RESUMO
PIP: This document presents the results of the Bolivia Demographic and Health Survey (DHS), or Encuesta Nacional de Demografia y Salud 1998, conducted by the Instituto Nacional de Estadistica, La Paz, Bolivia, within the framework of the DHS Program of Macro International. Data were collected from 12,109 households and complete interviews were conducted with 11,187 women aged 15-49. A male survey was also conducted, which collected data from 3780 men aged 15-64. The information collected include the following: 1) general characteristics of the population, 2) fertility, 3) fertility preferences, 4) current contraceptive use, 5) contraception, 6) marital and contraceptive status, 7) postpartum variables, 8) infant mortality, 9) health: disease prevention and treatment, and 10) nutritional status: anthropometric measures.^ieng
Assuntos
Aleitamento Materno/estatística & dados numéricos , Transtornos da Nutrição Infantil/epidemiologia , Anticoncepção/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Diarreia Infantil/epidemiologia , Fertilidade , Mortalidade Infantil , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Intervalo entre Nascimentos , Bolívia/epidemiologia , Pré-Escolar , Anticoncepção/métodos , Demografia , Diarreia Infantil/terapia , Educação , Características da Família , Feminino , Hidratação , Inquéritos Epidemiológicos , Humanos , Lactente , Mortalidade Infantil/tendências , Transtornos da Nutrição do Lactente/epidemiologia , Recém-Nascido , Estado Civil , Pessoa de Meia-Idade , Mães , Estado Nutricional , População Rural , População UrbanaRESUMO
PIP: This article presents summary statistics gathered from the 1998 Nicaragua Demographic and Health Survey (Encuesta Nicaraguense de Demografia y Salud 1998, ENDESA-98). Data from the nationally representative ENDESA-98 were collected from 11,528 households. Interviews were conducted with 13,634 women aged 15-49 years and 2912 men aged 15-59 years between December 1, 1997, and May 31, 1998. The statistics presented were on fertility trends, fertility differentials, age-specific fertility, fertility preferences, current contraceptive use, contraception, marital and contraceptive status, differentials in median age at first birth, postpartum variables, and infant mortality. In addition, statistical data on the health and nutritional status of children were also presented.^ieng
Assuntos
Demografia , Inquéritos Epidemiológicos , Adolescente , Adulto , Coeficiente de Natalidade/tendências , Anticoncepção/estatística & dados numéricos , Escolaridade , Características da Família , Feminino , Fertilidade , Nível de Saúde , Humanos , Mortalidade Infantil/tendências , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Estado NutricionalRESUMO
OBJECTIVE: To develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, the reference population, and the age and sex specific cut off points. DESIGN: International survey of six large nationally representative cross sectional growth studies. SETTING: Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the United States. SUBJECTS: 97 876 males and 94 851 females from birth to 25 years of age. MAIN OUTCOME MEASURE: Body mass index (weight/height(2)). RESULTS: For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut off points of 25 and 30 kg/m(2) for adult overweight and obesity. The resulting curves were averaged to provide age and sex specific cut off points from 2-18 years. CONCLUSIONS: The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
PIP: This study aimed to develop an internationally acceptable definition of child overweight and obesity, specifying the measurement, reference population, and age and sex specific cut off points. Data on body mass index (weight/height) were obtained from 6 large nationally representative cross sectional surveys on growth from Brazil, Great Britain, Hong Kong, the Netherlands, Singapore, and the US. The study included 97,876 males and 94,851 females from birth to 25 years of age. For each of the surveys, centile curves were drawn that at age 18 years passed through the widely used cut-off points of 25 and 30 kg/sq. m for adult weight and obesity. The resulting curves were averaged to provide age- and sex-specific cut-off points from 2 to 18 years. The proposed cut off points, which are less arbitrary and more internationally based than current alternatives, should help to provide internationally comparable prevalence rates of overweight and obesity in children.
