Ana Paula Sayuri Sato

Prevalência de anemia em gestantes e a fortificação de farinhas com ferro

Avaliou-se o impacto da fortificacao das farinhas com ferro, na prevalencia de anemia e concentracao de hemoglobina de gestantes. Este estudo transversal retrospectivo foi desenvolvido em um Centro de Saude Escola do municipio de Sao Paulo - SP. Os dados, colhidos de setembro a dezembro de 2006, foram obtidos de 750 prontuarios de gestantes distribuidas em dois grupos (nao fortificado e fortificado), antes e apos a fortificacao. Gestantes com nivel de hemoglobina inferior a 11g/dl foram consideradas anemicas. Realizou-se analise de regressao linear multipla. A anemia afetava 9,2% e 8,6% das gestantes, antes e apos a implantacao do programa, respectivamente (p>0,05). A analise multipla nao evidenciou diferenca estatistica na media de hemoglobina entre os grupos (p=0,117). Os resultados indicaram uma baixa prevalencia de anemia e medias de hemoglobina similares entre os grupos, fato que provavelmente nao permitiu constatar o efeito da fortificacao das farinhas.

Food Consumption and Iron Intake of Pregnant and Reproductive Aged Women

Comparar la practica alimentar y el consumo de alimentos fuentes de hierro, naturales y fortificados, de mujeres en edad reproductiva, gestantes o no, constituye el objetivo de esta investigacion. Se trata de un estudio transversal, desarrollado en un centro de salud del municipio de Sao Paulo, en el cual participaron 61 mujeres, siendo 30 gestantes. Se utilizo un cuestionario de frecuencia de consumo alimentar y un recordatorio de 24h. Las principales fuentes naturales de hierro fueron frijoles y hojas verdes. Alimentos fortificados tambien tuvieron participacion importante. Hubo una pequena diferencia estadisticamente significativa entre el consumo alimentar de las gestantes y no gestantes. Se observo inadecuacion del consumo de hierro, folato y calcio en los dos grupos. Las mujeres no gestantes atenderian la demanda de hierro, considerandose el adicional recomendado para la fortificacion de las harinas, sin embargo, las gestantes no. Hay necesidad de implementar estrategias combinadas: fortificacion de los alimentos, suplemento medicamentoso para gestantes y orientacion nutricional para las mujeres en general.Comparar a pratica alimentar e o consumo de alimentos fontes de ferro, naturais e fortificados, de mulheres em idade reprodutiva, gestantes ou nao, constituiu o objetivo desta pesquisa. Estudo transversal, desenvolvido em um centro de saude do municipio de Sao Paulo, envolvendo 61 mulheres, sendo 30 gestantes. Utilizou-se questionario de frequencia de consumo alimentar e recordatorio de 24h. As principais fontes naturais de ferro foram feijao e folhas verdes. Alimentos fortificados tambem tiveram participacao importante. Houve pequena diferenca estatisticamente significativa entre o consumo alimentar das gestantes e nao gestantes. Observou-se inadequacao do consumo de ferro, folato e calcio nos dois grupos. As mulheres nao gestantes atenderiam a demanda de ferro, considerando-se o adicional recomendado para a fortificacao das farinhas, porem, as gestantes nao. Ha necessidade de estrategias combinadas: fortificacao dos alimentos, suplementacao medicamentosa para gestantes e orientacao nutricional para as mulheres em geral.This study compares the eating habits and consumption of natural and fortified iron sources in pregnant and reproductive aged women. This cross-sectional study was developed in a health center located in São Paulo, SP, Brazil. We studied 61 women, of which 30 were pregnant. A food frequency questionnaire and a 24-hour recall instrument were used. The main natural sources of iron were beans and greens, although fortified foods were also an important source. There was little statistically significant difference between the food consumption of pregnant and non-pregnant women. Inadequate intake of iron, folate and calcium was observed in both groups. Non-pregnant women meet the iron recommendation, considering the iron added in fortified foods, though pregnant women do not. These results suggest the need for mixed strategies: food fortification, iron supplements for pregnant women and nutritional instruction for women in general.

Anemia in Brazilian pregnant women before and after flour fortification with iron

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Factors associated to vaccination against influenza among elderly in a large Brazilian metropolis.

