Analysis of socioeconomic gradients in the development of children aged 0-3 years in Fortaleza, Northeastern Brazil / Análisis de los gradientes socioeconómicos en el desarrollo de los niños de 0-3 años en Fortaleza, Noreste de Brasil

ABSTRACT OBJECTIVE To identify the socioeconomic gradients in the measures of development and well-being of children under three years of age in Fortaleza, Northeastern Brazil. METHODS We compiled information using a socioeconomic survey instrument, collecting anthropometric measurements, observing the home environment, and applying the Denver Test II to 2,755 children aged between zero and 28 months who are potential beneficiaries of the Cresça com Seu Filho program in Fortaleza. These children were randomly selected from a universe identified from the administrative record of the Cadastro Único of the Ministry of Social Development of Brazil. For the analysis, we reported descriptive statistics, Pearson correlations, and mean differences. RESULTS Rates of chronic malnutrition and overweight were 7.0%. The results of the Denver II test indicated that personal social (23%) and language (20%) are the domains in which children have the highest developmental delay, when compared with the international reference sample. Parental practices measured by two sub-scales of the Home Observation of the Environment Inventory were poor, with only 14.0% of families having two or more books in the home and 35.0% of the households reporting having spanked their child in the past three days. CONCLUSIONS We identified clear socioeconomic gradients in the anthropometric indicators, parenting practices, and the Denver Test II (especially in the language domain). Children from poorer households, as well as children of mothers with lower education levels, perform poorly on most measures.

RESUMEN OBJETIVO Identificar los gradientes socioeconómicos en medidas del desarrollo y bienestar en menores de tres años en Fortaleza, Nordeste de Brasil. MÉTODOS Se recolectó información a través de una encuesta socioeconómica, toma de medidas antropométricas, observación del ambiente en el hogar y aplicación del Test de Denver II de 2.755 niños de cero a 28 meses potenciales beneficiarios del programa Cresça com Seu Filho en Fortaleza. Estos niños fueron seleccionados aleatoriamente de un universo identificado a partir del registro administrativo del Catastro Único del Ministerio de Desarrollo Social de Brasil. Para el análisis se reportan estadísticas descriptivas, correlaciones de Pearson y diferencias de medias. RESULTADOS Las tasas de desnutrición crónica y el sobrepeso fueron iguales a 7,0%. Los resultados del Test de Denver II indicaron que las áreas en las que los niños presentan un mayor rezago en su desarrollo, cuando se compararon con la muestra de referencia internacional fueron personal-social (23,0%) y lenguaje (20,0%). Las prácticas parentales medidas por dos sub-escalas del Hom e Observation of the Enviroment fueron pobres, solo el 14,0% de las familias reportaron tener dos o más libros en el hogar y 35,0% de los hogares reportaron haberle pegado a su hijo en los últimos tres días. CONCLUSIONES Se identifican gradientes socioeconómicos claros en los indicadores antropométricos, las pautas de crianza y en la prueba Denver II (especialmente en el dominio de lenguaje). Los niños pertenecientes a los hogares más pobres, así como hijos de madres con menor nivel educativo, presentan un desempeño bajo en la mayoría de las medidas.

Diferencias de género en la calidad de vida relacionada con la salud en adolescentes escolarizados chilenos / Gender differences in health-related quality of life of Chilean adolescent students

Background: Health-related quality of life (HRQOL) refers to individuals' perception of their subjective well-being, considering various aspects of their life and the impact on their health. Aim: To analyze gender differences in the HRQOL of adolescent students in Chile, by age, type of school attended, and area of residence. Material and Methods: Analytical cross-sectional study conducted in a population of 5th and 12th grade students attending municipal, subsidized and private schools in 11 regions of the country. HRQOL was assessed with the KIDSCREEN-52, an instrument that has been previously adapted and validated in Chile. The database obtained from that adaption and validation process was analyzed. Results: In total, 7,910 students (median age 14 years, 53% female) completed the questionnaire. Compared to males, females had lower HRQOL scores in most of the KIDSCREEN-52 dimensions. However, males were more likely to have lower scores in the “Peers and Social Support” and “School Environment” dimensions. These differences remained valid when the sample was stratified by age, type of school, and area of residence were analyzed. Conclusions: This study supports the existence of inequalities in the self-perceived HRQOL of Chilean adolescent students. The existing differences are not only related to gender but are also evident when stratifying by type of school attended.

Salud ambiental infantil en el contexto de la reubicación de familias de campamentos a viviendas sociales / Child health environment in the context of relocating of camp site families to social housing

Introducción: Intervenciones habitacionales destinadas a superar la pobreza pueden generar cambios en la situación de salud de la población infantil, modificando factores de riesgo en el entorno físico y social de niños y niñas. El objetivo fue identificar indicadores de salud ambiental infantil susceptibles de ser modificados con la reubicación de familias desde campamentos a vivienda social. Sujetos y método: Estudio transversal en niños de 2-8 años. Se comparó dos grupos de familias provenientes de campamentos. Un grupo fueron familias reubicadas en viviendas sociales entre 2001 y 2002 (n = 115). El otro grupo corresponde a niños cuyas familias permanecieron en campamentos (n = 88) de la zona poniente de Santiago. Se recolectó información sobre: características socioeconómicas, ambiente intradomiciliario y de barrios, y eventos en salud: síntomas respiratorios, accidentabilidad y cuidado materno infantil. Se emplearon pruebas de x², Fisher y Mann-Whitney para la comparación de los grupos. Resultados: Se identifican diferencias entre los grupos comparados en relación a la tenencia de mascotas, presencia de hongos/humedad en el hogar, tipo de combustibles utilizados y problemas de seguridad percibidos en los barrios (p<0,05). Las familias de campamentos reportan una mayor tenencia de mascotas (73,8% v/s 32,2%%), presencia de huellas de humedad/hongos en el hogar (43,2% v/s 18,3%), uso de leña (39,8% v/s 0,0%), en comparación con familias de viviendas sociales. Residentes de viviendas sociales perciben mayores problemas de seguridad en el barrio, mientras que los niños presentan mayor frecuencia de síntomas relacionados con asma y menor diversidad de accidentes en el hogar comparado con el grupo residente en campamentos. Conclusiones: Entre los factores estudiados, aquellos susceptibles de ser modificados con la reubicación de familias desde campamentos a vivienda social se vinculan a indicadores de calidad del aire interior y seguridad en los barrios. Lo anterior refuerza la necesidad de profundizar en las influencias positivas y negativas de la movilidad residencial de estos grupos, desde una perspectiva centrada en el bienestar infantil.