Assuntos
Índice de Massa Corporal , Obesidade/diagnóstico , Adolescente , Adulto , Fatores Etários , Brasil , Criança , Feminino , Hong Kong , Humanos , Masculino , Países Baixos , Valores de Referência , Fatores Sexuais , Singapura , Reino Unido , Estados UnidosRESUMO
OBJECTIVE: To analyze the influence of parental stature and environmental factors on the stature of adolescents from a national survey sample. METHODS: A nationwide survey was carried out in 1989 among a stratified, two-stage, probability cluster sample of 14,455 Brazilian households to provide estimates of anthropometric deficits for urban and rural populations from the five regions of the country. Stature was measured for 5681 boys and girls age 14-18 years, 78.9% of their fathers, and 93.8% of their mothers. Associations between explanatory variables and adolescent height in centimeters were assessed by fitting multiple linear models to the data. RESULTS: The predicted effects of parental stature and environmental conditions together sum to a total of 17 cm when comparing a boy born to parents with stature below the median and living in the underdeveloped rural Northeast region (1.56 m) with one born to parents with stature above the median and living in the partially industrialized urban South region (1.73 m). For girls, this estimated difference was 12 cm. For boys, the overall influence of parents' stature was 10 cm (R(2)= 0.40) and the sociodemographic factors had an overall influence of 7 cm (R(2) = 0.29). For girls, these values were 7 cm (R(2)= 0.35) for the parental influence and 5 cm (R(2) = 0.11) for the sociodemographic factors. CONCLUSIONS: Mother's stature had the same influence on adolescent's stature as father's stature. Independent of parental stature, environmental factors have a strong influence on adolescent stature, particularly among boys.
Assuntos
Adolescente/fisiologia , Estatura/fisiologia , Pais , Fatores Socioeconômicos , Antropometria , Viés , Brasil , Análise por Conglomerados , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Características de Residência , Saúde da População Rural , Caracteres Sexuais , Distribuição por Sexo , Saúde da População UrbanaRESUMO
The aim of this study was to evaluate the growth of Chilean infants from medium-to-low socioeconomic status fed according to the current WHO guidelines. Growth pattern was compared to a recent reference chart published by WHO for infants, and the NCHS/WHO growth standards. The source of information was a nation-wide infant feeding survey conducted in 1993. From this database, infants aged 1-12 month +/- 5 days, with exclusive breast feeding until the fourth or sixth month were selected (939 males, 940 females). The weight-for-age z-score (WAZ), and the height-for-age z-score (HAZ) were calculated using both the NCHS/ WHO and the new WHO reference growth charts. At each month of age, WHZ and HAZ results were grouped in the following categories: < = -2.0; -1.9 to -1.0; 0 +/- 0.9; 1.0 to 1.9; and > = 2.0. Observed WAZ at the first month of age was below the new WHO reference chart (0.32 z-score), increasing up to 1.29 z-score at the tenth month. The HAZ results were lower the WHO reference chart throughout the period studied, although a trend to improved values was noted during the second semester (F = 6.01 p < 0.001). Growth pattern of the studied group was more similar to the NCHS/WHO chart than the new chart proposed by WHO. As a consequence, the new WHO reference chart identifies a higher proportion of the infants as having a subnormal nutritional status during the first semester of life, compared to those classified in this category by the NCHS/WHO standards (p < 0.001). This can be a factor for the introduction of complementary foods early in life. The relative homogeneity of the population used as source of the WHO reference chart may limit it use in developing countries.
PIP: Growth data from Chile's 1993 National Breast Feeding Survey of infants under 1 year old fed according the World Health Organization (WHO) recommendations were compared to recent reference standards for breast-fed infants published by WHO and to National Center for Health Statistics (NCHS)/WHO growth standards. WHO recommendations call for exclusive breast feeding for the first several months, with solid food introduced at 4-6 months. The Chilean sample included 939 boys and 940 girls. The z-scores for weight-for-age and height-for-age were calculated using both the NCHS/WHO and the new WHO growth charts. The weight-for-age z scores were below the new WHO norms by the 1st month of age, but later increased to 1.29 by the 10th month. Average height-for-age was below the new norm for the entire period studied, despite improved values noted in the second half of the 1st year of life. The observed pattern of growth was more similar to the old NCHS/WHO reference chart than to the proposed new WHO chart. The new WHO chart consequently identifies a higher proportion of breast-fed infants as showing nutritional deficits, which could contribute to premature introduction of supplemental feeding. The new WHO reference chart was based on observations of 226 infants in the US, Canada, Denmark, Sweden, Finland, and the UK who were exclusively breast fed for at least 4 months. The relative homogeneity of the population used as the source of the proposed WHO reference chart may make it inappropriate for use in developing countries.