Background This study aimed to estimate coverage and identify factors associated to vaccination against influenza in the elderly population. Methods The study design was cross-sectional and population based. Data was collected in 2010 by the Health, Well-Being and Aging Study. Sample consisted of 1,341 community-dwelling elderly, in São Paulo, Brazil. Association between vaccination and covariates was evaluated by means of prevalence ratios estimated by Poisson regression models. Results Self-reported vaccination coverage was 74.2% (95% confidence interval: 71.3–76.9). Remaining physically active and having had recent interaction with health services, mainly with public units of healthcare, were the main incentives to increase vaccination coverage among the elderly; whereas lower age, living alone and absent interaction with health services were the main constraints to influenza vaccination at the community level. These covariates had already been reported to influence influenza vaccination of elders in previous years. Conclusion Previous knowledge already available on the main constraints to influenza vaccination has not allowed to remove them. Influenza campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination. Instructing healthcare providers to recommend vaccine uptake is an important piece of this puzzle.

Anemia em gestantes brasileiras antes e após a fortificação das farinhas com ferro

OBJECTIVE To compare prevalence of anemia and hemoglobin (Hb) levels in Brazilian pregnant women before and after flour fortification with iron. METHODS A repeated cross-sectional panel study of public health care centers of municipalities in the five Brazilian regions was conducted. Retrospective data were obtained from 12,119 medical records of pregnant women distributed in two groups: before fortification (delivery prior to June 2004) and after fortification (date of last period after June 2005). Anemia was defined as Hb<11.0 g/dl. Hb levels according to gestational age were assessed using two references from the literature. Statistical analysis was carried out using chi-squared tests, Students t tests, and logistic regression, with a significance level of 5%. RESULTS In the total sample, prevalence of anemia fell from 25% to 20% after fortification (p<0.001). However, important regional differences were evident: while significant reductions were seen in the Northeast (37% to 29%) and North (32% to 25%) regions, where pre-fortification prevalence was high, smaller reductions were seen in the Southeast (18% to 15%) and South (7% to 6%) regions, where prevalence was low. Hb levels according to gestational age were slightly higher in the first months of pregnancy and lower after the third or fourth months, depending on the reference used. Logistic regression analysis showed that group, geographic region, marital status, trimester of pregnancy, initial nutritional status, and prior pregnancy were associated with anemia (p<0.05). CONCLUSIONS Prevalence of anemia decreased after fortification, but remains high in the North and Northeast regions. Although fortification may have played a role in this favorable outcome, the contribution of other public policies implemented during the studied period should also be considered.

Anemia em gestantes de municípios das regiões Sul e Centro-Oeste do Brasil

Received: 09/15/2009 Approved: 10/27/2009 Portuguese / Engli h: www.scielo.br/reeusp RESUMO Objetivou-se analisar a distribuicao da anemia em gestantes da rede basica de saude de dois municipios, na regiao Sul e CentroOeste do Brasil. Estudo transversal retrospectivo e descritivo desenvolvido a partir de dados de prontuarios de 954 e 781 gestantes em Cuiaba-MT e Maringa-PR, respectivamente. Coletaram-se dados de caracterizacao sociodemografica, de pre-natal e indicadores sociais. Foram consideradas anemicas, as mulheres com hemoglobina inferior a 11g/dL. A desigualdade social existente entre os municipios foi evidente. Gestantes atendidas em Cuiaba-MT apresentavam caracteristicas sociodemograficas significativamente mais precarias. A prevalencia de anemia era significativamente maior e valores medios de hemoglobina menores em Cuiaba-MT, independentemente da idade gestacional. Encontrou-se associacao dos niveis de hemoglobina com a idade, situacao conjugal, numero de gestacoes anteriores, estado nutricional e trimestre gestacional. As diferencas regionais na ocorrencia da anemia gestacional sao socialmente determinadas, o que deve ser considerado nas propostas de intervencao em saude coletiva.Objetivou-se analisar a distribuicao da anemia em gestantes da rede basica de saude de dois municipios, na regiao Sul e Centro-Oeste do Brasil. Estudo transversal retrospectivo e descritivo desenvolvido a partir de dados de prontuarios de 954 e 781 gestantes em Cuiaba-MT e Maringa-PR, respectivamente. Coletaram-se dados de caracterizacao sociodemografica, de pre-natal e indicadores sociais. Foram consideradas anemicas, as mulheres com hemoglobina inferior a 11g/dL. A desigualdade social existente entre os municipios foi evidente. Gestantes atendidas em Cuiaba-MT apresentavam caracteristicas sociodemograficas significativamente mais precarias. A prevalencia de anemia era significativamente maior e valores medios de hemoglobina menores em Cuiaba-MT, independentemente da idade gestacional. Encontrou-se associacao dos niveis de hemoglobina com a idade, situacao conjugal, numero de gestacoes anteriores, estado nutricional e trimestre gestacional. As diferencas regionais na ocorrencia da anemia gestacional sao socialmente determinadas, o que deve ser considerado nas propostas de intervencao em saude coletiva.

