Prevalence, socioeconomic factors and obstetric outcomes associated with adolescent motherhood in Ceará, Brazil: a population-based study.

BACKGROUND: Adolescent motherhood (AM) remains a public health problem, especially in low and middle income countries, where approximately 95% of these births occur. Evidence from studies with population representativeness about events associated with AM is limited. We assessed the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. METHODS: A population-based cross-sectional study on maternal and child health of women aged 10 to 49 years, living in the state of Ceará, in northeastern Brazil was carried out to assess the prevalence of AM, as well as its association with Socioeconomic Factors and Obstetric Outcomes. The definition of adolescence used in the study was the one utilized by the WHO. In addition to the interview, data were double-checked according to the information in the government's pregnancy health booklet. Sample-adjusted logistic models to determine the association of socioeconomic factors and AM, as well as the association of AM with obstetric outcomes, with a causal approach to multivariate analyses, were used. RESULTS: The prevalence of adolescent motherhood was 18.6%. Poverty and household crowding were associated with greater chances of AM (p values of 0.038 and <  0.001, respectively), as well as not being in a stable relationship (OR 2.26 (95%CI: 1.67, 3.07), p <  0.001). AM showed a greater chance of not using community health services (p <  0.001), had fewer prenatal consultations (ß - 0.432 (95%CI: - 0.75, - 0.10)) and started prenatal care at a later date (ß 0.38 (95%CI: 0.21, 0.55), p <  0.001)). AM are also less likely to be tested for HIV and more likely to have urinary tract infections. CONCLUSIONS: Interventions aimed at socially-vulnerable adolescents are suggested. However, if pregnant, adolescents should receive proactive and differentiated prenatal care.

Screen time and early childhood development in Ceará, Brazil: a population-based study.

BACKGROUND: Globally, children's exposure to digital screens continues to increase and is associated with adverse effects on child health. We aimed to evaluate the association of screen exposure with child communication, gross-motor, fine-motor, problem-solving, and personal-social development scores. METHODS: We conducted a population-based, cross-sectional study with cluster sampling among children 0-60 months of age living in the state of Ceará, Brazil. Child screen time was assessed by maternal report and the World Health Organization (WHO) recommendations were used to define excessive screen time exposure. Child development was assessed with the Brazilian Ages and Stages Questionnaire. Generalized linear regression was used to determine the association of screen exposure with developmental outcomes. We also examined the potential non-linear relationship of screen time with development scores using spline analyses. RESULTS: A total of 3155 children 0-60 months of age had screen time exposure evaluated and 69% percent were identified as exposed to excessive screen time. This percentage of excess screen time increased with child age from 41.7% for children 0-12 months to 85.2% for children 49-60 months. Each additional hour of screen time was associated with lower child communication (standardized mean difference (SMD): -0.03; 95% CI: - 0.04, - 0.02), problem solving (SMD: -0.03; 95% CI: - 0.05, - 0.02) and personal-social (SMD: -0.04; 95% CI: - 0.06, - 0.03) domain scores. CONCLUSIONS: Excess screen time exposure was highly prevalent and independently associated with poorer development outcomes among children under 5 years of age in Ceará, Brazil.

Effects of Vitamin A supplementation on child morbidity: a twenty-year time series analysis in the northeastern region of Brazil.

The present study aimed to determine the prevalence of supplementation between 1987 and 2007, and to measure the impact of this on morbidity. Five sequential cross-sectional studies in a 20-year time span were analyzed. Each had a sample of 8,000 domiciles representative of Ceará, in northeastern Brazil. Data were analyzed with descriptive statistics, followed by bivariate and multivariate analyses. Increases in coverage, ranging from 9.6 to 65.8 % were verified, and the study found that the impact of supplementation in reducing morbidity may not be significant. The study also found that supplementation may be associated with higher frequency of certain morbidities (OR 1.8, CI 95 % 1.20-2.95). When the supplementation variable was adjusted for socioeconomic factors, the risk was higher for diarrhea (OR 5.56, CI 95 % 2.63-11.75). The study concluded that in Brazil, vitamin A supplementation may have little benefit in reducing morbidity.

Reducing child mortality: the contribution of Ceará state, northeast of Brazil, on achieving the Millennium Development Goal 4 in Brazil.

