Ana Carolina Feldenheimer da Silva

Causas do declínio acelerado da desnutrição infantil no Nordeste do Brasil (1986-1996-2006)

OBJECTIVE To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes. METHODS Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions. RESULTS Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period. CONCLUSIONS The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.OBJETIVO: Descrever a variacao temporal na prevalencia de desnutricao infantil na regiao Nordeste do Brasil, em dois periodos sucessivos, identificando os principais fatores responsaveis pela evolucao observada em cada periodo. METODOS: Os dados analisados provem de amostras probabilisticas da populacao de criancas menores de cinco anos estudadas por inqueritos domiciliares do programa Demographic Health Surveys realizados em 1986 (n=1.302), 1996 (n=1.108) e 2006 (n=950). A identificacao dos fatores responsaveis pela variacao na prevalencia da desnutricao (altura para idade < -2 z) levou em conta mudancas na frequencia de cinco determinantes potenciais do estado nutricional, modelagens estatisticas da associacao independente entre determinante e risco de desnutricao no inicio de cada periodo e calculo de fracoes atribuiveis. RESULTADOS: A prevalencia da desnutricao foi reduzida em um terco de 1986 a 1996 (de 33,9% para 22,2%) e em quase tres quartos de 1996 a 2006 (de 22,2% para 5,9%). Melhorias na escolaridade materna e na disponibilidade de servicos de saneamento foram particularmente importantes para o declinio da desnutricao no primeiro periodo, enquanto no segundo periodo foram decisivos o aumento do poder aquisitivo das familias mais pobres e, novamente, a melhoria da escolaridade materna. CONCLUSOES: A aceleracao do declinio da desnutricao do primeiro para o segundo periodo foi consistente com a aceleracao de melhorias em escolaridade materna, saneamento, assistencia a saude e antecedentes reprodutivos e, sobretudo, com o excepcional aumento do poder aquisitivo familiar, observado apenas no segundo periodo. Mantida a taxa de declinio observada entre 1996 e 2006, o problema da desnutricao infantil na regiao Nordeste poderia ser considerado controlado em menos de dez anos. Para se chegar a este resultado sera preciso manter o aumento do poder aquisitivo dos mais pobres e assegurar investimentos publicos para completar a universalizacao do acesso a servicos essenciais de educacao, saude e saneamento.

Ações de alimentação e nutrição na atenção básica: a experiência de organização no Governo Brasileiro

The article describes the experience of the Brazilian government in the organization of food and nutrition actions in primary healthcare. The actions are developed by food and nutrition surveillance personnel having the Food and Nutrition Surveillance System as its main tool; Actions of Health and Healthy Food Habits Promotion, with the implementation of the Brazilian Food Guide; National Strategy for Healthy Complementary Feeding; Health at School Program; and actions for the prevention and control of obesity, non-communicable chronic diseases and micronutrient deficiencies, with special focus on iron-deficiency anemia and vitamin A deficiency. The actions related to food and nutrition in primary healthcare were strengthened by the inclusion of a dietician in the Family Health Support Teams - multidisciplinary teams that guarantee that primary healthcare teams have access to primary, secondary and tertiary food and nutrition actions. Intersectoral cooperation is one of the components of food and nutrition actions in primary healthcare, providing care to the families that receive financial aid (Bolsa Familia) and combining the actions of the different sectors (health, education, social assistance and labor) in the territory. The challenge is the consolidation, expansion and universalization of the actions proposed for primary care in Brazil.

Estado nutricional dos adolescentes e sua relação com variáveis sociodemográficas: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009

The aim of this study was to describe the nutritional status of adolescents in the 9th year of public and private schools of the Brazilian capitals and its association with socio-demographic variables. By means of a self-completed questionnaire, information related to sex, race, age, public/private school, macro-region of the country, maternal education and family possessions were recorded. Measures of weight and height were measured according to standardized procedures. Height for age and body mass index for age was evaluated according to the World Health Organization reference. Anthropometric measurements of 58,971 adolescents were obtained, of which 2.9% were stunted and 2.9% underweight. There was 23.0% of overweight and 7.3% of obesity, which were higher in the South and Southeast regions. Deficits in height and weight, overweight and obesity were more prevalent in boys. The deficits were higher at public schools while overweight and obesity at private ones. Adolescents whose mothers were less educated or from poorer families had greater deficits in height and the reverse occurred with overweight and obesity. The findings about the deficits, overweight and obesity highlight the need for nutritional interventions designed to reach this stage of life.

Produção científica sobre nutrição no âmbito da Atenção Primária à Saúde no Brasil: uma revisão de literatura

INTRODUCAO: Acoes de nutricao na Atencao Primaria a Saude (APS) tem importante papel na promocao da saude e na prevencao e tratamento de agravos. OBJETIVO: Mapear, sistematizar e avaliar a producao cientifica da nutricao no âmbito da APS no Brasil. METODOS: Trata-se de uma revisao de literatura. A busca de artigos foi feita no PubMed e Lilacs, utilizando descritores referentes a APS e a nutricao. Foram levantados estudos conduzidos no Brasil, com profissionais ou populacao atendida pelo SUS na APS e publicados ate marco de 2011. Ainda, foram consultadas as referencias dos artigos selecionados, a fim de identificar outros estudos. RESULTADOS: Do total de artigos localizados, 68 foram elegiveis e 49 foram identificados nas listas de referencias, totalizando 117 artigos analisados. Estes foram, em sua maioria, artigos originais, quantitativos, conduzidos no estado de SP, pela USP e publicados de 2002 a 2011. Abordavam o diagnostico, tendo como objeto a avaliacao do estado nutricional e envolviam criancas. CONCLUSAO: A producao na area e crescente, porem ha necessidade de redirecionar a abordagem e o objeto de futuros estudos, focando em modelos de intervencao e em avaliacao de programas.

