Revisão integrativa sobre doenças parasitárias em crianças de creches brasileiras / Integrative review on parasitic diseases in children in brazilian day care centers

As parasitoses intestinais constituem um importante problema de Saúde Pública, especialmente entre os pré-escolares, devido à imaturidade do sistema imune. Assim, este estudo objetivou realizar uma revisão integrativa dos estudos publicados entre os anos de 2010 a 2017 sobre parasitoses intestinais e os fatores associados ao desenvolvimento em crianças matriculadas em creches brasileiras. Foi realizada busca bibliográfica através das bases de dados Medline, Lilacs e SciELO, utilizando os descritores: infecção, parasitoses, diarreia e creches, e seus correspondentes em inglês: "infection", "parasitc diseases", "diarrhea" e "child day care centers". No caso das buscas no Medline o descritor Brazil também foi usado. Foram identificados 59 estudos, dos quais 11 foram incluídos no presente trabalho. Foi observado variação de 19,4% a 98,4% de parasitos e, a Giardia duodenalis foi o mais prevalente em crianças entre um e seis anos de idade, gênero masculino, com baixo peso, advindas de residências com alta densidade familiar e nível socioeconômico baixo. As análises mostraram a importância da compreensão dos fatores de risco para a incidência de parasitos, indicando a necessidade da promoção de estratégias efetivas para prevenção e controle das infecções parasitárias no país, visto que, tais infecções influenciam diretamente no desenvolvimento da criança, e em alguns casos, evoluindo a óbito.

Intestinal parasitosis is an important public health issue especially among pre-school children due to the immaturity of their immune system. Thus, this study aimed at carrying out an integrative review of studies published between 2010 and 2017 regarding intestinal parasites and associated factors in children registered in Brazilian day care centers. A bibliographic survey was performed through the Medline, Lilacs, and SciELO databases using the following descriptors: infection, parasitic diseases, diarrhea, and child day care centers, as well as their corresponding translations in Portuguese: "infecção", "parasitoses", "diarreia" and "creches". In the case of Medline searches, the descriptor Brazil was also used. Fifty-nine studies were identified, from which, 11 were included in this study. A variation of 19.4% to 98.4% of parasites could be observed, with Giardia duodenalis being the most prevalent in children between one and six years old, male, with low weight, coming from homes with high family density and low socioeconomic status. The analyzes showed the importance of understanding the risk factors for the incidence of parasites, showing the need to promote effective strategies for the prevention and control of parasitic infections in the country, since such infections have direct influence on the child's development, and in some cases, even evolving to death.

Vigilância do desenvolvimento de crianças em creche: um estudo sobre o olhar materno / Vigilancia del desarrollo infantil en la guardería: un estudio sobre la mirada materna / Surveillance of child development in a daycare center: a study on the maternal perspective

Resumo Objetivo Compreender a percepção materna acerca da vigilância do desenvolvimento de crianças menores de três anos que frequentam creche. Método Estudo qualitativo com nove mães de crianças menores de três anos, matriculadas em uma creche do município de João Pessoa-PB, vinculada a uma Unidade de Saúde da Família. Os dados foram coletados por meio de entrevistas semiestruturadas e submetidos à análise temática. Resultados A vigilância do desenvolvimento de crianças que frequentam creche encontra-se fragilizada, visto que a maioria das mães não costumam levar a criança para a unidade de saúde, para o acompanhamento do crescimento e desenvolvimento, e a inserção dos profissionais de saúde na creche ainda é limitada. Entretanto, as mães reconhecem a creche como cenário ideal para a promoção do desenvolvimento infantil e a importância da atuação dos profissionais de saúde nesse cenário. Conclusão e implicações para prática São necessárias ações conjuntas da creche com a Unidade de Saúde da Família para a atenção integral e vigilância do desenvolvimento infantil.

Resumen Objetivo Comprender la percepción materna sobre la vigilancia del desarrollo de los niños menores de tres años que asisten a la guardería. Metodo Estudio cualitativo con nueve madres de niños menores de tres años, inscriptos en una guardería de la ciudad de João Pessoa-PB, vinculada a una Unidad de Salud de la Familia. Los datos se recopilaron a través de entrevistas semiestructuradas y se sometieron a análisis temático. Resultados La vigilancia del desarrollo de los niños que asisten a la guardería se debilita, ya que la mayoría de las madres no llevan al niño a la guardería, para monitorear el crecimiento y desarrollo, y la inclusión de profesionales de la salud en la guardería aún es limitada. Sin embargo, las madres reconocen la guardería como un escenario ideal para la promoción del desarrollo infantil y la importancia del desempeño de los profesionales de la salud en este ámbito. Conclusión e implicaciones para la práctica Son necesarias acciones conjuntas de la guardería y la Unidad de Salud de la Familia para lograr la atención integral y vigilancia del desarrollo infantil.