Prevalência e distribuição espacial de defeitos do tubo neural no Estado de São Paulo, Brasil, antes e após a fortificação de farinhas com ácido fólico

This cross-sectional study analyzed the prevalence and spatial distribution of neural tube defects before and after folic acid flour fortification. The study used the Information System on Live Births (SINASC) and presented prevalence rates according to maternal characteristics with odds ratios (OR) and 95% confidence intervals (95%CI). Polynomial regression was used in time trend analysis and empirical Bayesian smoothed maps for spatial analysis. Total prevalence of neural tube defects decreased by 35%, from 0.57/1,000 to 0.37/1,000 live births after fortification (OR = 0.65; 95%CI: 0.59-0.72). There was a reduction among newborns of mothers with the following characteristics: all age groups (except < 15 years), more than three years of schooling, and seven or more prenatal visits. There was a reduction over time and in most of São Paulo State, except in a few municipalities (counties) located in the western region of the State. Other factors may have contributed to the observed decline, but the results corroborate flour fortification as an important measure to prevent neural tube defects. Further research is needed to elucidate the lack of a decline in neural tube defects in the western part of São Paulo State.Estudo transversal que analisou prevalencia e distribuicao espacial de defeitos do tubo neural, antes e apos a fortificacao das farinhas de trigo e milho com acido folico no Estado de Sao Paulo, Brasil, com uso do Sistema de Informacoes sobre Nascidos Vivos (SINASC). Sao apresentadas prevalencias segundo caracteristicas maternas por meio de odds ratio (OR) e intervalos de 95% de confianca (IC95%). Para analise temporal e espacial, foram utilizados, respectivamente, regressao polinomial e mapas com suavizacao bayesiana empirica. A prevalencia diminuiu 35%, de 0,57 para 0,37 por mil nascidos vivos apos a fortificacao (OR = 0,65; IC95%: 0,59-0,72). Verificou-se reducao para mulheres de todas as idades (exceto < 15 anos), com mais de tres anos de estudo e sete consultas ou mais de pre-natal. Confirmou-se reducao temporal na maior parte do estado, exceto alguns municipios do oeste. Outros aspectos podem ter contribuido para o declinio observado, porem os resultados reiteram a fortificacao de farinhas como medida importante para prevencao de defeitos do tubo neural. Outras analises devem ser realizadas para justificar resultado inverso no oeste paulista.

Consumo alimentar e ingestão de ferro de gestantes e mulheres em idade reprodutiva

Comparar la practica alimentar y el consumo de alimentos fuentes de hierro, naturales y fortificados, de mujeres en edad reproductiva, gestantes o no, constituye el objetivo de esta investigacion. Se trata de un estudio transversal, desarrollado en un centro de salud del municipio de Sao Paulo, en el cual participaron 61 mujeres, siendo 30 gestantes. Se utilizo un cuestionario de frecuencia de consumo alimentar y un recordatorio de 24h. Las principales fuentes naturales de hierro fueron frijoles y hojas verdes. Alimentos fortificados tambien tuvieron participacion importante. Hubo una pequena diferencia estadisticamente significativa entre el consumo alimentar de las gestantes y no gestantes. Se observo inadecuacion del consumo de hierro, folato y calcio en los dos grupos. Las mujeres no gestantes atenderian la demanda de hierro, considerandose el adicional recomendado para la fortificacion de las harinas, sin embargo, las gestantes no. Hay necesidad de implementar estrategias combinadas: fortificacion de los alimentos, suplemento medicamentoso para gestantes y orientacion nutricional para las mujeres en general.Comparar a pratica alimentar e o consumo de alimentos fontes de ferro, naturais e fortificados, de mulheres em idade reprodutiva, gestantes ou nao, constituiu o objetivo desta pesquisa. Estudo transversal, desenvolvido em um centro de saude do municipio de Sao Paulo, envolvendo 61 mulheres, sendo 30 gestantes. Utilizou-se questionario de frequencia de consumo alimentar e recordatorio de 24h. As principais fontes naturais de ferro foram feijao e folhas verdes. Alimentos fortificados tambem tiveram participacao importante. Houve pequena diferenca estatisticamente significativa entre o consumo alimentar das gestantes e nao gestantes. Observou-se inadequacao do consumo de ferro, folato e calcio nos dois grupos. As mulheres nao gestantes atenderiam a demanda de ferro, considerando-se o adicional recomendado para a fortificacao das farinhas, porem, as gestantes nao. Ha necessidade de estrategias combinadas: fortificacao dos alimentos, suplementacao medicamentosa para gestantes e orientacao nutricional para as mulheres em geral.This study compares the eating habits and consumption of natural and fortified iron sources in pregnant and reproductive aged women. This cross-sectional study was developed in a health center located in São Paulo, SP, Brazil. We studied 61 women, of which 30 were pregnant. A food frequency questionnaire and a 24-hour recall instrument were used. The main natural sources of iron were beans and greens, although fortified foods were also an important source. There was little statistically significant difference between the food consumption of pregnant and non-pregnant women. Inadequate intake of iron, folate and calcium was observed in both groups. Non-pregnant women meet the iron recommendation, considering the iron added in fortified foods, though pregnant women do not. These results suggest the need for mixed strategies: food fortification, iron supplements for pregnant women and nutritional instruction for women in general.