Introduction: Housing interventions aimed at overcoming poverty can lead to changes in the health status of children by modifying risk factors in their physical and social environment Objective: the aim was to identify children's environmental health factors to change with the relocation of families from slums to public housing. Subjects and method: A cross-sectional study was conducted in children ages 2-8 years old of families relocated to public housing (n=115) who were compared to children residing in slums (n=88) in Santiago, Chile. Family socioeconomic characteristics, indoor environment and neighborhoods were collected. It was included respiratory symptoms, accidents and maternal-child care of children. x², Fisher and Mann-Whitney test were used to compare groups. Results: There were differences in households related to pets keeping, presence of humidity/molds in homes, types of fuels, and perceived safety problems in neighborhoods (p<0.05). The families from slums reported higher tenancy of pets (73.8% v/s 32.2%%), humidity/molds in homes (43.,2% v/s 18.3%), use of wood for heating (39.8% v/s 0.0%), compared with families of public housing. Residents of public housing perceived more safety problems in neighborhood, and children have more asthma related symptoms and have lower diversity of accidents in home. Conclusion: Among the factors studied, indoor air quality and safety in neighborhoods could be linked to changes from the relocation of families. This reinforces the need to deepen the positive and negative influences of residential mobility of these groups focused on child welfare perspective.

Indicadores de bienestar y desarrollo infantil en México / Child wellbeing and development indicators in Mexico

Objetivo. Aportar evidencia e insumos para seguimiento del bienestar infantil en México. Material y métodos. Ajustando para el diseño muestral, se armonizó información para niños menores de 10 años de la ENSANUT 2012 con indicadores y metas nacionales e internacionales. Resultados. El 8.37% de los niños nació con bajo peso (<2 500 g). No se realizó el tamiz neonatal a 9.19% de los niños nacidos vivos. De los niños menores de 5 años, 78.03% recibió lactancia materna hasta los cuatro meses. De las madres de recién nacidos, 69.5% recibió capacitación sobre estimulación temprana. El 28% (23% en áreas rurales) de los niños recibió cinco consultas de vigilancia del desarrollo antes de cumplir dos años. Un 29% de los niños tienen o están en riesgo de tener una discapacidad. Conclusiones. En México existen progresos así como retos pendientes en la atención al desarrollo infantil. Se requiere crear estándares y valores nacionales de referencia y un sistema de monitoreo, tamizaje, canalización y atención para promover el bienestar y el desarrollo infantiles.

Objective. To provide evidence and input for monitoring child welfare and wellbeing in Mexico. Materials and methods. Adjusting for sampling design, information from ENSANUT 2012 for children <10 years was compared with national and international parameters and goals. Results. While 8.37% of infants were born with low birth weight (<2 500 g), neonatal screening was not performed on 9.4% of newborns. Of children <5 years, 78.03% were breastfed until at least four months. Among mothers of newborns, 69.5% received training in early stimulation. At the national level, 28% of children (23% in rural areas) received five medical consultations to monitor their early development. 29% of children either had a disability or were at risk of developing one. Conclusions. Progress has been made in Mexico in terms of services promoting early child development and wellbeing but important challenges persist. National standards and a system for monitoring, screening, referring and providing care for child development and wellbeing are necessary.

La invisibilidad de las condiciones laborales y de salud de niños del mercado Felipe Angeles / Invisibility of working conditions and children's health in the Felipe Angeles market

Objetivo Identificar las condiciones de trabajo y salud de los menores que trabajan en el mercado Felipe Ángeles de la Ciudad de Guadalajara. Metodología Se realizó un estudio descriptivo a 198 menores de 18 años de edad que desempeñaban alguna actividad laboral en dicho mercado. Se aplicó una encuesta que incluía variables sociodemográficas de los menores, de condiciones del trabajo y de salud. Resultados Los menores de que laboran en este mercado son principalmente hombres (89,9 %) con edades de entre 6 a 17 años, residentes de Guadalajara, 71 % asiste a la escuela. El 83 % de los niños iniciaron sus actividades laborales en el mercado entre los 7 y 10 años y 75 % de ellos llevan 1 año o más trabajando. La jornada laboral va de lunes a domingo en el 50 % de los casos. Los riesgos a la salud percibidos y presentados por los menores son lesiones durante la jornada laboral tales como abrasión, contusión, fracturas, atropellamiento; y las relacionadas con el aspecto psicosocial como son ser víctimas de robo o ser sujetos vulnerables para iniciarse en la drogadicción. Conclusiones Las condiciones de trabajo y salud en que laboran los menores no son adecuadas para su edad y afectan su desarrollo físico y psicosocial, ya que el sitio donde trabajan tiene deficiencias en la estructura arquitectónica, les impide la realización de actividades propias de su edad y los somete a riesgos laborales para los que no existe prevención.

