Experiences of violence across life course and its effects on mobility among participants in the International Mobility in Aging Study.

BACKGROUND: Life course exposure to violence may lead to disability in old age. We examine associations and pathways between life course violence and mobility disability in older participants of the International Mobility in Aging Study (IMIAS). METHODS: A cross-sectional study using IMIAS 2012 baseline. Men and women aged 65-74 years were recruited at 5 cities (n=1995): Kingston and Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Mobility was assessed by the Short Physical Performance Battery (SPPB) and by 2 questions on difficulty in walking and climbing stairs. Childhood physical abuse history and the HITS instrument were used to gather information on childhood exposure to violence and violence by intimate partners or family members. Multivariate logistic regression and mediation analysis models were constructed to explore the significance of direct and indirect effects of violence on mobility. Interaction effects of gender on violence and on each of the mediators were tested. RESULTS: Experiences of physical violence at any point of life were associated with mobility disability (defined as SPPB<8 or limitation in walking/climbing stairs) while psychological violence was not. Chronic conditions, C reactive protein, physical activity and depression mediated the effect of childhood exposure to violence on both mobility outcomes. Chronic conditions and depression were pathways between family and partner violence and both mobility outcomes. Physical activity was a significant pathway linking family violence to mobility. Gender interactions were not significant. CONCLUSIONS: Our results provide evidence for the detrimental effects of life course exposure to violence on mobility in later life.

Socioeconomic status, social relations and domestic violence (DV) against elderly people in Canada, Albania, Colombia and Brazil.

PURPOSE: To determine whether gender, socioeconomic conditions, and/or social relations are related to recent experiences of DV in older adult populations. MATERIALS AND METHODS: Data on socioeconomic status and social relations were collected in 2012 from 1995 community-dwelling older adults in Canada, Colombia, Brazil, and Albania. Violence experienced in the last 6 months was measured using the Hurt, Insulted, Threatened with harm, or Screamed at (HITS) scale and classified according to type (physical or psychological) and perpetrator (partner or family member). Binary logistic regression analyses were used to assess associations between experiences of violence and gender, socioeconomic conditions, and social relations. RESULTS: Physical violence (by partner or family member) was reported by 0.63-0.85% of participants; the prevalence of psychological violence (by partner or family member) ranged from 3.2% to 23.5% in men and 9% to 26% in women. After adjustment for socioeconomic status, social relations, age and site, women experienced more psychological violence perpetrated by family members than did men (odds ratio (OR): 1.8; 95% CI: 1.2-2.6). Social relations, such as multifamily living arrangements and low levels of support from partners, children, and family, were associated with psychological DV. Current working status was associated with greater odds of victimization by partners among men (OR: 2.35 95% CI: 1.34-1.41), but not among women. CONCLUSIONS: Gender and social relations are important determinants of experiencing violence in older adults. The findings of this study demonstrate the importance of a gender-based approach to the study of DV in older adults.

Validity and applicability of a video-based animated tool to assess mobility in elderly Latin American populations.

AIM: To assess the reliability and the validity of Portuguese- and Spanish-translated versions of the video-based short-form Mobility Assessment Tool in assessing self-reported mobility, and to provide evidence for the applicability of these videos in elderly Latin American populations as a complement to physical performance measures. METHODS: The sample consisted of 300 elderly participants (150 from Brazil, 150 from Colombia) recruited at neighborhood social centers. Mobility was assessed with the Mobility Assessment Tool, and compared with the Short Physical Performance Battery score and self-reported functional limitations. Reliability was calculated using intraclass correlation coefficients. Multiple linear regression analyses were used to assess associations among mobility assessment tools and health, and sociodemographic variables. RESULTS: A significant gradient of increasing Mobility Assessment Tool score with better physical function was observed for both self-reported and objective measures, and in each city. Associations between self-reported mobility and health were strong, and significant. Mobility Assessment Tool scores were lower in women at both sites. Intraclass correlation coefficients of the Mobility Assessment Tool were 0.94 (95% confidence interval 0.90-0.97) in Brazil and 0.81 (95% confidence interval 0.66-0.91) in Colombia. Mobility Assessment Tool scores were lower in Manizales than in Natal after adjustment by Short Physical Performance Battery, self-rated health and sex. CONCLUSIONS: These results provide evidence for high reliability and good validity of the Mobility Assessment Tool in its Spanish and Portuguese versions used in Latin American populations. In addition, the Mobility Assessment Tool can detect mobility differences related to environmental features that cannot be captured by objective performance measures.

