Luciana Rodrigues Silva

Hábitos alimentares de crianças menores de 1 ano amamentadas e não-amamentadas

OBJETIVOS: Descrever os habitos alimentares de criancas amamentadas e nao-amamentadas atraves da analise dos alimentos consumidos pelas criancas menores de 1 ano de idade na cidade de Feira de Santana, BA, no ano de 2001. METODOS: Foi realizado um estudo transversal, no qual foram aplicados questionarios as maes das criancas menores de 1 ano no dia nacional de vacinacao, presentes nas 44 (71%) unidades de vacinacao, selecionadas por estratificacao simples. Foram avaliadas 2.319 criancas, representando 24,3% da populacao estimada. As medidas de associacao calculadas foram: razao de prevalencia, com intervalo de confianca a 95%, e de significância estatistica, atraves do teste do qui-quadrado com respectivo valor p. RESULTADOS: Nas criancas com idade igual ou inferior a 4 meses e nao-amamentadas, foi observada uma chance 8,2 e 6,7 vezes maior de a crianca ser alimentada, respectivamente, com a refeicao da familia (IC 95% 3,23-20,66) e com papas de legumes (IC 95% 3,84-11,78). Na mesma faixa etaria, as prevalencias de criancas nao-amamentadas que receberam agua, chas, sucos e papa de frutas foram significativamente maiores (70,7% versus 19,7%, 63,3% versus 26,7%, 33,3% versus 4,9% e 14,4% versus 1,4%, respectivamente). CONCLUSOES: As criancas amamentadas, quando comparadas com as nao-amamentadas, apresentaram melhores habitos no que se refere a epoca de introducao dos alimentos complementares.

Determinants of breastfeeding initiation within the first hour of life in a Brazilian population: cross-sectional study.

BackgroundBreastfeeding within the first hour of life is a potential mechanism for health promotion. The purpose of this study was to evaluate the prevalence of breastfeeding initiation within the first hour of life in Feira de Santana, Bahia, Brazil, between 2004 and 2005, and investigate the influence of maternal, child and prenatal factors on this practice.MethodsThis is a cross-sectional study extracted from the results of a contemporary cohort conducted in 10 maternity hospitals in the city of Feira de Santana, Bahia, Brazil. A group of 1,309 mother-child pairs was included in the study. Information about mothers and babys characteristics, pregnancy, birth, and time of breastfeeding initiation was collected in the first 72 hours after delivery, through interview with mothers and hospital records. The data gathered were stored and analyzed using the SPSS 16.0 and R 8.0. The chi-square test and binary logistic regression analysis were used to examine the relationship between breastfeeding within the first hour and different variables.Results47.1% of the mothers initiated breastfeeding within the first hour after birth. Early initiation of breastfeeding was associated with birth at full term pregnancy (adjusted Prevalence Ratio 1.43; 95% confidence interval 1.10 to 2.00), mothers who received prenatal guidance regarding the advantages of breastfeeding (aPR1.23; 95% CI 1.11 to 1.41) and vaginal delivery (aPR 2.78; 95% CI 2.38 to 3.23).ConclusionsIn order to improve the rates of breastfeeding within the first hour of life, health care professionals must promote the factors favoring this practice such as prenatal guidance regarding the advantages of breastfeeding, vaginal delivery and full term birth, and stimulate this practice in vulnerable situations such as mothers with cesarean section and preterm birth.