Objective Identifying the work environment and health of children working in the Felipe Angeles market in Guadalajara. Methodology This was a descriptive study which included 198 children working in the aforementioned market. A questionnaire was used which asked about the sociodemographic variables, the work environment and the health of such children. Results The children working in the market were predominantly male (89.9 %), aged 6 to 17 years old, residing in Guadalajara; 71 % were attending school. 83 % of the children had started working in the market between 7 to 10 years old and 75 % had worked there for 1 year or more. Workdays lasted all week, without rest in 50 % of the cases. The children perceived health risks as concerning abrasion, contusion, fractures, being run over and other psychosocial types related to becoming the victims of theft or becoming addicts. Conclusions The children's work environment and health were not suitable for their age and affected their physical and psychosocial state as the site had deficient architecture making it impossible to carry out activities appropriate for their age and provoked workplace risk for which there was no prevention.

Effects of social and environmental determinants on overweight and obesity among Brazilian schoolchildren from a developing region / Efectos de los determinantes sociales y ambientales sobre la obesidad y el sobrepeso en escolares de una región en desarrollo del Brasil

OBJECTIVE: To identify the social and environmental determinants most strongly associated with overweight and obesity in Brazilian schoolchildren from a developing region. METHODS: Data were collected from a community-based survey of schoolchildren from the Valley of Jequitinhonha, Minas Gerais, Brazil. The sample was composed of 5 100 school children aged 6-18 years. Overweight and obesity were defined by body mass index based on the current method recommended by the World Health Organization in 2007. Social and environmental determinants were collected by using a structured questionnaire. RESULTS: The prevalence of overweight and obesity was 11.1 percent and 2.7 percent in girls and 8.2 percent and 1.5 percent in boys, respectively. The chance of overweight was higher in schoolchildren who engaged in remunerated work (odds ratio [OR] = 2.19, 95 percent confidence interval [CI] 1.30- 3.26), whose parents had higher education levels (OR = 1.52, 95 percent CI 1.12-2.07), who had two or fewer siblings (OR = 1.74, 95 percent CI 1.21-2.49), and who were in a high economic class (OR = 1.93, 95 percent CI 1.32-2.85). Schoolchildren who traveled by car to school (OR = 1.50, 95 percent CI 1.14-1.91), lived < 5 km from school (OR = 1.64, 95 percent CI 1.06-2.39), and consumed foods sold in the school cafeteria (OR = 1.56, 95 percent CI 1.19-2.16) presented high odds of being overweight. CONCLUSIONS: The background from a particular region of a country should be considered when implementing preventive measures regarding overweight and obesity, especially for very poor, developing regions like the Valley of Jequitinhonha. Measures taken should consider a multilevel intervention that includes the family, school, and physical environment.

OBJETIVO: Identificar los determinantes sociales y ambientales más firmemente asociados con el sobrepeso y la obesidad en niños que asisten a la escuela en una región en desarrollo del Brasil. MÉTODOS: Se recopilaron los datos de una encuesta comunitaria llevada a cabo en niños inscritos en escuelas del valle de Jequitinhonha, Minas Gerais (Brasil). La muestra estuvo integrada por 5 100 escolares de 6 a 18 años de edad. El sobrepeso y la obesidad se definieron según el índice de masa corporal, con base en el método actualmente recomendado por la Organización Mundial de la Salud (2007). Los determinantes sociales y ambientales se recopilaron mediante un cuestionario estructurado. RESULTADOS: La prevalencia del sobrepeso y de la obesidad fue de 11,1 por ciento y 2,7 por ciento en niñas y de 8,2 por ciento y 1,5 por ciento en niños, respectivamente. Las probabilidades de tener sobrepeso fueron mayores en los escolares que desempeñaban un trabajo remunerado (razón de probabilidades [RP] = 2,19; intervalo de confianza [IC] de 95 por ciento, 1,30-3,26); en aquellos cuyos padres tenían niveles superiores de educación (RP = 1,52; IC de 95 por ciento, 1,12-2,07); en quienes tenían dos o menos hermanos (RP = 1,74; IC de 95 por ciento, 1,21-2,49); y en los de clase económica alta (RP = 1,93; IC de 95 por ciento, 1,32-2,85). Presentaron altas probabilidades de tener sobrepeso los niños que viajaban en automóvil a la escuela (RP = 1,50; IC de 95 por ciento, 1,14-1,91), los que vivían a < 5 km de la escuela (RP = 1,64; IC de 95 por ciento, 1,06-2,39) y los que consumían los alimentos que se venden en la cafetería de la escuela (RP = 1,56; IC de 95 por ciento, 1,19-2,16). CONCLUSIONES: Deben tenerse en cuenta las características de cada región particular de un país cuando se ejecutan medidas preventivas del sobrepeso y la obesidad, especialmente en las regiones muy pobres y en desarrollo, como el valle de Jequitinhonha en Brasil. Las medidas que se adopten deben considerar una intervención en varios niveles que incluya a la familia, la escuela y el entorno físico.

