Luciane Simões Duarte

Aleitamento materno e níveis de hemoglobina em crianças menores de 2 anos em município do estado de São Paulo, Brasil

OBJECTIVE: The objective of this study is to assess the relationship between breastfeeding and hemoglobin concentration in children under 2 years of age in Itupeva City, SP, Brazil. METHODS: This cross-sectional population-based study was carried out in a representative sample of 254 children under 2 years of age randomly selected in the urban area of Itupeva, SP. The sampling process was done in three stages. The recommendations made by the World Health Organization were used to classify breastfeeding. Hemoglobin concentration was measured by the cyanmethemoglobin method, using the HemoCue system and anemia was defined when hemoglobin concentration was below 11.0g/dL. RESULTS: The prevalence of anemia was 41.7%. Anemia was more frequent among children who were weaned before 6 months (p<0.05). The mean hemoglobin levels of breastfed children were significantly higher among children under 6 months (p<0.05). Children who were exclusively or predominantly breastfed in the first six months of life had higher mean hemoglobin levels than the remaining children (12.3g/dL versus 10.99g/dL; p=0.022). CONCLUSIONS: The results suggest that partial or total substitution of breast milk before six months of age was associated with lower mean hemoglobin levels. The high frequency of anemia and the low percentage of children who were exclusively breastfed indicate that programs are needed to control nutritional anemia in this city and to promote exclusive breastfeeding in the first six months.

Brazilian Maternal Weight Perception and Satisfaction With Toddler Body Size: A Study in Primary Health Care.

UNLABELLED Maternal perception and satisfaction with childs weight status are important to detect early and to successfully treat the extremes in weight, especially during early childhood, when the child is more dependent on maternal care. OBJECTIVES To assess the inaccuracy of maternal perception of toddler body size and its associated factors and to analyze maternal dissatisfaction with toddler body size. METHODS Cross-sectional study with 135 mother-toddler dyads attending Primary Health Care Facilities, São Paulo, Brazil. Childrens actual weight status was classified using body mass index-for-age. Inaccuracy and dissatisfaction were assessed using an image scale. We used logistic regression to identify the factors associated with inaccuracy of maternal perception of toddler body size. RESULTS Inaccuracy in maternal perception was observed in 34.8% of participants. Mothers of excessive weight children were more likely to have inaccurate perceptions (OR=4.6; 95% CI 2.0-10.7), and mothers of children who attended well-child care were less likely to have inaccurate perceptions (OR=0.3, 95% CI 0.1-0.9). More than half of mothers (52.6%) were dissatisfied with their toddlers size and desired a larger child (75.0% of mothers of underweight children, 25.0% of mothers whose children were at risk for overweight and 23.0% of mothers of overweight children). CONCLUSION The majority of mothers were inaccurate in their perception and was dissatisfied with their toddlers body size. Maternal inaccuracy and dissatisfaction differed by the weight status of the toddler. Attendance at well-child visits was an effective way to decrease maternal inaccuracy, which reinforces the importance of the influence of health professionals.

Reprodução social e anemia infantil

Este estudo avaliou como a anemia infantil se relaciona com as formas de reproducao social das familias. Foi desenvolvido em amostra representativa de 254 criancas. residentes em Itupeva, SP. Hemoglobina ;0,05). O perfil de reproducao social das familias dos anemicos mostrou diferenca significativa (p<0,05). Observou-se que a ocorrencia da anemia atrelou-se as precarias formas de trabalhar dos estratos sociais inferiores e, consequentemente, inadequadas formas de viver.This study assessed the relationship between anemia in infancy and the social reproduction profile of the families. It was conducted with a representative sample of 254 children of the city of Itupeva, SP. Hemoglobin < 11 g/dL, determined by portable hemoglobin analyzer, was used to define anemia. Profiles of social reproduction had been built by 2 groups of indicators: working and living conditions. Three social homogeneous groups had been defined: upper, intermediate, lower. Anemia was prevalent in 41.7%, and more frequent in lower social groups (13.2%; 40.6%; 46.2%), but with no significant difference (p>0.05). However, profile of social reproduction of anemic families showed significant difference (p<0.05). Occurrence of anemia was related to poor working conditions in lower social groups and consequently inappropriate living conditions.

Fertility rates among very young adolescent women: temporal and spatial trends in Brazil

BackgroundWe assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012.MethodsWe used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation.ResultsBrazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest.ConclusionsOur findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.

