Impact of maternal vitamin A supplementation on the mother-infant pair in Brazil.

BACKGROUND/OBJECTIVES: Vitamin A deficiency (VAD) is a major public health problem. The supplementation of lactating women could be an effective strategy to combat it. The objective of this study was to assess the impact of maternal vitamin A supplementation on the mother-infant pair. SUBJECTS/METHODS: This was a double blind, placebo-controlled randomized clinical assay in which 33 women received 200 000 IU of vitamin A and 33 women received soy oil between 20th and 30th postpartum days. Maternal blood and milk samples were collected immediately before supplementation and 3 months after delivery, when blood was also collected from the babies. Retinol concentrations 0.70 µmol/l in serum and 1.05 µmol/l in milk were considered to indicate VAD. RESULTS: Increase in serum retinol level was observed in the supplemented group compared with the pre-supplementation levels (1.05 and 1.17 µmol/l, respectively; P=0.026) and to the post-supplementation levels of the control group (1.02 µmol/l; P=0.032). Reduction in breast milk retinol was observed in the control group compared with the pre-supplementation levels (1.93 and 1.34 µmol/l, respectively; P<0.0001) and to the post-supplementation levels of the supplemented group (1.56 µmol/l; P=0.0003). There was significant difference in the prevalence of VAD in breast milk after supplementation, 55.6% (15/27) in the control group and 16.1% (5/31) in the supplemented group (P=0.002). VAD was present in 66.1% (39/59) of infants, with mean serum retinol levels of 0.64±0.30 µmol/l in the control group and of 0.69±0.26 µmol/l in the supplemented group. CONCLUSIONS: Supplementation had a positive impact on maternal vitamin A status. No effect on infant status was detectable 2 months after supplementation with a single dose.

Vitamin A deficiency among Brazilian school-aged children in a healthy child service.

BACKGROUND/OBJECTIVES: Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group. SUBJECTS/METHODS: A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5-11 years had the relative dose-response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design. RESULTS: No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 micromol l(-1), respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61-4.34), weight and height (P> or =0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75-18.26), alpha-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15-15.42) and serum zinc (P=0.31). None of these variables was related to VAD. CONCLUSIONS: In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.

Detection of vitamin A deficiency in Brazilian preschool children using the serum 30-day dose-response test.

BACKGROUND: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism. OBJECTIVE: To identify VAD in preschool children by the serum 30-day dose-response test (+S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community. DESIGN: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30-45 days after supplementation in order to determine the +S30DR. RESULTS: In all, 74.5% (140/188; 95% confidence interval: 68.3-80.7%) of the children presented +S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 micromol/l, respectively; P < 0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the +S30DR value. CONCLUSIONS: The prevalence of VAD in the study group was elevated. +S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country.

Incidence of childhood accidents determined in a study based on home surveys.

A retrospective survey of accidents during a 12-month period was carried out at Vila Lobato in the town of Ribeirão Preto, Brazil using home surveys involving 25% of residences in this area. Variables relating to the accidents and data concerning the children involved were analyzed, i.e. sex, age, type of accident, place of occurrence, time of day, time of year, which part of the body was involved and the person accompanying the victim of the accident. There were 260 accidents during the year, mainly involving the 1-5-year (41.1%) and 5-10-year (33.1%) age ranges. The most frequent accidents were falls (46.9%), contusions (26.5%) and cuts (11.9%). Most accidents occurred at home (65.7%), followed by in the street (25.4%) and at school (6.1%). More accidents occurred in the late afternoon (49.6%) and during the summer months and school holidays (38.1%) than at other times. The lower limbs were the sites most often involved (36.9%), followed by the upper limbs (32.3%) and the head (25.4%). Most children (75.7%) were accompanied when they suffered an accident. Slightly more boys (55.4%) than girls (44.6%) had accidents. Statistical analysis of the results by the chi 2 test showed significant differences for all variables studied with respect to the occurrence of accidents (p < 0.05), except gender. The authors discuss the need to expand the debate on accidents and for the application of knowledge to prevent them occurring.

Growth of exclusively breast-fed infants from a poor urban population.

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-up.

Growth and hematological studies on Brazilian children of low socioeconomic level.

Anemia and undernutrition are common all over the world, especially in less developed countries. The relationship between low weight, short stature and iron deficiency should be better understood so that appropriate measures might be taken to prevent these problems. A total of 115 institutionalized children aged 12 to 72 months were studied in day-care institutions in the town of Pontal, Southeastern Brazil, during the second semester of 1999. Personal data, weight, height and hematological profile were obtained from all subjects. Food intake was evaluated in 20 children by a direct food-weighing method. The prevalence of low weight for age (2.6%), low weight for height (1.7%) and low height for age (4.3%) was considered low. Anemia was observed in 68.7% of the children. Diet was found to be adequate in terms of the major nutrients evaluated, but food iron supply was of low bioavailability. In conclusion, the population studied revealed a peculiar behavior i.e., the coexistence of fairly good anthropometric nutritional status along with iron-deficiency anemia. The prevention of this kind of malnutrition cannot be limited to an adequate calorie/protein supply but should also be based on the correction of the severe iron deficiency present in this low socioeconomic level preschool children in Brazil.

[Dog bite accidents in childhood]. / Acidentes de mordeduras de cães na infância.