Assuntos
Crescimento , Chile , Feminino , Humanos , Lactente , Recém-Nascido , Lactação/fisiologia , Masculino , Estudos RetrospectivosRESUMO
PIP: This study examines the impact of 4 health measures on wages of urban workers in Brazil. Data are obtained from the 1974-75 Estudo Nacional da Despesa Familiar among a sample population over 14 years old for wages earned by respondents 15-50 years old. The 4 health measures include height, body mass index (weight divided by height squared), per capita calorie intake, and per capita protein intake. Findings indicate that health measures significantly affected wages, even after accounting for endogeneity. Taller men and women earned more, even after controlling for education and other health measures. Body mass index affected only men's wages. The effect of height was larger for men. Body mass index had a larger impact on wages among persons with low levels of education. Nutrient intake affected wages of men and women in the market sector. More protein had the greatest return at high levels of intake, depending upon calorie intake, mass, and height. Height was a strong predictor of wages for self-employed men only. Body mass index affected the wages of only self-employed men with little or no education. Neither protein or caloric intake significantly affected wages of the self-employed. Models controlled for selection into the labor market and the choice between market and self-employment sectors in the estimated hazard rates based on multinomial logits, according to Heckman (1974) and Lee (1983). It is assumed that relative food prices and nonlabor income had no direct effect on wages. Findings suggest that health produces a substantial return in the formal sector of Brazilian labor markets.^ieng
Assuntos
Estatura , Peso Corporal , Dieta , Emprego , Ingestão de Energia , Renda , Fenômenos Fisiológicos da Nutrição , Salários e Benefícios , Fatores Sexuais , Estatística como Assunto , População Urbana , América , Biologia , Brasil , Demografia , Países em Desenvolvimento , Economia , Saúde , Mão de Obra em Saúde , América Latina , Fisiologia , População , Características da População , Pesquisa , Fatores Socioeconômicos , América do SulRESUMO
The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.
PIP: Findings from this study of the link between nutritional supplementation during breast feeding and infant growth disagree with earlier studies. The effect of nutritional supplementation on growth in length was only modest, but significant only in Senegal and not significant in the Congo, Bolivia, and New Caledonia. It is hypothesized that food supplementation during the 4-7 month period would have a positive effect on linear growth. This study included four controlled randomized trials among 120 infants in the Congo, 110 infants in Senegal, 127 infants in Bolivia, and 90 infants in New Caledonia. The infants were 4 months old when placed in the supplement or control groups. Supplementation included the addition of a cereal-based precooked porridge twice daily for 3 months. Both groups continued to eat local foods. Breast feeding patterns were different in New Caledonia, where only 47% of infants were still breast fed at 7 months of age. Mean daily supplementation varied among countries, from 558 to 790 kJ/day. Mean length was lowest in Bolivia, higher in Senegal and the Congo, and close to the US National Center for Health Statistics reference measures in New Caledonia. The study was conducted in rural parts of Senegal and New Caledonia and periurban parts of Bolivia and the Congo. Supplementation was supervised by field workers. The samples included infants with a length-for-age score of -2.5 or higher and a weight-for-length Z score of -2 or higher at 4 months. Anthropometric measurements were taken at 4 months and 4, 8, and 13 weeks later (at 4.9, 5.8, and 7.0 months of age). 24-hour food recalls were collected monthly for consumption of breast milk, special local infant food, commercial "western" baby food, milk substitutes, family food, water, and other than milk liquids.
