Anaemia iron deficiency and malaria in a rural community in Brazilian Amazon

To assess the incidence of anaemia iron deficiency and malaria in a malaria endemic community...

Complementary feeding: study on prevalence of food intake in two health centers of São Paulo city.

The infant feeding practices in the first year of life are of fundamental importance for their growth and development. This study was carried out aiming at checking on the prevalence of food intake by the infants during their first year of life. One-hundred-and-seventy-five children aged up to one year, attended to in two Health Centers of São Paulo city, Brazil, participated in this study. Their feeding practices, obtained through the status quo approach, were analyzed through multiple logistic regression models, using curves of prevalence for complementary food consumption. Fruit was the first solid food to be part of the infant diet, followed by vegetables, cereal, meat and/or eggs and, beans. Animal-protein-containing source foods (meat and eggs) entered the diet much later, being consumed by practically all children only at the end of their first year of life. The early introduction of complementary foods into the infant diet was made evident. The introduction of solid foods to complement breastfeeding is started with low-calorie density foods, in disagreement with the recommendations for Brazilian children. Results of this paper disclose a need for having programmatic actions in health education being carried out, in special those regarding exclusive breastfeeding promotion and orientation on the adequate introduction of complementary feeding.

Relative effectiveness of iron bis-glycinate chelate (Ferrochel) and ferrous sulfate in the control of iron deficiency in pregnant women.

The relative effectiveness of daily supplementation of iron deficiency during pregnancy using 15 mg/day of iron from iron-bis-glycinate chelate (71 pregnant women), or 40 mg iron from ferrous sulfate (74 pregnant women) was evaluated by measuring hemoglobin, transferrin saturation and serum ferritin, at the beginning of the study (< 20 weeks of pregnancy) and at 20-30 weeks and 30-40 weeks thereafter. Ingestion for 13 weeks or more was considered adequate. Seventy three percent of the Ferrochel consuming group and 35% of the ferrous sulfate consuming group were considered to have taken the treatment adequately. The decrease in levels of all the measured parameters was significantly less pronounced in the group that consumed Ferrochel in spite of the lower treatment dose. Iron depletion was found in 30.8% of the women treated with Ferrochel and in 54.5% of the women than consumed ferrous sulfate. Of the factors responsible for non compliance taste was reported in 29.8% of the ferrous sulfate consumers and none in the groups that consumed Ferrochel. It is concluded that daily supplementation with Ferrochel was significantly more effective, in spite of the lower dose, than supplementation with ferrous sulfate.

[Changes in nutritional status of pregnant women assisted at the basic health network, Santo Andre, Brazil]. / Evolución del estado nutricional de embarazadas atendidas en la red basica de salud, Santo Andre, Brasil.

Nutritional conditions in the pre-gestacional period and during pregnancy were evaluated in 372 pregnant women based on the body mass index and Rosso's Graph. Approximately half (51%) the pregnant women presented normal pre-gestacional weight; however, 17.7% were underweight and 31.3% overweight. In the third trimester, 18.8% were underweight and 28.2% overweight. The weight at birth increased as nutritional conditions during pregnancy improved. These results show the importance of appropriate anthropometric control in order to prevent a bad neonatal prognosis and reaffirms the importance of such activity during the whole routine of pre-natal control.

[Prevalence and risk factors for anemia in Southern Brazil]. / Prevalência e fatores de risco para anemia no Sul do Brasil.

OBJECTIVE: To measure the prevalence and evaluate the risk factors of anemia. METHODS: Cross sectional populational based study of the urban area of Criciuma town, in the state of Santa Catarina, Southern Brazil. The study population was a probabilistic sample of 476 children aged under three years. RESULTS: The prevalence of anemia found in the sample was 60.4% for children aged 0 to 35.9 months according to the Brault-Dubuc criteria and 54% for children aged 6 to 35.9 months according to the OMS criteria. The prevalence of anemia increases with age up to 18 months-old and then decreases. It is less prevalent in families where the father has a higher education level and where there is a higher total family income. Nevertheless, even within the 25% higher income group 40% of the children are anemic. The prevalence of anemia is higher among children living in unfinished and overcrowded houses, where the toilet is not equipped with flush, and among children who have two or more older brothers. It is also higher among teenager mothers (<20 years), and 35 years old or older mothers. The prevalence of anemia is lower among women who had 5 to 9 prenatal visits during pregnancy. Low weight at birth was associated with iron deficiency. The nutritional condition was associated with anemia only according to weight/age criteria. Hospitalizations in the last 12 months were not associated with the disease. In the hierarchical multivariate analysis children age, family income, and crowded house were the only significant variables. Reproductive health history, health service visits, birth weight, breast-feeding, anthropometry, and morbidity did not characterize a risk factor of anemia in the multivariate analysis. CONCLUSIONS: The study makes it evident that social inequality is a strong determinant of anemia. The risk imposed by anemia to children in regard to their health and intellectual development requires immediate action.

