities.

* 40.7% of the children were nursed for a period from 1 to 5 months

* Even though 96.5% of the mothers are aware of the making of domestic serum only 64.7% said they had done it.

* In the six months period before they were interviewed 23% of the children had had diarrhoea.

* Of the 97.3% of the children that had the inoculation card at the time of the visit, only 93% were in order with the inoculation calendar advised by the Health Department.

* Even though we know that in our area the SRIs are the biggest problem of the children only 38% of the mothers remembered facts from the last 6 months. Maybe this rate are not right due to the difficulty for the mothers or other people in charge cover such a long period of time. Of the 1946 children under 5 years of age 17% had already suffered one hospital internment. The highest alone cause for this is pneumonia followed by other respiratory problems as bronchitis and asthma.

* The indicator of low weight at time of birth (< 2,500 g) was of 10.6% what matches the indicator of the part of the population of low income of our City of Rio de Janeiro, around 12%.

* 51.5% of the children had their medical file in some health service.

* 74.4% of the children use tooth paste and only 9.8% had received orientation on oral hygiene.

The epidemiological survey in the dental decay by the dental unit (DMFT and ceo) demonstrate that the quantitative information agree with the former surveys carried out in Rio de Janeiro. The results of the four communities of this Project are listed beside.

In these three years of the elaboration of the Project we notice that the community participation was done in a passive voice. We met with goodwill to all proposed actions but there was not really a real partnership in the planning and development of the activities.

The process of promotion of health should include activities of continuous training and can not be disengaged from the promotion of citizenship. For that we need to develop a much more extensive task than the initially proposed in the Project. We gave the first steps. We believe we are in the right path. Nevertheless, we have a long way to go to get our main goal, that is a true integration of the University and the neighboring communities resulting in a positive exchange of experiences for both parts.

General Coordinator: * Roberto Braga de Carvalho Vianna

Executive Staff: * Alfa Maria Batista Claudino - Educator

* Ana Lúcia Ferreira - Pediatritian

* Andrea Soares Quirino da Silva - Pediatric Dentistry

* Vanessa Maria de Souza e Silva - Master in Social and Preventive Dentistry

Partner Institutions: * Faculty of Odontology

* Institute of Child Care and Pediatrics Martagão Gesteira

* Hospital - School São Francisco de Assis

* W. K. Kellogg Foundation

* Rio de Janeiro Federal University

Mailing address:

Fac. Odontologia/Univ. Fed. Rio de Janeiro

Fax: (021) 290-8148


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