Saúde e bem-estar de crianças em idade escolar / School aged children health and welfare

A percepção que as crianças têm sobre a sua própria saúde é um importante indicador para a definição de estratégias de promoção de saúde infantil. Este estudo correlacional analisa a percepção de saúde de uma amostra probabilística acidental de 216 crianças portuguesas do ensino básico. O questionário de recolha de dados (CHIP-CE) revelou boas propriedades psicométricas (alfa=0,84). Os resultados indicam médias e desvios-padrão de cinco fatores: Conforto (4,34; 0,45); Evitamento de risco (4,18; 0,53); Satisfação (4,03; 0,56); Resiliência (3,75; 0,60); Realização (3,75; 0,60). Resiliência e evitamento de risco são fatores com valores mais baixos. A dificuldade em realizar os trabalhos de casa e conviver com os colegas é indicadora da dimensão resiliência mais problemática. Os resultados permitem descrever o perfil de saúde e planejar uma intervenção de educação para a saúde das crianças, em contexto escolar, especialmente na área do relacionamento e motivação para o estudo.

O controle das consultas odontológicas dos bebês por meio da carteira de vacina: avaliação de um programa-piloto desenvolvido na Estratégia Saúde da Família em Ponta Grossa (PR, Brasil) / The control of babies' dental visits through the vaccines card: evaluating a pilot program developed at the Family Health Strategy at Ponta Grossa (PR, Brazil)

Este estudo avaliou um programa-piloto desenvolvido na área de abrangência de uma Unidade de Saúde da Família, o qual monitorou, durante dois anos, o retorno periódico dos bebês para acompanhamento odontológico por meio de suas carteiras de vacina. Foi realizado um estudo exploratório, que envolveu uma amostra de conveniência de 123 crianças de 12 a 36 meses de idade residentes na área. Os dados foram coletados durante a Campanha de Vacinação, em 2007, por meio de questionário aplicado aos pais, consulta às carteiras de vacina e exame clínico das crianças. Os resultados revelaram que 81 por cento das crianças examinadas estavam cadastradas na USF para atendimento odontológico; destas, 95 por cento haviam sido inscritas antes de completarem um ano de vida, possuindo registro na carteira de vacina. Verificou-se ainda que 50 por cento das crianças haviam visitado o cirurgião-dentista mais de uma vez por ano de vida, e 58 por cento delas retornaram para consulta odontológica no ano anterior à pesquisa. A prevalência de cárie foi menor neste grupo de crianças (17 por cento) do que no grupo sem retorno frequente ou que não estava cadastrado na USF (26 por cento). Concluiu-se que a carteira de vacina pode ser um instrumento útil para o monitoramento da frequência dos bebês ao cirurgião-dentista.

This study evaluated a concept-program developed in the area of a Family Health Unity, which monitored, for two years, the returns of infant children to regular attendance by the dentist, through their vaccines cards. A cross-sectional study was conducted, involving a convenience sample of 123 children aged 12 to 36 months, residents in the area. Data were collected during a campaign of immunization, in 2007, through a questionnaire answered by parents, vaccines cards checking, and clinical examination of children. The results showed that 81 percent of the examined children were registered in the FHU for dental care; from them, 95 percent had entered before reaching one year of life, having vaccines cards registration. It was also found that 50 percent of the children had visited the dentist more than once per year of life and 58 percent of them returned for dental appointments in the year before the survey. The prevalence of dental caries was lower in this group of children (17 percent), than in the group without frequent returns, or the one not registered in the FHU (26 percent). It was concluded that the vaccines card can be a useful tool for tracking the frequency of babies to dentist.

Trabajo infantil y salud en un mercado público de Valencia, Venezuela / Child labor and health in a public market, Valencia, Venezuela

Objetivo Determinar condiciones de vida, prácticas de trabajo, efectos a la salud y factores de riesgo asociados en un grupo de menores trabajadores de un mercado público en Valencia, Venezuela. Metodología Se aplicó una encuesta con variables demográficas y de exposición y se realizó análisis descriptivo de los datos, seleccionándose 44 menores. Resultados La jornada de trabajo promedio fue de 9,2 ± 3,2 horas/día. La actividad más desempeñada fue la venta de víveres/frutos (43,2 por ciento). El 22,7 por ciento de los menores presentaba retraso escolar evidente. Los síntomas más reportados fueron cefalea (84 por ciento), estrés (59,1 por ciento) y fatiga (58,2 por ciento). El 11,4 por ciento reportaron haber sufrido accidentes y 2,3 por ciento enfermedad relacionados con la actividad presente. Los factores de riesgo más reportados fueron calor (93,2 por ciento), ruido (88,6 por ciento) y repetitividad en la labor (84,1 por ciento). Se encontró una correlación significativa, inversamente proporcional, entre la edad y el estrés (p=0,04) lo cual es consistente con estudios que indican que el impacto negativo del estrés es más profundo en niños que tienen menos de 10 años de edad. Se determinó significativamente que a menor edad hay una mayor exposición a desechos tóxicos orgánicos (p=0,017) y al trabajo bajo presión (p=0,04). Conclusiones No existen procesos de recolección sistemáticos para evaluar el trabajo infantil en nuestro país aún cuando se identificaron una amplia variedad de factores de riesgo percibidas por los niños trabajadores. Para una evaluación más profunda del problema, se requieren indicadores más sensibles que permitan detectar daños tempranos y la forma de controlar la exposición a los mencionados riesgos.