Assuntos
Países em Desenvolvimento , Grão Comestível , Crescimento , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Estatura/fisiologia , Bolívia , Aleitamento Materno , Congo , Feminino , Alimentos Fortificados , Humanos , Lactente , Masculino , Nova Caledônia , Senegal , Aumento de Peso/fisiologiaRESUMO
The prevalence of vitamin A deficiency in a nationally representative sample of children 12-59 months old in Panama was assessed using serum retinol levels and dietary indicators. The median serum retinol level found was 1.27 +/- 0.42 mumol/L (38 micrograms/dL); 6.0% of the study sample providing adequate blood specimens had levels below 0.7 mumol/L (20 micrograms/dL), indicating deficient vitamin A intake. The Panama City Metropolitan Area and the country's western region had the highest prevalences of low serum retinol levels (below 0.7 mumol/L in 9% and 6% of the study children, respectively), as compared to overall prevalences of 5% in the two other regions studied. Low serum retinol levels were significantly more prevalent among Indians in the study group (primarily Guaymí Indians) than among non-Indians (13% versus 5%). Dietary information provided by the study children's mothers showed that high risk of inadequate dietary vitamin A intake closely paralleled low serum retinol levels; specifically, the highest prevalence of dietary inadequacy was found in the western region, especially among the Indians. The Panamanian Government is currently increasing distribution of high-dose vitamin A capsules to Indian preschoolers in Chiriquí and Bocas del Toro Provinces.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Deficiência de Vitamina A/epidemiologia , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/tratamento farmacológico , Pré-Escolar , Humanos , Lactente , Inquéritos Nutricionais , Panamá/epidemiologia , Prevalência , Vitamina A/sangue , Vitamina A/uso terapêutico , Deficiência de Vitamina A/sangue , Deficiência de Vitamina A/tratamento farmacológicoRESUMO
BACKGROUND: Data from a longitudinal study of 153 low-income Peruvian infants were used to assess the relationship between internationally-recommended definitions of feeding practices and infants' monthly weight gain and weight status at 12 months. METHODS: Infants were classified into feeding categories using monthly reported data. Analysis of variance was used to assess the relationship between reported usual feeding practices and growth. Reported breastfeeding practices were compared to observed breastfeeding practices and to weighted breast milk intakes to determine the validity of recommended breastfeeding definitions. RESULTS: Breastfed infants who consumed non-human milks during the first month of life gained less weight during that month (P < 0.002) than exclusively and predominantly breastfed infants. Reported daily nursing frequency was associated with observed nursing frequency and breast milk energy intake (P < 0.05) for infants < 9 months old. Patterns of growth varied according to early diets. Infants who consumed breast milk and non-human milks and those who were fully weaned by 4 months were more likely to be underweight at 12 months than other infants. Infants classified as token breastfeeders ( < or = 3 times/24 hours) from 0 to 120 days had monthly gains that were similar to those of fully weaned infants. CONCLUSIONS: Infants feeding definitions should 1) continue to differentiate exclusively breastfed infants from other infants who are almost exclusively or predominantly breastfed; 2) distinguish partially breastfed infants who consume only non-breastfeeding frequency or the % of their total daily energy that comes from breast milk.
Assuntos
Crescimento , Guias como Assunto , Fenômenos Fisiológicos da Nutrição do Lactente , Pobreza , Análise de Variância , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Peru , Reprodutibilidade dos TestesRESUMO
There is little information on the nutritional status of adolescents in developing countries. In particular there is a lack of data concerning black adolescents. We measured height, weight, and triceps and subscapular skinfolds in 452 13-14-year-old girls, randomly selected from those attending nine schools in Kingston, Jamaica. The girls' heights and body mass indices were appropriate for their age. This suggests that undernutrition was not a significant problem in this population. However, the girls' skinfolds were smaller than the US references, both those for the total population and those for blacks only. The fat pattern (triceps/subscapular ratio) was similar to that reported for adult black women in the United States. It is possible that the levels of fat in the references are not appropriate for this population. Data from other black populations are needed for comparison.
PIP: To obtain further information on the anthropometry of Black female adolescents in developing country settings, height, weight, and skinfold measurements were recorded for 452 randomly selected 13-14 year old girls attending nine secondary schools in Kingston, Jamaica. Although the heights and body mass index values of the Jamaican girls were comparable to those of the US reference population, the Jamaican teens had less fat at both triceps and subscapular skinfold sites. 23% of girls in the Jamaican sample had triceps skinfold thicknesses below the 5th percentile of the American references. The median triceps skinfold of Jamaican girls was also less than that of US Black females. The fat pattern (indicated by the mean triceps/subscapular ratio) among Jamaican girls was similar to that reported for adult Black women in the US and smaller than that among US White adult women. A correlation of anthropometric values and housing ratings indicated that more affluent Jamaican girls were slightly taller and heavier than their poorer counterparts and had more fat. Overall, these findings suggest that undernutrition is not a significant problem among low-income adolescent girls in Jamaica. The data from this study can be used for comparison with other Black populations in developing countries.
