Evaluation of knowledge and practices related to pediatric nutritional assessment among health providers (HPs) in the Programa de Saude da Familia (PSF), Vespasiano, Minas Gerais, Brazil Open Access

Abstract

Background
In 2009, data from the Food and Nutrition Surveillance System Network (SISVAN) indicated a
12% prevalence of wasting and 19% prevalence of obesity among children 0-3 year olds in
Vespasiano, Brazil. There is a need to assess the role of Brazil's Programa de Saude da Familia
(PSF) in preventing childhood malnutrition.
Goal
The goal of this study is to examine knowledge and practices of pediatric nutritional assessment
in PSF health professionals in Vespasiano, Minas Gerais, Brazil in 2010.
Methods
A quantitative survey was used to evaluate health providers' (HP) knowledge and practices
related to infant feeding and growth monitoring. In addition, medical records were randomly
selected and reviewed to determine the frequency of child visits that had height, weight, and age
recorded.
Results
Of 75 HPs surveyed, only 40 (53.3 %) correctly identified a normal growth curve, with a
borderline difference (p=0.05) between doctors, nurses, nurse aids, and community health agents
(CHAs). 70 (93.3%) of HPs identified that exclusive breastfeeding should be sustained for six
months. CHAs were more likely than nurses to report receiving training in child growth
monitoring (OR=4.52 95% CI [1.03, 19.88]). Most non-doctors believed the Food and Nutrition
Surveillance System Network (SISVAN) had improved PSF nutrition services yet felt it had
inefficiencies in data collection and dissemination of surveillance findings. 358 PSF medical
records were reviewed. Of all child visits, 76.4% had height, weight, and age recorded. For
every day and a half increase in a child's age there was a lower likelihood [OR=0.95 95% CI
(0.93, 0.97)] that a child had 75% of visits on track with the routine schedule.
Conclusion
PSF HPs had poor knowledge in child growth monitoring, possessed basic knowledge of infant
feeding practices, and recorded height, weight, and age for the majority of child visits.
Implications
These data on HPs' knowledge and practices related to growth monitoring and infant feeding
practices provides evidence for local level decision-makers to identify gaps in training and
develop strategies to encourage timely routine growth monitoring of the PSF's pediatric
population.

Table of Contents

LIST OF TABLES AND FIGURES............................................................................................ viii
LITERATURE REVIEW ............................................................................................................... 1
GLOBAL BURDEN OF MALNUTRITION ............................................................................. 1
GROWTH MONITORING ........................................................................................................ 4
CHILD FEEDING PRACTICES ................................................................................................ 6
NUTRITION SURVEILLANCE SYSTEMS ............................................................................ 8
MALNUTRITION IN BRAZIL ................................................................................................. 9
GOALS AND AIMS................................................................................................................. 13
SIGNIFICANCE ....................................................................................................................... 13

CONTRIBUTION OF STUDENT ............................................................................................... 15

MANUSCRIPT ............................................................................................................................. 16

INTRODUCTION .................................................................................................................... 16

METHODS ............................................................................................................................... 20

RESULTS ................................................................................................................................. 25

DISCUSSION ........................................................................................................................... 30

CONCLUSION AND RECOMMENDATIONS ......................................................................... 38

REFERENCES ............................................................................................................................. 40

TABLES AND FIGURES ............................................................................................................ 44

APPENDIX I - Institutional Review Board Approvals ............................................................... 51

APPENDIX II - KP Survey Instrument ....................................................................................... 54

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, Nutrition Health Sciences, Public Health
Keyword	Programa de Saude da Familia nutritional assessment
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Partnering Agencies	University, college or educational institution (other than Emory)

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