[Secular trends in childhood in the city of São Paulo, Brazil (1984-1996)]. / Tendência secular da anemia na infância na cidade de São Paulo (1984-1996).

OBJECTIVE: Data from two consecutive households surveys undertaken in mid-80s and mid-90s allow to characterize and analyse secular trends in infant and child anaemia in the city of S. Paulo, Brazil. METHODS: The two surveys included random population samples aged from zero to 59 months (1,016 in the period of 1984-85 and 1,280 in 1995-96). Capillary blood samples, collected by digital puncture in the two surveys, were analysed regarding their haemoglobin concentration. The anaemic status was determined when haemoglobin concentration was below 11 g/dL. For each survey, the study of the social distribution of child anaemia took into account tertiles of the per capita family income. For the study of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS: In the time span from the first to the second survey, there was a significant reduction in the average haemoglobin concentration (from 11.6 g/dl to 11.0 g/dl), as well as a considerable increase in anaemia prevalence (from 35.6% to 46.9%). Unfavourable trends were observed in both sexes, all age groups and all income strata. Trends were still less favourable among the poorest families, aggravating the social burden related to child anaemia. Changes in distal (family income and maternal schooling) and proximal determinants (breast or bottle-feeding) of child anaemia were positive in the study period and therefore they cannot explain the increase in the disease. A low iron diet could explain the high prevalence of anaemia in both surveys but could not explain its further increase.

[Iron nutritional status in pregnant adolescents, São Paulo, Brazil]. / Estado nutricional del hierro de gestantes adolescentes, São Paulo, Brasil.

The frequency of anemia, iron deficiency and iron body stores was assessed in 155 pregnant teenagers of low socioeconomic status in a prenatal care unit of a beneficent hospital in São Paulo, Brazil. By the criterion of the World Health Organization (Hb < 12 g/dL) 14.2% of the pregnant adolescents had anemia. The iron deficiency diagnostic by saturation of transferrin < 16% and zinc protoporphyrin concentration > 60 (mol/mol heme were 45.8 and 42.6%, respectively. The iron body store (serum ferritin < 12 micrograms/L) was depleted for 48.4% of adolescents. It is concluded that the iron nutritional status of these adolescents were characteristics of the pregravidic inadequate iron store. Despite low percentage of the anemia, the high frequency of iron deficiency and depleted iron stores suggest a practical procedure to detect iron deficiency and the use of iron supplementation in teenagers.

Prevalence and risk factors in iron deficiency and anemia.

Iron deficiency anemia is nowadays the world most prevalent nutritional problem. Several studies concerning anemia prevalence were carried out in Brazil with pregnant women and children aged less than 5 years, restricted mainly to northeast and southeast regions of the country. More recently, groups other than those of pregnant women and children aged less than 5 years, such as school children and adolescents, have become the target of those concerned with the issue. The differences found out among the groups and the diversity of methodologies employed, prevent us from reaching an evolutionary profile concerning nutritional anemia in Brazil. However, the high rates of prevalence verified by the various studies carried out are enough for justifying the general interest in controlling and/or eradicating the disease. This paper presents a model of causal determination of anemia, that points out the diet as the principal immediate factor. The typical Brazilian diet is poor in bioavailable iron. The two foods--meat and beans--responsible for the totality of this mineral in the habitual Brazilian diet have been registering a decreasing intake in the last decades. Iron deficiency is also observed in the food practice of infants and children aged less than 5 years. This situation justifying the urgency in finding an effective intervention to control this relevant nutritional problem.

[Anemia in the first year of life and its relation to breast-feeding]. / Anemia no primeiro ano de vida em relação ao aleitamento materno.

INTRODUCTION: Many studies in this field justify the hypothesis that early weaning is one of the causes of anemia in the first year of life. This study seeks to discover the prevalence of iron deficiency anemia and its relation to the duration of breast-feeding among infants aged 0-12 months. MATERIAL AND METHOD: A sample of 317 infants of four school health centers in the city of S. Paulo (Brazil) was studied. The information about diet was obtained by interviewing the mothers. The presence of anemia was verified by hemoglobin concentration, using the cianometahemoglobin method, and the criteria recommended by the World Health Organization (WHO) were utilized for the diagnosis. The duration of exclusive breast feeding was calculated by using the life table technique for censored data. RESULTS: The prevalence of anemia was found to be 14.5% for the whole population and 22.6% for infants aged more than 180 days. No association was found between anemia and time of breast-feeding; the median time were the same for both groups, anemic and non-anemic. COMMENTS: The results observed are more probably related to the demographic characteristics of the population studied and by no means lessen the importance of exclusive breast feeding in the prevention of anemia.