To describe the experience of Ceará, Northeast of Brazil, state on improving child survival, over a 20 year period, and discuss its contribution to Brazil's progress toward the achievement of MDG 4. Five population-based, statewide household surveys, with children <3 years of age, known as PESMIC (Mother and Child Health Survey of Ceará), were conducted in 1987, 1990, 1994, 2001 and 2007. They aimed to investigate levels and causes of mortality and access to child health services. The cluster sampling of 8,000 households identified 2,000 children on average. They used the same methodological approach and indicators. Important changes occurred in demographic and health indicators in the 20 year period, including 81 % reduction in the infant mortality rate, 43 % increase in breastfeeding rate and the achievement of a 95 % immunization rate. The prevalence of chronic malnutrition declined from 28 to 13 % and acute malnutrition from 13 to 5 %. Diarrheal diseases contributed with 36.6 % to the infant mortality in 1986 and 3.9 % in 2007. The major improvements in child health contributed substantially to the progress on MDG 4 in Brazil. Results of the 5 surveys produced reliable information for planning and evaluation that contributed to the remarkable progress made by the state.

Prevalence and factors associated with adverse early childhood experiences: a population-based study in Ceará, Brazil.

OBJECTIVE: To estimate the prevalence of adverse childhood experiences and identify associated factors. METHODS: A population-based cross-sectional study comprised data from a sample of 3,200 households with 3,566 children under 6 years of age, representative of the state of Ceará, Brazil. A multistage sampling approach was used, with stratification among the state capital, Fortaleza, and the 28 countryside municipalities, in which 160 census tracts were randomly selected, each one with a cluster of 20 households. The outcome variable was structured based on adverse childhood experiences as suggested by the Center for Disease Control and Prevention, according to the number of situations to which the child was exposed: 0-2, 3-5, and 6-9. Ordinal logistic regression multivariate model was applied to assess associations. RESULTS: Among the 3,566 children studied, 89.7% (95%CI 88.7-90.7) were exposed to at least one adverse experience, of which the most prevalent were neglect, and emotional/physical abuse. The main factors associated were maternal advanced age and smoking, paternal absence, low education level of the head of the family, food insecurity and lack of a social support network. CONCLUSION: The study found a high occurrence of adverse early childhood experiences, particularly among preschool children born to mothers of older age, solo, who smoke and in a situation of social and economic vulnerability, including food insecurity, who should be target of control and prevention measures.

Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil.

BACKGROUND: Physical distancing associated with the COVID-19 pandemic may lead to suboptimal maternal mental health, social support after birth, and infant feeding practices. RESEARCH AIMS: To compare breastfeeding prevalence in participants who were pregnant at a time when strict physical distancing measures were imposed in Fortaleza, the capital of Ceará state, Brazil, with the pre-pandemic breastfeeding levels, and to assess the association of breastfeeding prevalence with maternal common mental disorders, and sociodemographic and health predictors. METHOD: A cross-sectional prospective two-group comparison design using two population-based surveys was carried out in Fortaleza before and after the pandemic. Participants (n = 351) who had a live birth in Fortaleza in July or August 2020, and participants (n = 222) who had a child younger than 12 months in 2017 were surveyed. Crude and adjusted multinomial logistic regressions with robust variance were used to estimate risk ratios and 95% confidence intervals (CI). RESULTS: Similar prevalence of exclusive breastfeeding were observed in 2021 (8.1%) and 2017 (8.5%; p = .790). An increase in predominant (2.2% vs. 13.4%; p < .001) and a decrease in complementary breastfeeding (64.0% vs. 48.4%; p = .037) was observed in 2021, compared to 2017. The prevalence of maternal common mental disorders also increased in 2021 (17.6% vs. 32.5%, p < .001). No statistically significant associations were found between breastfeeding patterns, maternal common mental disorders, and other predictors in 2017 or 2021. CONCLUSIONS: Participants who delivered during the COVID-19 pandemic delayed solid foods introduction and breastfed predominantly longer than participants during the pre-pandemic period. While common mental disorders significantly increased, they were not associated with differences in breastfeeding.

Methodology of Maternal and Child Health Populational Surveys: A Statewide Cross-sectional Time Series Carried Out in Ceará, Brazil, from 1987 to 2017, with Pooled Data Analysis for Child Stunting.

