Gisela Soares Brunken

Determinantes da amamentação no primeiro ano de vida em Cuiabá, Mato Grosso

OBJETIVO: Avaliar os fatores de risco para a interrupcao de aleitamento materno e desmame em criancas menores de um ano. METODOS: Estudo transversal analitico com criancas menores de um ano de idade que compareceram aos postos de vacinacao do municipio de Cuiaba, Mato Grosso, em 2004, acompanhadas de seus responsaveis. Para definicao da amostra, foram sorteadas as unidades de vacinacao, seguindo-se o sorteio das criancas em cada unidade, de forma sistematica. Para coleta de dados, aplicou-se um questionario semi-estruturado aos acompanhantes das criancas, investigando variaveis caracteristicas sociodemograficas, referentes ao nascimento da crianca e maternas, uso de chupeta e alimentacao no primeiro dia em casa. Foram realizadas analise descritiva e regressao logistica dos fatores de risco para cada faixa etaria, apresentadas em odds ratio e intervalos de confianca. RESULTADOS: No total, 920 criancas menores de um ano foram avaliadas, das quais 205 menores de 120 dias e 275 menores de 180 dias. Verificou-se que usar chupeta, tomar cha no primeiro dia em casa, ter mae com escolaridade ate o primeiro ou segundo graus ou primipara, representam maior risco de nao estar em amamentacao exclusiva aos 120 dias de vida. Tais fatores se mostraram significativos tambem para menores de 180 dias, com excecao do consumo de cha, que nao foi indagado para essa faixa etaria. Nos menores de um ano, o uso de chupeta foi a unica variavel que manteve significância estatistica. CONCLUSOES: Fatores socioculturais mostraram-se determinantes da situacao de aleitamento materno. Ressalta-se a importância da instrucao e conscientizacao maternas, que refletem sobre as praticas que podem prejudicar a amamentacao.

Anemia in children under 3 years of age in public day care centers

OBJECTIVE: To study the prevalence of anemia in children aged less than 36 months in public day care centers in the city of Cuiabá, state of Mato Grosso, Brazil. METHODS: Cross-sectional study with all children (n=271) less than 36 months of age who attended public day care centers in mid-1997. Children were evaluated as to their hemoglobin levels (venous blood, analyzed at the Central State Laboratory) and anthropometric indicators (weight/age, height/age, weight/height). RESULTS: A high prevalence (63%) of anemia associated with age, weight and height deficit, and time of admittance at kindergarten was observed. The prevalence of malnutrition was 0.8% according to the weight/height ratio, 5.0% according to weight/age deficit, and showed an inadequacy of 10.3% as to the height/age ratio. Thus, the percentage of anemic children was six times higher than the height deficit and twelve times higher than the weight deficit. Malnutrition was not in fact associated with anemia, but at extreme anthropometric cut-off points of height and weight for age (< -2 z score), there is an association between these conditions. CONCLUSION: The high prevalence of anemia is regarded as a severe public health problem among preschool children in the city of Cuiabá.

Risk factors for early interruption of exclusive breastfeeding and late introduction of complementary foods among infants in midwestern Brazil.

OBJECTIVE To identify factors associated with early interruption (before 4 months) of exclusive breastfeeding and late introduction (after 8 months) of complementary foods. METHODS This is a cross-sectional study, based on a survey conducted on the first day of the National Vaccination Campaign in 2004, in Cuiabá, MT, Brazil. The sample comprised 921 children less than 1 year old, and the adult accompanying each child was interviewed and a semi-structured questionnaire filled out. Probit analysis was employed to assess consumption of liquids and solids, and logistic regression analysis was applied to identify factors associated with early introduction of liquids and with late introduction of solids. RESULTS There was elevated consumption of water and teas, followed by cows milk among those less than 120 days old. Children were more likely to be given liquids on the day of the survey if they had been consuming them on the day they were discharged from the maternity unit. Approximately 60% of the children were being given soup or the family meal by 8 months. CONCLUSIONS Liquids being given on the first day at home was a good predictor that they would be given for the first 4 months, emphasizing the need for intervention during prenatal care and at maternity units to counter the harm caused by this practice. After 8 months, however, it is necessary to emphasize the importance of the child participating in family meals, especially for adult mothers without higher education and primaparous mothers.