Assuntos
Antropometria , Estado Nutricional , Adolescente , Adulto , Negro ou Afro-Americano , Estatura , Índice de Massa Corporal , Peso Corporal , Países em Desenvolvimento , Feminino , Humanos , Jamaica , Valores de Referência , Dobras Cutâneas , Fatores SocioeconômicosRESUMO
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
PIP: The body mass index (BMI) is currently the most accepted indicator of body fat for clinical purposes and is useful in definition of overweight or obesity. Most studies of BMI have been done in the United States, and very few anywhere have focused on evolving BMIs of children or adolescents. Data on weight and height of 2015 girls and 2053 boys 18 and younger in Santo Domingo gathered for a different study were used to calculate BMI. The sample children were evaluated in private clinics and health facilities in Santo Domingo and were all healthy and well nourished. Nearly all of the infants were bottle fed. A table presents the smoothed BMIs for the 3rd, 50th, and 97th percentiles separately for boys and girls at birth, 3, 6, 9, 12, 18, and 24 months, and each year through 18. The values corresponding to 120% and 80% of the median values are also shown. The values tended to rise in the first 9 months of life, especially in males. Values declined slowly between 9 months and 7 years and then progressively increased until 14 or 15 years, when the rate of increase slowed considerably. The pattern of slowing at 14 or 15 years resembles the corresponding pattern observed in skin folds.^ieng
Assuntos
Adolescente , Peso Corporal , Criança , Crescimento , Lactente , Fenômenos Fisiológicos da Nutrição , Fatores Sexuais , Fatores Etários , América , Biologia , Região do Caribe , Desenvolvimento Infantil , Demografia , Países em Desenvolvimento , República Dominicana , Saúde , América Latina , América do Norte , Fisiologia , População , Características da PopulaçãoRESUMO
OBJECTIVES: To examine the probability of inadequacy of schoolchild nutrient intakes; to compare the predicted adequacy of schoolchild diets to previously published data for toddler diets and to examine the relative adequacy of the diets of sibling pairs. DESIGN: Food consumption data were measured 2 days per month across approximately one year. Mean nutrient intakes were calculated and compared to international standards using a probability approach. SETTING: Villages in Egypt, Kenya, and Mexico. SUBJECTS: 285 school-age children (7-9 years of age) and 255 toddlers (18-30 months of age) including 94 sibling pairs. RESULTS: Within a country, there was a striking similarity between the nutrients predicted to be inadequate in schoolchild and toddler diets across all nutrients except vitamin B12, which was more likely to be inadequate among schoolchildren. Nutrients of concern for both ages in one or more countries included iron, zinc, calcium, riboflavin, and vitamins B12, D, E, and A. For 94 toddler-schoolchild pairs, siblings at high risk of nutrient inadequacy could be identified from an indicator child with a sensitivity of 43-100% and a specificity of 59-100%. CONCLUSIONS: Nutrient adequacy tends to be a household characteristic for these two ages of children. Nutritional interventions that target the household have a high probability of benefitting multiple age groups of children.
PIP: The authors investigated the probability of inadequacy of schoolchild nutrient intakes in order to compare the predicted adequacy of schoolchild diets to previously published data for toddler diets, and to examine the relative adequacy of the diets of sibling pairs. Food consumption data were measured two days per month for approximately one year for 285 children aged 7-9 years and 255 infants aged 18-30 months, including 94 sibling pairs, in villages in Egypt, Kenya, and Mexico. Mean nutrient intakes were calculated and compared to international standards using a probability approach. Within a country, there was close similarity between the nutrients predicted to be inadequate in schoolchild and toddler diets across all nutrients except vitamin B(12), D, E, and A. For 94 toddler-schoolchild pairs, siblings at high risk of nutrient inadequacy could be identified from an indicator child with a sensitivity of 43-100% and a specificity of 59-100%. Nutritional interventions which target the household have a high probability of benefiting multiple age groups of children.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Saúde Suburbana , Criança , Pré-Escolar , Egito/epidemiologia , Humanos , Lactente , Quênia/epidemiologia , México/epidemiologia , Inquéritos Nutricionais , Prevalência , Sensibilidade e EspecificidadeRESUMO
The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C/100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal Day Care Centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0% respectively. The average hemoglobin before the intervention was 10.3 g/dl in the DCC and 10.5 in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children presented an improvement, 41.1% showed changes and only 1.9% became worse. In the BHCU, 11.4% presented better condition, 70.6% remained the same and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition, when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age.