Using the Short Physical Performance Battery to screen for frailty in young-old adults with distinct socioeconomic conditions.

AIM: To analyze the Short Physical Performance Battery's (SPPB) ability in screening for frailty in community-dwelling young elderly from cities with distinct socioeconomic conditions. METHODS: Elderly (65-74 years-of-age) from Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64) were evaluated with the SPPB to assess physical performance. Frailty was defined as the presence of ≥ 3 of the following criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. Linear regression and receiver operating characteristics analyses were carried out. RESULTS: The SPPB correlated with frailty (R(2) = 0.33), with better results for Saint Bruno. A cut-off of 9 in the SPPB had good sensitivity (92%) and specificity (80%) in discriminating frail from non-frail in Saint Bruno (area under the curve [AUC] = 0.81), but showed fair results in Santa Cruz (AUC = 0.61, sensitivity = 81% and specificity = 52%). CONCLUSIONS: The SPPB better discriminated frailty in elderly with higher socioeconomic conditions (Saint Bruno).

Explaining health differences between men and women in later life: a cross-city comparison in Latin America and the Caribbean.

This paper describes differences in health and functional status among older men and women and attempts to anchor the explanations for these differences within a lifecourse perspective. Seven health outcomes for men and women 60 years and older from seven Latin American and Caribbean cities are examined, using data from the 2000 SABE survey (Salud, Bienestar y Envejecimiento-n=10,587). Age-adjusted as well as city- and sex-specific prevalence was estimated for poor self-rated health, comorbidity, mobility limitations, cognitive impairment, depressive symptoms and disability in basic and instrumental activities of daily living. Logistic regressions were fitted to determine if the differences between men and women in each outcome could be explained by differential exposures in childhood (hunger, poverty), adulthood (education, occupation) and old age (income) and/or by differential vulnerability of men and women to these exposures. Sao Paulo, Santiago and Mexico, cities in countries with a high level of income inequalities, presented the highest prevalence of disability, functional limitations and poor physical health for both women and men. Women showed poorer health outcomes as compared with men for all health indicators and in all cities. Controlling for lifecourse exposures in childhood, adulthood and old age did not attenuate these differences. Women's unadjusted and adjusted odds of reporting poor self-rated health, cognitive impairment and basic activities of daily living disability were approximately 50% higher than for men, twice as high for number of comorbidities, depressive symptoms and instrumental activities of daily living disability, and almost three times as high for mobility limitations. Higher vulnerability to lifecourse exposures in women as compared with men was not found, meaning that lifecourse exposures have similar odds of poor health outcomes for men and women. A more integrated understanding of how sex and gender act together to influence health and function in old age needs consideration of additional biological and social factors.

Inequalities in breast and cervical cancer screening among urban Mexican women.

OBJECTIVE: To examine the equity of screening for breast and cervical cancer among women aged 50 and over living in Mexico City according to the Andersen behavioural model. METHODS: Logistic regressions were used to analyze the associations of predisposing factors, enabling resources and health needs with mammography and Pap testing among 1323 women aged 50 and over living in Mexico City. The data were taken from SABE, a survey conducted in Latin American and Caribbean cities in 1999-2000. RESULTS: Referring to the previous two years, use of mammography was less frequent (14.8%) than Pap testing (53.7%). Higher education and having private health insurance were associated with receiving both procedures. Being married was associated with receipt of Pap testing, while being unmarried was associated with mammography. Younger women were more likely to receive a Pap test. Other cancer prevention behaviours were strong predictors of mammography and Pap test use. CONCLUSIONS: There are inequities in access to cancer screening services among women aged 50 and over in Mexico. Cancer prevention programs need to implement strategies that guarantee free and accessible services independently of social conditions or type of health insurance. The observed clustering of screening services suggests that packaging screening programs for gynaecological cancer could be used to increase coverage.

Social networks and depressive symptoms among elderly women and men in Havana, Cuba.

