Breast Milk Retinol Levels after Vitamin A Supplementation at Different Postpartum Amounts and Intervals.

Maternal vitamin A (VA) supplementation in risk areas for Vitamin A deficiency (VAD) was launched to improve the level of this nutrient in nursing mothers and in their breast milk. This longitudinal and randomized study aimed to evaluate the levels of retinol in breast milk after supplementation with VA in varying amounts (200,000 IU or 400,000 IU) and different postpartum intervals. Women were distributed into four intervention groups and given a single 200,000 IU postnatal dosage of VA at time 0 h (postnatal morning) (G200 0H); a single 200,000 IU dosage of VA in week four (G200 4W); 200,000 IU of VA at time 0 h + 200,000 IU of VA 24 h after the first supplementation (G400 24H); and 200,000 IU of VA at time 0 h + 200,000 IU of VA one week after the first supplementation (G400 1W). Breast milk samples were collected over a 12-week period (0 h, 24 h and 1, 4, 12 weeks post-natal). Retinol levels were determined by high-performance liquid chromatography. The Generalized Estimated Equation (GEE) assessed the different retinol levels. The G200 (0H), G400 (24H), and G400 (1W) groups presented higher retinol levels at 24 h than the G200 (4W) group (p < 0.001). The retinol levels of all groups were similar at times 1, 4 and 12 weeks after delivery (p > 0.05). Maternal VA supplementation increased retinol levels in the colostrum. Different supplementation dosages or postpartum administration times did not result in added benefit to retinol levels in mature breast milk.

Dietary Lipid Intake Influences the Alpha-tocopherol Levels in Human Milk.

OBJECTIVE: Dietary lipid intake is associated with serum alpha-tocopherol levels; however, its impact on human milk is unknown. The objective of this study was to evaluate the relationship between maternal intake of vitamin E, lipids, and fatty acids and the concentration of alpha-tocopherol in human milk. METHODS: We conducted a longitudinal observational study, including 143 lactating women on 7, 30, and 90 days postpartum. Dietary intake was collected using 24-hour recall. On day 90, a human milk sample was collected and analyzed for alpha-tocopherol concentration. The prevalence of inadequate vitamin E intake was determined by the Estimated Average Requirement (16 mg/day), and the alpha-tocopherol concentration was analyzed by high-performance liquid chromatography. RESULTS: Dietary intake of vitamin E was associated with the intake of lipids (r = 0.237, P = 0.004) and fatty acids (P < 0.05), and 100% of the participants had inadequate vitamin intake. Mean alpha-tocopherol concentration in the human milk samples was 7.11 (standard deviation 3.95) µmol/L and was correlated with lipid (r = 0.201, P = 0.042) and polyunsaturated fatty acid intake (r = 0.235, P = 0.017). Higher vitamin E levels were found in participants with the highest quartile of polyunsaturated fatty acid intake. CONCLUSIONS: Alpha-tocopherol concentration was associated with the dietary intake of lipids and fatty acids, demonstrating that its bioavailability is associated with fats in the mammary gland. These results suggest development of appropriate strategies to increase the levels of vitamin E in breast milk that may help to prevent and treat vitamin E deficiency.

Dietary patterns and associated socio-economic factors in rural Mozambican adolescents.

Background: Assessing food consumption in adolescents is essential for the determination of an appropriate nutritional status. This study intended to assess dietary patterns and its associated factors in rural Mozambican adolescents. Methods: This was a cross-sectional study of 323 adolescents. A food frequency questionnaire was used and food was grouped into nine groups. An exploratory factorial analysis identified the food patterns. A principal component analysis provided food consumption scores in each factor, split into three groups. An adjustment of multinomial regression models was made. Results: Two diet patterns were identified: pattern 1 (fats, beans, meats and eggs, cereals and sugars) and pattern 2 (vegetables, roots and tubers, fruits, chestnuts and walnuts). The proportional model for pattern 1 indicated highest consumption for adolescents with per capita family income equal to or greater than 78.13 meticais (Mozambique's currency) and for adolescents whose parents had a formal job. For pattern 2, consumption was lower for adolescents whose guardians had high school education or more. The consumption in the first three quartiles was lower for individuals with an income between 1 and 78.12 meticais. Conclusions: For Mozambican adolescents, higher income, education and parents' jobs were predictive variables for consumption of fats, beans, meats and eggs, cereals, and sugars, while higher education and higher income implies lower consumption of vegetables, roots and tubers, fruits, chestnuts, and walnuts.

Stunting delays maturation of triceps surae mechanical properties and motor performance in prepubertal children.