Abstract Objective To understand the maternal perception about the surveillance of the development of children under three years old who attend a daycare center. Method A qualitative study with nine mothers of children under the age of three, enrolled in a daycare center in João Pessoa-PB, linked to a Family Health Unit. Data was collected through semi-structured interviews and subjected to thematic analysis. Results The monitoring of the development of children attending a daycare center is weakened, since most mothers do not take the child to childcare in order to monitor growth and development, and the inclusion of health professionals in the daycare center is still limited. However, the mothers recognize the daycare center as an ideal setting for the promotion of child development and the importance of health professionals in this setting. Conclusion and implications for the practice Joint actions of the daycare center with the Family Health Unit are necessary for comprehensive care and surveillance of child development.

Fatores associados ao ganho de peso rápido em pré-escolares frequentadores de creches públicas / Factors associated with rapid weight gain in preschool children in public day care centers

RESUMO Objetivo: Avaliar a prevalência e identificar os fatores associados ao ganho de peso rápido em pré-escolares. Métodos: Estudo transversal realizado entre fevereiro e dezembro de 2014, com 136 crianças entre 24 e 35 meses de idade frequentadoras de creches públicas do município de Mogi das Cruzes. Foram realizadas entrevistas com as mães para caracterização clínica, sociodemográfica e antropometria das crianças. Considerou-se ganho de peso rápido quando as crianças apresentaram diferença superior a 0,67 entre o escore Z de peso para idade do nascimento à avaliação. Foi ajustado modelo de regressão logística para fatores associados ao ganho de peso rápido. Resultados: Do total de crianças avaliadas, 50 (36,8%) apresentaram ganho de peso rápido e 36 (26,5%) excesso de peso. Destas, 22 crianças eram do grupo ganho de peso rápido. O maior tempo total do aleitamento materno (OR 0,94, IC95% 0,88-0,99; p=0,031) foi identificado como fator de proteção e o baixo nível socioeconômico (OR 4,18, IC95% 1,04-18,60; p=0,044), como fator de risco para ganho de peso rápido. Conclusões: Encontrou-se alta prevalência de ganho de peso rápido e de excesso de peso entre pré-escolares no terceiro ano de vida frequentadores de creches públicas. Incentivar a prática do aleitamento materno de crianças nos primeiros anos de vida e orientar a alimentação adequada, principalmente nas famílias de baixo nível socioeconômico, contribui potencialmente para a redução do ganho de peso rápido e, consequentemente, de futuras complicações metabólicas do excesso de peso.

ABSTRACT Objective: To evaluate the prevalence, and identify factors associated with rapid weight gain in preschool children. Methods: A cross sectional study was carried out with 136 children between 24 and 35 months of age attending public daycare centers in Mogi das Cruzes between February and December 2014. Interviews were conducted with the mothers for clinical, sociodemographic and anthropometric characterizations of the children. It was considered to be rapid weight gain when the children presented a difference greater than 0.67 between the weight for age Z score from birth to evaluation. A logistic regression model was adjusted for factors associated with rapid weight gain. Results: Fifty children (36.8%) presented rapid weight gain and 36 (26.5%) were overweight. Of these, 22 children were in the rapid weight gain group. The logistic model showed that longest total breastfeeding time (OR 0.94, 95%CI 0.88-0.99; p=0.031) was a protection factor, and low socioeconomic level (OR 4.18, 95%CI 1.04-18.60; p=0.044) was a risk factor for rapid weight gain. Conclusions: There was a high prevalence of rapid weight gain and being overweight among three year old preschoolers attending public day care centers in Brazil. Encouraging the practice of breastfeeding children in the first years of life, in addition to giving guidance about appropriate foods, especially for families with a low socioeconomic status, can potentially contribute to reduce rapid weight gain and, consequently, future metabolic complications of being overweight.

