Roberta Pereira Niquini

Avaliação da estrutura de sete unidades de saúde da família para a oferta da assistência nutricional no pré-natal no município do Rio de Janeiro, Brasil

OBJECTIVES: to evaluate the extent to which seven family health units in the municipality of Rio de Janeiro are equipped to provide prenatal care on nutrition. METHODS: a cross-sectional study was carried out in 2008. Seven family health units were selected and their structure was observed directly. Seven health workers and 230 pregnant women were interviewed at these units. The building structure, material resources, referral system, human resources and norms and routines were examined at each unit. RESULTS: direct observation and the interviews with the health workers ascertained that all the units had a suitable building structure and material resources. The norm that was least commonly complied with was the preventive maintenance of scales. The Ministry of Healths current prenatal card was found to have been implemented for 45% of the pregnant women. Access to ferrous sulfate and folic acid were reported by around 70% of pregnant women. There was found to be a shortfall in human resources and in referral of pregnant women to nutritionists. CONCLUSIONS: the study points out the importance of ensuring the minimum team size and installing Family Health Support Unites, when expanding the scope and improving the integration of prenatal care.

Avaliação do processo da assistência nutricional no pré-natal em sete unidades de saúde da família do Município do Rio de Janeiro

Nutritional care is of great importance in the prenatal period and the family health teams play a significant role in expanding the coverage of prenatal care. In this manner, the scope of this study was to evaluate the prenatal nutritional care process in seven family health units in the city of Rio de Janeiro. In 2008, a cross-sectional study was conducted and 230 pregnant women were interviewed and copies of their prenatal cards were obtained. The compliance of the process with the pre-established norms and criteria of the Ministry of Health was evaluated. Measurement and recording of blood pressure and weight and prescription of supplements and blood tests on the prenatal card are established steps in routine prenatal care. However, the results indicated that there was under-recording of stature, initial weight, edema, BMI by gestational age and laboratory tests results on the prenatal card. A lack of specific instruction on adequate use of the iron supplement, food consumption and weight gain was observed. The results indicated a pressing need for prenatal nutritional care and revealed deficiencies in this process, stressing the importance of minimum training for the health teams and the implementation of Family Health Support Centers.

Fatores associados à introdução precoce de leite artificial, Município do Rio de Janeiro, 2007

Este estudo objetivou analisar a associacao entre introducao de leite artificial e fatores demograficos e socioeconomicos em uma amostra representativa de 1.057 maes de criancas menores de seis meses, atendidas em 27 unidades basicas de saude no Municipio do Rio de Janeiro, no ano de 2007. As informacoes sobre caracteristicas maternas e tipo de alimentacao da crianca foram obtidas pela aplicacao de um questionario a mae apos uma consulta pediatrica. Para estimar a associacao entre as variaveis maternas e a introducao de leite artificial foi utilizado um modelo de regressao logistica multivariado com ponderacao, efeito de desenho e controlado pela idade da crianca. Os resultados apontaram que a chance de introducao de leite artificial foi significativamente maior, no nivel de 5%, entre as maes com trabalho informal, menos de oito anos de estudo e sem experiencia em amamentar. Verificou-se a presenca de interacao negativa entre situacao conjugal e a idade materna. Dentre as mulheres com companheiro, as adolescentes mostraram uma chance 2,06 vezes maior (IC 95% de 1,32 a 3,21) de introduzir leite artificial quando comparadas com as adultas, enquanto entre as mulheres sem companheiro, a adolescencia aparece como um fator protetor para a introducao de leite artificial (OR = 0,24, IC 95% 0,10 a 0,58). E necessaria a capacitacao de profissionais de saude para oferecer orientacoes sobre amamentacao atraves de uma abordagem que considere as caracteristicas maternas.

Assistência a crianças desnutridas: análise de dados do Sistema de Informação Hospitalar do Sistema Único de Saúde do Brasil

OBJECTIVES: to characterize features of care provided for malnourished children aged under five years admitted to hospitals affiliated to the Brazilian National Health Service in 2004. METHODS: geographical, demographic data and information relating to diagnosis, results of care and admission to hospital available on the Brazilian National Health Services Hospital Information System were analyzed. RESULTS: the highest rate for admission to hospital for malnutrition was found in the Northeast region. Of all admissions to hospital for malnutrition in Brazil as a whole, 36.2% were registered as non-specific. The hospital mortality rate for malnutrition in Brazil was low, but moderate for children aged under six months and high when severe malnutrition was registered in the secondary diagnosis field. The hospital mortality rate for malnutrition was also high in 102 Brazilian municipalities. It is worth noting that 11.4% of children died within the first 24 hours following admission to hospital and the complementary outpatient treatment was recommended in 3.7% of Hospital Admissions Authorizations. CONCLUSIONS: the study revealed the importance of health workers recognizing the value of the nutritional status evaluation and correctly registering this as the cause of admission to hospital, and also integrating and ordering the various levels of care for malnourished children.