Malnutrition can lead to possible irreversible consequences in the development of muscle function and some of them are yet poorly characterized. The present study evaluated the mechanical properties of the triceps surae and motor performance in stunted (S) and eutrophic (E) prepubertal children (9 years ± 6 months). Height-for-age ratio was used as indicator of stunting due to early malnutrition, according to the World Health Organization. Torque was determined by maximal voluntary contractions (MVC) and musculotendinous (MT) stiffness was achieved through quick-release tests to obtain MT stiffness index (SI(MT)) and passive stiffness (K (p)) from linear MT stiffness-torque relationships. Percutaneous supramaximal electrically elicited contractions determined twitch torque (Pt) and electromechanical delay (EMD). Motor performance was evaluated by balance test. S group presented significantly lower MVC and a trend of lower Pt values indicating lower capacities to develop force under voluntary or induced conditions. Significantly higher SI(MT) and EMD values were observed, while K (p) and motor performance in balance were significantly lower. Higher SI(MT) values have been reported previously in youngest prepubertal children, indicating that immature activation capacities can mask MT stiffness assessment during voluntary contractions, taking into consideration the higher EMD values as a measure of muscle stiffness contribution. Lower K (p) may indicate a delay in the maturation of tendinous tissue in S group, influencing motor performance in balance. The present study shows that malnutrition leads to adaptation of intrinsic MT elastic properties, but depends on the level of the observed structure.

Building a place for the father as an ally for breast feeding.

OBJECTIVE: to analyse the opinions of men and women on the father's participation in breast feeding. DESIGN: a qualitative and exploratory study, using the content analysis method, on its thematic modality. Data were collected at discussion groups that answered the following questions: which meanings and feelings are related to father's involvement in breast feeding? Which factors help or obstruct the act of breast feeding? How do fathers participate in breast feeding? SETTING: three discussion groups took place during the event 'The man as an ally in breast feeding process: is that the question?', supported by the Federal University of Pernambuco, Brazil. PARTICIPANTS: 11 men and nine women attended the event. Of the men, two had more than one child and five had babies who were being breast fed. Among the women, all were mothers and three were breast feeding. FINDINGS: four thematic nuclei emerged from the performed analysis, which was also based in the historical, social and cultural process of fatherhood: involvement in the pregnancy-puerperal cycle; feelings and meanings of breast feeding; meanings of breast feeding in public; and ways to include father in the breast-feeding process. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: fathers participating in breast feeding considered it to be a brief period in the process of fatherhood. Behaviours of ambivalence, conflict, exclusion, insecurity and concern towards breast feeding were revealed. There was a perception of the nursing mother as a sexless being. However, the participants also suggested ways of including fathers in the process of breast feeding. According to the participants, they could (1) provide a favourable environment for the mother and baby; (2) participate more during pregnancy and birth; (3) help with domestic chores; (4) develop parenthood; and (5) be present during breast feeding. These suggestions may function as foundations for health staff to develop programmes, in order to involve fathers in breast feeding. This could result in a contribution to improve the practice and duration of that process.

The participation of fathers in the breastfeeding process: experiences, knowledge, behaviors and emotions.

OBJECTIVE: To identify the experiences, knowledge, behaviors and emotions of fathers with relation to the process of breastfeeding. METHODS: This is a descriptive, explorative and qualitative study involving 17 couples resident in a favela in the city of Recife, PE, in the Northeast of Brazil, whose most recent child was aged between 6 and 8 months. A semi-structured interview employing leading questions was used for data collection. These data were analyzed in the light of theoretical references, the historical, social and cultural construction of fatherhood, by means of thematic content analysis. RESULTS: Four themes emerged from this analysis: faint/ambiguous memories of breastfeeding during childhood; knowledge about breastfeeding is focused on the child's health, mother's responsibility and savings for father; breastfeeding-related behavior of father during his participation in the pregnancy-child care cycle; and interconnected feelings of fragility when breastfeeding. CONCLUSIONS: The knowledge and emotions involved in fathers' participation in breastfeeding are the products of socialization of both men and women, centered on the biological body and reinforcing the belief that breastfeeding is the preserve of women.