Objectives This study was aimed at determining the living conditions, work practices, health effects and associated occupational risk factors in children working in a public market in Valencia, Venezuela. MethodologyA questionnaire was administered which included demographic and exposure variables; a descriptive analysis was then made of the data. Forty-four children were selected. Results The average workday lasted 9.2 ± 3.2 hours/day. Children were most frequently employed in selling provisions and fruit (43.2 percent); 22.7 percent of them were evidently backward at school. The symptoms most reported were headache (84 percent), stress (59.1 percent) and fatigue (58.2 percent). Occupational accidents were reported by 11.4 percent of the children and 2.3 percent had suffered an occupational disease related to their present activity. The most frequently occurring occupational risks were discomfort caused by heat (93.2 percent), noise (88.6 percent) and repetitive work (84.1 percent). A significant, indirect correlation was found between age and stress (p=0.04), as in publications showing that the negative impact of stress is more severe in children aged less than 10. It was determined that being a minor had greater significant association with the occupational risk of having greater exposure to organic toxic waste (p=0.017) and working under pressure (p=0.04). Conclusions There is no systematic data collection programme for assessing child labour in Venezuela even though a variety of risk factors have been identified and perceived for children. More sensitive indicators are required for the early identification of effects and how to control exposure to the risks mentioned above so that the problem can be studied in greater depth.

Saúde infantil em áreas pobres: resultados de um estudo de base populacional nos municípios de Caracol, Piauí, e Garrafão do Norte, Pará, Brasil / Child health in poor areas: findings from a population-based study in Caracol, Piauí, and Garrafão do Norte, Pará, Brazil

Este estudo teve por objetivo conhecer indicadores básicos de saúde infantil nos municípios de Caracol, Piauí, e Garrafão do Norte, Pará, Brasil. Mediante visitas domiciliares por amostragem sistemática, aplicaram-se questionários às mães de menores de cinco anos, investigando nível sócio-econômico, condições de habitação e saneamento da família, características demográficas, padrão de morbidade, de utilização de serviços de saúde e de assistência recebida durante a gestação e o parto. A análise consistiu da comparação de indicadores entre os dois municípios e foi avaliada através dos testes t e qui-quadrado. Das 1.728 crianças estudadas, 60 por cento de suas famílias possuíam renda inferior a um salário mínimo mensal; 41 por cento não contavam com qualquer tipo de sanitário; 10 por cento de suas mães não realizaram uma única consulta de pré-natal; 30 por cento nasceram no domicilio; 30 por cento foram levadas à consulta médica nos últimos três meses; 20 por cento apresentavam déficit > 2 desvios-padrão para o indicador altura/idade. Todos os indicadores estudados foram ruins em ambos os municípios, sobretudo em Garrafão do Norte. Aumentar a oferta de cuidados em saúde e melhorar as condições de habitação e saneamento deveriam ser prioridades nessas localidades.

The aim of this study was to evaluate child health indicators in the municipalities (counties) of Caracol, Piauí State, and Garrafão do Norte, Pará State, Brazil. Through household visits using systematic sampling, previously trained interviewers applied a standard questionnaire to mothers of under-five children, investigating socioeconomic status, housing and environmental sanitation, demographic characteristics, disease patterns, and prenatal and childbirth care. The analysis used the t-test and chi-square test to compare indicators between the two municipalities. Of the 1,728 children studied, 60 percent were from families with incomes less than one monthly minimum wage (approximately U$200), 41 percent had no type of sewage treatment or disposal, 10 percent of mothers reported zero prenatal visits, 30 percent of the children were born in the same municipality, and 30 percent had been taken to a pediatric consultation in the previous 3 months; 20 percent had a height-for-age deficit > 2 standard deviations. All target indicators were deficient in both the municipalities (especially in Garrafão do Norte). Expanding health care supply and improving housing and sanitation conditions are priorities in both municipalities.

Child health and mortality.

Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality.

The use of maternal and child health services in three population-based cohorts in Southern Brazil, 1982-2004 / A utilização de serviços de saúde materno-infantil em três coortes de base populacional no Sul do Brasil, 1982-2004

This study aimed to describe indicators of health care assistance during antenatal care, delivery and in the first year of life in Pelotas, Rio Grande do Sul State, Brazil. In 1982, 1993, and 2004, all hospital newborns from the urban area of Pelotas were enrolled in a cohort study. In this period, the number of pregnant women that did not attend antenatal care fell from 4.9 percent to 1.9 percent; the mean number of appointments increased from 6.7 to 8.1; and the number of women who began antenatal care in the third trimester of pregnancy decreased from 14.8 percent to 7 percent; caesarean sections increased from 27.7 percent to 45.2 percent and the proportion of deliveries assisted by physicians increased from 61.2 percent to 89.2 percent. Improvements in immunization rates during the first year of life mainly occurred between 1982 and 1993, while the number of preventive medical appointments improved among those born in 2004. This increase in coverage was greater for low-income mothers and children, which may reflect the implementation of universal coverage in Brazil; however, coverage levels in 1982 were already high for wealthy mothers and children, reducing the scope for further gains.

Este estudo teve como objetivo descrever os indicadores de atenção à saúde durante o pré-natal, parto e primeiro ano de vida em Pelotas, Rio Grande do Sul. Em 1982, 1993, e 2004, todas as crianças que nasceram em hospitais na área urbana de Pelotas foram incluídas num estudo de coorte. Durante o período, o número de mulheres que não receberam atendimento pré-natal diminuiu de 4,9 por cento para 1,9 por cento; o número médio de consultas de pré-natal aumentou de 6,7 para 8,1; a proporção de gestantes que iniciaram o pré-natal no terceiro trimestre da gravidez diminuiu de 14,8 por cento para 7 por cento; a taxa de cesarianas aumentou de 27,7 por cento para 45,2 por cento e a proporção de partos assistidos por médicos aumentou de 61,2 por cento para 89,2 por cento. No primeiro ano de vida, as taxas de imunização melhoraram principalmente entre 1982 e 1993, enquanto o número de consultas médicas preventivas melhorou na coorte de 2004. Esse aumento de cobertura foi maior entre mães e crianças de baixa renda, o que pode refletir a implementação de cobertura universal no Brasil; entretanto, em 1982 a cobertura já era alta para mães e crianças de renda mais alta, reduzindo assim os espaço para ganhos adicionais nessa faixa de renda.