Prevalência e fatores associados à anemia em crianças de creches: uma análise hierarquizada / Prevalence and factors associated with anemia in children enrolled in daycare centers: a hierarchical analysis

RESUMO Objetivo: Determinar a prevalência e os fatores associados à anemia em crianças menores de cinco anos assistidas em creches públicas de um município no sudoeste da Bahia. Métodos: Estudo transversal com uma amostra de 677 crianças matriculadas nas creches públicas de Vitória da Conquista, Bahia. Para determinação da hemoglobina por meio de punção digital, utilizou-se hemoglobinômetro portátil, considerando-se valores de hemoglobina <11 g/dL como ponto de corte para o diagnóstico da anemia. Aplicou-se questionário aos pais ou responsáveis para coleta de informações socioeconômicas, características maternas e de saúde e nutrição da criança. Medidas antropométricas de peso e estatura foram utilizadas para avaliação do estado nutricional da criança. Análise de regressão de Poisson com variância robusta e seleção hierárquica das variáveis foi usada para verificar fatores associados com anemia. Resultados: A prevalência de anemia foi de 10,2% e houve mais prevalência nas crianças cujas moradias não apresentavam instalação sanitária (RP 3,36; IC95% 1,40-8,03); naquelas que não receberam aleitamento materno exclusivo (RP 1,80; IC95% 1,12-2,91); nas crianças com idade inferior a 36 meses (RP 1,85; IC95% 1,19-2,89) e com baixa estatura para a idade (RP 2,06; IC95% 1,10-3,85). Conclusões: A prevalência de anemia pode ser considerada um problema de Saúde Pública menor em crianças de creches populares nesse município. Crianças com condições sanitárias inadequadas, que não receberam leite materno exclusivo, bem como as em idades mais precoces e com déficit nutricional foram mais suscetíveis.

ABSTRACT Objective: To determine the prevalence and factors associated with anemia in children younger than five years old enrolled in public daycare centers in a city in southwestern Bahia, in the northeast of Brazil. Methods: This was a cross-sectional study that included a sample of 677 children enrolled in public daycare centers in Vitória da Conquista, Bahia, Brazil. A portable hemoglobinometer was used to measure hemoglobin. The concentration of <11 g/dL was considered the cutoff point for a diagnosis of anemia. A questionnaire was applied to parents/guardians in order to collect socioeconomic data, maternal characteristics and information on the child's health and nutrition. Height and weight were measured to assess the child's nutritional status. Poisson regression with robust variance and hierarchical selection of variables was used to identify factors associated with anemia. Results: The prevalence of anemia was 10.2% and was more frequent in children whose homes had no sanitary facilities (PR 3.36; 95%CI 1.40-8.03); in those who did not exclusively breastfeed (PR 1.80; 95%CI 1.12-2.91); in children aged less than 36 months (PR 1.85; 95%CI 1.19-2.89) and those who had low height for age (PR 2.06; 95%CI 1.10-3.85). Conclusions: The prevalence of anemia is considered to be a mild public health problem in the children, who are enrolled in daycare centers. Children with inadequate sanitary conditions, and that were not exclusively breastfed, as well as younger children and children with a nutritional deficit, were more likely to present the condition.

Perfil antropométrico de crianças segundo a estrutura das creches / Anthropometric profile of children in accordance with the structure of daycare centers

Resumo O artigo tem por objetivos avaliar a estrutura de creches públicas e o perfil antropométrico de crianças do município de Campina Grande, Paraíba. Estudo transversal que envolveu 793 crianças assistidas em creches. Contemplaram-se informações para caracterizar as creches (estrutura relacionada à capacidade de atendimento à demanda e à de processamento da alimentação escolar, regime de acolhida, zona de localização) e o estado antropométrico das crianças (Estatura/Idade, Peso/Estatura). Menores escores-Z de Estatura/Idade e Peso/Estatura apresentaram-se nas crianças que frequentavam creches com maior número de crianças por funcionário, em regimes de acolhida de tempo parcial e localizadas na zona rural. As crianças que conviviam em salas de aula e em salas de descanso com maior número de crianças apresentaram, também, menores escores-Z de Estatura/Idade. Constatam-se problemas na estrutura das creches relacionados à capacidade de recursos humanos para prestar atenção às crianças e aos modos de convivência (aglomeração), os quais podem marcar diferenças no estado nutricional. Por sua vez, a frequência à creche em tempo integral e a urbanização predispõem positivamente o crescimento das crianças.