Participação do pai no processo da amamentação: vivências, conhecimentos, comportamentos e sentimentos / The participation of fathers in the breastfeeding process: experiences, knowledge, behaviors and emotions

OBJETIVO: Identificar vivências, conhecimentos, comportamentos e sentimentos do pai no processo da amamentação. MÉTODOS: Trata-se de um estudo descritivo, exploratório e qualitativo, realizado com 17 casais moradores de uma favela da cidade de Recife (PE), Nordeste do Brasil, em relação ao aleitamento materno do último filho, com idade entre 6 e 8 meses. A entrevista semi-estruturada, conduzida por questões norteadoras, foi utilizada para coletar as informações. Estas foram investigadas à luz do referencial teórico, da construção histórica, social e cultural da paternidade, através da análise de conteúdo, na modalidade temática. RESULTADOS: Desta análise, emergiram quatro temas: recordações ambíguas/esmaecidas sobre amamentação durante a infância; conhecimento sobre amamentação centrado na saúde da criança, responsabilidade da mulher e economia para o pai; comportamentos apresentados pelo pai durante a sua participação no ciclo grávido-puerperal direcionados à amamentação; e sentimentos entrelaçados de fragilidades ao amamentar. CONCLUSÕES: Os conhecimentos e sentimentos presentes na participação do pai na amamentação são produtos da socialização do homem/mulher, centrada no corpo biológico, reforçando que o amamentar pertence apenas à mulher.

OBJECTIVE: To identify the experiences, knowledge, behaviors and emotions of fathers with relation to the process of breastfeeding. METHODS: This is a descriptive, explorative and qualitative study involving 17 couples resident in a favela in the city of Recife, PE, in the Northeast of Brazil, whose most recent child was aged between 6 and 8 months. A semi-structured interview employing leading questions was used for data collection. These data were analyzed in the light of theoretical references, the historical, social and cultural construction of fatherhood, by means of thematic content analysis. RESULTS: Four themes emerged from this analysis: faint/ambiguous memories of breastfeeding during childhood; knowledge about breastfeeding is focused on the child's health, mother's responsibility and savings for father; breastfeeding-related behavior of father during his participation in the pregnancy-childcare cycle; and interconnected feelings of fragility when breastfeeding. CONCLUSIONS: The knowledge and emotions involved in fathers' participation in breastfeeding are the products of socialization of both men and women, centered on the biological body and reinforcing the belief that breastfeeding is the preserve of women.

Socioeconomic and dietary risk factors for anemia in children aged 6 to 59 months.

OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

Fatores socioeconômicos e dietéticos de risco para a anemia em crianças de 6 a 59 meses de idade / Socioeconomic and dietary risk factors for anemia in children aged 6 to 59 months

OBJETIVO: Este estudo tem como objetivo identificar, utilizando modelagem estatística, os fatores de risco da anemia em crianças de 6 a 59 meses de idade no estado de Pernambuco, contemplando aspectos socioeconômicos e da dieta. MÉTODOS: A amostra constou de 746 crianças de 6 a 59 meses do estado de Pernambuco, nas quais foram realizados dosagem de hemoglobina e inquérito dietético recordatório de 24 horas. Foi analisado o risco de anemia em relação às variáveis socioeconômicas e de consumo alimentar, utilizando modelos de análise multivariada. RESULTADOS: Os fatores de risco para a anemia foram: alta proporção de calorias do leite de vaca, baixa densidade de ferro não-heme, baixa idade e baixa escolaridade materna, destacando-se que as crianças com menos de 24 meses apresentaram risco 3,61 vezes maior de serem anêmicas em relação às demais. CONCLUSÕES: O presente estudo reforça a importância de se conhecer o consumo alimentar das crianças no país para melhor estabelecer a sua associação com a ocorrência da anemia. Os resultados revelaram que os fatores que mais explicaram o risco de anemia foram, com relação à dieta, a maior proporção de calorias do leite de vaca e menor densidade de ferro não-heme, além de idade menor de 24 meses e baixa escolaridade materna.

OBJECTIVE: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. METHODS: The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. RESULTS: The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. CONCLUSIONS: This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.

Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children

OBJECTIVES: to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. METHODS: Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. RESULTS: in more than 90 percent of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7 percent). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3 percent) and by the color scale (52.5 percent), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100 percent). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9 percent). CONCLUSIONS: this study suggests that moderate/severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale.