OBJECTIVES: To examine the main and the stress-buffering effects of social networks on depressive symptoms among elderly Cuban men and women living in La Havana. METHOD: Information was gathered from a representative sample of the elderly population in Havana (n = 1905), as part of the SABE (Salud, Bienestary Enuejecimiento) study. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. The structure and function of social networks were studied. Gender-specific multivariate logistic regressions were fitted to test the main (independent of stressors) and the stress-buffering effects (in the presence of financial strain or disabilities) on depressive symptoms. RESULTS: Social ties were associated with a lower prevalence of depressive symptoms in women and men independently of the presence of stressors. Women who were or had been married, lived in an extended family, and enjoyed balanced exchanges with relatives and children reported low prevalence of depressive symptoms. Men were less likely to report depressive symptoms if they were currently married, and did not live alone. Social networks buffered the effect of financial strain on depression, but not in the event of disability. CONCLUSION: In Cuba, networks centered on children and extended family were associated with low frequency of depressive symptoms, ruling contrary to common findings in developed societies. These living arrangements have an important role in buffering the impact of financial strain on depressive symptoms.

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population.

BACKGROUND AND AIMS: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. METHODS: We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and comorbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. RESULTS: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/ Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32-3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41-2.38 in women; OR= 3.42; 95% CI 2.41-4.86 in men). CONCLUSIONS: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.

Social and gender inequalities in depressive symptoms among urban older adults of latin america and the Caribbean.

OBJECTIVE: This study examined gender differences in depression by examining differential exposure and vulnerability to socioeconomic factors during the life course. METHODS: The data used for the analyses originated from a cross-national survey of older adults living in seven large Latin American cities. We examined associations between depressive symptomatology and socioeconomic conditions and health indicators in childhood, adulthood, and old age. We used the Geriatric Depression Scale to classify respondents with high levels of depressive symptoms. RESULT: The prevalence of depression in the urban population of Latin America was relatively low, ranging across cities from 0.4 to 5.2% in men and from 0.3 to 9.5% in women. Women were more exposed to social and material disadvantages during their life course than men but were not more vulnerable to them than men. Current socioeconomic conditions and health status as well as functional disabilities mainly accounted for gender differences in the prevalence of depression. Additionally, poor health and hunger during childhood, as well as illiteracy or lack of education, were associated with depression in both men and women. DISCUSSION: Cumulative life course exposure to social and material disadvantage and current material, social, and health conditions explain the higher frequency of depression in women.

Gender differences in lower extremity function in Latin American elders: seeking explanations from a life-course perspective.

OBJECTIVE: The authors examined the contribution of life-course exposures to gender differences in mobility in later life. METHOD: Data originate from a survey of persons aged 60 and older living in six Latin American and Caribbean cities (n = 10,661). Lower extremity limitations (LEL) were defined as the presence of three or more reported difficulties with five activities: lifting and carrying 10 lb, walking several blocks, climbing a flight of stairs, kneeling/ stooping/crouching, and getting up from a chair. Data were pooled after testing homogeneity of effects across cities. A multivariate model was fitted using logistic regression analysis. Complete data analyses were performed on 8,166 (72%) participants. RESULTS: Prevalence of LEL varies across cities (9.3-23.7% in men, 23.3-42.9% in women). Intervening life-course and health factors explained a small proportion of the gender difference in LEL (odds ratio = 2.39; 95% confidence interval = 2.04-2.79). Childhood hunger was predictive of LEL in women, and a stronger association between depression and LEL was found in men than in women. Little education and insufficient income were associated with LEL for both men and women. DISCUSSION: Life-course exposures predict mobility, but further research is needed to identify intervening factors relating gender to mobility in old age.

[Evaluation of an educational strategy on malaria in rural areas of the Colombian Pacific Coast]. / Evaluación de una estrategia educativa en malaria aplicada en localidades rurales del Pacífico colombiano.

INTRODUCTION: Health education interventions have proved effective in improving knowledge, preventing practices and decreasing occurrence of malaria. OBJECTIVE: To evaluate the impact of the educational intervention "The World of Malaria: Let's Learn to Manage it in Community" developed in Colombian malarial areas, in terms of increasing knowledge, preventive practices, treatment-seeking, and decreasing malaria occurrence. MATERIALS AND METHODS: A quasi-experimental post-test study with a non-equivalent control group was carried out. Four hundred and fifty people living in 20 rural villages were interviewed. These localities were randomly selected from 110 intervened localities. Paired "t" test was performed to evaluate the effect on malaria knowledge of the community health workers (n=243). The effect of the intervention on the effect variables was measured by using logistic regression and by comparing people who were exposed and non-exposed to the educational strategy. RESULTS: Knowledge on malaria in community health workers increased after the intervention (p < 0.05). In the communities, 170/447 (38%) interviewed individuals had contact with the intervention in the communities. Those exposed to the intervention showed improvements in knowledge about breeding sites (OR: 2.53, 95% IC:1.7-3.76), bed-nets use (OR:1.81, 95% IC:1.10-2.97) and a decrease in self-medication with antimalarial drugs (OR:1.97, 95% IC: 1.04-3.73). Contact with the intervention reduced reported episodes of malaria (OR:0.58, 95% CI: 0.39-0.87). CONCLUSION: Significant improvements in preventive practices may be achieved with educational interventions, which in turn may reduce malaria ocurrence.