Abstract The scope of this article is to evaluate the structure of public daycare centers and the anthropometric profile of children in the city of Campina Grande in the State of Paraíba, Brazil. It is a cross-sectional study that involved 793 children attended in daycare centers. Information to describe the daycare centers were included (structure related to the capacity of demand and the processing power of school meals, reception system of children, location area) and the anthropometric status of the children (Height/Age, Weight/Height). The mean Z-scores for Height/Age and Weight/Height were lower among children from daycare centers with a greater number of children per employee, attended on a part time basis and located in the rural zone. The Z-scores for Height/Age were also lower among children who studied in classrooms and were housed in rest rooms with a greater density of children. Problems were detected in the structure of daycare centers with respect to the capacity of human resources to look after the children and the ways of living together (coexistence), which can make a difference in the nutritional status of the children. For its part, full-time daycare attendance and urbanization predispose children positively to growth.

Preditores da introdução de alimentos industrializados na infância: estudo em creches públicas / Predictors of introduction of industrialized foods in childhood: study in public child day care centers

O aleitamento materno exclusivo até o sexto mês, assim como a alimentação complementar adequada, são práticas importantes para o bom desenvolvimento infantil e contribuem para a formação de hábitos alimentares saudáveis.Diante desse contexto e reconhecendo a importância de práticas alimentares adequadas nos primeiros anos de vida,destaca-se que o objetivo do presente estudo foi avaliar a idade de introdução de alimentos industrializados na dieta de 575 crianças de 4 a 38 meses, frequentadoras de berçários de creches públicas de São Paulo, bem como quantificar eventuais mudanças temporais e fatores de risco da introdução precoce destes alimentos. O estudo foi baseado em duas observações transversais, realizadas em 2007 e 2010, e posterior análise de Clusters para agrupar a amostra em dois grupos, além de análise de regressão logística. No modelo logístico final, o ano de coleta de dados (2007),o menor tempo de aleitamento materno exclusivo e a menor escolaridade materna foram identificadas como riscos independentes e significantes para a introdução precoce dos alimentos industrializados. Diante dos resultados, faz se necessário a capacitação de mães/educadores em alimentação infantil, reforçando os benefícios do aleitamento materno e os malefícios da introdução precoce dos industrializados, principalmente no grupo de mães com menor escolaridade

Exclusive breastfeeding by the sixth month, as well as adequate complementary feeding, are important practices forhuman development and contribute to the formation of healthy eating habits. In this context, and recognizing theimportance of appropriate food practices in the first years of life, the objective of the present study was: to evaluatethe age at which processed food was introduced in the diet of 575 children aged 4 to 38 months, attending the nurseries of public child daycare centers in São Paulo, and to quantify possible temporal changes and risk factorsof premature introduction of these food types. The study was based on two cross-sectional observations, performedin 2007 and 2010, and later Cluster analysis was performed to divide the sample in two groups. A multiple logistic regression analysis was also performed. In the final logistic model, the data collection year (2007), the shorter durationof exclusive breastfeeding, and less maternal education were identified as independent and significant risks to prematureintroduction of processed food. In view of the results, it is necessary to prepare mothers/ educators to manage infantfeeding, reinforcing the benefits of breastfeeding and the disadvantages of the premature introduction of industrialized foods, mainly concerning the mothers' group with lower education levels

Factors Affecting Daycare Center Teachers' Management of Childhood Fever

PURPOSE: The purposes of this study were to investigate daycare teachers'knowledge, anxiety and management of childhood fever and to identify factors affecting their management of childhood fever. METHODS: A descriptive correlation study was conducted. Participants were 109 daycare center teachers from G metropolitan city. A self-administered questionnaire was used for data collection. RESULTS: The mean percent of correct answers for knowledge about childhood fever was 42.9%. Levels of anxiety related to children's fever were high among day care teachers in this study. Many daycare center teachers used management practices which were not recommended for childhood fever management. There was a statistically significant difference in participants' knowledge about childhood fever by marital status and having a child. Moreover, there were statistically significant positive correlation between daycare center teachers' knowledge and management and negative correlation between daycare center teachers' anxiety and management of childhood fever. Knowledge and anxiety related to childhood fever accounted for 15.2% of variance for fever management. CONCLUSION: Results show that day care teachers' knowledge and anxiety related to fever are important factors in predicting their fever management. Development and evaluation of educational interventions to improve daycare teachers' childhood fever management are recommended.

Ultra-processed foods: Consumption among children at day-care centers and their classification according to Traffic Light Labelling system / Alimentos ultra-processados: consumo entre crianças em creches públicas e análise da composição nutricional segundo a ferramenta "Traffic Light Labelling"

Objective: To identify the age at which ultra-processed foods are introduced in the diet of infants enrolled in public daycare centers and analyze these foods' nutritional composition according to the Traffic Light Labelling system adapted to the Brazilian norms and recommendations.Methods: Cross-sectional study including 636 nursery age children attending day care centers. Their mothers were interviewed about the age of introduction of instant noodles, snack chips, encased meat, chocolate, ice cream, and stuffed cookies. The proximate composition of these foods was evaluated according to the Traffic Light Labelling adapted to the Brazilian norms and recommendations, which classifies total fat, saturated fat, trans fat, fiber, and sodium amounts as green, yellow, or red indicators.Results: It was found that before 12 months of age 70.6% of children had consumed instant noodles, 65.9% snack chips, 54.7% encased meat, 67.1% chocolate, 36.9% ice cream, and 68.7% stuffed cookies. In addition, all foods were classified as red for saturated fat and sodium and 50.0% were classified as red for total fat.Conclusion: The introduction of ultra-processed foods in the children's diets occurred early, but it is worth mentioning that such foods have an inadequate nutritional composition, contributing to the excess consumption of total fat, saturated fat, and sodium, as well as low fiber.

Objetivo: Identificar a idade de introdução de alimentos ultra-processados na alimentação de lactentes matriculados em creches públicas e analisar suas composições nutricionais segundo a ferramenta de classificação nutricional Traffic Light Labelling, adaptada às normas e recomendações brasileiras.Métodos: Estudo transversal com 636 crianças de berçários de creches, cujas mães foram entrevistadas sobre idade de introdução de macarrão instantâneo, salgadinhos, embutidos, chocolate, sorvete e bolacha recheada. Avaliaram-se as composições centesimais desses alimentos comparando-as com a ferramenta Traffic Light Labelling, adaptada às normas e recomendações brasileiras. Esta ferramenta classifica as quantidades de gordura total, gordura saturada, gordura trans, fibra e sódio em verde, amarelo ou vermelho.Resultados: Verificou-se que, antes dos 12 meses de idade, 70,6% das crianças haviam consumido macarrão instantâneo, 65,9% salgadinhos, 54,7% embutidos, 67,1% chocolate, 36,9% sorvete e 68,7% bolacha recheada. Em adição, todos os alimentos foram classificados como vermelho para gordura saturada e sódio, e 50,0% obteve classificação vermelha para gordura total.Conclusão: A introdução dos alimentos ultra-processados ocorreu precocemente na dieta das crianças, ressaltando que os mesmos apresentaram composição nutricional inadequada, fornecendo excesso de gordura total, gordura saturada, sódio e baixa quantidade de fibras.

Effects of Multiple Cleaning and Disinfection Interventions on Infectious Diseases in Children: A Group Randomized Trial in China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To assess the effectiveness of multiple cleaning and disinfection interventions in the homes and kindergartens, in reducing gastrointestinal and respiratory illnesses of children.</p><p><b>METHODS</b>From October 2010 to September 2011, we performed a prospective, controlled study in China. 408 children under 5 years old were recruited and group randomized into intervention and control groups. Families and kindergartens in the intervention group were provided with antibacterial products for hand hygiene and surface cleaning or disinfection for one year. Each child's illness symptoms and sick leave were recorded every day.</p><p><b>RESULTS</b>A total of 393 children completed the study, with similar baseline demographics in each of the 2 groups. Except for abdominal pain, the odds of symptoms (fever, cough and expectoration, runny nose and nasal congestion, diarrhea), illness (acute respiratory illness and gastrointestinal illness), and sick leave per person each month were significantly reduced by interventions. The rates of fever, diarrhea, acute respiratory illness, gastrointestinal illness and sick leave per person per year were significantly decreased as well.</p><p><b>CONCLUSION</b>Not only the acute respiratory and gastrointestinal illness but the sick leave rate in children were significantly reduced by multiple interventions.</p>

Job Satisfaction of Children Foodservice Employees at Daycare Centers

The research was conducted by center for children's foodservice management in Hanam-si. In order to improve job satisfaction, a survey was carried out by working conditions and job satisfaction in children foodservice employees working at child daycare centers registered from January to April. Ninety-five surveys out of 120 were collected, and 76 surveys were analyzed. Job satisfaction consisted of four elements, working environment, welfare, human relationships, and job-itself, analyzed by general characteristics. Pearson's correlation was carried out between job satisfaction and intention to change job by Likert 5 scales using SPSS statistic program. The percentages of child daycare centers owned by civilians was 52.6%, high school education level was 65.8%, permanent workers was 68.4%, and less than 1 year of foodservice was 34.2%. Average scores of job satisfaction were as follows: working environment scored 20.6 out of 25 points, welfare scored 10.3 out of 15 points, human relationships scored 17.5 out of 20 points, and job-itself scored 13.2 out of 15 points. The lowest job satisfaction average was 'I get paid fairly regarding the working hours and the amount of work' with a score of 3.6 points. Job satisfaction based on facility type, age, education level, and working period did not show significant differences, whereas hired status, numbers of foodservice children, and intention to change jobs showed significant differences. Hired status showed significant differences with welfare satisfaction (P<0.05). Numbers of children showed a significant difference with welfare and human relationship satisfaction (P<0.01, P<0.05). Intention to change job showed a significant difference with four elements of job satisfaction (P<0.05, P<0.01, P<0.01). In conclusion, to improve job satisfaction of children foodservice employees, working conditions and welfare satisfaction should be increased.

Fatores associados ao estado nutricional em criancas de creches publicas do municipio de Recife, PE, Brasil / Factors associated with nutritional status in infants attending public daycare centers in the municipality of Recife, PE, Brazil

Objetivo: Avaliar o perfil nutricional de crianças frequentadoras de creches do município de Recife e identificar potenciais fatores determinantes. Métodos: Trata-se de um estudo transversal conduzido com 321 crianças de 6 a 30 meses no período de agosto a outubro de 2004. A classificação do estado nutricional foi realizada a partir dos índices comprimento/idade, peso/idade, peso/comprimento e de massa corpórea/idade, utilizando o padrão de referência da Organização Mundial da Saúde. A análise de regressão linear multivariada avaliou o efeito das condições socioeconômicas e demográficas maternas e relacionadas às crianças sobre o índice comprimento/idade. Resultados: O percentual de desnutrição (< -2 escores Z) foi de 13,4%, 2,8%, 0,6% e 0,6% para os índices comprimento/idade, peso/idade, peso/comprimento e de massa corpórea/idade, respectivamente. O modelo final da análise de regressão linear multivariada mostrou que as condições socioeconômicas (tipo de teto e abastecimento de água) e biológicas da criança (peso ao nascer, idade e concentração de hemoglobina) foram as variáveis que significantemente influenciaram a variação do índice comprimento/idade, explicando 3,8% e 12,8%, respectivamente. Conclusão: Entre as variáveis estudadas, os fatores biológicos da criança tiveram uma influência maior na variação do índice comprimento/idade do que as socioeconômicas. .

Objective: To evaluate the nutritional status of infants attending daycare centers in the Municipality of Recife and to verify its association with potential determinant factors. Methods: This is a cross sectional study conducted with 321 infants in the age group of 6 to 30 months from August to October 2004. The nutritional status was assessed through length-for-age, weight-for-age, weight-for-length and body mass index-for-age using as reference pattern that of the World Health Organization. Multivariable linear regression analysis assessed the effect of maternal socioeconomic and demographical indicators, and child related variables on infant length-for-age. Results: The percentages of malnutrition (Z score < -2) were found in 13.4%, 2.8%, 0.6% and 0.6% for length-for-age, weight-for-age, weight-for-length and body mass index-for-age, respectively. The final model of the linear multivariable regression analysis showed that the socioeconomic (type of roof and water supply) and child biological conditions (birthweight, age and hemoglobin concentration) were the variables that significantly influenced the variation of length-for-age, explaining 3.8% and 12.8%, respectively. Conclusion: Among the studied variables, child biological factors had a higher influence in the variation of length-for-age than the socioeconomic ones. .

Fatores associados à interrupção do aleitamento materno exclusivo antes dos seis meses em crianças matriculadas em creches públicas e filantrópicas do Município de São Paulo, Brasil / Factors associated with the interruption of exclusive breastfeeding before six months for children enrolled in public and philanthropic daycare centers in Sao Paulo, Brazil

Breastfeeding meets ideal nutritional characteristics of children. The aim of this study was to describe the prevalence of exclusive breastfeeding and evaluate the factors described by mothers for early weaning among children attending public and philanthropic daycare centers in Sao Paulo. The study, which applies a qualitative and quantitative sample methodology, was based on two cross-sectional surveys; statistical analyses were performed using Kaplan Meier curves and Cox proportional hazards model. The average duration of exclusive breastfeeding was 87.2±61.36, median of 90 days. The following variables for exclusive breastfeeding were considered in the adjusted final model: mother's age <20 years (HR=1.43, 95% CI=1.09 to 1.88), use of the pacifier <3 months (HR=1.87, 95% CI=1.57 to 2.24) and prematurity (HR=1.36, 95% CI=1.04 to 1.77). Results show that there are many factors that can negatively influence breastfeeding duration; and that, as the daycare center is a place of education since the early age of those children; it can also be a place of education for the mothers, once it informs them about the importance of breastfeeding.

La lactancia materna exclusiva reúne las características adecuadas de la alimentación infantil. El objetivo de este estudio fue describir la prevalencia de la lactancia materna exclusiva y evaluar los factores asociados a su duración entre los niños que asisten a guarderías públicas y filantrópicas de São Paulo. Este estudio, que aplicó metodología de muestreo cuantitativo, fue realizado a partir de dos observaciones transversales, y los análisis estadísticos se realizaron utilizando las curvas de Kaplan Meier y el modelo de riesgos proporcionales de Cox. El tiempo medio de lactancia materna exclusiva fue de 87,2±61,36 y mediana de 90 días. En el análisis multivariado, entraron en el modelo final las siguientes variables: edad de la madre < de 20 años (HR=1,43, 95% CI=1,09- 1,88), uso de chupete < de 3 meses (HR=1,87, 95% CI=1,57-2,24) y prematuridad (HR=1,36, 95% CI=1,04-1,77). Los resultados mostraron que muchos factores influyen negativamente en la duración de la lactancia materna y que las guarderías, instituciones educativas que ocupan un lugar desde el inicio de la vida de los niños, pueden ser efectivas para educar a las madres al informar sobre los beneficios de la lactancia materna.

O aleitamento materno exclusivo faz parte de uma alimentação adequada das crianças. O objetivo deste trabalho foi descrever as prevalências de aleitamento materno exclusivo e avaliar os determinantes associados à sua duração entre crianças frequentadoras de creches públicas e filantrópicas do Município de São Paulo. Este estudo, que aplica metodologia amostral de natureza quantitativa, foi feito a partir de duas observações do tipo transversal, e as análises estatísticas foram feitas utilizando as curvas de Kaplan Meier e modelo de riscos proporcionais de Cox. O tempo médio de aleitamento materno exclusivo foi de 87,2±61,36, mediana de 90 dias. Na análise multivariada, entraram para o modelo final as seguintes variáveis: idade da mãe <20 anos (HR=1,43, 95% CI=1,09- 1,88), uso de chupeta com <3 meses (HR=1,87, 95% CI=1,57-2,24) e prematuridade (HR=1,36, 95% CI=1,04-1,77). Os resultados mostram muitos fatores que influenciam negativamente na duração do aleitamento materno exclusivo e que a creche, sendo um local de educação desde o início da vida destas crianças, pode ser um local de educação também das mães ao informar os benefícios da amamentação.

Knowledge Related to Child Obesity of Child Daycare Center Worker

PURPOSE: The purpose of this study was to investigate knowledge related to child obesity of child daycare center workers. METHODS: The participants in this study were 360 child daycare center workers in 2 cities in South Gyeongsang Province. Data were collected from February to June, 2011, using self-report questionnaires including questions about the general characteristics of the daycare center workers and their knowledge related to child obesity. Frequency, percentage, arithmetic mean, standard deviation, t-test and ANOVA were used to analyze the data with the SPSS WIN 16.0 program. RESULTS: The knowledge scores of child daycare center workers about child obesity averaged 74.8. The domains of diet (0.87 points) and prevention (0.86 points) had high scores, while, the domains of general characteristics (0.64 points) and diagnosis (0.59 points) had low scores. CONCLUSION: These results indicate that obese education programs for child daycare center workers should be developed in order to identify and teach children with obesity appropriately.

Development and Effect of a Web-based Child Health Care Program for the Staff at Child Daycare Centers

PURPOSE: The purpose of the study is to develop a web-based program on child health care, and to identify the effect of the program on knowledge of, attitudes towards child health care, and health care practice in staff of daycare centers. METHODS: The program was developed through the processes of needs analysis, contents construction, design, development, and evaluation. After the program was developed, it was revised through feedback from 30 experts. To identify the effect of developed program, onegroup pretest-posttest design study was conducted with 64 staff members from 12 daycare centers in Korea. RESULTS: The program was developed based on users' needs and consisted of five parts: health promotion, disease and symptoms management, oral health, injury and safety, sheets and forms. This study showed that the total score of staff who used the program was significantly higher in terms of knowledge, attitudes, and their health care practice compared with pretest score (p<.05). CONCLUSION: These results suggest that this Web-based program can contribute to the child health promotion as well as can provide the staff with the insightful child health information. Therefore, it is expected that this program will be applied to staff of other child care settings for children's health.

Riscos isolados e agregados de anemia em crianças frequentadoras de berçários de creches / Isolated and combined risks for anemia in children attending the nurseries of daycare centers

OBJETIVO: Identificar e quantificar os fatores de risco isolados e agregados de anemia, proporcionando visão ampliada quanto à probabilidade da sua ocorrência. MÉTODOS: Estudo transversal com 482 crianças, entre 4 e 29 meses de idade, frequentadoras de berçários de creches públicas e filantrópicas do município de São Paulo (SP), que participaram de dois inquéritos (2004 e 2007). Foram realizadas entrevistas com as mães, coleta de sangue por punção digital e antropometria. Considerou-se anemia, hemoglobina inferior a 11 g/dL. Foi ajustado modelo de regressão logística não-condicional para fatores de risco de anemia, considerando-se estatisticamente significantes associações com p < 0,05. Para definição das probabilidades pós-teste, foram utilizados os cálculos das chances pós-teste e razões de verossimilhança. Os pacotes estatísticos utilizados foram o Epi-InfoTM 2000 e o Stata 10.0. RESULTADOS: A prevalência de anemia foi de 43,6 por cento (IC95 por cento - 39,1 a 48,1 por cento). O modelo logístico final incluiu cinco variáveis: idade materna inferior a 28 anos (OR = 1,50; p = 0,041), renda per capita inferior a meio salário mínimo (OR = 1,56; p = 0,029), aleitamento materno exclusivo inferior a 2 meses (OR = 1,71; p = 0,009), perda de escore z peso/idade do nascimento ao inquérito (OR = 1,47; p = 0,050) e idade inferior a 17 meses (OR = 2,44; p < 0,001). As probabilidades pós-teste nas associações de fatores de risco de anemia isolados e agregados apresentaram-se entre 54,5 e 100 por cento. CONCLUSÕES: A probabilidade de anemia aumentou quanto mais agregados estiveram os cinco fatores de risco identificados. Esse cálculo disponibiliza instrumento simples e rápido de suspeição de anemia em crianças em triagem clínica ou populacional.

OBJECTIVE: To identify and quantify isolated and combined risk factors for anemia, providing a comprehensive view of the likelihood of its occurrence. METHODS: Cross-sectional study with 482 children aged 4 to 29 months attending the nurseries of philanthropic and public daycare centers in the city of São Paulo, Brazil, who participated in two surveys (2004 and 2007). Mothers were interviewed, blood was collected using digital puncture, and anthropometry was performed. Anemia was characterized by hemoglobin levels below 11 g/dL. Unconditional logistic regression was adjusted for anemia risk factors. A value of p < 0.05 indicated statistically significant associations. Post-test odds and likelihood ratios were calculated to define post-test probabilities. Epi-InfoTM 2000 and Stata 10.0 software packages were used for statistical analysis. RESULTS: Prevalence of anemia was 43.6 percent (95 percentCI 39.1-48.1). The final logistic model included five categorical variables: mother's age less than 28 years (OR = 1.50; p = 0.041), per capita income below half a minimum wage (OR = 1.56; p = 0.029), exclusive breastfeeding less than 2 months (OR = 1.71; p = 0.009), decrease in weight/age z score from birth to survey (OR = 1.47; p = 0.050), and age less than 17 months (OR = 2.44; p < 0,001). Post-test probabilities in the associations of isolated and combined risk factors for anemia ranged from 54.5 to 100 percent. CONCLUSIONS: The probability of anemia progressively increased as the identified risk factors were added. This calculation provides a simple and rapid tool for suspicion of anemia in children both in clinical practice and population screening.