OBJETIVOS: comparar a validade e reprodutibilidade dos sinais clínicos (palidez palmar e conjuntival) com a escala de cores da hemoglobina da Organização Mundial de Saúde. MÉTODOS: pesquisa realizada em 206 crianças de 6-23 meses, atendidas nos ambulatórios de puericultura e pediatria do Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Os sinais clínicos e a escala de cores da hemoglobina foram avaliados por dois observadores em diferentes momentos. A validação foi realizada utilizando-se a hemoglobina como padrão. RESULTADOS: em mais de 90 por cento dos casos, a concordância entre os valores da escala de cores e da hemoglobina laboratorial encontravam-se em <2 g/dL. Entre os sinais clínicos e a escala de cores, a maior sensibilidade para diagnosticar anemia (Hb<11 g/dL) foi apresentada pela escala de cores da hemoglobina (75,7 por cento) e na anemia moderada/grave (Hb<9 g/dL), pela palidez palmar ou de conjuntiva ocular combinadas (74,3 por cento) e pela escala de cores (52,5 por cento), para o primeiro e segundo examinadores, respectivamente. A maior especificidade foi apresentada na palidez palmar comparada à palma da mãe e palidez de conjuntiva (100 por cento) para Hb<11 g/dL e a escala de cores da hemoglobina (91,9 por cento) para a Hb<9 g/dL. CONCLUSÕES: o presente estudo sugere que o diagnóstico da anemia moderada/grave seja possível através dos sinais clínicos e da escala de cores e, no caso da anemia leve, o melhor instrumento parece ser a escala de cores.

[Cow's milk consumption and iron deficiency anemia in children]. / Consumo de leite de vaca e anemia ferropriva na infância.

OBJECTIVE: To thoroughly investigate the association between the consumption of cow's milk and anemia in childhood. SOURCES OF DATA: The information was gathered from papers catalogued in Lilacs and MEDLINE and published during the last two decades, and also from textbooks and publications by international organizations. SUMMARY OF THE FINDINGS: Iron deficiency anemia is a severe public health problem in developing countries. Breast milk contains adequate iron for full term babies in the first 6 months. Thereafter, an additional iron-rich diet becomes essential. In recognition of the importance of the diet in triggering anemia, this paper discusses the relationship in children between a high intake of cow's milk and iron deficiency anemia. Gastrointestinal and allergic problems may be caused by early introduction of cow's milk or by its substitution for breast milk. Furthermore, cow's milk has decreased iron density and bioavailability, excess protein and minerals, notably calcium, and thus interferes in the absorption of iron from other foods, and is also linked to small intestinal hemorrhage in young children. CONCLUSIONS: The use of cow's milk in lieu of other foods rich in bioavailable iron was shown to be a risk factor for anemia. Exclusive breastfeeding during the first 6 months of life, discretionary weaning only after the 24th month, and a complementary diet rich in iron are highly important to avoid anemia and its consequences.

Consumo de leite de vaca e anemia ferropriva na infância / Cow's milk consumption and iron deficiency anemia in children

OBJETIVO: Revisar aspectos do consumo de leite de vaca associados à anemia na infância. FONTES DOS DADOS: As informações foram coletadas a partir de artigos publicados nas 2 últimas décadas, pesquisados nas bases de dados Lilacs e MEDLINE, livros técnicos e publicações de organizações internacionais. SíNTESE DOS DADOS: A anemia ferropriva é um grave problema de saúde pública nos países em desenvolvimento. Até os 6 meses de idade, o leite materno supre as necessidades de ferro das crianças nascidas a termo. A partir daí, torna-se necessária a ingestão de uma alimentação complementar rica em ferro. Considerando a importância da dieta na determinação da anemia e o alto consumo de leite de vaca na infância, discute-se neste artigo a relação desse alimento com a deficiência de ferro. A introdução precoce ou a substituição do leite materno por leite de vaca pode ocasionar problemas gastrintestinais e alérgicos. Além disso, esse alimento apresenta baixa biodisponibilidade e densidade de ferro, excesso de proteínas e minerais, especialmente cálcio, interferindo na absorção do ferro de outros alimentos, e associa-se às micro-hemorragias intestinais, principalmente nas crianças menores. CONCLUSÕES: A utilização do leite de vaca em detrimento de outros alimentos ricos em ferro biodisponível constitui um risco para o desenvolvimento da anemia. O estímulo ao aleitamento materno exclusivo até os 6 meses de vida e sua continuidade até pelo menos 24 meses, juntamente com uma dieta complementar rica em ferro são medidas de grande importância para a prevenção da anemia e de suas conseqüências na infância.

Factors associated with Hb concentration in children aged 6-59 months in the State of Pernambuco, Brazil.