BACKGROUND: Cross-sectional studies are fundamental studies in the practice of epidemiological science. This article aims to present in detail the methodology for conducting a series of cross-sectional studies, as well as the analysis of data through pooled data. METHODS: The series of studies are population cross-sectional studies, with statewide coverage, searching for representative sample of reproductive aged women and pre-school children in Ceará, Brazil. The sampling plan followed simple random, stratified, systematic and by conglomerates, in sequence. About 300 variables were collected. For each of the individual studies, multivariate data analysis was used to verify associations between dependent variables. For all the studies together, techniques used were trend chi-squared and pooled data analysis using linear mixed modeling procedures. RESULTS: There were 6 studies in sequence, for 30 years. Among other findings, the variables income, maternal education and breastfeeding time proved to be associated with the reduction of malnutrition in children considering all the period (p values 0.013, 0.033 and 0.037, respectively). CONCLUSIONS: Cross-sectional studies can be replicated at regular time series following the methodology exposed in this, even for locations with limited resources, ensuring adequate management of decisions of using federal funding aimed at achieving targeted programs to maximize the results obtained with the public resource available.

Prevalence and socioeconomic determinants of development delay among children in Ceará, Brazil: A population-based study.

OBJECTIVE: To assess the prevalence of child development delay and to identify socioeconomic determinants. STUDY DESIGN: We conducted a population-based cross-sectional study of children 2 to 72 months of age residing in the state of Ceará, Brazil. In total, 3200 households were randomly selected for participation in the study and had child development assessed with the Ages and Stages Questionnaire (ASQ) version 3. Development delay was defined as a score of less than -2 standard deviations below the median of the Brazilian ASQ standard. We present population-level prevalence of delay in five development domains and assess socioeconomic determinants. RESULTS: A total of 3566 children completed the ASQ development assessment of which 9.2% (95% CI: 8.1-10.5) had at least one domain with development delay. The prevalence of delay increased with age in all domains and males were at higher risk for communication, gross motor and personal-social development delays as compared to females (p-values <0.05). We found robust associations of indicators of socioeconomic status with risk of development delay; increasing monthly income and higher social class were associated with reduced risk of delay across all domains (28,2% in the poorest and 21,2% in richest for any delay, p-values <0.05 for all domains). In addition, children in poor households that participated in conditional cash transfer (CCT) programs appeared to have reduced risk of delay as compared to children from households that were eligible, but did not participate, in CCT programs. CONCLUSIONS: There is a relatively high population-level prevalence of development delay in at least one domain among children 0-6 years of age in Ceará, Brazil. Integrated child development, social support, and poverty reduction interventions may reduce the population-level prevalence of development delay in Ceará and similar settings.

Interaction between vitamin A supplementation and chronic malnutrition on child development.

200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

Zika Virus Infection and Microcephaly: A Case-Control Study in Brazil.

BACKGROUND: Brazil presented an alarming number of newborns with microcephaly in the years 2015 and 2016. The investigation of the cases raised the suspicion of the association of these cases with maternal infections by the zika virus. Also, in 2015, there was an epidemic of zika virus infection in Brazil, reinforcing this hypothesis. OBJECTIVE: The objective of this study was to identify factors associated with the diagnosis of microcephaly in newborns, including zika virus infection. METHODS: We conducted a case-control study. The cases were defined as children who received clinical and imaging diagnosis of microcephaly, born after October 2015 in Ceará, Brazil, which recorded the highest number of microcephaly cases in Brazil during the outbreak. The cases were identified in medical records of public and private maternity hospitals and in child development stimulation clinics tracked until June 2017. Epidemiological, clinical, and socioeconomic variables were collected, visiting their homes and confirming data from their medical records. Controls were children without microcephaly identified in the vicinity of the residence of each case. Logistic regression models were used to control confounding. FINDINGS: We evaluated 58 cases and 116 controls. The odds of having a baby with microcephaly was 14 times higher among mothers who had zika virus infection (p < 0.001), after multivariate analysis. Arboviruses infections symptoms, as fever (p = 0.220), skin change (p < 0.001), and joint pain (p = 0.002) also demonstrated an association with microcephaly. CONCLUSIONS: Maternal infection zika virus was associated with a diagnosis of microcephaly. Our study contributes to the investigation of the epidemiological factors associated with the diagnosis of microcephaly.

