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1.
Asunción; s.n; Nov 2019. (1-67) p.
Tesis en Español | LILACS, BDNPAR | ID: biblio-1021733

RESUMEN

La infancia es considerada como una etapa trascendental en el proceso evolutivo del hombre, caracterizada por dos fenómenos: crecimiento y desarrollo, por tanto es fundamental una adecuada nutrición. Con relación a este aspecto, el programa de complementación nutricional denominado PANI (Programa Ampliado Nutricional Integral), se implementa, para garantizar la atención oportuna de niños desnutridos y en riesgo de desnutrición y evitar otros factores de riesgo que puedan poner en peligro a esta población vulnerable. Objetivo: Analizar el impacto de la implementación del programa PANI en niños menores de 5 años desnutridos y con riesgo de desnutrición en la Unidad de Salud Familiar ItáKa´aguy, durante el periodo 2015 a 2017. Metodología: Se realizó un estudio descriptivo, retrospectivo, transversal, en donde se evaluó a 74 niños menores de 5 años desnutridos y con riesgos de desnutrición, que fueron atendidos en la Unidad de Salud Familiar ItáKa´aguy, (Fernando de la Mora, XIa Región Sanitaria - Central). Se implementó con ellos el Programa de Asistencia Nutricional y luego de 2 años se compararon los resultados de la evaluación inicial, con las actuales. Resultados: Se resalta que, previo a la intervención sólo 4 niños tuvieron un peso adecuado; 19 niños se encontraban en estado de desnutrición; 6 niños se encontraban en el nivel de peso no adecuado y 40 niños se encontraban en "Riesgo de desnutrición". Mientras que posterior a la implementación del programa, 62 niños obtuvieron el peso adecuado a su edad; 3 niños se mantuvieron con signos clínicos de desnutrición y 4 niños manifestaron riesgo de desnutrición. Conclusión: se encontró que el PANI ha contribuido a mejorar de la desnutrición en los niños y niñas, como en el peso acorde con la edad, pero no así en aspectos como talla y el edema, por lo que se concluye que el impacto ha sido medio. Palabras Clave: Nutrición de los Grupos de Riesgo, Programas y Políticas de Nutrición y Alimentación,


The childhood is considered as a transcendental stage in the evolutionary process of man, characterized by two phenomena: growth and development, therefore proper nutrition is essential. In relation to this aspect, the nutritional complementation program called PANI (Comprehensive Nutritional Extended Program), is implemented to ensure timely care of malnourished children at risk of malnutrition and avoid other risk factors that may endanger this population vulnerable. Objective: To analyze the impact of the implementation of the PANI program in children under 5 years of age undernourished and at risk of malnutrition in the ItáKa'aguy Family Health Unit, during the period 2015 to 2017. Methodology: A descriptive, retrospective study was conducted, cross-sectional, in which 74 under-5 undernourished children with risk of malnutrition were evaluated, who were attended in the ItáKa'aguy Family Health Unit (Fernando de la Mora, XIa Sanitary - Central Region). The Nutritional Assistance Program was implemented with them and after 2 years the results of the initial evaluation were compared with the current ones. Results: It is highlighted that, prior to the intervention, only 4 children had an adequate weight, 19 children were in malnutrition, 6 children were at the unsuitable weight level and 40 children were at risk of malnutrition; while after the implementation of the program, 62 children obtained the appropriate weight at their age, 3 children remained with clinical signs of malnutrition and 4 children showed risk of malnutrition. Conclusion: it was found that PANI has contributed to improve malnutrition in boys and girls, as in weight according to age, but not in aspects such as height and edema, so it is concluded that the impact has been medium.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Programas de Nutrición , Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Políticas Públicas de Salud , Paraguay/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos , Estudios Transversales , Estudios Retrospectivos , Factores de Riesgo , Nutrición del Niño , Nutrición del Lactante , Clasificación Internacional de la Atención Primaria
2.
PLoS Med ; 16(8): e1002877, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31454347