[Nutritional status of adolescent pregnancy in São Paulo, Brazil]. / Estado nutricional de gestantes adolescentes en São Paulo, Brasil.

Several anthropometric patterns were used to evaluate the nutritional status of 155 pregnant teenagers of low socioeconomic status in a prenatal care unit of a beneficent hospital in São Paulo, Brazil. Using the body mass index 25.2% of them were classified as underweight before pregnancy and 3.3% during pregnancy. The Siqueira's et al curve and the Rosso's normogram showed higher percentages of underweight, as well as of overweight and obesity. The results indicated the necessity to review the anthropometrics patterns that classify specifically the nutritional status of pregnant adolescents.

[Prevention of anemia in the first year of life in health centers of Santo André, São Paulo]. / Prevenção de anemia no primeiro ano de vida em centros de saúde do município de Santo André, São Paulo.

The aim of this study was to evaluate the efficacy of an iron prophylactic supplementation program, in three health centers of Santo André, in São Paulo state. The prevalence of anemia was identified in a control group consisting of 201 children of 1 year old. The intervention group consisted of 308 children younger than 3 months, but 55% of them gave up during the survey. The mothers were instructed to give them daily prophylactic doses of iron sulfate (6 mg of iron/day) when they were 4 or 6 months old, according to the kind of breast-feeding. The mothers were also instructed about feeding and anemia and its risk to children's health. When the children were 12 months old, the diagnosis of anemia was made through dosage of hemoglobin concentration and the results were compared with those of the control group. It was verified that the 2 groups presented similar prevalences. It is important to realize that children with low frequency of visits to the health centers had prevalence of anemia significantly higher than those with high frequency. Some factors that possibly contributed to the result of the intervention are discussed.

Rapid epidemiologic assessment of breastfeeding practices: probit analysis of current status data.

We describe the use of probit analysis to estimate breastfeeding indicators from current status epidemiological data. A health centre-based sample of 2411 children aged 0-1 year was investigated in Santo Andre, a large town in the Metropolitan Area of Sao Paulo, southeastern Brazil. Mothers were interviewed during routine pediatric consultations and asked about their current infant feeding practices. Probit regressions were calculated by a public-domain microcomputer programme written by one of us. The median duration of total (i.e. exclusive plus partial) breastfeeding in this children's sample, estimated as 108.8 days (95 per cent confidence interval: 95.5-123.2 days), is close to that recently reported in the city of Sao Paulo and nearby towns. However, the median duration of exclusive breastfeeding (28.9 days, 95 per cent CI: 17.9-38.3 days) is rather short when compared to recent estimates from this same region. Despite the nationwide efforts for promotion of exclusive breastfeeding, only 14 per cent (95 per cent CI: 12.3-17 per cent) of the infants were still being exclusively breastfed by 120 days of age. Therefore, a key feature of breastfeeding practices in this population sample, namely, the early introduction of supplementary foods, was identified by using simplified methods of data collection and analysis. This communication suggests that probit analysis of current status data may be further explored as a method for rapid epidemiologic assessment of breastfeeding practices.

[Anemia and malnutrition in children at public schools in Osasco, São Paulo, Brazil]. / Anemia e desnutrição em escolares da rede pública do município de Osasco, São Paulo, Brasil.

The authors studied a sample of students entering the first grade in the Osasco public school system in order to determine both the prevalence of anemia and nutritional status. Osasco is part of the Greater S o Paulo Metropolitan Area. Diagnosis of anemia was made through the hemoglobin concentration of blood from digital puncture. World Health Organization (WHO) levels were used to define anemia. Nutritional Status assessment. was made through weight/age and height/age indices, using Z score distribution and the National Center for Health Statistics (NCHS) reference levels. Prevalence of anemia was 51%. Prevalence levels varied according to the schools' geographic location: 56.9% in peripheral neighborhoods and 41.7% in central areas. Children with illiterate parents had a higher prevalence of this condition. Risk of anemia was higher for children who were over eight years of age when entering the first grade. Acute malnutrition was not found. Prevalence was higher than expected and points to the urgent need to establish an anemia control program for schoolchildren in this population.

Anaemia, iron deficiency and malaria in a rural community in Brazilian Amazon.

