Luiz Antonio Del Ciampo

Factors associated with iron deficiency anemia in Brazilian preschool children

OBJECTIVE To examine the determining factors of anemia and iron deficiency in children attending two day care centers in the town of Pontal, southeast of Brazil. METHODS Cross-sectional study was conducted in 192 children aged 12 to 72 months. Personal data (age, sex, use of medicinal iron supplements, duration of breast-feeding, type of delivery, prenatal care, weight, and height), and socioeconomic data (number of co-inhabitants, parental schooling, and per capita family income) were obtained and evaluated together with hemoglobin, serum transferrin receptor, ferritin, and iron deficiency anemia. RESULTS Age was the variable that most affected iron nutritional status, with higher hemoglobin values, lower transferrin receptor concentrations, higher ferritin values and lower iron deficiency anemia being detected with increasing age. The other studied variables did not show any correlation with iron nutritional status. CONCLUSION The obtained data suggest that control strategies for this preschool population should be especially directed at younger children.

Control of iron-deficiency anaemia in Brazilian preschool children using iron-fortified orange juice

Different fortified foods have been used for the control of iron-deficiency anaemia in children. In Brazil, a low cost, abundant and culturally accepted food but not yet used for fortification, is orange juice. To evaluate the usefulness of fortified orange juice, 50 preschool children enrolled in a day-care centre in the town of Pontal, Southeast Brazil, received two flasks of 200 ml orange juice fortified with 20 mg ferrous sulfate heptahydrate, providing 2 mg elemental/100 ml, from Monday to Friday for 4 months (a total of 84 days). Capillary haemoglobin and z scores of the anthropometric indicators weight-for-age, weight-for-height and height-for-age were determined at the beginning of the study and after 4 months. Mean haemoglobin increased from 10.48 ± 1.66 to 11.60 ± 1.09 mg/dl (p = 0.00003) and the prevalence of anaemia (Hb < 11 mg/dl) decreased from 60 to 20%. No significant alterations in the mean z scores of the anthropometric indicators were observed. The acceptance of fortified juice was excellent and no undesired effect was observed. We conclude that the consumption of iron-fortified orange juice is an adequate strategy to complement iron intake in preschool children and, therefore, to treat and prevent iron-deficiency anaemia.

Effect of fortification of drinking water with iron plus ascorbic acid or with ascorbic acid alone on hemoglobin values and anthropometric indicators in preschool children in day-care centers in Southeast Brazil.

Background Iron-deficiency anemia currently is the most frequently occurring nutritional disorder worldwide. Previous Brazilian studies have demonstrated that drinking water fortified with iron and ascorbic acid is an adequate vehicle for improving the iron supply for children frequenting day-care centers. Objective The objective of this study was to clarify the role of ascorbic acid as a vehicle for improving iron intake in children in day-care centers in Brazil. Methods A six-month study was conducted on 150 children frequenting six day-care centers divided into two groups of three day-care centers by drawing lots: the iron-C group (3 day-care centers, n = 74), which used water fortified with 10 mg elemental iron and 100 mg ascorbic acid per liter, and the comparison group (3 day-care centers, n = 76), which used water containing only 100 mg ascorbic acid per liter. Anthropometric measurements and determinations of capillary hemoglobin were performed at the beginning of the study and after six months of intervention. The food offered at the day-care centers was also analyzed. Results The food offered at the day-care center was found to be deficient in ascorbic acid, poor in heme iron, and adequate in non-heme iron. Supplementation with fortified drinking water resulted in a decrease in the prevalence of anemia and an increase in mean hemoglobin levels associated with height gain in both groups. Conclusions Fortification of drinking water with iron has previously demonstrated effectiveness in increasing iron supplies. This simple strategy was confirmed in the present study. The present study also demonstrated that for populations receiving an abundant supply of nonheme iron, it is possible to control anemia in a simple, safe, and inexpensive manner by adding ascorbic acid to drinking water.

Prevalence of chronic constipation in children at a primary health care unit

OBJECTIVE To study the frequency of chronic constipation in childhood at a Primary Health Care Unit and to observe its characteristics in this population. METHODS The sample consisted of 313 children aged between one and 10 years treated at the Centro de Saúde Escola, in the district of Tibério, in the town of Ribeirão Preto. Among these, 84 children with chronic constipation were selected. The chi-squared test was used to compare the groups of constipated and nonconstipated children (p=0.01). RESULTS The prevalence of chronic constipation was 26.8%. In the group of chronic constipation, 85.7% of the children had hardened stools, 25% showed reduction in fecal mass, 17.9% had an interval between evacuations longer than 2 days (constipated children), 14.3% revealed fecal soiling and 21.4% presented blood in stools. CONCLUSION The prevalence of chronic constipation was high and the interval between evacuations was as an important diagnostic criterion for the selection of constipated children.

O Programa de Saúde da Família e a Puericultura

This paper suggests a proposal of Child Health Care, to children and adolescents, to be developed in the Family Health Care Programs.