RESUMEN

BACKGROUND: Community management of acute malnutrition (CMAM) is a highly efficacious approach for treating acute malnutrition (AM) in children who would otherwise be at significantly increased risk of mortality. In program settings, however, CMAM's effectiveness is limited because of low screening coverage of AM, in part because of the lack of perceived benefits for caregivers. In Burkina Faso, monthly screening for AM of children <2 years of age is conducted during well-baby consultations (consultation du nourrisson sain [CNS]) at health centers. We hypothesized that the integration of a preventive package including age-appropriate behavior change communication (BCC) on nutrition, health, and hygiene practices and a monthly supply of small-quantity lipid-based nutrient supplements (SQ-LNSs) to the monthly screening would increase AM screening and treatment coverage and decrease the incidence and prevalence of AM. METHODS AND FINDINGS: We used a cluster-randomized controlled trial and allocated 16 health centers to the intervention group and 16 to a comparison group. Both groups had access to standard CMAM and CNS services; caregivers in the intervention group also received age-appropriate monthly BCC and SQ-LNS for children >6 months of age. We used two study designs: (1) a repeated cross-sectional study of children 0-17 months old (n = 2,318 and 2,317 at baseline and endline 2 years later) to assess impacts on AM screening coverage, treatment coverage, and prevalence; (2) a longitudinal study of 2,113 children enrolled soon after birth and followed up monthly for 18 months to assess impacts on AM screening coverage, treatment coverage, and incidence. Data were analyzed as intent to treat. Level of significance for primary outcomes was α = 0.016 after adjustment for multiple testing. Children's average age was 8.8 ± 4.9 months in the intervention group and 8.9 ± 5.0 months in the comparison group at baseline and, respectively, 0.66 ± 0.32 and 0.67 ± 0.33 months at enrollment in the longitudinal study. Relative to the comparison group, the intervention group had significantly higher monthly AM screening coverage (cross-sectional study: +18 percentage points [pp], 95% CI 10-26, P < 0.001; longitudinal study: +23 pp, 95% CI 17-29, P < 0.001). There were no impacts on either AM treatment coverage (cross-sectional study: +8.0 pp, 95% CI 0.09-16, P = 0.047; longitudinal study: +7.7 pp, 95% CI -1.2 to 17, P = 0.090), AM incidence (longitudinal study: incidence rate ratio = 0.98, 95% CI 0.75-1.3, P = 0.88), or AM prevalence (cross-sectional study: -0.46 pp, 95% CI -4.4 to 3.5, P = 0.82). A study limitation is the referral of AM cases (for ethical reasons) by study enumerators as part of the monthly measurement in the longitudinal study that may have attenuated the detectable impact on AM treatment coverage. CONCLUSIONS: Adding a preventive package to CMAM delivered at health facilities in Burkina Faso increased participation in monthly AM screening, thus overcoming a major impediment to CMAM effectiveness. The lack of impact on AM treatment coverage and on AM prevalence and incidence calls for research to address the remaining barriers to uptake of preventive and treatment services at the health center and to identify and test complementary approaches to bring integrated preventive and CMAM services closer to the community while ensuring high-quality implementation and service delivery. TRIAL REGISTRATION: ClinicalTrials.gov NCT02245152.


Asunto(s)
Servicios de Salud del Niño , Trastornos de la Nutrición del Lactante/prevención & control , Burkina Faso/epidemiología , Estudios Transversales , Humanos , Incidencia , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Trastornos de la Nutrición del Lactante/epidemiología , Recién Nacido , Estudios Longitudinales , Masculino , Tamizaje Masivo
3.
PLoS Med ; 16(8): e1002892, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31454356

RESUMEN

BACKGROUND: Community-based management of acute malnutrition (CMAM) has been widely adopted to treat childhood acute malnutrition (AM), but its effectiveness in program settings is often limited by implementation constraints, low screening coverage, and poor treatment uptake and adherence. This study addresses the problem of low screening coverage by testing the impact of distributing small-quantity lipid-based nutrient supplements (SQ-LNSs) at monthly screenings held by community health volunteers (CHVs). Screening sessions included behavior change communication (BCC) on nutrition, health, and hygiene practices (both study arms) and SQ-LNSs (one study arm). Impact was assessed on AM screening and treatment coverage and on AM incidence and prevalence. METHODS AND FINDINGS: A two-arm cluster-randomized controlled trial in 48 health center catchment areas in the Bla and San health districts in Mali was conducted from February 2015 to April 2017. In both arms, CHVs led monthly AM screenings in children 6-23 months of age and provided BCC to caregivers. The intervention arm also received a monthly supply of SQ-LNSs to stimulate caregivers' participation and supplement children's diet. We used two study designs: i) a repeated cross-sectional study (n = approximately 2,300) with baseline and endline surveys to examine impacts on AM screening and treatment coverage and prevalence (primary study outcomes) and ii) a longitudinal study of children enrolled at 6 months of age (n = 1,132) and followed monthly for 18 months to assess impact on AM screening and treatment coverage and incidence (primary study outcomes). All analyses were done by intent to treat. The intervention significantly increased AM screening coverage (cross-sectional study: +40 percentage points [pp], 95% confidence interval [CI]: 32, 49, p < 0.001; longitudinal study: +28 pp, 95% CI: 23, 33, p < 0.001). No impact on treatment coverage or AM prevalence was found. Children in the intervention arm, however, were 29% (95% CI: 8, 46; p = 0.017) less likely to develop a first AM episode (incidence) and, compared to children in comparison arm, their overall risk of AM (longitudinal prevalence) was 30% (95% CI: 12, 44; p = 0.002) lower. The intervention lowered CMAM enrollment by 10 pp (95% CI: 1.9, 18; p = 0.016), an unintended negative impact likely due to CHVs handing out preventive SQ-LNSs to caregivers of AM children instead of referring them to the CMAM program. Study limitations were i) the referral of AM cases by our research team (for ethical reasons) during monthly measurements in the longitudinal study might have interfered with usual CMAM activities and ii) the outcomes presented by child age also reflect seasonal variations because of the closed cohort design. CONCLUSIONS: Incorporating SQ-LNSs into monthly community-level AM screenings and BCC sessions was highly effective at improving screening coverage and reducing AM incidence, but it did not improve AM prevalence or treatment coverage. Future evaluation and implementation research on CMAM should carefully assess and tackle the remaining barriers that prevent AM cases from being correctly diagnosed, referred, and adequately treated. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323815.