Neonatal mortality in infants with low birth weigh

OBJECTIVE To evaluate the factors associated with neonatal mortality in infant born with low birth weight. METHOD Cross-sectional study that analyzed data from 771 live births with low birth weight (<2500 g) in the city of Cuiabá, MT, in 2010, of whom 54 died in the neonatal period. We obtained data from the Information System on Live Births and Mortality, by integrated linkage. RESULTS In multiple logistic regression, neonatal mortality was associated with: number of prenatal visits less than 7 (OR=3.80;CI:1,66-8,70); gestational age less than 37 weeks (OR=4.77;CI:1.48-15.38), Apgar score less than 7 at the 1st minute (OR=4.25;CI:1.84-9.81) and the 5th minute (OR=5.72,CI:2.24-14.60) and presence of congenital anomaly (OR=14.39;IC:2.72-76.09). CONCLUSION Neonatal mortality in infants with low birth weight is associated with avoidable factors through adequate attention to prenatal care, childbirth and infants.Objective To evaluate the factors associated with neonatal mortality in infant born with low birth weight. Method Cross-sectional study that analyzed data from 771 live births with low birth weight (<2500 g) in the city of Cuiaba, MT, in 2010, of whom 54 died in the neonatal period. We obtained data from the Information System on Live Births and Mortality, by integrated linkage. Results In multiple logistic regression, neonatal mortality was associated with: number of prenatal visits less than 7 (OR=3.80;CI:1,66-8,70); gestational age less than 37 weeks (OR=4.77;CI:1.48-15.38), Apgar score less than 7 at the 1st minute (OR=4.25;CI:1.84-9.81) and the 5th minute (OR=5.72,CI:2.24-14.60) and presence of congenital anomaly (OR=14.39;IC:2.72-76.09). Conclusion Neonatal mortality in infants with low birth weight is associated with avoidable factors through adequate attention to prenatal care, childbirth and infants.

Excesso de peso e obesidade abdominal em mulheres atendidas em Unidade da Estratégia Saúde da Família

We performed an investigation of the prevalence of overweight and abdominal obesity and associate variables in women. A cross-sectional study with 298 women (20-59 years), users of a Family Health Strategy unit, in São Paulo-SP. Overweight was considered as follows: body mass index>25kg/m²; abdominal obesity: waist circumference 0.80m or waist-hip ratio>0.85. Logistical regression analysis was performed. Overweight affected 56% of the women, 37% were overweight and 19% were obese, and was associated with age, family income, tobacco use and hypertension. Of all the participants, 59% had abdominal obesity associated to age and hypertension. A high prevalence of overweight and abdominal obesity was observed in the women, thus reinforcing the importance of assessing the waist circumference and/or waist-hip ratio in the physical examination, besides the body mass index, which are aspects that help to predict risk. It is evidenced there is a need for community interventions that promote the reduction of overweight and abdominal obesity.We performed an investigation of the prevalence of overweight and abdominal obesity and associate variables in women. A cross-sectional study with 298 women (20-59 years), users of a Family Health Strategy unit, in Sao Paulo-SP. Overweight was considered as follows: body mass index>25kg/m2; abdominal obesity: waist circumference 0.80m or waist-hip ratio>0.85. Logistical regression analysis was performed. Overweight affected 56% of the women, 37% were overweight and 19% were obese, and was associated with age, family income, tobacco use and hypertension. Of all the participants, 59% had abdominal obesity associated to age and hypertension. A high prevalence of overweight and abdominal obesity was observed in the women, thus reinforcing the importance of assessing the waist circumference and/or waist-hip ratio in the physical examination, besides the body mass index, which are aspects that help to predict risk. It is evidenced there is a need for community interventions that promote the reduction of overweight and abdominal obesity.