Prevalence and factors associated with adverse early childhood experiences: a population-based study in Ceará, Brazil / Prevalência e fatores associados a experiências adversas na primeira infância: um estudo de base populacional no Ceará, Brasil

ABSTRACT Objective: To estimate the prevalence of adverse childhood experiences and identify associated factors. Methods: A population-based cross-sectional study comprised data from a sample of 3,200 households with 3,566 children under 6 years of age, representative of the state of Ceará, Brazil. A multistage sampling approach was used, with stratification among the state capital, Fortaleza, and the 28 countryside municipalities, in which 160 census tracts were randomly selected, each one with a cluster of 20 households. The outcome variable was structured based on adverse childhood experiences as suggested by the Center for Disease Control and Prevention, according to the number of situations to which the child was exposed: 0-2, 3-5, and 6-9. Ordinal logistic regression multivariate model was applied to assess associations. Results: Among the 3,566 children studied, 89.7% (95%CI 88.7-90.7) were exposed to at least one adverse experience, of which the most prevalent were neglect, and emotional/physical abuse. The main factors associated were maternal advanced age and smoking, paternal absence, low education level of the head of the family, food insecurity and lack of a social support network. Conclusion: The study found a high occurrence of adverse early childhood experiences, particularly among preschool children born to mothers of older age, solo, who smoke and in a situation of social and economic vulnerability, including food insecurity, who should be target of control and prevention measures.

RESUMO Objetivo: Estimar a prevalência de experiências adversas na infância e identificar fatores associados. Métodos: O estudo transversal de base populacional compreendeu os dados de uma amostra de 3.200 domicílios com 3.566 crianças menores de seis anos, representativa do estado do Ceará, Brasil. Foi utilizado um processo de amostragem multiestágio, com estratificação entre a capital do estado, Fortaleza, e os 28 municípios do interior, nos quais foram sorteados 160 setores censitários, cada qual com um conglomerado de 20 domicílios. A variável desfecho foi estruturada com base nas situações de experiências adversas na infância sugeridas pelo grupo Centers for Disease Control and Prevention, de acordo com o número de situações a que a criança foi exposta: 0-2, 3-5 e 6-9. O modelo multivariado de regressão logística ordinal foi utilizado para avaliar as associações. Resultados: Das 3.566 crianças estudadas, 89,7% (intervalo de confiança — IC95% 88,7-90,7) foram expostas a pelo menos uma experiência adversa, sendo as mais prevalentes negligência e abuso emocional/físico. Os principais fatores associados às experiências adversas na infância foram a idade materna mais elevada e o tabagismo materno, a ausência paterna, a baixa escolaridade do chefe da família, a insegurança alimentar e a falta de rede de apoio social. Conclusão: O estudo encontrou alta ocorrência de experiências adversas na primeira infância, principalmente entre crianças nascidas de mães de idade mais elevada e tabagistas, sem a presença paterna, e em situação de vulnerabilidade social e econômica, como a insegurança alimentar, que deve ser alvo prioritário de medidas de prevenção e controle.

Análise do estado de cobertura vacinal de crianças menores de três anos no município de Fortaleza em 2017 / Analysis of the state of vaccination coverage of children under three years old in the city of Fortaleza in 2017 / Análisis del estado de cobertura de vacunación de niños menores de tres años de edad en la ciudad de Fortaleza en 2017

Objetivo: Analisar o estado atual da cobertura vacinal (CV) de crianças menores de três anos no município de Fortaleza, CE, e sua relação com a condição socioeconômica das famílias. Métodos: Pesquisa transversal de base populacional com amostragem aleatória. As informações foram obtidas por meio da aplicação de questionários e conferência de Cadernetas de Saúde quanto ao estado vacinal, bem como de dados ecológicos de desenvolvimento humano. A CV foi estimada em crianças na faixa etária de 19 a 36 meses. Resultados: Observou-se que 45,2% das crianças estudadas apresentavam-se com a CV recomendada pelo Ministério da Saúde (MS). Além disto, verificou-se fatores socioeconômicos determinantes de cobertura vacinal e que áreas descobertas de Agentes Comunitários de Saúde apresentaram pior cobertura. Conclusão: O presente estudo revela que é necessário fortalecer as ações que aumentem as cobertura vacinais no município.

Objective: To analyze the current state of the vaccination coverage (VC) of children under three years old in the city of Fortaleza, CE, and its relation with the socioeconomic status of the families. Methods: A population-based cross-sectional survey with random sampling, information was obtained through questionnaires applied and Health Booklets conferred to the vaccination status, as well as ecological human development data. VC was estimated in children between the ages of 19 and 36 months. Results: It was observed that 45.2% of studied children presented a VC recommended by the Ministry of Health. In addition, socioeconomic factors which are determinants of vaccine coverage were identified and that areas not covered by community health agents have worse coverage. Conclusion: The present study reveals that it is necessary to strengthen actions that increase VC in the municipality.