Promotion of breastfeeding: the importance of pediatricians with specific training

OBJECTIVE To study the factors involved in the maintenance of exclusive breastfeeding in healthy infants during the first 4 months of life, with emphasis on the role of pediatricians. MATERIAL AND METHODS A longitudinal study was carried out with 101 healthy term babies at a pediatrics outpatient clinic in Uberaba, state of Minas Gerais, Brazil. The babies were divided at random into three groups: G1, receiving advice from a multiprofessional breastfeeding team; G2, receiving advice from a pediatrician trained in breastfeeding; and G3, receiving advice from a pediatrician with no breastfeeding training. Group randomization was confirmed by analysis of variance. The factors involved in the type of feeding at 4 months were analyzed by the chi-square test, by analysis of variance and by multiple variable analysis. RESULTS At the end of follow-up, Groups 1 and 2 showed similar percentages with respect to exclusive breastfeeding. In addition, the percentage of exclusively breastfed babies in Groups 1 and 2 was significantly higher than in Group 3 (p = 0.002). The use of a pacifier was negatively correlated with exclusive breastfeeding (p = 0.003). More maternal schooling increased the chance of exclusive breastfeeding at 4 months (p = 0.041). CONCLUSIONS In this study, a pediatrician who was prepared and motivated to encourage breastfeeding performed similarly to a multiprofessional breastfeeding team in terms of promoting exclusive breastfeeding until 4 months.

Acidentes de mordeduras de cães na infância

The incidence of dog bites injuries among children aged 0 to 15 years seen at CSE D. Pedro I health center in Ribeirão Preto, Brazil, in the period of 1993 to 1997, was studied. The results show that there is a need to develop and implement educational and preventive programs about the risks and severity of accidents occurred while in contact with dogs.Estudou-se a incidencia de casos de mordeduras caninas atendidas em uma unidade basica de saude da cidade de Ribeirao Preto, SP, no periodo de 1993 a 1997, entre criancas com idades de 0 a 15 anos. Os dados encontrados mostraram a importância de se promover programas educativos sobre os riscos dessas ocorrencias para evitar acidentes causados por contatos com caes.

Nível sérico de zinco e sua associação com deficiência de vitamina A em crianças pré-escolares

OBJECTIVES: To identify the prevalence of zinc deficiency in a population with high prevalence of vitamin A deficiency; to verify whether zinc deficiency is associated with vitamin A deficiency in the population studied; to verify risk factors for zinc deficiency (sex, age, diarrhea and fever). METHOD: Cross-sectional study of 182 healthy children aged > 24 months and 48 and 48 and < 60 months tended to have lower zinc serum levels than children of other ages. Zinc serum levels were not changed by previous diarrhea and/or fever.

Assessment of mid-upper arm circumference as a method for obesity screening in preschool children

OBJETIVOS: O presente estudo visou a avaliar se o perimetro braquial poderia ser utilizado para a triagem de criancas obesas na idade pre-escolar. METODOS: 1.090 criancas com idades entre 12 e 59,99 meses foram estudadas, obtendo-se informacoes pessoais, alem de peso, estatura e perimetro braquial. Foram obtidas as sensibilidades e especificidades de diferentes escores z de perimetro braquial para idade e perimetro braquial para estatura, para a deteccao de criancas obesas, definidas como aquelas que apresentaram escore z de peso para estatura acima de 2. RESULTADOS: Das 1.090 criancas avaliadas, 6,6% apresentaram escore z de peso para estatura acima de 2. O escore z de 0,7 do indicador perimetro braquial para idade determina a melhor associacao entre sensibilidade (76,5%) e especificidade (77,9%), para a deteccao das criancas obesas. O escore z de 0,6 do indicador perimetro braquial para estatura determina a melhor associacao entre sensibilidade (79,4%) e especificidade (77,6%) para a deteccao das criancas obesas. CONCLUSOES: Nao se observou vantagem do uso do perimetro braquial relacionado a estatura quando comparado a sua relacao com a idade. Dessa forma, propoem-se pontos de corte, utilizando-se apenas o indicador perimetro braquial para idade que, pela sua facilidade e rapidez de obtencao em populacoes, e um metodo alternativo viavel para triagem de criancas pre-escolares portadoras de obesidade.

Peso insuficiente ao nascer: estudo de fatores associados em duas coortes de recém-nascidos em Ribeirão Preto, São Paulo

OBJECTIVE: To evaluate factors associated to the increase in insufficient birth weight (IBW) rates in two population-based-cohorts of singletons born alive in Ribeirao Preto, Sao Paulo, Brazil, separated by 15 years (1978/79 and 1994). METHODS: The first cohort (1978/79) comprised 6,223 newborns and the second (1994), 2,522, excluding low birth weight newborns. Independent variables association with IBW (maternal age, work, schooling and smoking; previous abortion, previous stillbirth, number of live births, maternal marital status, family income, occupation group, type of hospital, mode of insurance, number of antenatal visits, type of delivery; newborn gender and gestational age) were analyzed. The Odds Ratio (OR) was determined using a logistic regression model and 95% confidence limits were calculated. RESULTS: In 1978/79, maternal age <20 years (p=0.014), family income <5 minimum Brazilian wages (p=0.030), <4 antenatal visits (p=0.003), vaginal delivery (p<0.001), female newborn gender (p<0.001), maternal smoking (p<0.001) and preterm birth (p<0.001) were associated with IBW. In 1994, maternal work outside home (p=0.020), female newborn gender (p<0.001), maternal smoking (p<0.001) and preterm births (p<0.001) were associated with IBW. CONCLUSIONS: Socioeconomics variables associated with IBW in 1978/79 were not determinants in 1994. Newborn gender, maternal smoking and preterm birth remained significant determinants of IBW in both moments. Considering the decrease in rate of maternal smoking and the maintenance of female births, the increase in IBW could be explained by increasing rates of preterm birth in this interval of 15 years.