PIP: The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C per 100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal day care centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0%, respectively. The average hemoglobin level before the intervention was 10.3 g/dl in the DCC and 10.5 g/dl in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children showed improvement, 41.1% showed no change, and only 1.9% grew worse. In the BHCU, 11.4% showed improvement, 70.6% remained the same, and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age. (author's)
Assuntos
Anemia Ferropriva/terapia , Ácido Ascórbico/administração & dosagem , Alimentos Fortificados , Hemoglobinas/análise , Ferro/administração & dosagem , Leite , Instituições de Assistência Ambulatorial , Análise de Variância , Animais , Antropometria , Brasil , Creches , Humanos , Lactente , Estudos Longitudinais , Estado Nutricional , Prevalência , Valores de Referência , Fatores SocioeconômicosRESUMO
Physical growth of Amerindian children living in two Aymara and three Quechua peasant communities in the Andean highlands of southern Peru (altitude 3,810-3,840 m) was studied, taking into account differences in the microclimate, agronomic situation, and sociodemographic variables. Anthropometric measurements were taken in 395 children aged under 14 years of age in a sample of 151 families in these communities, who were surveyed for sociodemographic variables as well. Data on the land system were available for 77 families. In comparison with reference populations from the United States (NCHS) and The Netherlands, stature, weight, head circumference, and midupper arm circumference (but not weight for stature) in the sample children were reduced. Growth retardation increased after the age of 1 year. Stature and weight in the present sample were very similar compared with previously published data on growth of rural Aymara children living near Lake Titicaca in Bolivia. Head circumference, midupper arm circumference, and weight for stature were significantly larger in Aymara children compared with Quechua children. Land was significantly more fragmented in Aymara compared with Quechua families, but amount of land owned was not different. Perinatal and infant mortality was elevated in Aymara vs. Quechua communities. Most families in Aymara communities used protected drinking water. One Quechua community had a severe microclimate, grim economic outlook, and weak social cohesion. Children in this community showed significant reductions in weight and midupper arm circumference compared with their peers in the other communities. We conclude that (presumably nutritionally mediated) intervillage and Aymara-Quechua differences in childhood physical growth existed in this rural high-altitude population in Peru and were associated with microclimate and the village economy, sociodemographic factors, and differences in the land system.
Assuntos
Altitude , Transtornos do Crescimento/epidemiologia , Indígenas Sul-Americanos , Adolescente , Antropometria , Criança , Pré-Escolar , Características Culturais , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/etnologia , Inquéritos Epidemiológicos , Habitação/normas , Humanos , Lactente , Masculino , Microclima , Inquéritos Nutricionais , Estado Nutricional , Peru/epidemiologia , Fatores de Risco , População Rural , Fatores SocioeconômicosRESUMO
Wasting and stunting are widely used indices for describing the prevalence of malnutrition in childhood. Studies from Latin America, however, consistently show low prevalences of wasting in the presence of other indicators of poor health. A data base assembled by the World Health Organization, including 175 studies with information on wasting and stunting among 1-y-old children from four regions (Africa, Americas, Asia and Eastern Mediterranean), was used for examining the prevalences of the two indices and their associations. Whereas there was little variation in the median prevalences of stunting among the four regions, those of wasting showed a sevenfold differential. In Africa and Latin America, the correlations between the two prevalences were low; nevertheless, wasting was about three times higher in Africa, for any given level of stunting, than in Latin America. In Asia and the Eastern Mediterranean, there were strong positive correlations between stunting and wasting, but wasting was about twice as common in Asia for any given level of stunting. To interpret low prevalences of wasting as being indicative of a low intensity of malnutrition may be misleading; weight-for-height standards and cut-offs may have to be re-examined for use in different populations.
