Impact of the Family Health Program in Vespasiano, Brazil on the Nutritional Status of Children Five Years and Younger Open Access

Abstract

Background: Increasingly, the dual burden of both under-nutrition and over-nutrition has been
an issue in rapidly developing countries such as Brazil. [1] Brazil's Programa Saúde da Familia
(PSF) is aimed at supporting the primary healthcare system. There is a need to assess the role of
this program in preventing childhood malnutrition.

Goal: The goal of this study was to examine the prevalence and determinants of nutritional
indicators, including stunting, wasting, underweight, overweight-obesity, and anemia among
children under five in Vespasiano, Minas Gerais, Brazil and to assess the impact of the status of
enrollment in the PSF on these nutritional indicators.

Methods: To address these goals, in 2010, children under the age of five years were sampled from
households, through a cross-sectional design, to quantify the prevalence of nutritional status
indicators in Vespasiano. In 2011, children under five were sampled from clinics, through a case-
control design to evaluate the influence of enrollment in the PSF on nutritional status indicators.

Results: We found lower prevalence of all indicators in 2010 and most in 2011, compared to
recent data on the municipality of Vespasiano, with the exception of stunting and underweight in
2011 No significant prevalence differences were found between PSF and non-PSF enrolled
families. Significant associations between indicators and adjusted risk factors included negative
associations between female gender and overweight-obesity (OR=0.20 (95%CI 0.05,0.83)), female
gender and stunting (OR=0.31 (95%CI 0.11,0.89)), and number of siblings and overweight-obesity
(OR=0.32 (95%CI 0.11,0.92)). Positive associations were found between siblings and stunting
(OR=1.62 (95%CI 1.13,2.30)) and between low birth-weight (LBW) and stunting (OR=4.17 (95%CI
1.24,14.03)), wasting (OR=34.2 (95%CI 2.263,515.909)) and anemia (OR=4.8 (95%CI 1.24,18.64)).

Conclusion: We conclude from these data that there was no significant effect of the PSF on the
nutritional status of children under five in Vespasiano. Determinants that did have a significant
effect on malnutrition included gender, age, LBW, and number of siblings.

Implications: We suggest that regardless of the PSF, efforts be made to improve the assessment
and prevention of stunting and underweight status among children under five in Brazil.
Particular attention should be given to nutritional intake of boys and LBW children.

Table of Contents

TABLE OF CONTENTS
Literature Review...1
Introduction...10
Methods...13
Results...20
Discussion...25
Tables...33
Public Health Implications...36
References...37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	PSF nutrition Brazil
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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