RESUMO
Durante muchos años se han usado los valores de perímetro braquial inferiores a cierto límite como índice alternativo del estado nutricional de los menores de 5 años de edad en épocas de hambruna o crisis de refugiados y también como método adicional de tamizaje en situaciones normales. Sin embargo, recientemente se ha puesto en duda la independencia del perímetro braquial respecto de la edad y el sexo. Tras revisar las pruebas científicas en las que se basan el uso y la interpretación del perímetro braquial, un Comité de Expertos de la OMS recomendó nuevos valores de referencia de perímetro braquial según la edad en menores de 5 años. Sin embargo, en algunas situaciones es difícil evaluar la edad de un niño y en tales circunstancias el perímetro braquial según la altura puede ser una buena alternativa. La regla QUAC (del inglés Quaker arm circumference) para medir la altura es un medio sencillo para determinar el punto de corte del perímetro braquial correspondiente a una altura dada. Este artículo describe los valores de referencia del perímetro braquial y la construcción y uso del medidor QUAC, así como la utilización del método de curvas de características funcionales (receiver operating characteristic curve) para evaluar el rendimiento del perímetro braquial, el perímetro braquial según la edad y el perímetro braquial según la altura en la detección de niños malnutridos.
Mid-upper-arm circumference (MUAC) based on a single cut-off value for all children under 5 years of age has been used for many years as an alternative nutritional status index for children during famines or refugee crises, and as an additional screening tool in nonemergencies. However, it has recently been questioned whether MUAC is age- and sex-independent. After reviewing the scientific evidence underlying the use and interpretation of MUAC, a WHO Expert Committee recommended a new MUAC-for-age reference for under-5-year-olds. In some settings, however, it is difficult to assess a child's age and in such circumstances MUAC-for height may be a good alternative. The height-based QUAC stick offers a simple means of adjusting MUAC cut-offs according to height, and the MUAC-for-height reference and construction and use of the QUAC stick are described in this article. Also described is the use of the receiver operating characteristic (ROC) curve method to evaluate the performance of MUAC, MUAC-for-age, and MUAC-for-height in screening malnourished children.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Braço/anatomia & histologia , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/epidemiologia , Distúrbios Nutricionais/epidemiologia , Estado Nutricional , Estatura , Transtornos da Nutrição Infantil/prevenção & controle , Crescimento , América Latina/epidemiologia , Programas de Rastreamento , Distúrbios Nutricionais/diagnóstico , Refugiados , Inanição , Organização Mundial da SaúdeRESUMO
This article examines trends in the nutritional status of children in EI Salvador between 1988 and 1993 (before and after the signing of a peace accord that ended the civil war.) The data derive from two national surveys, each of which included measurements of the height and weight of children aged 3-59 months. The prevalence of low weight-for-age (< -2 SD) dropped from 15% in 1988 to 10.5% in 1993. The prevalence of low weight-for-height (< -2 SD) was minimal in both surveys: falling from 3.9% to 2.9%. The prevalence of low height-for-age (< -2 SD) fell from 28.1% to 22%. These declines in malnutrition indicators resulted from an upward shift in the distributions of weight and height of children, not from thinner lower tails of the distributions. The quality of anthropometric data appears to be high for both surveys: < 1% of surveyed children had heights or weights outside the expected range. This analysis demonstrates the value of repeated surveys of nutritional status.
PIP: This study uses anthropometric measurement data from a family health survey in 1993 and a general nutritional survey in 1988 in El Salvador in order to determine whether child health improved after the signing of the peace accord. Data were weighted to account for lack of access to some census sectors engaged in war activity in 1988. Low weight-for-age is the measure of general malnutrition. Low weight-for-height indicates acute malnutrition and wasting. Low height-for-age means chronic malnutrition or stunting. Socioeconomic factors are included in the analysis. Greater analytical attention is directed to chronic malnutrition, due to its greater prevalence. Findings indicate that low weight-for-age rates declined from 15% in 1988 to 10.5% in 1993. Low weight-for-height rates remained low and without any statistically significant change. Low height-for-age rates declined from 28.1% in 1988 to 22% in 1993. Z-score distributions for weight-for-age and height-for-age shifted closer to the reference population over time. Weight-for-height Z-scores were close to the reference group in both years. Over the 5-year period, 22% of the gap between the Salvadorian population and the reference population closed for the mean weight-for-age Z-scores. 16% of the gap closed for the height-for-age Z-scores. The standard deviation of the Z-scores remained identical during 1988-93, which suggests that improvement was unrelated to thinner, lower tails in the distributions. The prevalence of chronic malnutrition increased with age and peaked in the third year of life. Rates were highest among children of rural mothers with limited education and lower socioeconomic status in both years. Improvements in socioeconomic status accounted for almost 40% of the decline in chronic malnutrition.
Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Inquéritos Nutricionais , Estado Nutricional , Adulto , Antropometria , Criança , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Demografia , El Salvador/epidemiologia , Feminino , Humanos , Lactente , Masculino , Fatores Socioeconômicos , GuerraRESUMO
"Although techniques for calculating mean survival time from current-status data are well known, their use in multiple regression models is somewhat troublesome. Using data on current breast-feeding behavior, this article considers a number of techniques that have been suggested in the literature, including parametric, nonparametric, and semiparametric models as well as the application of standard schedules. Models are tested in both proportional-odds and proportional-hazards frameworks....I fit [the] models to current status data on breast-feeding from the Demographic and Health Survey (DHS) in six countries: two African (Mali and Ondo State, Nigeria), two Asian (Indonesia and Sri Lanka), and two Latin American (Colombia and Peru)."
Assuntos
Aleitamento Materno , Estudos de Avaliação como Assunto , Modelos Teóricos , Estatística como Assunto , África , África Subsaariana , África do Norte , África Ocidental , América , Ásia , Sudeste Asiático , Colômbia , Países em Desenvolvimento , Saúde , Indonésia , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Mali , Nigéria , Fenômenos Fisiológicos da Nutrição , Peru , Pesquisa , América do Sul , Sri LankaRESUMO
Both breastfeeding initiation and duration increased in Peru during 1977-86. Although one would have expected that the average incidence and duration of breastfeeding would have declined as a result of changes in population characteristics, the potential for an overall decline was more than overcome by changes in behavior. A net increase in initiation and duration is shown for all subgroups of interest. The largest absolute increases are documented for children who, in 1977, were the least likely to be breastfed and who were breastfed for the shortest durations.
PIP: Demographers compared current-status data on 3560 surviving singleton live births born to ever married women in Peru (1977-1978 World Fertility Survey) with 816 such births (1986 Demographic and Health Surveys) to examine changes in breast feeding behavior. More women were educated (secondary or higher, 35.9% vs. 21.2%), employed outside of the home (60.7% vs. 46.5%), and used contraceptives (34% vs. 20.8%) in 1986 than in 1977. Yet, mean duration of breast feeding and percent of ever breast fed children increased (14.3-17.1 months and 91.7-95.8%). The largest absolute significant increases occurred among women who, in 1977, were the least likely to breast feed and to breast feed for the shortest durations (urban women, highly educated women, professional women, and modern contraceptive users). These findings indicate that reductions in breast feeding incidence and duration are not necessarily inevitable as a society undergoes modernization. Between the two surveys, Peru's Ministry of Health had breast feeding promotion campaigns that stressed breast feeding during diarrheal episodes. They postulated that these campaigns were successful because the population already had adequate access to health care providers and to the mass media. Another possible factor contributing to the improvements in breast feeding patterns was the severe economic crisis in the early 1980s. Poor and uneducated women may have turned to breast milk as a substitute for other infant foods. These two possibilities raise some concerns. If the economy improves, the poor and uneducated may reduce breast feeding, but, if the breast feeding promotion campaigns indeed had the most impact, continuation of these campaigns would offset any declines and have a lasting impact on breast feeding behavior.