Mônica Maria Osório

Prevalence of anemia in children 6-59 months old in the state of Pernambuco, Brazil

OBJECTIVE To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there. METHODS In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomly selected to represent the state and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census lists, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were selected. Blood was collected by venipuncture, and hemoglobin was measured with a portable hemoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution. RESULTS The prevalence of anemia among children 6-59 months old was 40.9% for the state as a whole. Prevalence in the metropolitan region of Recife was 39.6%, and it was 35.9% in the urban interior. The rural interior had the highest prevalence, 51.4%. Prevalence was twice as high in children aged 6-23 months as among those 24-59 months old, 61.8% vs. 31.0% (chi 2 = 77.9, P < 0.001). The mean hemoglobin concentrations in the younger and older age groups were 10.4 g/dL (standard deviation (SD) = 1.5) and 11.4 g/dL (SD = 1.4), respectively. There was no statistically significant difference between the sexes in terms of prevalence. CONCLUSIONS This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed.

Fatores determinantes da anemia em crianças

Objetivo: apresentar uma revisao sobre os principais fatores determinantes da anemia em criancas menores de cinco anos. Fontes dos dados: foram utilizadas as informacoes de artigos publicados em revistas cientificas nacionais e internacionais indexadas, livros tecnicos e publicacoes de organizacoes internacionais. Sintese dos dados: a anemia constitui o problema nutricional de maior magnitude no mundo, sendo as criancas menores de cinco anos um dos grupos populacionais de maior risco. Como qualquer problema de saude publica, sua origem e multicausal e, desta maneira, tenta-se nesse artigo interpretar a sua relacao direta ou indireta com seus possiveis fatores determinantes, e os principais achados concordantes ou discordantes nos estudos epidemiologicos. Dentre esses fatores encontram-se as condicoes socioeconomicas, as condicoes de assistencia a saude da crianca, seu estado nutricional, a presenca de morbidades, o consumo alimentar e os fatores biologicos. Destacam-se o papel da dieta, no que diz respeito ao consumo e biodisponibilidade de ferro, e a idade da crianca como os principais determinantes. Conclusoes: tendo em vista a magnitude do problema e a abrangencia de seus fatores de risco revisados neste trabalho, torna-se necessaria a implementacao de medidas urgentes de prevencao e tratamento da anemia ferropriva. E importante ressaltar que uma unica estrategia podera ter pouco sucesso se outras medidas nao forem tomadas simultaneamente, sendo relevante o papel da educacao alimentar, juntamente com outras acoes implementadas. As criancas menores de dois anos e as que residem em areas rurais e carentes devem ser priorizadas nos programas de combate a anemia.

Factors associated with Hb concentration in children aged 6-59 months in the State of Pernambuco, Brazil

In 1997, the prevalence of anaemia was 40.9 % among children aged 6-59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6-59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6-23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8.3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3.3, serum retinol 2.7, diarrhoea 2.4, water treatment 1.7, sanitation 1.3 and low birth-weight 0.5 %. The final model explained 23.4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged <2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

Fatores socioeconômicos e dietéticos de risco para a anemia em crianças de 6 a 59 meses de idade

OBJECTIVE The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS The risk factors for anemia were: a high proportion of calories from cows milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cows milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cows milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cows milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

Padrão alimentar de crianças menores de cinco anos

OBJECTIVE: To characterize the alimentary profile of under-five year old children in the State of Pernambuco, Brazil, according to geographical area (metropolitan region of Recife, urban inland, rural inland), the childs age and sex, family income and mothers schooling. METHODS: Cross-sectional home based study with a stratified sample of 969 under-five year old children. Food consumption was registered by a 24-hour recording method. The chi-square test was used to verify the association between food consumption and the studied variables. RESULTS: The most consumed food items (30% of the children) in the State of Pernambuco were: milk, sugar, fat, rice, beans and meat. There were statistically significant differences between the consumption of most food items and geographical area, childs age, family income and mothers schooling. There was no significant difference between the consumption foods and the childs sex. CONCLUSION: The food consumption by under-five year old children in the State of Pernambuco, although presenting some differences in the studied variables, was generally monotonous, with little diversification. It was basically made up of a lacteous diet, with a high intake of sugar and fats and low intake of fruits and vegetables.