Asunto(s)
Suplementos Dietéticos , Trastornos de la Nutrición del Lactante/prevención & control , Enfermedad Aguda , Adulto , Servicios de Salud Comunitaria , Estudios Transversales , Composición Familiar , Femenino , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Estudios Longitudinales , Masculino , Malí , Tamizaje Masivo
4.
Glob Health Action ; 12(1): 1638020, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31333077

RESUMEN

Background: Delayed introduction of solid, semi-solid or soft foods (complementary feeding) and associated factors are related to stunting and severe stunting among children in many low- and middle-income countries. In India, however, there is limited evidence on the relationship between delayed complementary feeding and associated factors with stunting and severe stunting to advocate for policy interventions. Objectives: The present study investigated the relationship between delayed complementary feeding and associated factors with stunting and severe stunting among infants aged 6-8 months in India. Methods: Survey data on 13,548 infants aged 6-8 months were obtained from the 2015-16 National Family Health Survey in India. Logistic regression (Generalized Linear Latent and Mixed Models [GLLAMM] with a logit link and binomial family) models that adjusted for clustering and sampling weights were used to investigate the relationship between delayed complementary feeding and associated factors (community, household, maternal, child and health service factors) with stunting and severe stunting among infants aged 6-8 months in India. Results: The prevalence of stunting and severe stunting was 22.0% (95% CI: 21.0-23.7%) and 10.0% (95% CI: 9.0-11.0%) among infants aged 6-8 months who received no complementary foods, respectively. Delayed introduction of solid, semi-solid or soft foods was associated with stunting (adjusted Odd ratios [aOR] = 1.24, 95% CI: 1.09-1.41) and severe stunting (aOR = 1.21, 95% CI: 1.01-1.45) among infants aged 6-8 months. High maternal education (secondary or higher education) and household wealth (middle, richer and richest) were protective against stunting and severe stunting. Conclusion: Delayed introduction of complementary foods and associated factors were related to stunting and severe stunting among infants aged 6-8 months in India. Reducing the proportion of infants who are stunted in India would require comprehensive national nutrition policy actions that target the sub-population of mothers with no schooling and limited resources.


Asunto(s)
Trastornos de la Nutrición del Lactante/epidemiología , Fenómenos Fisiológicos Nutricionales del Lactante , Femenino , Alimentos , Encuestas Epidemiológicas , Humanos , India/epidemiología , Lactante , Modelos Logísticos , Masculino , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos
5.
Nutrients ; 11(6)2019 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-31238506

RESUMEN

Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.


Asunto(s)
Dieta , Trastornos de la Nutrición del Lactante/prevención & control , Fenómenos Fisiológicos Nutricionales del Lactante , Desnutrición/prevención & control , Estado Nutricional , Valor Nutritivo , Factores de Edad , Estudios Transversales , Encuestas sobre Dietas , Etiopía/epidemiología , Femenino , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/fisiopatología , Masculino , Desnutrición/epidemiología , Desnutrición/fisiopatología , Programación Lineal , Ingesta Diaria Recomendada , Factores de Riesgo
6.
S Afr Med J ; 109(5): 328-332, 2019 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-31131800

RESUMEN

BACKGROUND: Early-life exposure to excess sugar affects eating behaviour and creates a predisposition to non-communicable diseases (NCDs). While reducing sugar consumption has been high on the public health agenda, little is known about the sugar content of baby foods. OBJECTIVES: To describe and analyse the sugar content of baby foods in South Africa (SA). METHODS: A cross-sectional study was conducted to analyse the sugar content of baby foods. The study sample included commercially available baby foods targeted at children aged <12 months, sold in supermarkets and by other major retailers in SA. Primary data were obtained from the packaging, and sugar content was compared with recommended intake guidelines. Bivariate analyses were conducted to determine whether there were any associations between the sugar content, added sugar and the characteristics of foods. RESULTS: Over 70% of products were sweet in taste, with one in four containing added sugars. Sugar content was high in 78% of the foods sampled. Over 80% of cereals and pureed desserts contained added sugar. Fewer than 10% of pureed composite meal and pureed fruit and vege-table categories contained added sugar. Most products adhered to SA labelling standards, but none had front-of-pack nutritional information. CONCLUSIONS: The SA baby food market is characterised by products with a high sugar content, promoting an environment that encourages development of sweet-taste preferences and in the long term contributing to the rising burden of NCDs. There is an urgent need for mandatory regulation of sugar in baby foods.


Asunto(s)
Alimentos Infantiles/análisis , Trastornos de la Nutrición del Lactante/prevención & control , Estado Nutricional , Valor Nutritivo , Azúcares/análisis , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Masculino , Ingesta Diaria Recomendada , Estudios Retrospectivos , Sudáfrica
7.
Epidemiol Serv Saude ; 28(1): e2017507, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30970067

RESUMEN

OBJECTIVE: to verify how and when complementary feeding (CF) begins, its profile, consumption of processed foods and nutritional status of children aged 1-3 years. METHODS: children enrolled at public schools in Pelotas, RS, Brazil, were evaluated; length/height-for-age and weight-for-age scores, and body mass index (BMI)/age were used, and a structured questionnaire was administered to parents/caregivers; CF was considered early when started before the age of six months; data were presented in a descriptive way. RESULTS: 79 children were evaluated, of whom 13 were overweight and 6 obese; 11 had high weight-for-age; mean age for beginning CF was 5.3 months; when aged <6 months, 43% received gelatin, and 12.7% juice from cartons; when aged 6-24 months, 96.2% received filled biscuits and 91.1% salty snacks. CONCLUSION: CF and consumption of processed foods began early; obesity and overweight were more prevalent than malnutrition.