Maternal-child health in Pelotas, Rio Grande do Sul State, Brazil: major conclusions from comparisons of the 1982, 1993, and 2004 birth cohorts / Saúde materno-infantil em Pelotas, Rio Grande do Sul, Brasil: principais conclusões das comparações de coortes de nascimento de 1982, 1993 e 2004

Important changes were observed in maternal characteristics, health care indicators, and child health during the 22 years covered by the three population-based birth cohort studies conducted in the city of Pelotas, Southern Brazil. Maternal education levels improved, cigarette smoking during pregnancy was reduced, and birth intervals became longer. Also, there were more single mothers, and maternal obesity increased. Coverage of antenatal and delivery care by professionals improved, but inductions and caesarean sections increased markedly, the latter accounting for 45 percent of deliveries in 2004. With regard to child health, the reductions in neonatal and infant mortality rates were modest, and the significant increase in preterm births - 14.7 percent of all births in 2004 - appears to have colluded with this stagnation. Other infant health indicators, such as immunization coverage and breastfeeding duration, showed improvements over the period. Regarding infant nutrition, malnourishment at age 12 months decreased, but the prevalence of overweight was higher in 2004. The existence of three population-based birth cohorts using comparable methodology allowed for the study of important secular trends in maternal and child health.

Foram observadas mudanças importantes nas características maternas, de assistência à saúde e de saúde infantil ao longo dos 22 anos cobertos pelas três coortes de base populacional na cidade de Pelotas, Rio Grande do Sul. Melhorou o nível de escolaridade materna, houve uma redução no tabagismo durante a gravidez e aumentou o espaçamento entre filhos. Além disso, havia mais mães solteiras e aumentou a obesidade materna. Melhoraram a cobertura pré-natal e assistência ao parto por profissionais, mas houve um aumento marcante nos partos induzidos e nas cesarianas, que representaram 45 por cento do total de partos em 2004. Com relação à saúde infantil, houve uma redução apenas modesta nas taxas de mortalidade neonatal e infantil, e o aumento significativo nos partos prematuros (14,7 por cento de todos os nascimentos em 2004) parece haver contribuído para essa estagnação. Outros indicadores de saúde infantil, como cobertura de imunização e duração do aleitamento materno, melhoraram durante o período. Em relação à nutrição infantil, a desnutrição aos 12 meses de idade diminuiu, mas a prevalência de sobrepeso foi maior em 2004. A existência de três coortes de nascimento de base populacional utilizando metodologias comparáveis permitiu o estudo de importantes tendências seculares na saúde materno-infantil.

Em busca da eficiência: visibilidade internacional da produção científica dos programas brasileiros de pós-graduação em saúde infantil e do adolescente entre 1998 e 2003 / Pursuing efficiency: international visibility of the scientific production of Brazilian graduate programs in child and adolescent health from 1998 through 2003

OBJETIVO:Avaliar a tendência do número de publicações oriundos dos programas de pós-graduação brasileiros em saúde da criança e do adolescente e a proporção de citações desses artigos no MEDLINE e no Journal Citation Reports (JCR), utilizando a primeira base de dados como medida de eficiência e a última como indicador de visibilidade. MÉTODOS: Avaliamos 14 programas de pós-graduação quanto ao número de teses, dissertações e artigos citados no MEDLINE e JCR, através de dados secundários das duas últimas avaliações trienais realizadas pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), de 1998 até 2000 e de 2001 até 2003. RESULTADOS:O número de artigos publicados aumentou (de 1.520 para 1.917), bem como o número mediano de artigos citados tanto no MEDLINE (de 32,5 para 45) como no JCR (de 24,5 para 27). O número mediano de dissertações aumentou de 19,5 para 26,5; o número mediano de teses cresceu de 12 para 13,5. O número mediano de orientadores diminuiu (de 21,5 para 18,4). CONCLUSÃO: Os programas de pós-graduação em saúde infantil e do adolescente tornaram-se mais eficientes quanto à produção de conhecimento através da publicação de mais artigos com maior visibilidade internacional. Tal tendência foi acompanhada contraditoriamente pela redução no número de orientadores.

OBJECTIVE:To assess the trend in the number of published articles by Brazilian graduate programs in child and adolescent health and the proportion of such publications cited in MEDLINE and Thomson Scientific's Journal Citation Reports (JCR), using the former database as a proxy for efficiency and the latter as an indicator of visibility. METHODS: We assessed the trends of 14 graduate programs concerning the number of theses, dissertations, and articles cited in MEDLINE and JCR, through secondary data from the latest two triennial evaluations carried out by the Brazilian Federal Agency for the Improvement of Higher Education (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES) between 1998 and 2000 and between 2001 and 2003). RESULTS:The number of published articles increased (1,520 to 1,917), as did the median number of articles cited both in MEDLINE (32.5 to 45) and in JCR (24.5 to 27). The median number of dissertations rose from 19.5 to 26.5; the median number of theses went up from 12 to 13.5. The median number of faculty advisors decreased (21.5 to 18.4). CONCLUSION: Graduate programs in child and adolescent health became more efficient in producing knowledge through the publication of more articles with broader international visibility. Such trend was contradictorily accompanied by a diminishing number of advisors.