Objetivo: Analizar el estado actual de la cobertura vacunal (CV) de niños menores de tres años en el municipio de Fortaleza y su relación con la condición socioeconómica de las familias. Métodos: Investigación transversal de base poblacional con muestreo aleatorio, se obtuvo información a través de cuestionarios aplicados y Cuadernos de Salud conferidos al estado vacunal, así como datos ecológicos de desarrollo humano. La CV fue estimada en niños en el grupo de edad de 19 a 36 meses. Resultados: Se observó que el 45,2% de los niños estudiados se presentaban con la CV recomendada por el Ministerio de Salud. Además, que factores socioeconómicos son determinantes de cobertura vacunal y que áreas descubiertas de agentes comunitarios de salud presentan peor cobertura. Conclusión: El presente estudio revela que es necesario fortalecer las acciones que aumenten las CV en el municipio.

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil.

OBJECTIVE: To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS: Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS: A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother's education, toilet and tap water availability, children's medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS: Socioeconomic development, along with health interventions, may have contributed to improvements in children's nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Interaction between vitamin A supplementation and chronic malnutrition on child development / Interação entre suplementação de vitamina A e desnutrição crônica no desenvolvimento infantil

Abstract 200 million pre-school age children are not developing properly. Delays in child development are associated with multiple factors. This study aims to analyze if vitamin A supplementation is associated with improved development and how this effect could be mediated by nutritional status. Population-based study surveyed a representative sample of 8000 households, 1232 children 0-35 months, in the state of Ceará, Brazil. The variables analysed included child developmental status, nutritional determinants and confounding factors. The main effects and interactions were evaluated using Cox regressive models. Vitamin A supplementation showed protective effect to delay in cognitive and motor development modified by interaction with nutritional status. While well-nourished supplemented children presented a 67% lower risk of cognitive delay (adjusted PRR = 0·33 [0·21-0·53]), stunted children had no benefit from supplementation (adjusted PRR = 0·97 [0·39-2·40]). Vitamin A supplementation has a protective effect on child development, but not in stunted children. This suggests that supplementation is effective in promoting child development, especially if associated to a joint effort to improve the nutritional status of children, given the importance of this mediator.

Resumo Duzentos milhões de crianças em idade pré-escolar não estão se desenvolvendo adequadamente. Os atrasos no desenvolvimento estão associados a múltiplos fatores. Este estudo pretende analisar se a suplementação de vitamina A está associada a melhor desenvolvimento e a forma como esse efeito pode ser mediado pelo estado nutricional. Estudo de base populacional com amostra de 8.000 famílias, 1.232 crianças 0-35 meses, no estado do Ceará, Brasil. As variáveis analisadas incluíram desenvolvimento, determinantes nutricionais e fatores de confusão. Os efeitos e as interações foram avaliados utilizando modelos regressivos de Cox. A suplementação de vitamina A foi protetora para atraso no desenvolvimento cognitivo e motor modificado pela interação com o estado nutricional. Crianças suplementadas bem nutridas apresentaram um risco 67% menor de atraso cognitivo (PRR ajustado = 0 33 [0 21-0 53]), já as crianças desnutridas não se beneficiaram (PRR ajustado = 0 97 [0 39-2 40]). A suplementação tem um efeito protetor sobre o desenvolvimento, mas não em crianças desnutridas. Isso sugere que a suplementação é eficaz na promoção do desenvolvimento, especialmente se associada a um esforço para melhorar o estado nutricional infantil, dada a importância desse mediador.

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil / A relação dos programas de transferência de renda e a insegurança alimentar entre famílias com pré-escolares da região semiárida do Brasil

Abstract Background Food insecurity has important effects on human health, particularly in children's. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, " Bolsa Família", have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children's nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Resumo Introdução A insegurança alimentar tem efeitos importantes na saúde humana, em particular na das crianças. Continua aumentando, com uma prevalência estimada de 14,9% nos EUA e de 35% no Brasil. Existem poucos estudos sobre o efeito de programas de transferência de renda (PTR) sobre a prevalência de segurança alimentar no Brasil. Objetivo Avaliar a associação de programas de transferência de renda e da redução da inequidade com a insegurança alimentar. Método Estudo transversal de base populacional no Estado do Ceará, no Nordeste do Brasil, em uma amostra de 8 mil domicílios. O Ceará é um dos estados mais pobres do país. A população estadual é de 8,5 milhões de habitantes e os benefícios da segurança social e subsídios governamentais, como o Bolsa Família, tornaram-se a fonte de renda mais estável. As principais variáveis foram insegurança alimentar e a participação em PTR. Foram construídos modelos logísticos multivariados para avaliar a associação entre participação em PTR e segurança alimentar. Resultados A participação em PTR foi relacionada de forma independente com a prevalência de segurança alimentar (APR 2,29 IC 95% 1,57-3,33), assim como nível educacional, ambiente residencial e estado nutricional das crianças. Conclusões PTR e investimentos em educação são iniciativas que podem ser utilizadas para reduzir a insegurança alimentar.