Uso e preenchimento da caderneta de saúde da criança com foco no crescimento e desenvolvimento

Objetivo Evaluar el uso y llenado de la Libreta de Salud Infantil (LSI), especialmente el crecimiento y el desarrollo. Metodo Estudio transversal con 358 pares de madres e hijos matriculados en 12 Unidades Basicas de Salud (UBS) de una ciudad pequena. Las madres fueron entrevistadas en el UBS desde febrero a abril 2013 mediante un cuestionario. Se utilizo Epi-info y software SPSS. Resultados 53% de las madres estaban llevando LSI durante la entrevista, proporcion similar a las madres que recibieron instrucciones para llevar el LSI a la atencion de la salud. Anotaciones en LSI durante las visitas se registraron en un 49%. Calendario de vacunas fue completa en el 97% de LSI, pero solo el 9% y el 8% de LSI tenido, respectivamente, las curvas de crecimiento y desarrollos debidamente cumplimentados. Conclusion El uso y el relleno satisfactorio de LSI refuerzan la necesidad de inversion en la formacion profesional y el acercamiento a la comunidad para la LSI se convierte efectivamente en un instrumento de promocion de la salud infantil.Objective To evaluate the use and records of the Child Health Handbook (CHH), especially growth and development. Method Cross-sectional study with 358 mother-child pairs registered in 12 Primary Health Centers (PHCs) of a small municipality. Mothers were interviewed at the PHC from February to April 2013 using a questionnaire. Data analysis was done using WHO Anthro software, Epi InfoTM and Stata. Results Fifty-three percent of the mothers were carrying the CHH at the time of the interview, similar to the proportion of mothers who were instructed to bring the CHH to health appointments. Annotations in the CHH during the visits were reported by 49%. The vaccination schedule was completed in 97% of the CHH, but only 9% and 8% of the CHH, respectively, contained growth charts and properly completed developmental milestones. Conclusion Low rates of use and unsatisfactory record-keeping in the CHH reinforce the need for investment in professional training and community awareness for the CHH to become an effective instrument of promotion of child health.

Use and records of child health handbook focused on growth and development

Objetivo Evaluar el uso y llenado de la Libreta de Salud Infantil (LSI), especialmente el crecimiento y el desarrollo. Metodo Estudio transversal con 358 pares de madres e hijos matriculados en 12 Unidades Basicas de Salud (UBS) de una ciudad pequena. Las madres fueron entrevistadas en el UBS desde febrero a abril 2013 mediante un cuestionario. Se utilizo Epi-info y software SPSS. Resultados 53% de las madres estaban llevando LSI durante la entrevista, proporcion similar a las madres que recibieron instrucciones para llevar el LSI a la atencion de la salud. Anotaciones en LSI durante las visitas se registraron en un 49%. Calendario de vacunas fue completa en el 97% de LSI, pero solo el 9% y el 8% de LSI tenido, respectivamente, las curvas de crecimiento y desarrollos debidamente cumplimentados. Conclusion El uso y el relleno satisfactorio de LSI refuerzan la necesidad de inversion en la formacion profesional y el acercamiento a la comunidad para la LSI se convierte efectivamente en un instrumento de promocion de la salud infantil.Objective To evaluate the use and records of the Child Health Handbook (CHH), especially growth and development. Method Cross-sectional study with 358 mother-child pairs registered in 12 Primary Health Centers (PHCs) of a small municipality. Mothers were interviewed at the PHC from February to April 2013 using a questionnaire. Data analysis was done using WHO Anthro software, Epi InfoTM and Stata. Results Fifty-three percent of the mothers were carrying the CHH at the time of the interview, similar to the proportion of mothers who were instructed to bring the CHH to health appointments. Annotations in the CHH during the visits were reported by 49%. The vaccination schedule was completed in 97% of the CHH, but only 9% and 8% of the CHH, respectively, contained growth charts and properly completed developmental milestones. Conclusion Low rates of use and unsatisfactory record-keeping in the CHH reinforce the need for investment in professional training and community awareness for the CHH to become an effective instrument of promotion of child health.

Social reproduction and anemia in infancy

Este estudo avaliou como a anemia infantil se relaciona com as formas de reproducao social das familias. Foi desenvolvido em amostra representativa de 254 criancas. residentes em Itupeva, SP. Hemoglobina ;0,05). O perfil de reproducao social das familias dos anemicos mostrou diferenca significativa (p<0,05). Observou-se que a ocorrencia da anemia atrelou-se as precarias formas de trabalhar dos estratos sociais inferiores e, consequentemente, inadequadas formas de viver.This study assessed the relationship between anemia in infancy and the social reproduction profile of the families. It was conducted with a representative sample of 254 children of the city of Itupeva, SP. Hemoglobin < 11 g/dL, determined by portable hemoglobin analyzer, was used to define anemia. Profiles of social reproduction had been built by 2 groups of indicators: working and living conditions. Three social homogeneous groups had been defined: upper, intermediate, lower. Anemia was prevalent in 41.7%, and more frequent in lower social groups (13.2%; 40.6%; 46.2%), but with no significant difference (p>0.05). However, profile of social reproduction of anemic families showed significant difference (p<0.05). Occurrence of anemia was related to poor working conditions in lower social groups and consequently inappropriate living conditions.