Asunto(s)
Conducta Alimentaria , Estado Nutricional , Sobrepeso/epidemiología , Obesidad Pediátrica/epidemiología , Factores de Edad , Índice de Masa Corporal , Peso Corporal , Brasil/epidemiología , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Femenino , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Fenómenos Fisiológicos Nutricionales del Lactante , Masculino , Prevalencia , Bocadillos
8.
PLoS One ; 14(2): e0211883, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30730946

RESUMEN

OBJECTIVE: The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria. METHODS: The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method. RESULTS: The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child's age (0-23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West). CONCLUSIONS: To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Factores Socioeconómicos , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Persona de Mediana Edad , Nigeria/epidemiología
9.
PLoS One ; 14(1): e0210982, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30682097

RESUMEN

BACKGROUND: In resource limited settings, there is variability in the level of adherence to clinical guidelines in the inpatient management of children with common conditions like severe anemia. However, there is limited data on the effect of adherence to clinical guidelines on inpatient mortality in children managed for severe anemia. METHODS: We analyzed data from an uncontrolled before and after in-service training intervention to improve quality of care in Lira and Jinja regional referral hospitals in Uganda. Inpatient records of children aged 0 to 5 years managed as cases of 'severe anemia (SA)' were reviewed to ascertain adherence to clinical guidelines and compare inpatient deaths in SA children managed versus those not managed according to clinical guidelines. Logistic regression analysis was conducted to evaluate the relationship between clinical care factors and inpatient deaths amongst patients managed for SA. RESULTS: A total of 1,131 children were assigned a clinical diagnosis of 'severe anemia' in the two hospitals. There was improvement in the level of care after the in-service training intervention with more children being managed according to clinical guidelines compared to the period before, 218/510 (42.7%) vs 158/621 (25.4%) (p < 0.001). Overall, children managed according to clinical guidelines had reduced risk of inpatient mortality compared to those not managed according to clinical guidelines, [OR 0.28, (95%, CI 0.14, 0.55), p = 0.001]. Clinical care factors associated with decreased risk of inpatient death included, having pre-transfusion hemoglobin done to confirm diagnosis [OR 0.5; 95% CI 0.29, 0.87], a co-morbid diagnosis of severe malaria [OR 0.4; 95% CI 0.25, 0.76], and being reviewed after admission by a clinician [OR 0.3; 95% CI 0.18, 0.59], while a co-morbid diagnosis of severe acute malnutrition was associated with increased risk of inpatient death [OR 4.2; 95% CI 2.15, 8.22]. CONCLUSION: Children with suspected SA who are managed according to clinical guidelines have lower in-hospital mortality than those not managed according to the guidelines. Efforts to reduce inpatient mortality in SA children in resource-limited settings should focus on training and supporting health workers to adhere to clinical guidelines.


Asunto(s)
Anemia/mortalidad , Anemia/terapia , Anemia/sangre , Transfusión Sanguínea , Mortalidad del Niño , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Comorbilidad , Femenino , Hemoglobinas/metabolismo , Mortalidad Hospitalaria , Hospitalización , Humanos , Lactante , Mortalidad Infantil , Trastornos de la Nutrición del Lactante/epidemiología , Recién Nacido , Modelos Logísticos , Malaria/epidemiología , Masculino , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Factores de Riesgo , Uganda/epidemiología
10.
Enferm. glob ; 18(53): 464-475, ene. 2019. tab
Artículo en Español | IBECS | ID: ibc-183424

RESUMEN

Introducción: La fuente de alimentación es un factor importante para asegurar el correcto crecimiento y desarrollo de un niño. Objetivo: Identificar el perfil socioeconómico de los niños menores de un año ingresados en hospital público en interior de Maranhão y de sus madres; conocer la alimentación complementaria practicada por ellas y el histórico de amamantamiento materno. Método: Investigación descriptiva, transversal de naturaleza cuantitativa, realizada entre febrero y septiembre de 2015. Datos recolectados en formularios aplicados a las madres de los niños, siendo la muestra de 174 sujetos. Resultados: Eran del sexo masculino 62,7% de los niños, 42,5% tenían de 1 a 4 meses, 55,7% fueron ingresados con problemas respiratorios, sus madres eran amas de casa con edad entre 15 y 35 años. Los datos muestran que los niños recibieron líquidos, leche artificial y alimentos precozmente, y sólo 20,1% practicaron al amamantamiento materno exclusivo hasta el sexto mes. Conclusión: Los niños menores de un año ingresados presentaron tipo alimentación inadecuado. Por lo tanto, son necesarias acciones que promuevan la práctica de la alimentación saludable


Introdução: A alimentação é um fator de importância para assegurar a existência, o crescimento e o desenvolvimento adequados de uma criança. Objetivos: identificar o perfil socioeconômico das crianças menores de um ano internadas em hospital público no interior do Maranhão e de suas mães; conhecer a alimentação complementar praticada por elas e o histórico de aleitamento materno das mesmas. Método: Pesquisa descritiva, transversal, quantitativa, realizada entre fevereiro e setembro de 2015. Dados coletados através de formulários aplicados às mães, sendo que a amostra compreendeu 174 sujeitos. Resultados: Eram do sexo masculino 62,7% das crianças, 42,5% tinham de 1 a 4 meses, 55,7% foram internadas com problemas respiratórios, suas mães eram donas de casa com idade entre 15 e 35 anos. Os dados mostram que as crianças receberam líquidos, leite artificial e alimentos precocemente, e apenas 20,1% praticaram ao aleitamento materno exclusivo até o sexto mês. Conclusão: As crianças menores de um ano internadas apresentam padrão alimentar inadequado. Portanto, são necessárias ações que promovam a prática da alimentação saudável


Introduction: Food is an important factor to ensuring the existence, growth and development of a child. Objectives: to identify the socioeconomic profile of children under one year of age hospitalized in a public hospital in the country side of Maranhão and of their mothers; to know the complementary feeding given tby mothers and their history of breastfeeding. Method: Descriptive, cross-sectional, quantitative research conducted between February and September 2015. Data were collected through forms applied to mothers, and the sample comprised 174 individuals. Results: 62.7% of the children were male, 42.5% were 1 to 4 months old, 55.7% were hospitalized with respiratory problems, their mothers were housewives aged between 15 and 35 years. The data showed that children received liquids, artificial milk and food precociously, and only 20.1% had practiced exclusive breastfeeding until the sixth month. Conclusion: The children under one year of age have an inadequate eating pattern. Therefore, actions that promote the practice of healthy feeding are necessary


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Nutrición del Lactante , Alimentos Infantiles/análisis , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Conducta Alimentaria , Niño Hospitalizado/estadística & datos numéricos , Alimentos Fortificados/análisis
11.
Arch Dis Child ; 104(3): 229-235, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30266874

RESUMEN

BACKGROUND: Stunting is the most common manifestation of childhood undernutrition worldwide. Children presenting with severe acute malnutrition (SAM) are often also severely stunted. We evaluated linear growth and its determinants after medically complicated SAM. METHODS: We performed secondary analysis of clinical trial data (NCT00934492) from HIV-uninfected Kenyan children aged 2-59 months hospitalised with SAM. Outcome was change in height/length-for-age z-score (HAZ) between enrolment and 12 months later. Exposures were demographic, clinical, anthropometric characteristics and illness episodes during follow-up. RESULTS: Among 1169 children with HAZ values at month 12 (66% of those in original trial), median (IQR) age 11 (7-17) months and mean (SD) HAZ -2.87 (1.6) at enrolment, there was no change in mean HAZ between enrolment and month 12: -0.006Z (95% CI -0.07 to 0.05Z). While 262 (23%) children experienced minimal HAZ change (within ±0.25 HAZ), 472 (40%) lost >0.25 and 435 (37%) gained >0.25 HAZ. After adjusting for regression to the mean, inpatient or outpatient episodes of diarrhoea and inpatient severe pneumonia during follow-up were associated with HAZ loss. Premature birth and not being cared by the biological parent were associated with HAZ gain. Increases in mid-upper arm circumference and weight-for-age were associated with HAZ gain and protected against HAZ loss. Increase in weight-for-height was not associated with HAZ gain but protected against HAZ loss. No threshold of weight gain preceding linear catch-up growth was observed. CONCLUSIONS: Interventions to improve dietary quality and prevent illness over a longer period may provide opportunities to improve linear growth.


Asunto(s)
Trastornos del Crecimiento/etiología , Trastornos de la Nutrición del Lactante/complicaciones , Desnutrición Aguda Severa/complicaciones , Estatura/fisiología , Preescolar , Método Doble Ciego , Femenino , Estudios de Seguimiento , Crecimiento/fisiología , Trastornos del Crecimiento/epidemiología , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Kenia , Masculino , Desnutrición Aguda Severa/epidemiología
13.
BMC Pediatr ; 18(1): 396, 2018 12 28.
Artículo en Inglés | MEDLINE | ID: mdl-30593271

RESUMEN

BACKGROUND: Although poor complementary feeding is associated with poor child growth, nutrition interventions only have modest impact on child growth, due to high burden of infections. We aimed to assess the association of malaria with linear growth, hemoglobin, iron status, and development in children aged 6-18 months in a setting of high malaria and undernutrition prevalence. METHODS: Prospective cohort study, conducted in Mangochi district, Malawi. We enrolled six-months-old infants and collected weekly data for 'presumed' malaria, diarrhea, and acute respiratory infections (ARI) until age 18 months. Change in length-for-age z-scores (LAZ), stunting, hemoglobin, iron status, and development were assessed at age 18 months. We used ordinary least squares regression for continuous outcomes and modified Poisson regression for categorical outcomes. RESULTS: Of the 2723 children enrolled, 2016 (74.0%) had complete measurements. The mean (standard deviation) incidences of 'presumed' malaria, diarrhea, and ARI, respectively were: 1.4 (2.0), 4.6 (10.1), and 8.3 (5.0) episodes/child year. Prevalence of stunting increased from 27.4 to 41.5% from 6 to 18 months. 'Presumed' malaria incidence was associated with higher risk of stunting (risk ratio [RR] = 1.04, 95% confidence interval [CI] = 1.01 to 1.07, p = 0.023), anemia (RR = 1.02, 95%CI = 1.00 to 1.04, p = 0.014) and better socio-emotional scores (B = - 0.21, 95%CI = - 0.39 to - 0.03, p = 0.041), but not with change in LAZ, haemoglobin, iron status or other developmental outcomes. Diarrhea incidence was associated with change in LAZ (B = - 0.02; 95% CI = - 0.03 to - 0.01; p = 0.009), stunting (RR = 1.02; 95% CI = 1.01 to 1.03; p = 0.005), and slower motor development. ARI incidence was not associated with any outcome except for poorer socio-emotional scores. CONCLUSION: In this population of young children living in a malaria-endemic setting, with active surveillance and treatment, 'presumed' malaria is not associated with change in LAZ, hemoglobin, or iron status, but could be associated with stunting and anemia. Diarrhea was more consistently associated with growth than was malaria or ARI. The findings may be different in contexts where active malaria surveillance and treatment is not provided. TRIAL REGISTRATION: NCT00945698 (July 24, 2009) and NCT01239693 (November 11, 2010).