Spontaneous and induced abortion trends and determinants in the Northeast semiarid region of Brazil: a transversal series / Tendência de abortos espontâneos e induzidos na região semiárida do Nordeste do Brasil: uma série transversal

Abstract Objectives: this study intends to estimate the rates, associated factors and trends of selfreported abortion rates in the northeast of Brazil. Methods: series of population-based surveys realized in Ceará, northeast of Brazil, one of the poorest states in the country. A sample of about 27,000 women of reproductive age was used. Abortion was assessed according to women´s information and rates were calculated using official population estimates. The trends and the association among socioeconomic and reproductive factors were studied using regressive models. Results: a trend for reduction in rates was identified. For induced abortion, the determinants were: not having a partner, condom in the last sexual intercourse, first child up to 25years old (AOR= 5.21; ACI: 2.9 - 9.34) and having less than 13years old at first sexual intercourse (AOR= 5.88; ACI: 3.29 - 10.51). For spontaneous abortion were: having studied less than 8 years, knowledge and use of morning-after pill (AOR= 26.44; ACI: 17.9 - 39.05) and not having any children (AOR= 3.43). Conclusions: rates may have been low due to self-reporting. Young age and knowledge about contraceptive methods were associated to both kinds of abortion, while education level along with spontaneous and marital status with induced. Programs to reduce abortion rates should focus on single younger women with low education.

Resumo Objetivos: este estudo objetiva estimar as taxas, fatores associados e tendência das taxas de aborto no Nordeste do Brasil. Métodos: série de estudos transversais realizada no Ceará, um dos estados mais pobres do país. Uma amostra de cerca de 27000 mulheres em idade reprodutiva foi utilizada. A ocorrência de aborto foi aferida através de informação dada pela participante e taxas foram calculadas usando estimativas populacionais oficiais. As tendências e associações entre fatores socioeconômicos e reprodutivos foram estudadas através de modelos regressivos. Resultados: foi identificada tendência de redução nas taxas de abortamento. Para aborto induzido, os determinantes foram não ter um parceiro fixo, ter utilizado camisinha na última relação sexual, ter tido o primeiro filho com menos de 25 anos (AOR= 5,21; ACI: 2,9 - 9,34), e ter tido a primeira relação com menos de 13 anos (AOR= 5,88; ACI: 3,29 - 10,51). Para o espontâneo, ter estudado menos de oito anos, conhecimento sobre a pílula do dia seguinte (AOR= 26,44; ACI: 17,9 - 39,05), e não ter filhos (AOR= 3,43). Conclusões: as taxas podem ser subestimadas por serem auto relatadas. Estar na adolescência e ter conhecimento sobre métodos contraceptivos foram associados aos dois tipos de aborto, enquanto nível educacional com o espontâneo e estado conjugal com induzido. Programas para reduzir taxas de abortamento deveriam focar em mulheres solteiras e com baixa educação.

[Prevalence and determinants of obesity and overweight among reproductive age women living in the semi-arid region of Brazil]. / Prevalência e determinantes de obesidade e sobrepeso em mulheres em idade reprodutiva residentes na região semiárida do Brasil.

The study estimated the prevalence and determinants of overweight and obesity in women of reproductive age in the Semi-Arid Region of Brazil. In the cluster sampling of 8,000 households of the state of Ceará, 6,845 women were surveyed. Overweight and obesity were measured by the body mass index and risk factors identified by multivariate analysis. The prevalences of overweight and obesity were 32.6% and 16.1%, respectively. After adjusted analysis, obesity was positively associated with age>30 years (PR=1.55), marital status, married (PR=1.36), elementary education (PR=1.40), age at menarche<12 years (OR=1.59), having >1 child (PR=1.65) and contraceptive use (PR=1.31). Specific health and nutritional conditions were identified as highly associated to morbid obesity: hypertension (PR=3.11), diabetes (PR=2.08), dissatisfaction with body image (PR=4.26) and procedures for weight loss (PR=2.73). The study concluded that overweight and obesity are highly prevalent in the Semi-Arid Region of Brazil. Education was the only socioeconomic determinant considered as amenable to change. The reproductive risk factors identified enforce the need to mobilize the services of prenatal and postpartum care and family planning to prevent and control obesity.

Programa saúde na escola: estratégia promotora de saúde na atenção básica no Brasil / The health school programme: a health promotion strategy in primary care in Brazil

The Health School Programme (HSP) should be understood as a permanent development process. In this context, the actions of a policy aimed at children and adolescentsare paramount in the HSP OBJECTIVE: to identify and describe the actions developed by the Family Health Group in the HSP, from the National Programme for ImprovingAccess and Quality of Primary Care (PIPCAQ METHODS: this cross-sectional research used secondary data collected fromthe 17,202 groups who joined PIPCAQ in 2012 RESULTS: all regions showed significant results concerning the execution of school activities. the Northern region was the one that performed most school actions (80.5%), followed by the Northeast, Midwest, South and Southeast, respectively. However, some items, such as professional training in education and health work need to be streng the ned CONCLUSION: HSP in Brazil has mobilised significant actions, even though it has not happened in homogeneously in all Brazilian regions...

A promoção da saúde no cenário escolar deve ser entendida como um processo em permanente desenvolvimento. Nesse contexto, destacam-se as ações do Programa Saúde na Escola, como política voltada para crianças e adolescentes OBJETIVO: identificar e descrever as ações desenvolvidas pelas Equipes de Saúde da Família (ESF) no Programa Saúde na Escola (PSE), participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ MÉTODO: trata-se de uma pesquisa transversal que utilizou dados secundários coletados junto a 17.202 equipes que aderiram ao PMAQ em 2012 RESULTADO: todas as regiões apresentaram resultados expressivos acerca da realização de atividades na escola. A região Norte é a que mais executa ações ao escolar (80,5%), seguidas das regiões Nordeste, Centro-Oeste, Sul e Sudeste respectivamente. Contudo, alguns itens como a capacitação dos profissionais para trabalhar com educação e saúde precisam ser fortalecidos CONCLUSÃO: o PSE no Brasil tem mobilizado ações relevantes, mesmo que isto não tenha se dado de forma homogênea em todas as regiões brasileiras...

Metodologia das Pesquisas Populacionais de Saúde Materno-Infantil: uma série transversal realizada no Estado do Ceará de 1987 a 2007 / Method of the Populational Researches in Maternal and Child Health: a transversal series held in the State of Ceará from 1987 to 2007

Descrever os métodos utilizados nas Pesquisas de Saúde Materno-Infantil (PESMIC) no Ceará, durante 20 anos. Métodos: a série de inquéritos realizados no período de 20 anos foi analisada nos seguintes aspectos: a) Estudos transversais em série de base populacional, com amostra representativa de 8000 famílias; b) Utilizou-se questionários e medições antropométricas, estudando-se níveis e causas de mortalidade infantil, prevalência de desnutrição da mãe e da criança, duração da amamentação, cobertura vacinal, prevalência e manejo da diarreia e acesso aos serviços de saúde materno-infantil; c) Obteve-se como resultado as variáveis desfechos (principal mortalidade infantil) e diversos determinantes materno-infantis e socioeconómicos. Resultados: o índice de resposta foi de quase 100 por cento nos cinco inquéritos realizados (1986-2007), e ocorreram importantes mudanças nos indicadores sociodemográficos e de saúde; redução de 81 por cento da taxa de mortalidade infantil, aumento de 43 por cento da taxa de amamentação; índice de imunização de 95 por cento. Observou-se aumento de 243 por cento do índice de sobrepeso. Foram entrevistados no total somado dos cinco estudos: 177.132 residentes, sendo 47.508 mulheres e 13.049 crianças. Conclusões: recomenda-se a continuidade desses estudos utilizando-se a mesma metodologia, possibilitando analises de variações temporais...