In 1997, the prevalence of anaemia was 40.9 % among children aged 6-59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6-59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6-23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8.3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3.3, serum retinol 2.7, diarrhoea 2.4, water treatment 1.7, sanitation 1.3 and low birth-weight 0.5 %. The final model explained 23.4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged <2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

Fatores determinantes da anemia em crianças / Determinant fators of anemia in children

Objetivo: apresentar uma revisão sobre os principais fatores determinantes da anemia em crianças menores de cinco anos. Fontes de dados: foram utilizadas as informações de artigos publicados em revistas científicas nacionais e internacionais indexada, livros técnicos e publicações de organizações internacionais.Síntese dos dados: a anemia constitui o problema nutricional demaior magnitude no mundo, sendo as crianças menores de cinco anos um dos grupos populacionais de maior risco. Como qualquer problema de saúde pública, sua origem é multicausal e, desta maneira, tenta-se nesse artigo interpretar a sua relação direta ou indireta comseus possíveis fatores determinantes, e os principais achados concordantes ou discordantes nos estudos epidemiológicos. Dentre esses fatores encontram-se as condições socioeconômicas, as condições de assistência à saúde da criança, seu estado nutricional, a presençade morbidades, o consumo alimentar e os fatores biológicos. Destacam-se o papel da dieta, no que diz respeito ao consumo e biodisponibilidade de ferro, e a idade da criança como os principais determinantes.Conclusões: tendo em vista a magnitude do problema e aabrangência de seus fatores de risco revisados neste trabalho, torna-se necessária a implementação de medidas urgentes de prevenção e tratamento da anemia ferropriva. + importante ressaltar que uma única estratégia poderá ter pouco sucesso se outras medidas não forem tomadas simultaneamente, sendo relevante o papel da educação alimentar, juntamente com outras ações implementadas. Ascrianças menores de dois anos e as que residem em áreas rurais e carentes devem ser priorizadas nos programas de combate à anemia

[Determinant factors of anemia in children]. / Fatores determinantes da anemia em crianças.

OBJECTIVE: To present a review about the main determining factors of anemia in children under 5 years old. SOURCE OF DATA: Information was used from articles published in indexed national and international scientific journals, technical books and publications from international organizations. SUMMARY OF THE FINDINGS: Anemia constitutes the world's nutritional problem of the greater magnitude, and children under 5 years old represent one of the highest risk population groups. As with any public health problem, the origin of anemia is multi-causal and thus in this article the attempt is to interpret its direct or indirect relation with possible determinant factors and the main concordant or discordant findings in epidemiological studies. Among these factors are the social and economic conditions, the conditions of child health care, the child's nutritional state, the presence of morbidity, food consumption and biological factors. The role of the diet is emphasized with respect to the consumption and bioavailability of iron, and age of the child as the main determinants. CONCLUSIONS: Bearing in mind the magnitude of the problem and the breadth of its risk factors reviewed in this study, the implementation of urgent prevention and treatment measures for iron-deficiency anemia becomes necessary. It is important to stress that a single strategy may have little success if other measures are not taken simultaneously; the role of nutritional education being relevant, together with other implemented actions. Children under 2 years old and children who live in rural and deprived areas should be priorities in programs to combat anemia.

Prevalence of anemia in children 6-59 months old in the state of Pernambuco, Brazil

Objetive. To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there. Methods. In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomy selected to represent the stat and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census list, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were seleted. Blood was colected by venipuncture, and hemoglobin was measured with a portable homoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution. Results. The prevalence of anemia among children 6-59 months old was 40.9 for the state as awhole. Prevalence in the metropolitan region of Recife was 39.6, and it was 35.9 in the urban interior. The rural interior had the highest prevalence, 51.4. Prevalence was twices as high in children aged 6-23 months as among those 24-59 months old, 61.8 vs. 31.0 (x2=77.9,P0.001). The mean hemoglobin concentration in the younger and older age groups were 10.4g/dL (standard deviation (SD)=1.5) and 11.4g/dL (SD=1.4),respectively. There was no statically significant difference between the sexes in terms of prevalence. conclusions. This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed

Prevalence of anemia in children 6-59 months old in the state of Pernambuco, Brazil

Objetive. To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there. Methods. In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomy selected to represent the stat and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census list, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were seleted. Blood was colected by venipuncture, and hemoglobin was measured with a portable homoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution. Results. The prevalence of anemia among children 6-59 months old was 40.9 for the state as awhole. Prevalence in the metropolitan region of Recife was 39.6, and it was 35.9 in the urban interior. The rural interior had the highest prevalence, 51.4. Prevalence was twices as high in children aged 6-23 months as among those 24-59 months old, 61.8 vs. 31.0 (x2=77.9,P0.001). The mean hemoglobin concentration in the younger and older age groups were 10.4g/dL (standard deviation (SD)=1.5) and 11.4g/dL (SD=1.4),respectively. There was no statically significant difference between the sexes in terms of prevalence. conclusions. This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed