Nutritional Status and Risk Factors for Children ≤ Five Years Old Covered by the Family Health Program in Vespasiano, Minas Gerais, Brazil 公开

Gould, Regina Holan (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/mp48sd36b?locale=zh
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Abstract

Background: Extensive evidence shows that growth deficiencies in childhood are associated with higher mortality, increased susceptibility to infectious disease, and delayed physical and cognitive development. 1-4 Due to limited epidemiological data in Vespasiano, Minas Gerais, Brazil there is a pressing need to assess the nutritional status of children under five in the municipality in addition to any risk factors associated with anthropometric failures.

Objectives: The objective of this study is to identify factors associated with the nutritional status of children five years and younger, covered by the PSF (O Programa de Saúde da Família), in the municipality of Vespasiano, Minas Gerais, Brazil from June 2010 to July 2010.

Methods: We examined the nutritional status of children five years and younger who use the services of Brazil's primary health care program (PSF), in Vespasiano, Minas Gerais state, Brazil. In order to determine risk factors associated with undernutrition, we collected data through household self-report surveys regarding caretaker demographics, access to healthcare, child feeding practices, diarrhea prevalence, and nutritional information. A proportionally allocated stratified random sample of n=265 households was selected (completed 219, 82% response rate). The height and weight of one child age 0-59 months living in the sampled households was measured. Children were classified as stunted (low height-for-age) or underweight (low weight-for-age) if their z score fell below -2 (<3% of the reference population). Chi-squared and multivariate logistic modeling was used in the analysis.

Results: The majority of the respondents were married females, minimally educated and unemployed. The median monthly household income was self-reported at 969 Brazilian Reais (~577 USD). The mean prevalence of stunting in Vespasiano was 8%, underweight status was 2% and no wasting was found in our study population. The 2-week period prevalence of household reported diarrhea in children 5 years and younger in Vespasiano was 17% during the months June-July. 39% of caretakers reported exclusively breastfeeding their child for the first six months. The majority of respondents said that they did not receive information regarding child diarrhea and nutrition. No exposure variables were significant with the outcomes of anthropometric failures except for those caretakers that received nutritional information were significantly more likely to have a stunted child (OR=3.15, 95% CI: 1.04, 9.58, p=0.043).

Discussion: Overall anthropometric failure in children five years and younger was low in Vespasiano whereas diarrhea prevalence was high. This prevalence of undernutrition and diarrhea in Vespasiano helps define a baseline for future research in the community. Furthermore, the demographic profile collected not only helps to characterize the population of Vespasiano but may also help to illuminate other potential risk factors associated with undernutrition in children five years and younger.

Table of Contents

LIST OF TABLES AND FIGURES. 8
LITERATURE REVIEW... 9
GLOBAL PERSPECTIVE OF MALNUTRTION.. 9
DEFINTION OF NUTRTIONAL ASSESSMENT. 10
SOCIAL DETERMINANTS AND INDICATIORS FOR UNDERNUTRITION.. 11
INTERVENTIONS FOR UNDERNUTRITION.. 15
HEALTH SYSTEM ROLE FOR CHILD HEALTH IN BRAZIL. 16
SUS/ PSF ROLE IN CHILD HEALTH.. 18
GOALS AND AIMS OF THESIS. 20
SIGNIFICANCE. 20
CONTRIBUTION OF STUDENT. 21
MANUSCRIPT. 22
INTRODUCTION.. 22
METHODS. 25
RESULTS. 28
DISCUSSION.. 32
CONCLUSIONS. 37
PUBLIC HEALTH IMPLICATIONS/RECOMMENDATIONS. 39
REFERENCEES. 41
TABLES AND FIGURES. 44
APPENDIX I- Supplemental Tables. 50
APPENDIX II - Institutional Review Board Approval-Emory University. 51
APPENDIX III - Institutional Review Board Approval-FASEH.. 52
APPENDIX IV - Survey Instrument. 53

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