Describe the methods used in mother-child health studies (PESMIC), over a period of 20 years in Ceará. Methods: a series of studies carried out over a twenty-year period were examined with regard to the following aspects: a) population-based cross-sectional series studies, with a representative sample of 8000 families; b) questionnaires and anthropo-metric measurements were used, studying the levels and causes of infant mortality, the prevalence of mother and child malnutrition, the duration of breastfeeding, vaccination coverage, the prevalence and management of diarrhea and access to mother-child health services; c) the results obtained were outcome variables (mainly infant mortality) and various determining factors relating to the child and the mother and social and economic conditions. Results: the response rate was nearly 100 percent for the five studies (1986-2007) and there were important changes in socio-demographic and health indicators, an 81 percent reduction in the infant mortality rate, a 43 percent increase in breastfeeding an immunization rate of 95 percent. There was also a 243 percent increase in overweight. In total the five studies covered 177,132 residents, 47,508 women and 13,049 children. Conclusion: it is recommended that these studies should be continued using the same methodology, making it possible to analyze variations over time...

Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil / Prevalência e determinantes da desnutrição infantil no semiárido do Brasil / Prevalencia y determinantes de la desnutrición infantil en el semiárido de Brasil

OBJECTIVE : To analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil. METHODS : Data were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model. RESULTS : A sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting. CONCLUSIONS : Socioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition. .

OBJETIVO : Analisar tendências na prevalência e determinantes da desnutrição em crianças na região semiárida do Brasil. MÉTODOS : Foram analisados dados de duas pesquisas transversais domiciliares de base populacional que utilizaram a mesma metodologia. A amostragem por conglomerados foi utilizada para coletar os dados de 8.000 famílias, do estado do Ceará, Nordeste do Brasil, para os anos de 1987 e 2007. A desnutrição aguda foi calculada como peso/idade < -2 desvios padrão; nanismo como altura/idade < -2 desvios padrão; e emaciação como peso/altura < -2 desvios padrão. Os dados sobre os determinantes biológicos e sociodemográficos foram analisados por meio de análises multivariadas com base em um modelo teórico hierarquizado. RESULTADOS : Amostras de 4.513 e 1.533 crianças menores de três anos de idade, em 1987 e 2007, respectivamente, foram incluídas nas análises. A prevalência de desnutrição aguda foi reduzida em 60,0%, passando de 12,6% em 1987, para 4,7% em 2007, enquanto a prevalência de nanismo foi reduzida em 50,0%, passando de 27,0% em 1987 para 13,0% em 2007. A prevalência de emaciação teve pouca alteração no período. Em 1987, as características socioeconômicas e biológicas (renda familiar, escolaridade da mãe, disponibilidade de latrina e água potável, consulta médica e hospitalização da criança, idade, sexo e peso ao nascer) foram fatores significativamente associados à desnutrição, ao nanismo e à emaciação. Em 2007, os determinantes da desnutrição ficaram restritos às características biológicas (idade, sexo e peso ao nascer). Apenas uma característica socioeconômica, a disponibilidade de latrina, permaneceu significantemente ...

OBJETIVO : Objetivo: Analizar tendencias en la prevalencia y determinantes de la desnutrición en niños en la región semiárida de Brasil. MÉTODOS : Se analizaron datos de dos investigaciones transversales domiciliares de base poblacional que utilizaron la misma metodología. El muestreo por conglomerados se utilizó para colectar los datos de 8.000 familias, del estado de Ceará, Noreste de Brasil, para los años de 1987 y 2007. La desnutrición aguda fue calculada como peso/edad < -2 desviaciones estándar; enanismo como altura/edad < -2 desviaciones estándar; y demacración como peso/altura < -2 desviaciones estándar. Los datos sobre los determinantes biológicos y sociodemográficos se analizaron por medio de análisis multivariados con base en un modelo teórico jerarquizado. RESULTADOS : Muestras de 4.513 y 1.533 niños menores de tres años de edad, en 1987 y 2007, respectivamente, se incluyeron en los análisis. La prevalencia de desnutrición aguda fue reducida en 60,0%, pasando de 12,6% en 1987, a 4,7% en 2007, mientras que la prevalencia del enanismo fue reducida en 50,0% pasando de 27,0% en 1987 a 13,0% en 2007. La prevalencia de demacración tuvo poca alteración en el período. En 1987, las características socioeconómicas y biológicas (renta familiar, escolaridad de la madre, disponibilidad de letrina y agua potable, consulta médica y hospitalización del niño, edad, sexo y peso al nacer) fueron factores significativamente asociados con la desnutrición, el nanismo y la demacración. En 2007, los determinantes de la desnutrición quedaron restringidos a las características biológicas (edad, sexo y peso al nacer). Sólo una característica socioeconómica, la disponibilidad de letrina, permaneció significativamente asociada con el enanismo. ...