Maria da Purificação Nazaré Araújo

Effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections in young children in Brazil

A beneficial effect of periodic vitamin A supplementation on childhood mortality has been demonstrated, but the effect on morbidity is less clear. We investigated the effect of vitamin A supplementation on diarrhoea and acute lower-respiratory-tract infections (ALRI) in children from northeastern Brazil in a randomised, double-blind, placebo-controlled community trial. 1240 children aged 6-48 months were assigned vitamin A or placebo every 4 months for 1 year. They were followed up at home three times a week, and data about the occurrence and severity of diarrhoea and ALRI were collected. Any child with cough and respiratory rate above 40 breaths per min was visited by a paediatrician. The overall incidence of diarrhoea episodes was significantly lower in the vitamin-A-supplemented group than in the placebo group (18.42 vs 19.58 x 10(-3) child-days; rate ratio 0.94 [95% Cl 0.90-0.98]). The benefit of supplementation was greater as regards severe episodes of diarrhoea; the incidence was 20% lower in the vitamin A group than in the placebo group (rate ratio 0.80 [0.65-0.98]). With the standard definition of diarrhoea (> or = 3 liquid or semi-liquid stools in 24 h) the effect of vitamin A on mean daily prevalence did not reach significance, but as the definition of diarrhoea was made more stringent (increasing number of stools per day), a significant benefit became apparent, reaching for diarrhoea with 6 or more liquid or semi-liquid stools in 24 h a 23% lower prevalence. We found no effect of vitamin A supplementation on the incidence of ALRI. The reduction in severity of diarrhoea may be the most important factor in the lowering of mortality by vitamin A supplementation.

Distribuição da anemia em pré-escolares do semi-árido da Bahia

The objective of this survey was to determine the prevalence of anemia and potential determinants thereof in 754 children from urban areas of seven small towns in the semi-arid region of Bahia. Hemoglobin was measured in 745 children 1 to 72 months of age. For the 6-to-72 month-old group, hemoglobin < 11.0 g/dl was considered anemia (following WHO recommendations) whereas <9.5 g/dl was considered severe anemia. The same cutoffs were used for children under 6 months, which are the same ones used in clinical-hematology. A mean hemoglobin of 12.1 g/dl was found, distributed differently according to age groups (p=0.001). The study found prevalences of 22.2 % for anemia and 5.8% for severe anemia, respectively. Occurrence of anemia varied significantly with age (p=0.001); the highest prevalence was 50.0% in children 12 to 23 months of age, followed by 29.9% in children below 12 months. The association of anemia with mothers education (controlled for age) and per capita family income was not statistically significant.

Situação nutricional e alimentar de pré-escolares no semi-árido da Bahia (Brasil): II Hipovitaminose A

Foram estudados 754 pre-escolares de areas urbanas de sete municipios do semi-arido do Estado Bahia, Brasil, com o objetivo de determinar a prevalencia da hipovitaminose A e sua associacao com a idade, sexo, renda em salario-minimo, escolaridade materna e adequacao dietetica em vitamina A. Na amostra estudada nao se registrou nenhum caso de sinais e/ou sintomas de xeroftalmia durante o exame clinico-oftalmologico. Em 563 criancas foi possivel a coleta de sangue para determinacao de retinol serico; encontrou-se um valor medio de 20,3 µg/dl (DP=10,8µg/dl) e uma prevalencia de 15,3% de niveis deficientes (abaixo de 10,0 µg/dl). Em todos os sete municipios estudados a prevalencia de retinol serico deficiente foi superior a 5,0% que e nivel critico proposto pela OMS para considerar a hipovitaminose A como problema de saude publica. A distribuicao de retinol serico encontrada nao teve relacao com o sexo das criancas, mas com a idade, diminuindo a prevalencia de niveis deficientes e baixos na medida em que a idade aumenta. Nao se encontrou associacao entre renda familiar per capita ou escolaridade materna e a prevalencia de niveis de retinol deficiente. Os resultados de consumo alimentar provenientes do inquerito recordatorio de 24h mostraram que apenas 8% das criancas consumiram quantidades adequadas de retinol ou de seus precursores; 66% ingeriam abaixo da metade e quase 35% delas nao chegaram a ingerir nem um quarto da quantidade recomendada para sua faixa etaria. A carencia de vitamina A deve ser considerada como problema de saude publica severo, tanto pela alta prevalencia de niveis deficientes de retinol em todos os municipios como tambem pela dimensao da inadequacao dietetica.

Projeto pedagógico do programa de graduação em nutrição da Escola de Nutrição da Universidade Federal da Bahia: uma proposta em construção

The pedagogical project principles are based on eight educational issues: professional profile, competency, educational strategies, topic issues, curriculum organization, learning assessment system and course evaluation. The fundamental aim of these issues is the integration of knowledge(s), in order to overcome dichotomies such as those of the biological versus the social, the theory versus practice, the basic cycle versus the professional, and the individual approach versus the collective and the multiprofessional practices. The searches for curricular flexibility and methodological innovation imply a new way of learning which is based on the autonomy and independence of the students. Incorporated in the project, as its central elements, are the scientific and pedagogical training of teachers and the course evaluation process. The proposal intends to socialize the discussion, thus contributing to improve the education of nutrition professionals in Brazil.

Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002. 3 - o Programa Nacional de Controle da Deficiência de Vitamina A

Vitamin A supplements have been distributed during National Immunization Days since 1983, and Brazil has been a pioneer in this kind of strategy. The current study evaluated the National Program from 1995 to 2002, from a structure-process-results perspective. The methodology involved document research, interviews with health services managers, and a case study in 44 municipalities in Bahia State, resulting in 1,344 household interviews. In relation to structure, from 1998 on the program operated without a normative instrument due to the extinction of the National Institute of Nutrition. Improvements in the processes of vitamin supply procurement and distribution had a positive impact on coverage, reaching 3.5 million capsules in 2002 (72% coverage). For the 2,546 children studied in Bahia, vitamin A distribution was irregular, with annual coverage varying from 8% to 26%. Program managers reported time constraints and insufficient human resources, consistent with the hypothesis that this type of strategy does not help inform the population about the importance of vitamin A. These findings point to the need for systematic linkage between different levels of government in order to fully implement and monitor the program.

Factors Associated with Hypertension and Overweight in Metallurgical Workers: A Cross-Sectional Study

Factors Associated with Hypertension and Overweight in Metallurgical Workers: A Cross-Sectional Study The prevalence of overweight and hypertension have increased among Brazilian workers. There are evidences that chronic exposure to stressful working conditions. Furthermore,it is believed that such conditions may favor the occurrence of unhealthy behaviors such as smoking, excessive alcohol consumption and hyperalimentation, which are risk factors for hypertension and overweight. This study aims to identify factors associated with overweight and hypertension in metallurgical workers of the state of Bahia - Brazil. Its a crosssectional study conducted with 139 workers.