Causes of the accelerated decline in child undernutrition in Northeastern Brazil (1986-1996-2006)

OBJECTIVE To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes. METHODS Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions. RESULTS Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period. CONCLUSIONS The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.OBJETIVO: Descrever a variacao temporal na prevalencia de desnutricao infantil na regiao Nordeste do Brasil, em dois periodos sucessivos, identificando os principais fatores responsaveis pela evolucao observada em cada periodo. METODOS: Os dados analisados provem de amostras probabilisticas da populacao de criancas menores de cinco anos estudadas por inqueritos domiciliares do programa Demographic Health Surveys realizados em 1986 (n=1.302), 1996 (n=1.108) e 2006 (n=950). A identificacao dos fatores responsaveis pela variacao na prevalencia da desnutricao (altura para idade < -2 z) levou em conta mudancas na frequencia de cinco determinantes potenciais do estado nutricional, modelagens estatisticas da associacao independente entre determinante e risco de desnutricao no inicio de cada periodo e calculo de fracoes atribuiveis. RESULTADOS: A prevalencia da desnutricao foi reduzida em um terco de 1986 a 1996 (de 33,9% para 22,2%) e em quase tres quartos de 1996 a 2006 (de 22,2% para 5,9%). Melhorias na escolaridade materna e na disponibilidade de servicos de saneamento foram particularmente importantes para o declinio da desnutricao no primeiro periodo, enquanto no segundo periodo foram decisivos o aumento do poder aquisitivo das familias mais pobres e, novamente, a melhoria da escolaridade materna. CONCLUSOES: A aceleracao do declinio da desnutricao do primeiro para o segundo periodo foi consistente com a aceleracao de melhorias em escolaridade materna, saneamento, assistencia a saude e antecedentes reprodutivos e, sobretudo, com o excepcional aumento do poder aquisitivo familiar, observado apenas no segundo periodo. Mantida a taxa de declinio observada entre 1996 e 2006, o problema da desnutricao infantil na regiao Nordeste poderia ser considerado controlado em menos de dez anos. Para se chegar a este resultado sera preciso manter o aumento do poder aquisitivo dos mais pobres e assegurar investimentos publicos para completar a universalizacao do acesso a servicos essenciais de educacao, saude e saneamento.

Scientific output on nutrition in the scope of Primary Health Care in Brazil: a review of the literature

Nutrition campaigns in Primary Health Care (PHC) play an important role in health promotion and the prevention and treatment of injuries. The scope of this paper is to chart and evaluate the scientific output of nutrition in Brazilian PHC. A search and review of the literature and papers was conducted on the PubMed and Lilacs databases, using key words related to PHC and nutrition. The studies were restricted to Brazil with the professionals or population assisted by PHC in the Brazilian Unified Health System and published prior to March 2011. The references in the selected articles were also consulted in order to identify additional studies. From the total of papers located, 68 were eligible and a further 49 were identified in the references lists, such that a total of 117 papers were analyzed. The studies reviewed were mostly original articles, using quantitative methodology, carried out by São Paulo University in that state and published from 2002 to 2011. The main issues were diagnosis seeking the evaluation of nutritional status involving children. The output in this field is growing, although there is a need to redirect the scope of future studies to a focus on intervention models and program evaluation.

Causas de la disminución acelerada de la desnutrición infantil en Noreste de Brasil (1986-1996-2006)

OBJECTIVE To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes. METHODS Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions. RESULTS Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period. CONCLUSIONS The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.OBJETIVO: Descrever a variacao temporal na prevalencia de desnutricao infantil na regiao Nordeste do Brasil, em dois periodos sucessivos, identificando os principais fatores responsaveis pela evolucao observada em cada periodo. METODOS: Os dados analisados provem de amostras probabilisticas da populacao de criancas menores de cinco anos estudadas por inqueritos domiciliares do programa Demographic Health Surveys realizados em 1986 (n=1.302), 1996 (n=1.108) e 2006 (n=950). A identificacao dos fatores responsaveis pela variacao na prevalencia da desnutricao (altura para idade < -2 z) levou em conta mudancas na frequencia de cinco determinantes potenciais do estado nutricional, modelagens estatisticas da associacao independente entre determinante e risco de desnutricao no inicio de cada periodo e calculo de fracoes atribuiveis. RESULTADOS: A prevalencia da desnutricao foi reduzida em um terco de 1986 a 1996 (de 33,9% para 22,2%) e em quase tres quartos de 1996 a 2006 (de 22,2% para 5,9%). Melhorias na escolaridade materna e na disponibilidade de servicos de saneamento foram particularmente importantes para o declinio da desnutricao no primeiro periodo, enquanto no segundo periodo foram decisivos o aumento do poder aquisitivo das familias mais pobres e, novamente, a melhoria da escolaridade materna. CONCLUSOES: A aceleracao do declinio da desnutricao do primeiro para o segundo periodo foi consistente com a aceleracao de melhorias em escolaridade materna, saneamento, assistencia a saude e antecedentes reprodutivos e, sobretudo, com o excepcional aumento do poder aquisitivo familiar, observado apenas no segundo periodo. Mantida a taxa de declinio observada entre 1996 e 2006, o problema da desnutricao infantil na regiao Nordeste poderia ser considerado controlado em menos de dez anos. Para se chegar a este resultado sera preciso manter o aumento do poder aquisitivo dos mais pobres e assegurar investimentos publicos para completar a universalizacao do acesso a servicos essenciais de educacao, saude e saneamento.