Undernutrition and short duration of breastfeeding association with child development: a population-based study

Abstract Objective: To explore the relationship of undernutrition and the short duration of breastfeeding with child development of children 0-66 months of age residing in Ceará, Brazil. Methods: The authors of the present study utilized population-based data from children enrolled in the Study on Maternal and Child Health in Ceará, Brazi (PESMIC). Children's development was assessed with the Ages and Stages Questionnaire third version, validated in Brazil. Undernutrition was accessed through anthropometric measures obtained by trained staff. Breastfeeding information was obtained through the mothers' report and confirmed in the child's governmental booklet. The authors used logistic regressions adjusted for sample clusters used in PESMIC design in a theoretical model for known determinants of child development following the World Health Organization nurturing framework. Results: A total of 3,566 children were enrolled in the sixth PESMIC study and had their development assessed. The authors found that 8.2%, 3.0%, 2.1%, and 3.6% of children were stunted, underweight, or wasted, at the time of the interview, respectively. All studied factors were associated with a higher prevalence of child development impairment in at least one of the assessed domains. Underweight was the factor with the strongest effect, with an adjusted odds ratio (AOR) of 4,14 (2,26-7,58), p < 0.001. Breastfeeding for up to two months compared to more than six months (AOR2,08 (1,38-3,12)) was also associated. Conclusions: The authors found that undernutrition and short duration of breastfeeding are associated with development outcomes among Brazilian children. As a result, integrated nutritional programs may improve child development outcomes.

Birth in Brazil: national survey into labour and birth.

BACKGROUND: Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. METHODS: Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients' medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson's groups). Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. DISCUSSION: This study, for the first time, depicts a national panorama of labour and birth outcomes in Brazil. Regardless of the socioeconomic level, demand for Caesarean section appears to be based on the belief that the quality of obstetric care is closely associated to the technology used in labour and birth. Within this context, it was justified to conduct a nationwide study to understand the reasons that lead pregnant women to submit to Caesarean sections and to verify any association between this type of birth and it's consequences on postnatal health.

Impact of IMCI health worker training on routinely collected child health indicators in Northeast Brazil.

The Integrated Management of Childhood Illness (IMCI) is a global strategy including improvements in case management at health facilities, strengthening health systems support and improving key family and community practices relevant to child health. In Brazil, IMCI was introduced in 1997, being largely restricted to training health workers in case management. IMCI training of doctors and nurses took place in many municipalities, but implementation of the other two components of IMCI was very limited. We analyze the impact of IMCI health worker training on infant mortality in three states in north-eastern Brazil, by comparing three groups of municipalities over the period 1999 to 2002: 23 with training coverage of 50% or greater, 216 with lower training coverage, and 204 without any IMCI training. Two sources of mortality data are used: vital registration of deaths and births, and the community health workers' (CHW) demographic surveillance system. The latter resulted in a larger number of deaths being reported and in more stable mortality rates over time than the former. Infant mortality rates (IMR) declined rapidly according to both sources of information, during the study period. After adjustment for confounding factors, there was no association between IMCI training coverage and infant mortality measured through either information system. According to the CHW data, the adjusted annual changes were of -7.2 deaths per 1,000 births in the high IMCI training coverage group, -4.6 in the low IMCI training coverage and -5.0 in the no IMCI group (p=0.46). According to vital statistics, the corresponding average annual changes were -5.0, -4.2 and -2.8 deaths per 1,000 births (p=0.16). The negative findings from the Brazil evaluation suggest that IMCI clinical training, in the absence of the other two components of IMCI, and in an area with infant mortality under 50 per 1,000, is unlikely to lead to a measurable impact on mortality.

[Recurrent pneumonia in a pediatric pulmonology outpatient unit: concept and prevalence] / Pneumonias de repetição em ambulatório de pneumologia pediátrica: conceito e prevalência.

OBJECTIVE: This study aimed to determine the prevalence of recurrent episodes of pneumonia in patients referred to the pulmonology outpatient unit at "Serviço de Pneumologia Pediatrica" of the Instituto de Puericultura e Pediatria Martagão Gesteira/UFRJ and to review the recurrent concept in accordance to medical references currently available. METHODS: Data were obtained by reviewing all documented initial appointments from January 1st, 1995 up to April 30th, 1997. RESULTS: One hundred and one visits out of six hundred and thirty eight appointments with suspected diagnosis of recurrent episodes of pneumonia were studied. In less than 40% of this population the initial diagnosis was in accordance with the criteria usually required in our unit to perform such diagnosis. CONCLUSIONS: We concluded that the recurrent nature of pneumonia episodes should be further clarified and discussed with pediatricians because it is up to them to refer such patients to specialists. Furthermore we emphasize the importance of normal chest roentgenograms taken between acute episodes so that "recurrent pneumonia" can be adequately characterized. This may help identify those patients who need subsequent evaluation by specialists regarding complementary diagnosis.