Fatores associados à interrupção precoce do aleitamento materno exclusivo e à introdução tardia da alimentação complementar no centro-oeste brasileiro

OBJECTIVE: To identify factors associated with early interruption (before 4 months) of exclusive breastfeeding and late introduction (after 8 months) of complementary foods. METHODS: This is a cross-sectional study, based on a survey conducted on the first day of the National Vaccination Campaign in 2004, in Cuiaba, MT, Brazil. The sample comprised 921 children less than 1 year old, and the adult accompanying each child was interviewed and a semi-structured questionnaire filled out. Probit analysis was employed to assess consumption of liquids and solids, and logistic regression analysis was applied to identify factors associated with early introduction of liquids and with late introduction of solids. RESULTS: There was elevated consumption of water and teas, followed by cows milk among those less than 120 days old. Children were more likely to be being given liquids on the day of the survey if they had been consuming them on the day they were discharged from the maternity unit. Approximately 60% of the children were being given soup or the family meal by 8 months. CONCLUSIONS: Liquids being given on the first day at home was a good predictor that they would be given for the first 4 months, emphasizing the need for intervention during prenatal care and at maternity units to counter the harm caused by this practice. After 8 months, however, it is necessary to emphasize the importance of the child participating in family meals, especially for adult mothers without higher education and primaparous mothers.

Concentração de hemoglobina em crianças do nascimento até um ano de vida

Este estudo foi desenvolvido com o objetivo de descrever a evolucao da concentracao de hemoglobina [Hb], considerando os fatores: peso ao nascer; velocidade relativa de crescimento e alimentacao. E um estudo transversal realizado com criancas no primeiro ano de vida, atendidas para acompanhamento do crescimento e do desenvolvimento em servicos publicos de saude, em cidades localizadas nas cinco regioes geograficas brasileiras. Verificou-se que 51,7% das criancas entre 6 e 12 meses de idade eram anemicas. A estimativa da Hb, por meio de uma equacao teorica, sugeriu que o ferro endogeno permite manter os niveis normais de Hb no primeiro trimestre de vida. A prevalencia de baixa Hb foi maior entre as criancas com baixo peso ao nascer. A velocidade relativa de crescimento, avaliada pela diferenca do peso atual e peso ao nascer, em unidades de Z escore, nao foi fator de relevância para a Hb. A importância do aleitamento materno foi evidente nos primeiros meses de vida. Verificou-se, entretanto, que os alimentos complementares nao influenciaram a Hb. A elevada prevalencia de niveis baixos de hemoglobina indica a necessidade de enfatizar programas de intervencao para o controle da anemia ferropriva.

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.

Weekly iron supplementation reduces anemia prevalence by 1/3 in preschool children

A weekly medication scheme, followed by nutritional guidance on diets in child-care centers, was evaluated in order to make it feasible for routine use. The study was conducted in six child-care centers in the town of Cuiaba - Brazil. The supplement (6 mg/kg) was provided on a weekly basis to all children (n=178) less than three years old during four months at the institution by the classroom staff. After this initial phase, nutritional guidance was provided regarding the child-care centers normal diet as a way to control hemoglobin levels. This is an intervention study whose individuals were examined at three different periods: at the beginning of treatment (T0); after four months of iron supplementation (T1) and after five months of nutritional guidance (T2). Hemoglobin measurements were obtained using a portable hemoglobinometer - HemoCue. A significant improvement was observed in the hemoglobin levels of anemic children after controlling for age and initial hemoglobin. The hemoglobin concentration of these children improved an average of 0.1 g/l after each dose of iron sulfate. At the end of four months there was an average gain of 1.6 g/l, and prevalence of anemia reduced by 1/3, sufficient to meet the United Nations target adopted by Brazil. At the end of nine months (four months of weekly drug intervention followed by 5 months of nutritional guidance) the prevalence of anemia dropped by 1/4 in the child-care centers. The intervention proved to be feasible for child-care centers and pre-school population.

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.

Breastfeeding trends in a State capital in the Central West region of Brazil, 1999-2004

A cross-sectional study was held on the first day of the National Vaccination Campaign in 2004, in Cuiabá, Mato Grosso State, Brazil, with the objective of identifying breastfeeding evolution from 1999 to 2004 during the first year of life. A two-stage sampling procedure was used, considering the numbers of vaccination units and children in each unit. A nutritional survey with a 24-hour food recall questionnaire was applied to 921 parents or accompanying persons of children less than one year of age. There was an increase in exclusive breastfeeding in all age brackets. At the end of six months, there were low percentages of infants in exclusive breastfeeding (< 5% in 1999 and < 10% in 2004). The prevalence of exclusive breastfeeding doubled in five years in infants less than four months of age, from 17.7% to 28.5%. The measures taken to promote breastfeeding were effective, although insufficient in light of the serious situation. More such measures are needed to improve the existing programs.