Consumo de leite de vaca e anemia ferropriva na infância

OBJETIVO: Revisar aspectos do consumo de leite de vaca associados a anemia na infância. FONTES DOS DADOS: As informacoes foram coletadas a partir de artigos publicados nas 2 ultimas decadas, pesquisados nas bases de dados Lilacs e MEDLINE, livros tecnicos e publicacoes de organizacoes internacionais. SINTESE DOS DADOS: A anemia ferropriva e um grave problema de saude publica nos paises em desenvolvimento. Ate os 6 meses de idade, o leite materno supre as necessidades de ferro das criancas nascidas a termo. A partir dai, torna-se necessaria a ingestao de uma alimentacao complementar rica em ferro. Considerando a importância da dieta na determinacao da anemia e o alto consumo de leite de vaca na infância, discute-se neste artigo a relacao desse alimento com a deficiencia de ferro. A introducao precoce ou a substituicao do leite materno por leite de vaca pode ocasionar problemas gastrintestinais e alergicos. Alem disso, esse alimento apresenta baixa biodisponibilidade e densidade de ferro, excesso de proteinas e minerais, especialmente calcio, interferindo na absorcao do ferro de outros alimentos, e associa-se as micro-hemorragias intestinais, principalmente nas criancas menores. CONCLUSOES: A utilizacao do leite de vaca em detrimento de outros alimentos ricos em ferro biodisponivel constitui um risco para o desenvolvimento da anemia. O estimulo ao aleitamento materno exclusivo ate os 6 meses de vida e sua continuidade ate pelo menos 24 meses, juntamente com uma dieta complementar rica em ferro sao medidas de grande importância para a prevencao da anemia e de suas consequencias na infância.

Concentração de hemoglobina e anemia em crianças no Estado de Pernambuco, Brasil: fatores sócio-econômicos e de consumo alimentar associados

This study aimed to assess hemoglobin level and anemia prevalence and their association with food-consumption and socioeconomic variables. A cross-sectional survey was conducted in the State of Pernambuco, Brazil, in 1997, using three-stage sampling which included 746 6-to-59-month-old children. Hemoglobin testing and a 24-hour food recall interview were performed. The anemia rate was 40.6% and was higher in the rural area and inversely proportional to age, income, and maternal schooling. Most children (88.9%) consumed cows milk. Anemia was associated directly with the proportion of calories from cows milk and indirectly with the iron level. Childs age, geographic area, per capita family income, maternal schooling, iron density (total, heme, and non-heme), and the proportion of calories from cows milk in the diet were determinants for anemia.

Consumo alimentar de macro e micronutrientes de crianças menores de cinco anos no Estado de Pernambuco, Brasil

OBJECTIVE: to analyze the food consumption of macro and micronutrients by children under fiver years old in the State of Pernambuco based on the Dietary Reference Intakes, in three geographic areas: Metropolitan Region of Recife, Urban Interior and Rural Interior. METHODS: the sample consisted of 948 children under five years old and was representative for the State of Pernambuco and its three geographic areas. The 24-hour recall method was used to register food consumption. The median and the prevalence of both macro and micronutrient inadequacy were analyzed according to the Dietary Reference Intakes. RESULTS: the deficit of energy and micronutrients prevailed in children of all age ranges and geographic areas; however, protein consumption exceeded the references levels. There was a high prevalence of micronutrient inadequacy, especially iron and zinc, in children above 12 months old. The results in the Rural Interior were the lowest, considering the nutrients analyzed. CONCLUSIONS: food consumption by children in the State of Pernambuco is low in energy, macro and micronutrients. It is expected that these results may contribute to the implementation of health and nutrition policies at State level, aiming to prevent the main nutritional disturbances in children under five years old.

Alimentação do recém-nascido pré-termo: métodos alternativos de transição da gavagem para o peito materno

This study investigates the methods normally used to effect the transition from tube-feeding to full breastfeeding in preterm infants. The information was gathered from papers catalogued in the Lilacs, Medline, and SciElo databases, between 1994 and 2007. Four articles were selected and only randomized studies considered (three of them, being controlled). The literature describes a number of methods used to effect the transition from tube-feeding to full breastfeeding: bottle-feeding and cup-feeding. The studies demonstrate that the babies who used cup-feeding obtained better results in relation to physiological stability (cardiac frequency and oxygen saturation) and to the impact on full breastfeeding on being discharged from hospital. Given the scarcity of studies in the literature and the methodological problems found, it is clear that more studies need to be carried out to compare the alternative methods used for the preterm feeding plan.

Perfil e fatores asssociados ao aleitamentamento materno em crianças menores de 25 meses da Região Nordeste do Brasil

OBJETIVOS: avaliar o perfil do aleitamento materno em criancas menores de 25 meses de idade na Regiao Nordeste do Brasil e verificar a associacao entre a duracao mediana do aleitamento e algumas variaveis demograficas, maternas, de assistencia ao parto e culturais. METODOS: estudo transversal. Dados obtidos do banco de dados da Pesquisa Nacional sobre Demografia e Saude de 1996, do qual foram selecionadas 813 criancas. A frequencia e a duracao mediana do aleitamento materno foram estimadas por meio de tabuas de vida. RESULTADOS: a duracao mediana do aleitamento materno foi de 199,8 dias. Verificou-se que no primeiro mes de vida 90,4% das criancas estavam mamando. Aos quatro e seis meses, os percentuais foram 64,7% e 54,4%, respectivamente. A duracao mediana do aleitamento materno foi maior: nas criancas que residiam em areas rurais, com o aumento da idade materna, e nas criancas que nao utilizaram a mamadeira. CONCLUSOES: a duracao do aleitamento materno ainda se encontra distante do recomendado pela Organizacao Mundial de Saude, necessitando, portanto da intensificacao das acoes de incentivo e apoio ao aleitamento materno. Os fatores que influenciam o aleitamento materno devem ser considerados na operacionalizacao destas acoes.