Asunto(s)
Discapacidades del Desarrollo/epidemiología , Trastornos del Crecimiento/epidemiología , Hemoglobinas/análisis , Trastornos de la Nutrición del Lactante/epidemiología , Hierro/sangre , Malaria/epidemiología , Anemia/epidemiología , Comorbilidad , Discapacidades del Desarrollo/sangre , Diarrea/epidemiología , Trastornos del Crecimiento/sangre , Humanos , Incidencia , Lactante , Trastornos de la Nutrición del Lactante/sangre , Prevalencia , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología
14.
Asia Pac J Clin Nutr ; 27(5): 1084-1094, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30272857

RESUMEN

BACKGROUND AND OBJECTIVES: The failure of infants in developing countries to meet nutrient intake recommendations is well documented. The objective of this study was to assess the nutritional adequacy and identify problem nutrients of the diets of Guatemalan infants with continued breastfeeding. METHODS AND STUDY DESIGN: A single previous-day dietary recall was collected from a convenience sample of 94 mothers of infants aged 6-11 mo attending a public health clinic in the urban area of Quetzaltenango, Guatemala. Energy and nutrient content of complementary feeding (CF) and breastmilk, modelled by subtracting estimated energy intakes from CF from energy requirements, were calculated and nutrient adequacy of the diet was assessed. Nutrient densities and critical nutrient densities of CF were computed to identify "problem nutrients" and main food sources of these nutrients. RESULTS: Complementary diets were adequate for protein, but likely to be inadequate for pantothenic acid and vitamins C, A, D, E, and K, as well as calcium, iron and zinc. In the worst-case scenario, i.e. for small girls with limited energy allowances, riboflavin, niacin, vitamin B-6 and magnesium were identified as "problem nutrients" as well. Formula milk, cow milk and Incaparina® were main food sources of "problem nutrients". CONCLUSIONS: The intake of micronutrients during the first six months of the recommend CF period in Guatemala has a number of notable inadequacies, but the gaps are narrower than traditionally reported for this age group in low-income settings.


Asunto(s)
Lactancia Materna , Alimentos Infantiles , Trastornos de la Nutrición del Lactante/epidemiología , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Nutrientes/deficiencia , Países en Desarrollo , Ingestión de Energía , Femenino , Guatemala/epidemiología , Humanos , Lactante , Masculino , Valor Nutritivo , Población Urbana
15.
Parasit Vectors ; 11(1): 451, 2018 Aug 06.
Artículo en Inglés | MEDLINE | ID: mdl-30081945

RESUMEN

BACKGROUND: Malnutrition is common in children in sub-Saharan Africa and is thought to increase the risk of infectious diseases, including malaria. The relationship between malnutrition and malaria was examined in a cohort of 6-59 month-old children in rural Gambia, in an area of seasonal malaria transmission. The study used data from a clinical trial in which a cohort of children was established and followed for clinical malaria during the 2011 transmission season. A cross-sectional survey to determine the prevalence of malaria and anaemia, and measure the height and weight of these children was carried out at the beginning and end of the transmission season. Standard anthropometric indices (stunting, wasting and underweight) were calculated using z-scores. RESULTS: At the beginning of the transmission season, 31.7% of children were stunted, 10.8% wasted and 24.8% underweight. Stunting was more common in Fula children than other ethnicities and in children from traditionally constructed houses compared to more modern houses. Stunted children and underweight children were significantly more likely to have mild or moderate anaemia. During the transmission season, 13.7% of children had at least one episode of clinical malaria. There was no association between stunting and malaria incidence (odds ratio = 0.79, 95% CI: 0.60-1.05). Malaria was not associated with differences in weight or height gain. CONCLUSIONS: Chronic malnutrition remains a problem in rural Gambia, particularly among the poor and Fula ethnic group, but it was not associated with an increased risk of malaria. TRIAL REGISTRATION: Trial registration: ISRCTN, ISRCTN01738840 , registered: 27/08/2010 (Retrospectively registered).


Asunto(s)
Trastornos de la Nutrición del Niño/complicaciones , Trastornos de la Nutrición del Lactante/complicaciones , Malaria/epidemiología , Población Rural , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Femenino , Gambia/epidemiología , Trastornos del Crecimiento/epidemiología , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Masculino , Factores de Riesgo , Delgadez/epidemiología
16.
PLoS One ; 13(8): e0202053, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30161151