[Effects of an educational and participatory community intervention on malaria control in Buenaventura, Colombia]. / Efectos de una intervención educativa y de participación comunitaria en el control de la malaria en Buenaventura, Colombia.

INTRODUCTION: A four-component, non randomized, primary-care based intervention for malaria control was implemented in Buenaventura, Colombia. OBJECTIVE: To evaluate the effect of the applied intervention on knowledge about malaria, attention of febrile events and frequency of malaria occurrence in three communities of Buenaventura. MATERIALS AND METHODS: A post-intervention evaluation with a non-equivalent control group was performed. Two non-intervened groups (those residing more and less than six months, respectively, in the area) and one intervened group were identified. We interviewed 661 women household heads. Contact was defined as having been exposed to at least one of the four intervention components. RESULTS: Fourteen percent of the respondents had contact with the intervention. The attention of a febrile episode was better in those who had contact with the intervention than in the nonintervened ones who had resided in the area for more than six months. Those without contact and with less than six months stay in the area reported lower use of bed-nets (OR:0.46; 95% CI:0.23-0.93) and less fumigation practices (OR:0.38; 95% CI:0.19-0.75). The analysis of the malaria case trend showed a reduction in the proportion of cases contributed by the intervened communities, from 25% to 17%, six years after the intervention. CONCLUSION: An educational strategy is effective to enhance knowledge and modify the practices of the urban population of Buenaventura with respect to malaria.

Efectos de una intervención educativa y de participación comunitaria en el control de la malaria en Buenaventura, Colombia / Effects of an educational and participatory community intervention on malaria control in Buenaventura, Colombia

Introducción. Una intervención para el control de la malaria no aleatoria compuesta por cuatro componentes y basada en atención primaria fue implementada en Buenaventura, Colombia. Objetivo. Evaluar el efecto de la intervención en conocimientos y prácticas en malaria, atención de eventos febriles y frecuencia de malaria en tres comunas de Buenaventura. Materiales y métodos. Se realizó una evaluación post-intervención con grupo control no equivalente. Se identificaron dos grupos de no contacto de más y menos seis meses de residencia en la zona, respectivamente, y un grupo contacto con la intervención. Se entrevistaron 661 mujeres jefes de hogar. El contacto fue el haber estado expuesto al menos a uno de los cuatro componentes de la intervención. Resultados. El 14 por ciento de los entrevistados tuvieron contacto con la intervención. El evento febril fue mejor atendido en el grupo de personas contacto que en el grupo "sin contacto" que habían vivido en el lugar por más de seis meses. Los sin contacto con menos de seis meses en el lugar reportaron menor uso de toldillos (OR: 0,46; IC 95 por ciento: 0,23-0,93) y de práctica de fumigación (OR: 0,38; IC 95 por ciento: 0,19-0,75). El análisis de tendencia de casos de malaria mostró disminución de 25 por ciento a 17 por ciento de casos aportados por los grupos intervenidos, seis años después de la intervención. Conclusión. La estrategia educativa es efectiva para elevar los conocimientos y modificar las prácticas de la población urbana de Buenaventura frente a la malaria.