Acolhimento e características maternas associados à oferta de líquidos a lactentes

OBJETIVO: Identificar caracteristicas maternas y acciones de acogimiento en las madres de ninos menores de seis meses asociadas a la oferta precoz de liquidos. METODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de ninos menores de seis meses (n=1.057) usuarias de unidades basicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociacion entre las variables explicativas y la oferta de liquidos se utilizo un modelo de regresion logistica multivariada con ponderacion, efecto de diseno y controlado por la edad del nino. RESULTADOS: De las madres, 32% no recibieron la tarjeta de acogimiento en la maternidad, 47% no recibieron orientacion sobre amamantamiento en la primera ida a la USB posterior al parto y 55% relataron la oferta de liquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de liquidos mayor que aquellas con experiencia (OR=1,57;IC 95%:1,16;2.13). Las que no recibieron orientacion sobre amamantamiento en la primera ida a la unidades de salud posterior al parto tuvieron oportunidad 58% mayor de ofrecer liquidos que aquellas que recibieron orientacion. La oferta de liquidos se mostro positivamente asociada con la adolescencia entre mujeres con companero (OR=2,17; IC 95%: 1,10;4,30) y negativamente asociada con la adolescencia entre aquellas sin companero (OR=0,31; IC 95%: 0,11;0,85). Entre mujeres con menos de ocho anos de estudio, las que no recibieron orientacion sobre amamantamiento posterior al nacimiento del nino presentaron oportunidad de oferta de liquidos 1,8 veces mayor que aquellas que recibieron orientacion. CONCLUSIONES: Edad, situacion conyugal y experiencia anterior en amamantar son caracteristicas maternas asociadas a la oferta de liquidos para ninos menores de seis meses. El recibimiento de orientacion precoz sobre amamantamiento materno puede reducir el ofrecimiento de liquidos a los lactantes.OBJECTIVE To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it. CONCLUSIONS Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.

User embracement and maternal characteristics associated with liquid offer to infants

OBJETIVO: Identificar caracteristicas maternas y acciones de acogimiento en las madres de ninos menores de seis meses asociadas a la oferta precoz de liquidos. METODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de ninos menores de seis meses (n=1.057) usuarias de unidades basicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociacion entre las variables explicativas y la oferta de liquidos se utilizo un modelo de regresion logistica multivariada con ponderacion, efecto de diseno y controlado por la edad del nino. RESULTADOS: De las madres, 32% no recibieron la tarjeta de acogimiento en la maternidad, 47% no recibieron orientacion sobre amamantamiento en la primera ida a la USB posterior al parto y 55% relataron la oferta de liquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de liquidos mayor que aquellas con experiencia (OR=1,57;IC 95%:1,16;2.13). Las que no recibieron orientacion sobre amamantamiento en la primera ida a la unidades de salud posterior al parto tuvieron oportunidad 58% mayor de ofrecer liquidos que aquellas que recibieron orientacion. La oferta de liquidos se mostro positivamente asociada con la adolescencia entre mujeres con companero (OR=2,17; IC 95%: 1,10;4,30) y negativamente asociada con la adolescencia entre aquellas sin companero (OR=0,31; IC 95%: 0,11;0,85). Entre mujeres con menos de ocho anos de estudio, las que no recibieron orientacion sobre amamantamiento posterior al nacimiento del nino presentaron oportunidad de oferta de liquidos 1,8 veces mayor que aquellas que recibieron orientacion. CONCLUSIONES: Edad, situacion conyugal y experiencia anterior en amamantar son caracteristicas maternas asociadas a la oferta de liquidos para ninos menores de seis meses. El recibimiento de orientacion precoz sobre amamantamiento materno puede reducir el ofrecimiento de liquidos a los lactantes.OBJECTIVE To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it. CONCLUSIONS Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.

Atencao nutricional no pre-natal de baixo risco do Sistema Unico de Saude: teoria e modelizacao

OBJECTIVES: to describe the low risk prenatal nutritional care theory adopted by Brazilian National Health System. METHODS: an evaluative study was carried out based on the Loves Implementation Evaluation Model (2004), in its third stage (deliver the program). Coverage was examined using the database of the 2006 National Demographics and Health Survey and components analysis included the development of causal and logical-operational models. RESULTS: prenatal care has virtually universal coverage in Brazil. However, non-participation in prenatal and nutritional care is related to lower socio-economic status. The high level of nutritional disorders during pregnancy and the presumed logical chain of causes of these disorders and their consequences show the importance of intervening in the nutritional status of pregnant women, given that it is possible to act on this cause and that such actions have been shown to be effective / efficacious. The logico-operational model showed that, if the structure and the process of nutritional care are adequately implemented, the desired results can be achieved. CONCLUSIONS: the description and modeling of the theory of intervention can be shown to be fundamental stages in the evaluation and improvement of the implementation of nutritional care during the prenatal period.