Fatores associados ao aleitamento materno e desmame em Feira de Santana, Bahia

OBJETIVOS: conhecer a prevalencia do aleitamento materno e os fatores associados ao desmame das criancas menores de um ano, em Feira de Santana, no ano 2001. METODOS: estudo transversal com aplicacao de questionarios as 2319 maes presentes nas 44 (71,1%) unidades de vacinacao selecionadas, por estratificacao simples. Foi calculada a razao de prevalencia e considerado como significante p < 0,05 e intervalo de 95% de confianca. RESULTADOS: a prevalencia do aleitamento foi 69,2% nos menores de um ano. A ocorrencia da amamentacao exclusiva foi maior nas criancas que nao usavam chupeta (49,4%) e que mamaram no primeiro dia de vida (40,4%). As variaveis estatisticamente significantes relacionadas com as maiores chances de amamentar foram: amamentacao no primeiro dia (p <0,001), maes que nao trabalhavam fora do lar (p <0,001), menor renda familiar (p <0,001), multiparidade (p = 0,03) e a nao utilizacao de chupetas (p <0,001). CONCLUSOES: as atividades assistenciais quanto a prevencao do desmame devem estar voltadas sobretudo para as maes que trabalham fora do lar, aquelas de maior renda familiar e primiparas. Quanto as criancas, para as que nao foram aleitadas no peito no primeiro dia de vida e que usam chupetas.

Child feeding and diarrhea morbidity

OBJECTIVE To evaluate the protective role of breastfeeding against diarrhea in children younger than one year of age in the city of Feira de Santana, Brazil, in 2001. METHODS A cross-sectional study was carried out. Questionnaires were applied to mothers by 104 university students on the national vaccination day in 44 health units (71.0%) selected by simple stratification. 2,319 children were evaluated (24.3% of the estimated population). The prevalence ratio was calculated and considered significant if p< or =0.05 with a 95% confidence interval. RESULTS Diarrhea occurred in 11.6% of the sample, with greater frequency after the sixth month (63.3%). The chance for presenting diarrhea was 64% higher in children younger than six months who were not breastfed vs. breastfed children (p<0.02). When compared to the children who were exclusively breastfed, the chance for presenting diarrhea increased to 82% in children who were not breastfed (95% CI 1.11-3.01). CONCLUSIONS Breastfeeding and exclusive breastfeeding were a protective factor against diarrhea in the first six months of life.

Poor zinc and selenium status in phenylketonuric children and adolescents in Brazil

Because of the restricted intake of high-biologic-value protein, children with phenylketonuria (PKU) may have lower than normal plasma concentrations of copper, zinc, and selenium. The purpose of the present study was to investigate erythrocyte zinc levels and serum copper and selenium levels in children and adolescents with PKU by analyzing the relation between their diet and the laboratory profiles of these elements. The study was conducted in 32 children and adolescents with PKU, who were on a special diet. Dietary records and blood samples were collected from each subject. Erythrocyte zinc and serum selenium levels were below normal in 37.5% and 90.6% of the subjects, respectively. Plasma copper levels were normal. Metabolic formulas were the only source of 86.9% of the zinc, 65.6% of the copper, and 32.4% of the selenium. Despite this, there was no significant correlation between the zinc formula supply and erythrocyte zinc levels (rho = -0.143, P = .435) or the supply and serum levels for copper (rho = -0.117, P = .523) and selenium (rho = 0.113, P = .538). These results suggest that Brazilian patients with PKU present with low ingestion levels, low serum selenium levels, and low erythrocyte zinc levels.

Incidence of diarrhea in children living in urban slums in Salvador, Brazil

Diarrhea remains a major health issue in developing countries, with high morbidity and mortality rates. Determining the incidence of acute diarrhea in children and its associated factors is crucial to the planning of preventive approaches. The objective of this study was to determine the incidence of diarrhea and to assess some relevant associated factors to it in children younger than 40 months living in two slums of Salvador, Brazil. This is the first prospective cohort, community-based study that was performed in two periurban slums of Salvador, Brazil. Eighty-four children younger than 40 months were randomly selected and visited every other day for one year. The chi-square test was used to evaluate the occurrence of diarrhea and its associated factors. During the surveillance period, 232 diarrhea episodes were identified, resulting in an incidence rate of 2.8 episodes/child/year. In average (mean value of 84 children),each child suffered 11.1 days of diarrhea per year, yielding an average duration of 3.9 days per episode. The highest incidence rates were found among children under one year old. Early weaning, male sex, malnutrition, having a mother younger than 25 years or who considered her child malnourished, missed immunizations and previous pneumonia were associated factors for suffering diarrheal episodes. The rates of incidence and duration of diarrhea that we found are in accordance to those reported by others. Additionally, our results reinforce the importance of environmental and health-related associated factors to the onset of diarrhea.