Basic indicators of child health in an urban area in southern Brazil: estimating prevalence rates and evaluating differentials

OBJETIVO: Avaliar e comparar indicadores básicos de saúde infantil entre menores de 5 anos residentes na área urbana do município de Rio Grande (RS) em 1995 e 2004. MÉTODOS: Foram realizados dois estudos transversais de base populacional nessa cidade. Entrevistadores previamente treinados aplicaram questionários padronizados em domicílios com crianças menores de 5 anos. Foram investigados: renda familiar, escolaridade materna, tipo de construção da moradia, disponibilidade de sanitário, água encanada, rede de esgotos e eletrodomésticos. Sobre as crianças, investigou-se número de consultas e idade de início do pré-natal, tipo e atendimento ao parto, padrão de amamentação e dieta, morbidade e utilização de serviços de saúde. As crianças foram pesadas e medidas para altura/comprimento. A comparação de freqüências nos dois estudos foi feita através do teste do qui-quadrado. RESULTADOS: Foram estudadas 395 crianças em 1995 e 384 em 2004. Nesse período, houve melhorias no tipo de construção de moradia, na presença de sanitário com descarga, na disponibilidade de água encanada e no padrão e duração da amamentação. A ocorrência de diarréia diminuiu, enquanto as taxas de cobertura vacinal básica, monitoração do crescimento, posse do cartão de saúde e de notificação do peso ao nascer aumentaram. Houve piora no poder aquisitivo das famílias e no número médio de consultas pré-natais realizadas. A prevalência de obesidade infantil aumentou em 92 por cento, enquanto a ocorrência de desnutrição praticamente não se modificou. CONCLUSÕES: A comparação dos indicadores de saúde no período entre os dois estudos mostrou, além de melhorias na maioria dos indicadores avaliados, substancial aumento na prevalência de obesidade infantil.

OBJECTIVE: To evaluate and compare basic indicators of the health of children under 5 years old in the urban area of Rio Grande, RS, Brazil, for 1995 and 2004. METHODS: Two cross-sectional population studies were carried out in the city. Interviewers were previously trained and applied standardized questionnaires during visits to families with children under 5 years old. The following variables were investigated: family income, maternal education, type of construction of home (wooden/masonry etc.), availability of toilet, running water, sewage system and domestic appliances. Data collected on the children themselves included number of antenatal consultations and age at first antenatal, type of delivery and medical care received during delivery, breastfeeding and dietary patterns, morbidity and health services utilization. Children were weighed and measured for height/length. Comparisons of frequencies between the two datasets were made using the chi-square test. RESULTS: In 1995, 395 children were studied and in 2004 there were 384. During the intervening period improvements had taken place in type of construction, number of homes with flush toilet, the availability of running water and in breastfeeding pattern and duration. The frequency of diarrhea reduced, while rates of basic vaccination coverage, growth monitoring, patients in possession of their own medical cards and reporting of birth weights all increased. There was a deterioration in families' purchasing power and in the mean number of antenatal consultations. The prevalence of childhood obesity increased by 92 percent, while the incidence of malnutrition remained practically unchanged. CONCLUSIONS: Comparing health indicators from the two periods revealed that, in addition to improvements in the majority of the indicators assessed, there had been a substantial increase in the prevalence of childhood obesity.

HIV and conflict in Nepal: relation and strategy for response.

Conflict and displacement make affected population more vulnerable to HIV infection. Refugees and internally displaced persons, in particular women and children, are at increased risk of exposure to HIV. In Nepal, there is considerable increase in the number of HIV infection since 1996 when conflict started. Along with poverty, stigma and lack of awareness, conflict related displacement, economic migration, and closure of HIV programmes have exacerbated the HIV situation in Nepal. Government has established "National AIDS Council" and launched HIV/AIDS Strategy. The strategy has not included the specific needs of displaced persons. While launching an HIV prevention programme in the conflict situation, the guidelines developed by Inter Agency Standing Committee (IASS) are important tools. This led to suggestion of an approach with implementations steps in the case of Nepal in this report.

Quem são as crianças que se sentem gordas apesar de terem peso adequado? / Who are the children with adequate weight who feel fat?

OBJETIVO: Investigar a prevalência de crianças com peso adequado que se sentem gordas e os fatores associados a essa percepção. METODOLOGIA: Estudo transversal com 901 escolares, entre 8 e 11 anos, selecionados por conglomerados. As crianças tiveram peso e altura aferidos e responderam um questionário com escala de auto-estima, autopercepção do peso e percepção da expectativa dos pais e amigos em relação a seu peso. RESULTADOS: A prevalência de escolares com percentil do índice de massa corporal (IMC) < 85 que se sentem gordos foi 13 por cento, e as variáveis significativamente associadas a essa percepção foram sexo feminino (RC = 2,45; IC95 por cento 1,42-4,24), ter 11 anos de idade (RC = 2,35; IC95 por cento 1,13-4,89), quartil inferior de auto-estima (RC = 2,08; IC95 por cento 1,17-3,68), percepção de que os pais gostariam que eles fossem mais magros (RC = 3,00; IC95 por cento 1,52-5,91) e percentil do IMC (RC = 1,04; IC95 por cento 1,03-1,06). CONCLUSÃO: A percepção de ser gordo, mesmo com peso adequado, atinge crianças antes da adolescência, em especial meninas de 11 anos de idade, com maior IMC, menor auto-estima e que pensam que seus pais gostariam que fossem mais magras. São necessários mais estudos que aprofundem as causas e conseqüências desse comportamento.