Factors associated with non-adherence to prescribed iron supplement use: a study with pregnant women in the city of Rio de Janeiro

Objectives: to identify factors associated with non-use of iron supplements (IS) by pregnant women attending National Health System (SUS) prenatal care in the Municipality of Rio de Janeiro. Methods: a cross-sectional study was conducted in 2007/2008 with a representative sample of pregnant women using SUS hospitals and basic care in the Municipality of Rio de Janeiro. The group that had gestational age of ≥ 20 weeks at the time of the interview and who had been prescribed IS (n=1407) was subjected to a Poisson multiple regression model to estimate the association between use and independent variables. Results: of the 1407 pregnant women, 65% reported use of IS. Younger age, black skin/race, larger number of births, not having received guidance on use of IS, not having tried to obtain IS at the SUS (with a stronger association between pregnant women with lower levels of education and lower household assets indicator - HAI) and not having been able to obtain them at the SUS (amongpregnant women with lower HAI) were significantly associated with non-use. Conclusions: the guidance of health professionals regarding use of IS and their regular availability may increase adherence to prescription among pregnant women and prevent iron deficiency anemia.

Acogimiento y características maternas asociadas a la oferta de líquidos a lactantes

OBJETIVO: Identificar caracteristicas maternas y acciones de acogimiento en las madres de ninos menores de seis meses asociadas a la oferta precoz de liquidos. METODOS: Estudio transversal realizado en 2007 con muestra representativa de madres de ninos menores de seis meses (n=1.057) usuarias de unidades basicas de salud en la ciudad de Rio de Janeiro, Sureste de Brasil. Para estimar la asociacion entre las variables explicativas y la oferta de liquidos se utilizo un modelo de regresion logistica multivariada con ponderacion, efecto de diseno y controlado por la edad del nino. RESULTADOS: De las madres, 32% no recibieron la tarjeta de acogimiento en la maternidad, 47% no recibieron orientacion sobre amamantamiento en la primera ida a la USB posterior al parto y 55% relataron la oferta de liquidos a los lactantes. Mujeres sin experiencia anterior en amamantar por al menos seis meses presentaron oportunidad de oferta de liquidos mayor que aquellas con experiencia (OR=1,57;IC 95%:1,16;2.13). Las que no recibieron orientacion sobre amamantamiento en la primera ida a la unidades de salud posterior al parto tuvieron oportunidad 58% mayor de ofrecer liquidos que aquellas que recibieron orientacion. La oferta de liquidos se mostro positivamente asociada con la adolescencia entre mujeres con companero (OR=2,17; IC 95%: 1,10;4,30) y negativamente asociada con la adolescencia entre aquellas sin companero (OR=0,31; IC 95%: 0,11;0,85). Entre mujeres con menos de ocho anos de estudio, las que no recibieron orientacion sobre amamantamiento posterior al nacimiento del nino presentaron oportunidad de oferta de liquidos 1,8 veces mayor que aquellas que recibieron orientacion. CONCLUSIONES: Edad, situacion conyugal y experiencia anterior en amamantar son caracteristicas maternas asociadas a la oferta de liquidos para ninos menores de seis meses. El recibimiento de orientacion precoz sobre amamantamiento materno puede reducir el ofrecimiento de liquidos a los lactantes.OBJECTIVE To identify the maternal characteristics and welcoming actions towards mothers of infants aged less than six months associated with early liquid offer. METHODS Cross-sectional study performed in 2007, with a representative sample of mothers of infants aged less than six months (n=1,057), users of Primary Health Care (PHC) Units, in the city of Rio de Janeiro, Southeastern Brazil. A multivariate logistic regression model was used to estimate the association between explanatory variables and liquid offer, with weighing and design effect and controlled for infant age. RESULTS Of all mothers, 32% did not receive the welcoming card in the maternity hospital, 47% did not receive guidance on breastfeeding at their first visit to the PHC unit after childbirth and 55% reported they had offered liquids to their infants. Women without at least six months of previous breastfeeding experience were more likely to offer liquids than those with such experience (OR=1.57; 95% CI: 1.16;2.13). Mothers who had not received guidance on breastfeeding at their first visit to the UBS after childbirth were 58% more likely to offer liquids than those who had received it. Liquid offer was positively associated with adolescence among women with a partner (OR=2.17; 95% CI: 1.10;4.30) and negatively associated with adolescence among those without a partner (OR=0.31; 95% CI: 0.11;0.85). Among women with less than eight years of education, those who had not received guidance on breastfeeding after childbirth were 1.8 times more likely to offer liquids than others who had received it. CONCLUSIONS Age, marital status and previous breastfeeding experience are maternal characteristics associated with liquid offer to infants aged less than six months. Receiving early guidance on breastfeeding could reduce liquid offer to infants.