Training in nutritional counseling: knowledge assessment and applicability in child's healthcare

Objetivos: avaliar conhecimento de profissionais da atenção básica antes e após capacitação em aconselhamento nutricional e sua aplicabilidade na saúde da criança. Métodos: estudo de intervenção não controlado, tipo antes e depois, de abordagem quantitativa, desenvolvido no município de Itupeva, São Paulo. Capacitação como intervenção foi implementada para enfermeiros, auxiliares de enfermagem (AE) e agentes comunitários de saúde (ACS), com base na educação crítico-reflexiva. Aplicou-se teste de conhecimento com 16 questões de múltipla escolha antes e após a capacitação. Aplicabilidade da capacitação em aconselhamento nutricional na rotina dos serviços foi avaliada por questão aberta. Utilizou-se estatística descritiva e Teste Exato de Fisher com significância de 5%. Resultados: após capacitação, o conhecimento ‘satisfatório’ aumentou 71% no grupo Enfermeiros e no grupo AE/ACS. Os profissionais apontaram a capacitação como uma oportunidade de qualificação, mas para sua aplicabilidade, falta suporte político e organização dos serviços. Conclusões: a capacitação contribui para ampliação do conhecimento de profissionais da atenção básica, porém a aplicabilidade na rotina depende de esforços da gestão local e organização dos serviços. Palavras-chave Capacitação profissional, Nutrição da criança, Saúde da criança, Enfermagem em saúde pública, Atenção primária à saúde

Aleitamento materno: o que mudou após uma década?

Objective: to analyze the changes in prevalence, median duration and correlates of breastfeeding in a small city in Sao Paulo state, Brazil. Method: analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%. Results: an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions. Conclusions: advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.ABSTRACT Objective: to analyze the changes in prevalence, median duration and correlates of breastfeeding in a small city in São Paulo state, Brazil. Method: analysis of two cross-sectional studies, conducted at intervals of one decade, with 261 and 302 children younger than two years, respectively. We used Kaplan-Meier survival analysis for calculation of the median duration of breastfeeding, and Cox regression for correlates analysis, with significance level of 5%. Results: an increase of 33.4% in the prevalence of exclusive breastfeeding and 20.9% in breastfeeding was identified. Regarding the latter, the median duration increased from 7.2 to 12 months. In the most recent study, the median duration was lower in first-born children who used pacifiers, and it was not associated with breastfeeding incentive actions. Conclusions: advances in the prevalence and duration of breastfeeding were observed during the 10 year-period, however, pacifier use still remains associated to a shorter median duration of breastfeeding. Our findings contribute to highlighting the need for intensification of nursing actions in the promotion of breastfeeding, and discouragement regarding the use of pacifiers.

Uso y llenado de la libreta de salud infantil con el foco en el crecimiento y el desarrollo

Objetivo Evaluar el uso y llenado de la Libreta de Salud Infantil (LSI), especialmente el crecimiento y el desarrollo. Metodo Estudio transversal con 358 pares de madres e hijos matriculados en 12 Unidades Basicas de Salud (UBS) de una ciudad pequena. Las madres fueron entrevistadas en el UBS desde febrero a abril 2013 mediante un cuestionario. Se utilizo Epi-info y software SPSS. Resultados 53% de las madres estaban llevando LSI durante la entrevista, proporcion similar a las madres que recibieron instrucciones para llevar el LSI a la atencion de la salud. Anotaciones en LSI durante las visitas se registraron en un 49%. Calendario de vacunas fue completa en el 97% de LSI, pero solo el 9% y el 8% de LSI tenido, respectivamente, las curvas de crecimiento y desarrollos debidamente cumplimentados. Conclusion El uso y el relleno satisfactorio de LSI refuerzan la necesidad de inversion en la formacion profesional y el acercamiento a la comunidad para la LSI se convierte efectivamente en un instrumento de promocion de la salud infantil.Objective To evaluate the use and records of the Child Health Handbook (CHH), especially growth and development. Method Cross-sectional study with 358 mother-child pairs registered in 12 Primary Health Centers (PHCs) of a small municipality. Mothers were interviewed at the PHC from February to April 2013 using a questionnaire. Data analysis was done using WHO Anthro software, Epi InfoTM and Stata. Results Fifty-three percent of the mothers were carrying the CHH at the time of the interview, similar to the proportion of mothers who were instructed to bring the CHH to health appointments. Annotations in the CHH during the visits were reported by 49%. The vaccination schedule was completed in 97% of the CHH, but only 9% and 8% of the CHH, respectively, contained growth charts and properly completed developmental milestones. Conclusion Low rates of use and unsatisfactory record-keeping in the CHH reinforce the need for investment in professional training and community awareness for the CHH to become an effective instrument of promotion of child health.