Detección de hipertensión arterial en niños en edad escolar / Detection of arterial hypertension in school childrens

INTRODUCCIÓN: La Hipertensión Arterial (HTA) es un padecimiento multifactorial, con incidencia y prevalencia crecientes, por lo que se considera un problema de salud pública. OBJETIVOS: Conocer la prevalencia de HTA en niños de 6 a 12 años, en la ciudad de Cipolletti. Comprobar si existen diferencias en cuanto a sexo y edad. Institucionalizar la toma de Tensión Arterial (TA) como parte del examen físico de rutina en el control del niño. MATERIAL Y MÉTODOS: El estudio fue de tipo corte transversal, a partir de una muestra de 1038 alumnos con edades comprendidas entre 6 y 12 años, pertenecientes a 7 establecimientos públicos de la ciudad de Cipolletti. Se utilizó esfingomanómetro mercurial y brazaletes de 7.5 x 15 cm. y de 12 x 22 cm.. Se empleó el método auscultatorio en fase 1 y V de Korotkoff. Se siguieron las recomendaciones de la Second Task Force for Blood Pressure in Children. La toma de la TA se realizó en tres visitas, en cada una de ellas se identificó aquellos alumnos que se encontraban en valores iguales o mayores a los establecidos para hipertensión: Niños:115/75 mmHg (6-8 años); 118/79 mmHg(9-1O) y 122/80 mmHg (11-12). Niñas: 113/74 mmHg (6-8 años); 118/77 mmHg (9-10) y 122/79 mmHg (1112). RESULTADOS: La prevalencia HTA es del 3.37%. Siendo más frecuente en el rango de edades comprendidas entre los 6 y 8 años, correspondiendo a un 74.29% de los hipertensos. Las medias de TA para el grupo de hipertensos son: a) varones: 122.92 mmHg:!:: 4.1l/78.43 mmHg:!:: 5.19; b) mujeres: 123.63 mmHg :!:: 7.43/ 80.22 mmHg :!:: 2. No existen diferencias significativas al nivel del 5% (á = 0.05) entre sexos. A 597 (58%) estudiantes nunca se les había tomado la tensión arterial. CONCLUSIONES: La prevalencia de HTA en Cipolletti es similar a las estadísticas internacionales. Hay un número de niños hipertensos que no se detectan en la consulta debido a la falta de institucionalización de la toma de la tensión arterial.

INTRODUCTION: Hypertension is a multifactorial disease, with increasingly incidence and prevalence, that is why it is considered a public health issue. OBJECTNES: To know the prevalence of hypertension in children from 6 to 12 years old, in Cipolletti city. To check if there are differences as regards sex and age. To institutionalizalice blood pressure measurement as part of the rutinary physical examination in the control of a child. METHODS AND MATERlALS: This was a cross sectional study. Blood pressure readings were obtained from 1038 students aged between 6 and 12 years old; who belong to 7 public schools of Cipolletti. Mercury sphyngomanometer and cuffs of 7.5 per 15 cm and 12 per 22 cm were used. The auscultatory method was used in phase 1 and V of Korotkoff. The second Task Force recommendations for blood pressure in children were followed. Blood pressure readings were obtained in 3 visits. Those students who had blood pressure measurement iqual to or higher than those established for hypertension were identified during each visit: boys 115/ 75 mmHg (6-8 years) 118/79 mmHg (9-10 years) and 122/80 mmHg (11-12 years) ; girls 113/74 mmHg ( 6-8 years) 118/79 mmHg ( 9-10 years) and 122/79 mmHg (11-12). RESULTS: The prevalence of hypertension is 3.37%, being more frequent in the range of ages that go from between 6 to 8 years, which corresponds to a 74.29% of the hypertensed children. The hypertense group measurements of blood pressure are: a)Boys: 122.92 mmHg :!: 4.11/78.43mmHg :!: 5.19; b)Girls: 123.63 mmHg:!: 7.43/80.22mmHg:!: 2. There were not significant differences between sexes at the 5% (a=0.05) level!. The blood pressure has never been measurered to 597 students (58%). CONCLUTIONS: The prevalence of hypertension in Cipolletti is similar to international statistics. There is a number of children with hypertension that is not detected during medical examination due to lack of blood pressure measurement institutionalization.

Risk factors for diarrhoea and upper respiratory tract infections among children in a rural area of Uganda.

This study explored risk factors associated with diarrhoea and upper respiratory tract infections (URTIs) among children in Sembabule district, Uganda. Data were collected from 300 women with children aged less than two years using the WHO 30-cluster sampling technique. The prevalence of diarrhoea among children was 40.3%. A child not immunized (odds ratio [OR] 2.8, p < 0.001), absence of latrine in a house (OR 1.4, p < 0.03), low knowledge of mixing oral rehydration salts (OR 1.7, p < 0.01), garbage thrown anywhere around the house (OR 2.6, p < 0.001), not washing hands after using latrine (OR 1.8, p < 0.03), and not washing hands before preparing food (OR 1.4, p < 0.04) were risk factors for diarrhoea. The prevalence of URTIs among children was 37.4%. A child not immunized (OR 2.4, p < 0.001), children aged 6-11 months (OR 2.1, p < 0.03), and previous episode of diarrhoea (OR 2.5, p < 0.001) were risk factors for URTIs. The results showed that low immunization status was an important risk factor for diarrhoea and URTIs among children in the study district of Uganda. For 75% of the children, care for fever was obtained from drug shops, while 9.2% were taken to health units. This is in contrast to diarrhoea cases where 49.5% of children were taken to health units for care. To reduce the burden of disease among children in this district, an integrated package of immunization services and other childcare programmes need to be implemented in addition to improved personal and environmental hygiene. There is also a need to design well-focused health-education messages to improve treatment-seeking behaviour for childhood diseases.