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Background: Multi-dimensional monitoring evaluation and learning strategies are needed to address the complex set of factors that affect early child development in marginalized populations, but few studies have explored their effectiveness. Objective: To compare improvement of health and development of children 0-3 years between intervention communities (IC) and control communities (CC) from peripheral settlements of Lima. Sequential interventions included: (1) home and community gardens, (2) conscious nutrition, and (3) parenting workshops following the International Child Development Program (ICDP). Methods: Interventions were delivered by community health promoters (CHPs) using a "step-by-step" learning system. Both IC and CC were monitored before the interventions began, at 8 and 12 months (n = 113 IC and 127 CC children). Data were collected on household characteristics, diet, food security, health indicators (history of diarrhea and respiratory infections, hemoglobin, intestinal parasites, anthropometry), caregiver-child interactions and stress, and achievement of Pan-American Health Organization age-specific developmental milestones. Stepwise multiple logistic regressions were used to determine if the interventions affected food insecurity, as well as motor, social/cognitive and language delays. Results: At baseline, 2.6% were categorized as "suspected developmental delay" and 14.2% were on "alert for development delay." Food insecurity, diarrhea and respiratory infections were lowered following the interventions. Through the "step-by-step" approach, caregivers in IC gained skills in gardening, conscious nutrition and parenting that reduced the risk of food insecurity [Adjusted Risk Ratio = 0.20 (95% CI: 0.08-0.51)] and language delay [0.39 (0.19-0.82)] but not motor or social/cognitive delay. Use of a multiple micronutrient supplement decreased the risk of motor delay [0.12 (0.03-0.56)], but more pets were associated with higher risk of motor [3.24 (1.47-7.14)] and social/cognitive delay [2.72 (1.33-5.55)], and of food insecurity [1.73 (1.13-2.66)]. Conclusion: The combined interventions delivered by CHPs helped to mitigate the impact of adversity on food insecurity and language delay. Additional improvements may have been detected if the interventions had continued for a longer time. Our results indicate that control of infections and pets may be needed to achieve measurable results for motor and social/cognitive development. Continuous monitoring facilitated adjusting implementation strategies and achieving positive developmental outcomes.
Assuntos
Cuidadores , Desenvolvimento Infantil , Criança , Jardinagem , Jardins , Humanos , Peru/epidemiologia , Populações VulneráveisRESUMO
Introduction: Anemia is a condition in which there is a low concentration of hemoglobin (Hb) levels. Although many causes of anemia have been identified, there are few studies in which they are related to epidemiological factors in the first months of life. Objective: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Methods: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Results: 61.4% of the infants were women, and only 6.7% of the proportion of the studied population was less than 1 month old. 6.7% had a low birth weight, and 53.2% had a normal delivery. The level of anemia in hospitalized children under 6 months of age is 66.7%. Conclusions: The factors associated with hemoglobin levels were age, nutritional status, weight for length, and hospital causes. Likewise, an association was found between age and the median Hb in boys and girls aged 0 to 5 months.
Introducción: La anemia es una condición en la cual hay una baja concentración de los niveles de hemoglobina (Hb). Si bien se ha identificado muchas causas de la anemia, existen pocos estudios en los cuales se relacionan con factores epidemiológicos en los primeros meses de vida. Objetivo: Determinar los factores asociados a los niveles de hemoglobina en niños menores de 6 meses de edad hospitalizados en un centro pediátrico especializado de Perú. Métodos: Estudio analítico, transversal en niños menores de 6 meses de edad hospitalizados en los servicios de medicina de un centro pediátrico durante el año 2017, se revisaron 267 historias clínicas dándose énfasis en características clínicas y epidemiológicas. Resultados: El 61,4% de los lactantes eran mujeres, y solo un 6,7% de la proporción de la población estudiada presentaba menos de 1 mes. El 6,7% tuvieron baso peso al nacer, y el 53,2% tuvo un parto eutócico. El nivel de anemia en niños menores de 6 meses de edad hospitalizados es del 66,7%. Conclusion: Los factores asociados a los niveles de hemoglobina fueron edad, estado nutricional de peso para la longitud y causas hospitalarias. Asimismo, se encontró asociación entre la edad con la mediana de Hb en los niños y niñas de 0 a 5 meses.
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Los antibióticos ß-lactámicos son los más utilizados, dada su eficacia para patógenos bacterianos comunes y su precio relativamente bajo. Para evaluar la sensibilización a los alérgenos mayores y menores de la penicilina en pacientes que padecen enfermedades alérgicas, se realizó un estudio observacional analítico de casos y controles, en el universo de 458 individuos derivados al Servicio de Alergia Previsora (Camagüey, Cuba), desde enero del 2010 hasta noviembre del 2016. Se seleccionó una muestra de 178 niños y adultos con el diagnóstico de asma, rinitis y urticaria de las edades 6 a 60 años. Los que tenían antecedentes, no confirmados, de alergia a penicilinas se consideraron casos (n=60) y los que no tenían el antecedente controles (n=118). Toda la muestra tenía pruebas de Prick positivas a uno o más de los ácaros domésticos Dermatophagoides pteronysinus, Dermatophagoides siboney y Blomia tropicalis, así como a algún alimento. Un grupo de ellos también resultaron positivos a PPL y MD. Se distribuyeron los pacientes en sensibilizados o no con los alérgenos PPL y MD. La prevalencia general de alergia a las penicilinas fue de 24,15 por ciento (15,7 por ciento en los casos y 8,9 por ciento en los controles). La prueba DAP® - Penicilinas mostró mayor número de positivos en los casos que en los controles (p=0,037, OR=5,21). Del total de alérgicos a las penicilinas, el mayor número de pacientes correspondieron al sexo femenino (p=0,031). El test cutáneo con alérgenos PPL y MD puede confirmar el diagnóstico de alergia a penicilinas en pacientes atópicos(AU)
ß-lactam antibiotics are the most widely used, given their efficacy for common bacterial pathogens and their relatively low price. To evaluate sensitization to major and minor allergens of penicillin in patients suffering from allergic diseases, an observational, analytical study of cases and controls was carried out in the universe of 458 individuals referred to the Previsora Allergy Service (Camagüey, Cuba) from January 2010 to November 2016. A sample of 178 children and adults aged 6 to 60 years diagnosed with asthma, rhinitis and urticarial was selected. Those who had a medical history, not confirmed, of allergy to penicillins were considered cases (n=60) and those who did not have the antecedent were the controls (n=118). All the sample had positive Prick tests to one or more of the house mites Dermatophagoides pteronysinus, Dermatophagoides siboney and Blomia tropicalis, as well as against some foods. Some individuals were also positive for PPL and MD. Patients were distributed in sensitized or not with the allergens PPL and MD. The general prevalence of allergy to penicillins was 24.15 percent (15.7 percent in cases and 8.9 percent in controls). The DAP® - Penicillins test showed a greater number of positives in cases than in controls (p=0.037; OR=5.21). The largest number of patients allergic to penicillins corresponded to the female sex (p=0.031). The skin test with allergens PPL and MD can confirm the diagnosis of allergy to penicillins in atopic patients(AU)