Fatores preditivos da interrupção do aleitamento materno exclusivo no primeiro mês de lactação

OBJECTIVE: To investigate factors associated with discontinuation of exclusive breastfeeding in the first month of lactation, in the city of Feira de Santana, Brazil. METHODS: Cohort study with follow-up of 1,309 mother-child pairs selected from all maternities in the municipality. Data were collected in hospital and in home visits during the first month of life. Logistic regression analysis was used to examine the relationship between outcome and variables of interest. RESULTS: Lack of prior breastfeeding experience (PR 1.24; 95%CI 1.75-1.43), cracked nipples (PR 1.25; 95%CI 1.09-1.43), use of fixed breastfeeding schedules (PR 1.42; 95%CI 1.09-1.84) and pacifier use (PR 1.53; 95%CI 1.34-1.76) were identified as factors predicting discontinuation of exclusive breastfeeding. CONCLUSIONS: Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers.

Factors predicting early discontinuation of exclusive breastfeeding in the first month of life.

OBJECTIVE To investigate factors associated with discontinuation of exclusive breastfeeding in the first month of lactation, in the city of Feira de Santana, Brazil. METHODS Cohort study with follow-up of 1,309 mother-child pairs selected from all maternities in the municipality. Data were collected in hospital and in home visits during the first month of life. Logistic regression analysis was used to examine the relationship between outcome and variables of interest. RESULTS Lack of prior breastfeeding experience (PR 1.24; 95%CI 1.75-1.43), cracked nipples (PR 1.25; 95%CI 1.09-1.43), use of fixed breastfeeding schedules (PR 1.42; 95%CI 1.09-1.84) and pacifier use (PR 1.53; 95%CI 1.34-1.76) were identified as factors predicting discontinuation of exclusive breastfeeding. CONCLUSIONS Measures to prevent early discontinuation of exclusive breastfeeding must focus on women without breastfeeding experience and include prevention of nipple trauma, encourage breastfeeding on demand, and discourage the use of pacifiers.

Risk Factors for Developing Nosocomial Infections Among Pediatric Patients

Background: Nosocomial infections (NIs) are important causes of morbidity and mortality in pediatric hospitals. Multiple factors contribute towards exposing children to the risk of infection when hospitalized, and some of them differ from those in adults. Methods: This was a prospective study in a tertiary-level teaching pediatric hospital in Salvador, Bahia, Brazil, conducted from January to July, 2003, to describe the epidemiologic characteristics of NIs. Centers for Disease Control’s standard definitions were used and the data recorded included intrinsic and extrinsic risk factors. Results: We evaluated 808 patients. There were 143 episodes of NI in 124 patients (15.4%). The overall incidence of NI cases was 9.2 per 1,000 patient-days, with higher rates among children aged less than 1 year (P < 0.001) and those with nonsurgical clinical diseases (P < 0.001). Gastrointestinal infections (39.2%) and eye, ear, nose, throat or mouth infections (29.4%) were most common. The factors most closely associated with higher incidence of NI were respiratory disease on admission (incidence density ratio [IDR], 4.0; 95% confidence interval [CI], 2.83–5.72), another disease associated with admission diagnosis (IDR, 3.5; 95% CI, 2.41–5.02), nonsurgical clinical disease (IDR, 5.9; 95% CI, 3.92–8.85) and pediatric intensive care unit residence (IDR, 3.5; 95% CI, 1.91–6.28). The lengths of hospital stay for patients with and without nosocomial infection were, respectively, 14.1 days (SD, 20.5 days) and 5.1 days (SD, 6.6 days) (t = 121.76; P < 0.001). Conclusions: Nosocomial infections are a frequent complication in pediatrics. They are not necessarily related to invasive procedures but certainly are related to a group of factors that have particular characteristics in the pediatric age group.

Avaliação da atenção à saúde através da investigação de óbitos infantis

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mothers interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this studys operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.