Introduction. A four-component, non randomized, primary-care based intervention for malaria control was implemented in Buenaventura, Colombia. Objective. To evaluate the effect of the applied intervention on knowledge about malaria, attention of febrile events and frequency of malaria occurrence in three communities of Buenaventura. Materials and methods. A post-intervention evaluation with a non-equivalent control group was performed. Two non-intervened groups (those residing more and less than six months, respectively, in the area) and one intervened group were identified. We interviewed 661 women household heads. Contact was defined as having been exposed to at least one of the four intervention components. Results. Fourteen percent of the respondents had contact with the intervention. The attention of a febrile episode was better in those who had contact with the intervention than in the nonintervened ones who had resided in the area for more than six months. Those without contact and with less than six months stay in the area reported lower use of bed-nets (OR:0.46; 95% CI:0.23-0.93) and less fumigation practices (OR:0.38; 95% CI:0.19-0.75). The analysis of the malaria case trend showed a reduction in the proportion of cases contributed by the intervened communities, from 25% to 17%, six years after the intervention. Conclusion. An educational strategy is effective to enhance knowledge and modify the practices of the urban population of Buenaventura with respect to malaria.

[Social determinants, feeding practices and nutritional consequences of intestinal parasitism in young children]. / Determinantes sociales, prácticas de alimentación y consecuencias nutricionales del parasitismo intestinal en niños de 7 a 18 meses de edad en Guapi, Cauca.

INTRODUCTION: Studies on intestinal intestinal parasitism in children under 2 years of age have rarely been performed. The nutritional consequences and feasibility of parasite prevention justify the current study. OBJECTIVES: The study was undertaken with 3 goals: (1) to identify the prevalence of pathogenic intestinal parasites (PIP), (2) to determine the social factors, sanitary conditions and nutritional practices that predict PIP, and (3) to evaluate PIP effects on infant nutritional status. MATERIALS AND METHODS: All mothers with children under 18 months of age and living in an urban community of coastal Colombia were invited to participate in the PIP study. A fecal sample was obtained from each of 136 children; they represented 62% of the total 7-18 month-old population in the community. Presence of intestinal parasites was identified by direct microscopy and confirmed by a concentration test (Ritchie-Frick procedure). Logistic regressions were used to predict presence of PIP. The Z scores of length-for-age (< -2 SD-chronic malnutrition) and weight-for-length (< -2 SD-acute malnutrition) and covariance analysis were done to detect associations between intestinal parasitism and nutritional status. RESULTS: Of the 136 children, 30.6% were infected; 26.2% had helminth infections (A. lumbricoides, T. trichiura, S. stercoralis), 14.9% had protozoan infections (G. lamblia) and 11.8% had mixed infections. Wasting and stunting were present in 2.9% and 12.5%, respectively. Lack of sanitary toilet facilities and low maternal education were related to mixed infections and presence of helminths (p < 0.05). Weaned children were at greater risk of mixed infections (Odds Ratio (OR) 6.5; 90% CI: 1.9-21.5) and of G. lamblia infections (OR: 2.89; 90% CI: 1.0-8.34). Children infected with T. trichiura and with mixed infections were more likely to show wasting (p < 0.05). CONCLUSION: The high infections in young children indicate that they be included in periodic antiparasitic chemotherapy. Burden of disease associated to intestinal parasitism may be reduced if breastfeeding is continued beyond 6 months of age.

Determinantes sociales, prácticas de alimentación y consecuencias nutricionales del parasitismo intestinal en niños de 7 a 18 meses de edad en Guapi, Cauca / Social determinants, feeding practices and nutritional consequences of intestinal parasitism in young children

Introducción. Los estudios de parasitismo intestinal en menores de 2 años raramente se realizan. Sus consecuencias nutricionales y la factibilidad de la prevención justifican su estudio. Objetivos. Identificar la prevalencia de parásitos intestinales patógenos, sus asociaciones con los determinantes sociales y las prácticas de alimentación y sus efectos sobre el estado nutricional. Materiales y métodos. Se censó a los niños menores de 18 meses de una comunidad urbana de la región Pacífica colombiana. Se obtuvieron 136 muestras, que representaban 62 por ciento de la población de menores de 18 meses en el área de estudio. Se identificó la presencia de parásitos intestinales patógenos a partir del examen directo y el concentrado de Ritchie-Frick modificado. Se utilizaron regresiones logísticas múltiples para predecir la presencia de parásitos intestinales patógenos. Se calcularon los puntajes Z de longitud para edad (<2 DE, desnutrición crónica) y peso para longitud (<2 DE, desnutrición aguda). Se realizaron análisis de covarianza para determinar la relación entre los parásitos intestinales patógenos y el estado nutricional con ajustes por edad. Resultados. El 30,6 por ciento de los niños estaban infectados: 26,2 por ciento presentaba helmintiasis (Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercolaris); 14,9 por ciento tenía protozoos (Giardia lamblia), y 11,8 por ciento poliparasitismo intestinal. La prevalencia de desnutrición aguda y crónica fue de 2,9 por ciento y 12,5 por ciento, respectivamente. La ausencia de sanitario y una baja escolaridad de la madre se asociaron a una mayor presencia de poliparasitismo y helmintiasis (p<0,05). La suspensión de la lactancia materna se asoció con la presencia de poliparasitismo (RM: 6,5 IC90 por ciento: 1,9 a 21,5) y con la presencia de Giardia (RM: 2,89 IC90 por ciento: 1,0 a 8,34). La desnutrición aguda fue más frecuente en niños infectados con T. trichiura y con varios parásitos (p<0,05). Conclusión. Nuestros resultados sugieren que la desparasitación periódica debe incluir a la población lactante. La promoción de la lactancia materna es un elemento importante en la disminución de la carga de la enfermedad producida por los parásitos intestinales patógenos.