The incidence of dog bites injuries among children aged 0 to 15 years seen at CSE D. Pedro I health center in Ribeirão Preto, Brazil, in the period of 1993 to 1997, was studied. The results show that there is a need to develop and implement educational and preventive programs about the risks and severity of accidents occurred while in contact with dogs.

Comparison of four anthropometric methods of nutritional assessment and evaluation of the agreement between two reference populations.

A total of 841 children, aged 10 days to 5 years, seen at a primary health care centre in Ribeirão Preto, Brazil, were studied in order to compare the methods of Gomez, Waterlow, Shakir, and Kanawati and McLaren and to determine the correlation between the Brazilian and the National Center for Health Statistics (NCHS) reference populations, which are frequently used in Brazil. Anthropometric measurements (weight, height, arm circumference, and head circumference) were made and personal data were obtained in order to evaluate nutritional status according to the above methods. The two reference populations were compared by the method of Gomez. The NCHS and the Brazilian reference populations were concordant. Comparison of the methods of Gomez and Shakir showed a very mild agreement in the evaluation of nutritional status. Comparison of Waterlow 'wasting' with Kanawati & McLaren and with Gomez showed a mild agreement.

[Evaluation of the use of the 10th percentile of weight for age as a cut point for detection of children under nutritional risk] / Avaliação do uso do percentil 10 de peso para idade como ponto de corte para detecção de crianças sob risco nutricional.

OBJECTIVE: To evaluate the use of the 10th percentile of weight for age as a cut off point for detection of children under nutritional risk, especially for programs of alimentary supplementation. METHODS: 841 children with age between 10 days and 60 months were studied in a primary health care center located in the periphery of Ribeirão Preto, SP, Brazil. It was a cross-sectional study that included age, sex, weight and height, later computing the z scores of weight for age, height for age and weight for height, on the basis of the data of the NCHS. Through 2x2 type tables, where the results in relation with the 10th percentile (above or below this cut off point) and other indices were compared (above or below - 2 z scores), the capacity of 10th percentile of weight for age to detect children with various anthropometric deficits was estimated. RESULTS: The false negative results were always very low, between 0 and 1%, in opposition to the false positive results, that varied from 76.3 to 90.5%. The values of sensitivity/specificity have been 100/85.9%; 93.3/83.8%; 82.9/85.7%, respectively for deficits of weight for age, weight for height and height for age. CONCLUSIONS: The 10th percentile of weight for age was found adequate for population screening of children with weight for the age and weight for the height deficits (high sensitivity), but these children must be better evaluated later on (too many false positive results). For height for age deficits, the 10th percentile resulted inadequate.

[Influence of the different types of room on newborns during breastfeeding]. / Influências dos diferentes tipos de alojamento sobre recém-nascidos na prática do aleitamento materno.

The present study was developed in the CMSCVL, which is a primary medical attendment clinic for children and pregnant women, during the period of 01/10/1980 to 31/12/1984, containing 132 children. The study was longitudinal and respective and the two distinct groups of children may be established, differing in accordance to the hospital stay period of postpartum, in rooming-in or traditional nursery. After the statistic analysis of all the variables involved in the study, the only variable that really resulted was the site of internation during the postpartum period. Although these exist a tendency to the greater frequency of breast feeding in the group that utilized the rooming-in, the statistics analysis showed that this difference is not significant. However should consider the important paper carried out by the CMSCVL, in the encouragement of the practice of the breast-feeding, what may have homogenized the two groups. The medium time of weaning found for the population of 132 children studied was 8 months, while for those children that utilized the rooming-in is system was 10 months and for those that stayed in the traditional nursery it took 9 months. The motives of weaning were also identified for the studied population that showed similarity to other published projects.

[Perinatal health in Ribeirão Preto, Brazil: distribution of the head circumference measurement of newborn infants]. / Saúde perinatal em Ribeirão Preto, Brasil: distribuição do perímetro craniano em recém-nascidos.

A sample of 4554 of newborn was used to study the distribution of the head circumference measure shortly after birth. The sample is part of the cohort born in Ribeirão Preto, Brazil, from June 1st, 1978 to May 31st, 1979. It was possible to show that such measure follows a normal distribution for both sex (either separately or together) and to calculate 'normality limits' for practical use.

Caracterizacao do risco e suplementacao alimentar em um programa de puericultura. / High risk children and supplemented food in puericulture programs

Os autores estudam 69 criancas de "maior risco" seguidas no Centro Medico Social Comunitario de Vila Lobato no ano de 1979.Define-se como "maior risco" as criancas que nao apresentam um desempenho satisfatorio do ponto de vista de puericultura.Suas familias tinham uma composicao media de 7,5 pessoas por familia, envolvendo um total de 522 pessoas. Foram analisadas: idade materna, seguimento de pre-natal tipo parto e relacao da crianca na irmandade Concluiram que: 1) A caracteristica demografica/sexo nao auxilia na caracterizacao das criancas de "maior risco". 2) As criancas de cor nao branca tem maior probabilidade de apresentar um desempenho nao satisfatorio no ambulatorio de puericultura; 3) A introducao precoce da mamadeira evidencia-se como uma das caracteristicas das criancas de "maior risco". 4) A mamadeira nao foi causa de desmame precoce pois 39 criancas (56,2%) com a idade de um ano ainda permaneciam em aleitamento misto; 5) A analise das condicoes socio-economicas sanitarias nos levou a ampliar o nosso conceito de " criancas de maior risco" para "familia de alto risco"