RESUMEN

BACKGROUND: Severe acute malnutrition (SAM) is a major global health problem affecting some 16.9 million children under five. Little is known about what happens to children 6-24 months post-discharge as this window often falls through the gap between studies on SFPs and those focusing on longer-term effects. METHODS: A protocol was registered on PROSPERO (PROSPERO 2017:CRD42017065650). Embase, Global Health and MEDLINE In-Process and Non-Indexed Citations were systematically searched with terms related to SAM, nutritional intervention and follow-up between June and August 2017. Studies were selected if they included children who experienced an episode of SAM, received a therapeutic feeding intervention, were discharged as cured and presented any outcome from follow-up between 6-24 months later. RESULTS: 3,691 articles were retrieved from the search, 55 full-texts were screened and seven met the inclusion criteria. Loss-to-follow-up, mortality, relapse, morbidity and anthropometry were outcomes reported. Between 0.0% and 45.1% of cohorts were lost-to-follow-up. Of those discharged as nutritionally cured, mortality ranged from 0.06% to 10.4% at an average of 12 months post-discharge. Relapse was inconsistently defined, measured, and reported, ranging from 0% to 6.3%. Two studies reported improved weight-for-height z-scores, whilst three studies that reported height-for-age z-scores found either limited or no improvement. CONCLUSIONS: Overall, there is a scarcity of studies that follow-up children 6-24 months post-discharge from SAM treatment. Limited data that exists suggest that children may exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting. Prospective cohort studies assessing a wider range of outcomes in children post-SAM treatment are a priority, as are intervention studies exploring how to improve post-SAM outcomes and identify high-risk children.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Trastornos de la Nutrición del Lactante/epidemiología , Alta del Paciente , Desnutrición Aguda Severa/epidemiología , Trastornos de la Nutrición del Niño/mortalidad , Trastornos de la Nutrición del Niño/terapia , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Trastornos de la Nutrición del Lactante/mortalidad , Trastornos de la Nutrición del Lactante/terapia , Masculino , Morbilidad , Recurrencia , Desnutrición Aguda Severa/mortalidad , Desnutrición Aguda Severa/terapia
17.
Nutrients ; 10(9)2018 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-30149537

RESUMEN

Stunting can afflict up to one-third of children in resource-constrained countries. We hypothesized that low-grade systemic inflammation (defined as elevations in serum C-reactive protein or alpha-1-acid glycoprotein) in infancy suppresses the growth hormone⁻insulin-like growth factor (IGF) axis and is associated with subsequent stunting. Blood samples of 590 children from periurban Dar es Salaam, Tanzania, were obtained at 6 weeks and 6 months of age as part of a randomized controlled trial. Primary outcomes were stunting, underweight, and wasting (defined as length-for-age, weight-for-age and weight-for-length z-scores < -2) between randomization and endline (18 months after randomization). Cox proportional hazards models were constructed to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of time to first stunting, underweight, and wasting as outcomes, with measures of systemic inflammation, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) as exposures, adjusting for numerous demographic and clinical variables. The incidences of subsequent stunting, underweight, and wasting were 26%, 20%, and 18%, respectively. In multivariate analyses, systemic inflammation at 6 weeks of age was significantly associated with stunting (HR: 2.14, 95% CI: 1.23, 3.72; p = 0.002). Children with higher levels of IGF-1 at 6 weeks were less likely to become stunted (HR: 0.58, 95% CI: 0.37, 0.93; p for trend = 0.019); a similar trend was noted in children with higher levels of IGF-1 at 6 months of age (HR: 0.50, 95% CI: 0.22, 1.12; p for trend = 0.07). Systemic inflammation occurs as early as 6 weeks of age and is associated with the risk of future stunting among Tanzanian children.


Asunto(s)
Desarrollo Infantil , Trastornos del Crecimiento/sangre , Mediadores de Inflamación/sangre , Inflamación/sangre , Factores de Edad , Biomarcadores/sangre , Estatura , Proteína C-Reactiva/análisis , Femenino , Trastornos del Crecimiento/diagnóstico , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/fisiopatología , Humanos , Incidencia , Lactante , Trastornos de la Nutrición del Lactante/sangre , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/fisiopatología , Fenómenos Fisiológicos Nutricionales del Lactante , Inflamación/diagnóstico , Inflamación/epidemiología , Inflamación/fisiopatología , Proteína 3 de Unión a Factor de Crecimiento Similar a la Insulina/sangre , Factor I del Crecimiento Similar a la Insulina/análisis , Masculino , Desnutrición/sangre , Desnutrición/epidemiología , Desnutrición/fisiopatología , Estado Nutricional , Orosomucoide/análisis , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Tanzanía/epidemiología , Delgadez/sangre , Delgadez/epidemiología , Delgadez/fisiopatología , Aumento de Peso
18.
Nutrients ; 10(6)2018 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-29890670

RESUMEN

The objective of this study was to examine the influence of improved information and educational messages on outer packaging of a micronutrient powder (MNP), locally known as “Taburia”, on knowledge and adherence to recommended use. A community-based cluster randomized controlled trial was conducted among 1149 caregivers and their children aged 6⁻36 months. Caregiver⁻child dyads were randomized by their villages to receive 30 sachets of Taburia with the: (i) original outer packaging; (ii) improved outer packaging; or (iii) improved outer packaging combined with cooking demonstrations. Adherence to Taburia use was assessed through caregiver interviews and observation of unused sachets during home visits; “high” adherence was defined as consuming 13⁻17 sachets in the previous month. Data collection included surveys and focus groups discussions. The majority of caregivers (>80%) preferred the improved packaging because it was more attractive and contained more comprehensive information. Caregivers who received the improved packaging had better knowledge regarding the recommended use of Taburia (p < 0.001) and higher adherence with the prescribed use of Taburia (43% with “high” adherence) (p < 0.001) than those who received the original packaging (29% with “high” adherence). Caregivers who participated in cooking demonstrations generally had better knowledge regarding the benefits of Taburia and recommended use, but this did not lead to higher adherence to recommended use. “Underconsumption” of Taburia (≤7 sachets) was much less prevalent than “overconsumption” (≥23 sachets), and original packaging users were more likely to consume Taburia daily instead of every two days as recommended. We conclude that the design of the outer packaging and comprehensiveness of information provided are important influencers of recommended MNP use by caregivers.