OBJECTIVE: To assess the incidence of anaemia, iron deficiency and malaria in a malaria-endemic community. DESIGN: Three consecutive cross-sectional surveys (A, B and C) of the whole population made at 6-month intervals and malaria surveillance between the surveys. SETTING: Urupá, a rural community in Western Brazilian Amazon. SUBJECTS: 133 people of all age groups present in at least two cross-sectional surveys. INTERVENTIONS: Anaemic patients received ferrous sulphate during 3 months. Patients parasitized by intestinal nematodes were given mebendazole and parasitologically proven Plasmodium falciparum and P. vivax malaria attacks were treated with quinine or chloroquine plus primaquine. RESULTS: Anaemia (haemoglobin concentrations [Hb] below the cut-off values proposed by the World Health Organization) was diagnosed in respectively 10.0% (13 of 130) subjects in survey A, 9.2% (10 of 109) in B and 29.7% (27 of 91) in C. Depleted iron stores [serum ferritin (SF) < 12 micrograms/l] were detected in 10.0% subjects in survey A, 10.1% in B but in only 8.8% subjects in survey C. Concomitant anaemia and low SF was detected in 5.4% subjects in survey A, 3.7% in B and 6.6% in C. Mean Hb from anaemic patients diagnosed and treated during the study (n = 17) raised 1.2 g/dl after iron therapy and most of them (13 of 17, 76.5%) became non-anaemic. The highest malaria transmission was observed between surveys B and C. People who suffered at least one malaria attack during this period (27 of 63) were at a slightly greater risk of subsequent anaemia (odds ratio = 2.85, 95% confidence interval 0.81-10.28). CONCLUSIONS: Both malaria and iron deficiency could be considered as important causes of anaemia in this population. SPONSORSHIP: Supported by grants from the UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (no. 890245), the Ministére des Affaires Etrangeres, France, and from the Fundação de Amparo à Pesquisa do Estado de São Paulo (no. 92/1336-4). M.A.C. was supported by a doctoral fellowship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico.

[Anemia in a population from an endemic area of malaria, Rondônia (Brazil)]. / Anemia em população de área endêmica de malária, Rondônia (Brasil).

With the purpose of describing the prevalence rate of anaemia among inhabitants of a malaria endemic area--Candeias district, a periurban locality near Porto Velho, in Rondônia State, Brazilian Amazon Basin--a random population sample comprehending 1,068 individuals of all age groups (14.1% of the total population) was screened for anaemia (measurement of blood haemoglobin concentration) and malaria (Giemsa-stained thick-smear microscopy). Two-hundred and ninety-nine individuals (28.0% of the sample) were found to be anaemic, using the cut-off haemoglobin values proposed by the World Health Organization for each age group. Highest prevalence rates were found among children with ages varying from 6 months to 1 year (70.0%) and from 1 to 6 years (38.4%), as well as in pregnant women (41.2%, 7/17) and malaria patients (44.4%, 8/18). Parasitological stoll examinations were made on a voluntary sample of 476 individuals (44.6% of the sample population); of these, 118 (26.8%) were positive. Eggs of Ascaris lumbricoides, the most frequent intestinal parasite in this population sample, was detected in 67 stool samples (14.1%); only 27 patients (5.7%) eliminated Ancylostomidae eggs. In this voluntary sample, no significant difference in anaemia prevalence rates between parasite carriers and non-parasited individuals was detected. On the other hand, the more recent the last malarial episode referred to by the patients, the lighter prevalence rate of anaemia in individuals above the age of 14 years. The role played by malaria as an underlying cause of anaemia in Candeias district inhabitants, particularly in the economically active age group, is further discussed.

[Maternal anemia and malnutrition and their relation to birth weight]. / Anemia e desnutrição maternas e sua relação com o peso ao nascer.

With a view to evaluating the effect of anemia and maternal undernourishment on birth weight, a sample of 691 pregnant women, from an assistential maternity hospital, in S. Paulo, Brazil, were studied at delivery. Anemia was found in 29.1% and undernourishment in 17.2% of the women, though no association was detected between these nutritional deficiencies. Neither was any association detected between institutional ante-natal care and anemia or undernourishment. Among single newborns the incidence of low birth weight (LBW) was of 12.9%. LBW was observed in 23.6% of children born to women who came to the end of their pregnancy with a low weight for height ratios while among adequate weight for height women the percentage was 10.8. Children of women who remained undernourished throughout their pregnancy had a relative risk of being born with LBW 2.8 times greater than the children of those who recovered normal weight by the end of their pregnancy. Our results emphasize the need for implementation of nutritional status control activities in programs of ante-natal care.