RESUMO

The aim of the study was to compare the development of children with and without a programme of psychosocial stimulation in 'control' and 'intervention' sites in a poorly resourced area of northeast Brazil. The sample (n = 156, born 1998) was from a larger cohort. The cohort was tested at 12 months (baseline) with the Bayley Scales of Infant Development. All children in the intervention site with a mental development index (MDI) and/or psychomotor development index (PDI) < or = 100 were enrolled. Each time such a child was enrolled, the next child tested in that site of the same sex and with an index of 101 to 115 was also enrolled, and the next two children matched for sex and scores of < or = 100 and 101 to 115 in the control sites were recruited in parallel. The intervention comprised 14 contacts between 13 and 17 months of age. All children were tested again at age 18 months. The intervention and control groups were similar at baseline for a range of socioeconomic, demographic, environmental, and biological variables, and their MDI and PDI were also similar. At 18 months, the mean differences between the intervention and control groups were + 9.4 points for MDI and + 8.2 points for PDI (p < 0.001 in each case). For children with an initial score of < or = 100, the mean difference between the intervened and control groups was + 11.2 points for MDI (p < 0.001), and + 10.8 points for PDI (p = 0.001). The intervention was thus associated with significant improvements in cognitive and motor development.

Assuntos

RESUMO

This paper describes the design, implementation and evaluation of an intervention to promote improved hygiene practices in a shanty town area of Lima, Peru. Following formative research, the intervention focused on behaviors associated with the hygienic use of potties by children aged 15-47 months and keeping the home environment free from feces. A health communications strategy was developed involving delivery through routine health services, and using video presentations, leaflets and counseling by health staff during consultations. Intervention activities occurred during a 6-month period in health centers and posts of four intervention communities; four other communities acted as a comparison group. Process and impact indicators were measured through questionnaires and 4-h structured observations conducted in over 600 households both pre- and post-intervention implementation, and through intervention monitoring activities. The intervention materials and approach were well received by the study community; however, in the time-frame of the project only limited coverage of the target audience was achieved, which was insufficient to result in an impact on behaviors. Nevertheless sufficient positive features existed to suggest that with higher coverage, an impact on target behaviors might have been achieved. Reasons for the intervention's shortcomings are discussed and suggestions made for more effective implementation.

Assuntos

RESUMO

Sanitary disposal of feces is vital to combat childhood diarrhea, and its promotion is key to improving health in developing countries. Knowledge of prevailing feces disposal practices is a prerequisite to formulation of effective intervention strategies. Two studies were conducted in a shantytown area of Lima, Peru. First, information was gathered through in-depth interviews with mothers and structured observations (4 hours) of young children and their caretakers. Data on beliefs and practices related to feces disposal behaviors were obtained. Excreta were deposited by animals or humans in or near the house in 82% of households observed. Beliefs about feces depended on their source and were reflected in how likely the feces were to be cleared. While 22% of children aged 318 months were observed to use a potty for defecation, 48% defecated on the ground where the stools often remained. Although almost all children were cleaned after defecation, 30% retained some fecal matter on their body or clothes. Handwashing after the child's defecation was extremely rare for both children (5%) and caretakers (20%). The hygienic disposal of feces poses problems in this type of community. Nevertheless existing practices were found that show promise for promotion on a wider scale, including greater use of potties.

La disposición sanitaria de las heces es indispensable para poder combatir la diarrea de la infancia y su promoción es esencial para mejorar la salud en países en desarrollo. Es necesario conocer las prácticas actuales de disposición de excretas a fin de formular estrategias de intervención eficaces. Dos estudios se llevaron a cabo en un barrio pobre de Lima, Perú. En el primero se recolectó información por medio de entrevistas minuciosas a madres y observaciones estructuradas (4 horas) de niños pequeños y sus responsables. Se obtuvieron datos sobre las creencias y prácticas vigentes con respecto a la disposición de excretas. En 82% de los domicilios observados, se encontraron excretas depositadas por animales o seres humanos dentro o en el exterior. Las creencias en torno a las heces dependieron de su origen y se vieron reflejadas en las posibilidades de que las heces fueran recogidas. Aunque se observó que 22% de los niños de 18 meses o más defecaban en un recipiente, 48% defecaban en el suelo, donde las heces a menudo se quedaban. Pese a que a casi todos los niños los limpiaron después de defecar, 30% siguieron teniendo materia fecal en el cuerpo o en la ropa. Los niños (5%) o sus responsables (20%) raras veces se lavaron las manos después de la defecación del niño. En este tipo de comunidad, la disposición sanitaria de las heces plantea un problema. No obstante, se observaron algunas prácticas que apuntan a que en un futuro su promoción, incluido el uso de un recipiente, será más amplia.

Assuntos

Assuntos

RESUMO

Em um estudo de coorte de base populacional, foram estudados todos os 6.011 nascimentos hospitalares ocorridos na cidade de Pelotas, RS, em 1982. As parturientes foram entrevistadas logo apòs o parto, e 80 por cento delas foram novamente contactadas em suas residências no início de 1986, em média 43 meses mais tarde. Dessas mulheres, 39 por cento haviam engravidado novamente. Esta proporçäo variou inversamente em relaçäo à idade materna, anos de escolaridade e renda familiar. Quanto à paridade, a proporçäo de gravidez subsequentes foi maior para primíparas e para multíparas. Mäes cujos filhos nasceram através de cesareana também apresentasram menor fecundidade, mesmo apòs exclusäo daquelas que, por ocasiäo da operaçäo cesárea, sofreram ligadura de trompas. Análise através de regressäo logística mostrou que esses fatores permaneceram significativamente associados à fecundidade mesmo apòs o ajuste estatístico para as demais variáveis. Das mäes que engravidaram apòs 1982, 60 por cento informaram que näo a desejaram. A proporçäo das gravidezes indesejadas foi mais elevada em mulheres de maior paridade, sendo esta tendência mais marcada em mulheres de familias de alta renda

Assuntos