Asunto(s)
Cuidadores/psicología , Suplementos Dietéticos , Etiquetado de Medicamentos , Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Trastornos de la Nutrición del Lactante/dietoterapia , Desnutrición/dietoterapia , Cumplimiento de la Medicación , Adolescente , Adulto , Preescolar , Culinaria , Femenino , Humanos , Indonesia/epidemiología , Lactante , Trastornos de la Nutrición del Lactante/diagnóstico , Trastornos de la Nutrición del Lactante/epidemiología , Trastornos de la Nutrición del Lactante/fisiopatología , Fenómenos Fisiológicos Nutricionales del Lactante , Entrevistas como Asunto , Masculino , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/fisiopatología , Persona de Mediana Edad , Estado Nutricional , Valor Nutritivo , Polvos , Ingesta Diaria Recomendada , Factores Socioeconómicos , Factores de Tiempo , Adulto Joven
19.
Nutr Hosp ; 35(2): 271-278, 2018 02 27.
Artículo en Inglés | MEDLINE | ID: mdl-29756958

RESUMEN

INTRODUCTION: stunted growth is the most common manifestation of malnutrition in México. Breastfeeding, adequate introduction of complementary feeding and dietary diversity can avoid this. OBJECTIVE: to characterize the feeding practices in children 1-24 months of age in rural communities of Hidalgo and define their relationship with stunting. METHODS: a 24-hour recall was used to obtain information. Z-scores for length-for-age (ZLA), complementary feeding (CF) and minimal dietary diversity (MDD) were determined. The sample was divided into breastfed and not breastfed children. RESULTS: one hundred eighty nine mother-child dyads were evaluated; 59.3% were breastfed and 40.7% were not. Stunting was found in 10.1% and was identified starting at the fourth month of life. This was accompanied by early CF close to the third month (57.0%) and by a reduction in exclusive breastfeeding during the second month of life to only 30%. The proportion of not breastfed children with stunting (27.5%) was almost twice that of breastfed children (12.0%) (p < 0.03). By age, mean ZLA was different with a trend towards stunting increasing with age (p < 0.05): 1-6 months -0.463 ± 1.445; 7-12 months -0.669 ± 1.225; and 13-24 months -0.985 ± 0.917. MDD was greater in not breastfed children (69.7%) (p < 0.04) and by age greater in children 13-24 months (69.7%) (p < 0.02). CONCLUSIONS: the feeding practices of most mothers did not meet WHO recommendations. It is necessary to carry out nutrition education interventions aimed at mothers in rural population.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Dieta , Trastornos del Crecimiento/epidemiología , Fenómenos Fisiológicos Nutricionales del Lactante , Población Rural , Adulto , Estudios Transversales , Femenino , Trastornos del Crecimiento/etiología , Humanos , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Recién Nacido , Masculino , Desnutrición/complicaciones , Desnutrición/epidemiología , México/epidemiología , Madres
20.
PLoS One ; 13(4): e0195619, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29621355

RESUMEN

BACKGROUND: In urban Maharashtra, India, approximately half of mothers exclusively breastfeed. For children residing in informal settlements of Mumbai, this study examines factors associated with exclusive breastfeeding, and whether exclusive breastfeeding, in a community-based nutrition program to prevent and treat wasting among children under age three, is associated with enrolment during the mother's pregnancy. METHODS: The nutrition program conducted a cross-sectional endline survey (October-December 2015) of caregivers in intervention areas. Factors associated with exclusive breastfeeding for infants under six months of age were explored using multi-level logistic regressions. Additionally, program surveillance data collected during home-based counselling visits documented breastfeeding practices for children under six months of age. Using the surveillance data (January 2014-March 2016), exclusive breastfeeding status was regressed adjusting for child, maternal and socioeconomic characteristics, and whether the child was enrolled in the program in utero or after birth. RESULTS: The community-based endline survey included 888 mothers of infants. Mothers who received the nutrition program home visits or attended group counselling sessions were more likely to exclusively breastfeed (adjusted odds ratio 1.67, 95% CI 1.16, 2.41). Having a normal weight-for-height z-score (adjusted odds ratio 1.57, 95% CI 1.00, 2.45) was associated positively with exclusive breastfeeding. As expected, being an older infant aged three to five months (adjusted odds ratio 0.34, 95% CI 0.25, 0.48) and receiving a prelacteal feed after birth (adjusted odds ratio 0.57, 95% CI 0.41, 0.80) were associated with lower odds of exclusively breastfeeding. Surveillance data (N = 3420) indicate that infants enrolled in utero have significantly higher odds of being exclusively breastfed (adjusted odds ratio 1.55, 95% CI 1.30, 1.84) than infants enrolled after birth. CONCLUSIONS: Prenatal enrolment in community-based programs working on child nutrition in urban informal settlements of India can improve exclusive breastfeeding practices.


Asunto(s)
Trastornos de la Nutrición del Niño/prevención & control , Educación en Salud , Trastornos de la Nutrición del Lactante/prevención & control , Desnutrición/prevención & control , Madres/educación , Síndrome Debilitante/prevención & control , Lactancia Materna , Trastornos de la Nutrición del Niño/epidemiología , Preescolar , Ciudades , Consejo , Estudios Transversales , Femenino , Educación en Salud/métodos , Visita Domiciliaria , Humanos , India , Lactante , Trastornos de la Nutrición del Lactante/epidemiología , Masculino , Desnutrición/epidemiología , Conducta Materna , Organizaciones sin Fines de Lucro , Pobreza , Embarazo , Encuestas y Cuestionarios , Síndrome Debilitante/epidemiología
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