Assuntos
Saúde Global , Distúrbios Nutricionais/epidemiologia , África , Ásia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , América Latina , Masculino , Análise de RegressãoRESUMO
The present study tested whether maternal nutrition knowledge was a mediating factor in the association between maternal schooling and child nutritional status, and whether the mechanism involved differed according to socioeconomic status. The data were collected in Lesotho on 921 mother-child pairs and included scores from a nutrition knowledge test, socioeconomic and demographic information, and the child's anthropometric data. A wealth factor derived from a factor analysis was used to stratify the sample into two socioeconomic groups. Two-stage least-squares estimation was used to test the mediating role of nutrition knowledge between maternal schooling and child weight-for-age. Results showed that both the importance of maternal schooling and the mechanism by which it affects the child's weight-for-age are contingent upon the family's socioeconomic status. While maternal schooling was positively associated with weight-for-age for both wealthier and poorer households, the size of the effect was much larger for the latter group. The effect of maternal schooling on weight-for-age was mediated by the mother's nutrition knowledge only among wealthier households. These results imply that, in Lesotho, nutrition education for mothers could contribute to improving children's growth, but only in households that have access to a minimum level of resources. For poorer households, nutrition education would not be sufficient.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Mães , Fenômenos Fisiológicos da Nutrição , Adulto , Escolaridade , Análise Fatorial , Feminino , Humanos , Lactente , Lesoto , Análise Multivariada , Estado Nutricional , Fatores SocioeconômicosRESUMO
Early identification of children at high risk of diarrhoea-associated dehydration would be of great value to health care workers in developing countries. To identify prognostic factors for life-threatening dehydration, we carried out a case-control study among under-2-year-olds in Porto Alegre, Brazil. Cases were 192 children admitted to hospital with moderate or severe dehydration, while controls were children matched to controls by neighbourhood and age, who experienced nondehydrating diarrhoea in the week preceding the interview. The following variables were significantly associated with an increased risk of dehydration, after adjustment for age and other confounding variables: absence of the father from the home; low paternal education level; young age; maternal age 25-29 years or less than 20 years; mother of mixed race; high birth order; short birth interval; low birth weight; stunting, underweight and wasting; lack of breast-feeding; presence of other under-5-year-olds in the home; families with 4-5 members; lack of antenatal care; less than three doses of diphtheria-pertussis-tetanus or poliomyelitis vaccine; previous admission to hospital; use of medicines during the fortnight prior to the episode; and living in an unclean home. The associations were particularly strong (P less than 0.001) for the child's age, birth weight and other anthropometric indicators, birth interval, and feeding mode. In terms of their sensitivity and specificity, however, these prognostic factors were not as effective as early signs and symptoms for predicting the outcome of the episode.
PIP: During the primary diarrhea season (December 1987-April 1988) in metropolitan Porto Alegre in southern Brazil, researchers compared 192 children aged less than 2 years who were admitted to a hospital with moderate or severe dehydration with 192 neighborhood- and age-matched controls who had a diarrhea episode without dehydration during the seven days before the interview. They aimed to identify factors predicting life-threatening dehydration. When the researchers controlled for age and other confounding variables, the following factors were significantly related to an increased risk of dehydration: no father in the household, low paternal education level, young age, maternal age 25-29 years or less than 20 years, mixed race mother, high birth order, short birth interval, low birth weight, stunting, underweight and wasting, non-breast milk, children aged less than 5 in the household, family size of 4-5, no prenatal care, less than three doses of diphtheria-pertussis-tetanus or poliomyelitis vaccine, previous admission to a hospital, use of medicines during the two weeks before the diarrhea episode, and living in an unsanitary household. The strongest factors associated with an increased risk of dehydration (p 0.001) included young age, low birth weight and malnutrition, short birth interval, and non-breast milk. These factors were not as effective at predicting an increased risk of dehydration as early signs and symptoms. Specifically, their sensitivities were lower than those of early signs and symptoms. Notwithstanding, these findings support current efforts towards promotion of breast feeding, prevention and treatment of malnutrition, and birth spacing since they contribute to the prevention of diarrhea-related dehydration.
Assuntos
Aleitamento Materno , Desidratação/diagnóstico , Diarreia Infantil/complicações , Estado Nutricional , Antropometria , Brasil , Estudos de Casos e Controles , Fatores de Confusão Epidemiológicos , Desidratação/etiologia , Características da Família , Humanos , Lactente , Recém-Nascido , Prognóstico , Fatores de Risco , Fatores SocioeconômicosRESUMO
Information on nutritional status of the rural Mexican population is mostly obtained from cross-sectional studies. This investigation evaluates semi-longitudinally the nutritional level of a sample of the rural population of Mexico. A total of 15,552 individuals in 2,587 households from 208 rural communities were evaluated. Body weight and height of rural boys and girls were found to be significantly lower than in their urban counterparts. Severe forms of weight for age or height for age inadequacy were more frequent in females than in males, in smaller communities than in larger ones, and in economically depressed zones than in those with a good economy. Our data showed a lower frequency of mild and moderate forms of possible malnutrition than previous studies (20 vs 50%) using as a criterion weight for age. These differences are explained on the basis of sampling bias.