[Maternal beliefs, feeding practices and nutritional status in Afro-Colombian infants]. / Creencias maternas, prácticas de alimentación y estado nutricional en niños Afro-Colombianos.

This study describes maternal practices and beliefs on children feeding and their relationship with nutritional status of Afro-Colombian children aged 6 to 18 months. We combined ethnographic and epidemiological data. We collected information using a food frequency questionnaire. Nine focus groups and 5 deep interviews to mothers of children less than 2 years of age were performed. Our data showed a prevalence of wasting of 2.6% (< -2 SD weight-for-length) and prevalence of stunting of 9.8% (< -2 SD height-for-age). These practices are characterized by a universal onset of breastfeeding, that lasted 10 months in average, and an early introduction of complementary food (mean: 3 months). Breastfeeding is a cultural norm. Weaning is related to new pregnancy, to low milk production and to negative effects of breast process on mothers' health. Early complementary feeding and bottle-feeding are highly valued due to their positive effect on nutritional status and adaptation of children to adult-type diets. The introduction of complementary food after 4 months, the quality of the first food introduced and the diversity of complementary food predicted better nutritional status (p < 0.05). We conclude that nutritional illiteracy and mothers' erroneous beliefs result in 50% of the mothers having inadequate feeding practices. We suggest focused interventions on those beliefs limiting good practices.

Growth trajectories are influenced by breast-feeding and infant health in an afro-colombian community.

We conducted a longitudinal study among an Afro-Colombian population to investigate the influence of feeding practices and child morbidity on linear and ponderal growth during infancy. We enrolled 133 children at 5-7 mo and followed them until 18 mo. Repeated anthropometric measures were taken every 2-3 mo, with monthly interviews on feeding practices and daily self-reports on morbid conditions by the mothers of the infants. Mothers' social conditions and infants' fixed variables (gender and gestational age at birth) were measured at baseline. Growth starting points and trajectories were modeled via Hierarchical Linear Models (HLM). Children started with a mean length of 64.8 cm (95% CI: 59.8-69.7) and a mean weight of 7.68 kg (95% CI: 5.37-9.9), and gained length at a rate of 1.13-1.70 cm/mo, and weight at 66.5-319 g/mo. Breast-feeding, defined as receiving breast milk at any time within a 2-3-mo interval, was positively related to length gain (regression coefficient = 0.27 cm/mo; P = 0.04), after adjusting for social conditions and food consumption. Among mothers with low levels of education, breast-feeding had a positive effect on weight gain (regression coefficient = 0.30 kg/mo; P = 0.04); among nonbreast-fed infants, complementary food diversity generated a positive effect on weight (regression coefficient = 0.14 kg/mo; P = 0.03). Mean differences in length were related to the total proportion of healthy time (regression coefficient = 3.1; P = 0.02), whereas weight-gain rates were negatively associated with changes during illness (regression coefficient = -0.70; P = 0.04 for fever). No association was found between diarrhea episodes and infant growth. Our study confirms that breast-feeding after 6 mo of life is important for nutrition and health, likely by mitigating the negative effects of poor social conditions and diarrhea on infant growth.

Validación de escalas de seguridad alimentaria y de apoyo social en una población afro-colombiana: aplicación en el estudio de prevalencia del estado nutricional en niños de 6 a 18 meses / Validation of food security and social support scales in an Afro-Colombian community: application on a prevalence study of nutritional status in children aged 6 to 18 months

Nosotros realizamos un estudio transversal en 193 madres de niños de 6 a 18 meses de edad de una comunidad afro-colombiana con los objetivos: (1) adaptar y validar la escala de hambre del Community Childhood Hunger Identification Project, de apoyo social de DUKE-UNC-11, y de apoyo del compañero del Québec Longitudinal Study of Child Development (QLSCD), e (2) identificar la relación entre la inseguridad alimentaria y el soporte social con el estado nutricional infantil. Se midió la validez de constructo mediante análisis factoriales y correlaciones no-paramétricas basadas en modelos teóricos. Se establecieron los resultado-Z de talla-para-edad y peso-para-talla. El análisis factorial redujo la escala de hambre y la escala de QLSCD a un factor; y la escala de DUKE-UNC-11 a dos factores. El alfa de Cronbach osciló entre 0,70 y 0,90. Las tres escalas se correlacionaron con las condiciones sociales. Las escalas de apoyo se correlacionaron con las redes sociales y la salud percibida de la madre. La inseguridad alimentaria y el apoyo social negativo (emocional y del compañero) se asociaron a menores índices talla-para-edad, y mayor proporción de desnutrición crónica. El estudio apoya la utilidad de los instrumentos presentados en la medición de los conceptos planteados.

[Validation of food security and social support scales in an Afro-Colombian community: application on a prevalence study of nutritional status in children aged 6 to 18 months]. / Validación de escalas de seguridad alimentaria y de apoyo social en una población afro-colombiana: aplicación en el estudio de prevalencia del estado nutricional en niños de 6 a 18 meses.

We conducted a cross-sectional study on 193 mothers of children 6 to 18 months of age in an African-Colombian community, with the objectives: (1) to adapt and validate the Community Childhood Hunger Identification Project scale, the DUKE-UNC-11 social support scale, and the Quebec Longitudinal Study of Child Development (QLSCD) partner support scale, and (2) to identify any existent relationship between nutritional status in infancy and both food insecurity and social support. We determined construct validity using factor analysis and theoretical models-based non-parametric correlations. Length-for-age and weight-for-length Z-results were calculated. Factor analyses reduced the hunger scale to one factor, the DUKE-UNC-11 scale to two factors, and the QLSCD scale to one factor. The Cronbach's alpha test ranged between 0.70 and 0.90. Both food insecurity and social support scales were correlated with mother's social conditions, and social support was positively associated with social networks and mother's self-perceived health status. Food insecurity, emotional-social support, and partner's negative support were associated with lower height-to-age and therefore a higher ratio of chronic malnutrition. The study supports the appropriateness of the instruments to measure the expressed concepts.

Creencias maternas, prácticas de alimentación, y estado nutricional en niños afro-colombianos / Maternal beliefs, feeding practices and nutritional status in afro-colombian infants

Este estudio describe las creencias y prácticas de la alimentación infantil, y su relación con el estado nutricional de niños de 6 a 18 meses. Se combinaron datos etnográficos y epidemiológicos. Se recolecto información de la dieta mediante un cuestionario de frecuencia de alimentos. Se realizaron 9 grupos focales, y 5 entrevistas a profundidad en madres de menores de 2 años. Nuestros datos muestran una prevalencia de desnutrición aguda, 2.6 por ciento (<-2DE peso-para-talla), y una prevalencia de 9.8 por ciento de desnutrición crónica (<-2DE talla-para-edad). Las practicas se caracterizan por el inicio universal de la lactancia, un promedio de duración de 10 meses e introducción temprana de alimentos (promedio 3 meses). La práctica de la lactancia se considera una norma cultural. El destete se asocia a nuevos embarazos, escasez de la leche o a efectos negativos del amamantamiento en la salud de la madre. La introducción temprana de alimentos y el uso de biberón son valorados positivamente por las madres por sus efectos sobre el estado nutricional y la adaptación del niño a la dieta familiar. El inicio de la alimentación complementaria después de los 4 meses, la calidad del primer alimento introducido, y la diversidad de la dieta complementaria predicen mejor estado nutricional (p< 0.05). En conclusión, la falta de conocimiento básico nutricional y algunas creencias erradas llevan a que al menos 50 por ciento de las madres tengan prácticas de alimentación inadecuadas. Se sugiere concentrar nuevas intervenciones en las creencias que limitan las buenas prácticas