PIP: The nutritional status of 15,552 individuals of both sexes in 2587 households from 208 rural communities in Mexico was evaluated in a semilongitudinal nationwide study. Research was carried out from March 1982 to February 1983. The communities were randomly selected from among the 3000 with Mexican Institute of Social Security-COPLAMAR primary health care services. The 8 geoeconomic zones identified by Bassols-Batalla were represented. 10 families with at least 1 infant under 1 year old were selected in communities with under 5000 inhabitants, while 20 such families were selected from communities with 5001-20,000 inhabitants. Body weight, height or length, and arm and calf circumferences were measured in all household members in March-April 1982, and again in July-August 1982 and January-February 1983. The proportion of household heads employed primarily in agriculture ranged from 88% in the smaller communities to 32% in the larger. Families in small communities were mainly peasants in subsistence farming, while household heads in larger communities who were employed in agriculture were mostly owners of small plots. 40-54% of the mothers in communities of different sizes had 3 years or less of school attendance. Comparison of growth curves of the rural population with reference data from urban children showed similar median body weight in both groups at 2 years of age. But by age 18, median weight and height, respectively, were 8.6 kg lower and 9 cm shorter for rural boys and 5.5 kg lower and 5 cm shorter for rural girls. The most severe forms of inadequacy in weight for age were more frequent in females than males, in smaller communities than larger, and in the economically depressed zones. Severe inadequacy of height for age was more frequent in the states located on the southern Pacific Coast and the Gulf of Mexico. The frequency of mild and moderate forms of malnutrition according to weight for age was 20%, lower than the rate of 50% estimated in previous published studies. Selection of a broader range of rural communities rather than just the most marginal, and the bias introduced by selecting the sample from among communities with primary health services may explain the lower rate in this study.
Assuntos
Estado Nutricional , Saúde da População Rural , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Distúrbios Nutricionais/epidemiologia , Inquéritos Nutricionais , Fatores SocioeconômicosRESUMO
Three national anthropometric surveys carried out in Colombia in 1965-1966, 1977-1980, and 1986-1989 provide a reasonably standardized basis for comparing the nutritional status of infants and young children in those years. That comparison, presented here together with appropriate socioeconomic data, indicates marked reduction of malnutrition paralleling strong socioeconomic gains.
PIP: Researchers analyzed data from 3 countrywide health surveys (1965-1966, 1977-1980, and 1986-1989) in Colombia to examine the nutritional status of infants and young children in those years. They also compared these trends in nutritional status with those of socioeconomic development. In 1965-1966, the prevalence of overall childhood malnutrition stood at 21.1% and of stunting at 31.9%. Wasting was 3.9%, mainly affecting 6-23 month old children. Overall malnutrition and stunting fell to 16.8% (20% reduction) and 22.4% (30% reduction) respectively by 1977-1980. Yet wasting rose to 4.9% between the 2 surveys. By 1986-1989, overall malnutrition, stunting, and wasting decreased to 10.1%, 16.6%, and 2.9% respectively. Despite the improvements in overall malnutrition, children 2 years old remained at highest risk of malnutrition, especially protein energy malnutrition. In the 1960s and 1970s, the economy grew evenly with simultaneous public investment in the social sector and the nation's infrastructure. It even grew somewhat in the 1980s. During this period, the country transformed from a predominantly agricultural society to an urban residents and 76% of rural residents) had access to potable water. Further, in 1990, 99% of urban households had electricity, 95% a piped water supply, and 89% a sewerage system. These corresponding figures for rural households were 71%, 43%, and 17%. Besides, in this time period, Colombia improved its initial unequal distribution of income. For example, between 1971-1978, poverty fell 2.9%/year. Moreover Colombia experienced a rapid demographic transition with considerable declines in fertility and population growth. 1 reason for this transition was increased education for women and access to jobs. Further improvements in health care and access to it have also occurred.