Asociación entre violencia contra la mujer ejercida por la pareja y desnutrición crónica en sus hijos menores de cinco años en Perú / Association between violence against women inflicted by the partner and chronic malnutrition in their children under five years old in Peru

Objetivos: Evaluar la asociación entre violencia contra la mujer ejercida por su pareja y la prevalencia de desnutrición crónica en sus hijos menores de cinco años. Materiales y métodos. Análisis secundario transversal de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011, realizada en el Perú y con representatividad nacional. La variable dependiente fue desnutrición crónica en el último hijo menor de cinco años. Las variables independientes fueron el autorreporte de violencia emocional, violencia física (leve o severa) y violencia sexual, ejercidas por el último compañero o esposo de la madre en los últimos 12 meses. Realizamos análisis univariados y multivariables utilizando modelos generalizados lineales (regresión log-binomial), teniendo en cuenta la naturaleza compleja de la muestra. Se ajustaron los modelos para variables sociodemográficas y de salud madre hijo. Se calcularon razones de prevalencias (RP) e intervalos de confianza al 95%. Resultados. Se analizaron datos de 5154 madres e hijos. La prevalencia de desnutrición crónica fue de 19,8% (IC 95%: 18,1-21,6). En el análisis multivariable se encontró una mayor prevalencia de desnutrición crónica en los hijos de madres con historia de violencia física severa RP 1,27% (IC 95%: 1,09-1,48). No hubo evidencia de asociación entre la prevalencia de desnutrición crónica y los otros tipos de violencia ejercida por la pareja. Conclusiones. El reporte de violencia física severa en el último año, por parte de las madres, estuvo asociado a un aumento en la prevalencia de desnutrición crónica en sus niños menores de cinco años.

Objectives: To assess the association between violence against women inflicted by their partner and the prevalence of chronic malnutrition in their children less than five years old. Materials and methods. A secondary cross-sectional analysis of the 2001 Peru Demographic and Health Survey performed in Peru, with national representativeness. The dependent variable was chronic malnutrition in the youngest child under five years old. The independent variables were emotional violence, physical violence (mild or severe) and sexual violence self-report; the violence was inflicted by the mother’s last partner or spouse in the last 12 months. Univariate and multivariate analysis was performed, generalized linear models (log-binomial regression) were used, and the nature of the sample was taken into account. Models for socio-demographic and mother-son health variables were adjusted. Prevalence ratios (PR) and confidence intervals were calculated. Results. Data from 5,154 mothers and children were analyzed. The prevalence of chronic malnutrition was 19.8% (CI 95%: 18.1-21.6). In the multivariate analysis, a higher prevalence of chronic malnutrition was found in the children whose mothers had a history of severe physical violence history: PR=1.27% (IC 95%: 1.09-1.48). There was no evidence of association between the prevalence of chronic malnutrition and other kinds of violence inflicted by a partner. Conclusions. The mothers’ report of physical violence in the last year was associated with an increased prevalence of chronic malnutrition in children under five years old.

Prevalence and Determinants of Chronic Malnutrition among Preschool Children: A Cross-sectional Study in Dhaka City, Bangladesh.

Chronic malnutrition is one of the major causes of morbidity and mortality among preschool children and the future productivity of nations. To understand the prevalence of chronic malnutrition and to identify the factors affecting height-for-age z-score (HAZ) among preschool children, a cross-sectional study was conducted among 380 randomly-selected children aged less than five years in Dhaka city, Bangladesh. Results of analysis of this study data revealed that the prevalence of stunting among preschool children in Dhaka city was 39.5%, with 25% severely stunted and 14% moderately stunted (p<0.001). Results of bivariate analysis revealed that socioeconomic and demographic factors were most significantly associated with the stunting of children. Children were found to be well-nourished if their parents had a tertiary-level education or higher and if the mother held a job and had good knowledge of nutrition. Well-nourishment of the children were also associated with the height of mothers (above 148 cm), good family educational background, normal birthweight, greater frequency of food intake (more than six times/day), and fewer fever episodes in the last six months. Results of multivariate linear regression models showed that height of mothers, birthweight of children, education of fathers, knowledge of mothers on nutrition, and frequency of feeding were the most significant factors that had an independent and direct influence on the stunting of children. To achieve the Millennium Development Goal target of 34% malnutrition prevalence by 2015, it is important to have specific government intervention to focus on the causes that directly influence the stunting of children.

Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea.

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severelymalnourished children (weight-for-age <60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p<0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p<0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition.

Promoção da saúde com mães de crianças desnutridas na zona rural / Health promotion with mothers of undernourished children from the rural area

A prática de bons hábitos alimentares é importante desde a infância, porém a mídia, a cultura e as condições socioeconômicas impõem normas para a prática alimentar, na maioria das vezes, divorciada da realidade. Este estudo objetivou descrever o perfil socioeconômico de crianças residentes na zona rural, além de avaliar as mudanças comportamentais das mães de crianças desnutridas ocorridas com a implementação de oficinas educativas. A pesquisa foi do tipo participante, com abordagem qualitativa. Realizouse no distrito de Tuína, situado no município de Massapê- CE, e as informantes foram nove mães de crianças desnutridas menores de quatro anos. A coleta de dados ocorreu por meio de observação participante, entrevista e oficinas educativas durante os meses de outubro/2006 a março/2007. Na análise de dados, foi utilizada a técnica de conteúdo do tipo categorial temática proposta por Bardin(2007). Os dados foram levantados durante a visita domiciliar,emergindo as seguintes categorias: hábito alimentar na zona rural e conceituando a desnutrição. Nas oficinas educativas, foram abordadas temáticas relacionadas à desnutrição infantil como: aleitamento materno, alimentação saudável, parasitoses intestinais, higiene e infecção intestinal. As mães possuem disponibilidade para cuidarem dosfilhos desnutridos, mas não detêm conhecimento suficiente, sendo necessárias estratégias de educação em saúde para a melhoria da qualidade de vida das crianças desnutridas.

Although good eating habits from childhood are important,the media promotes and cultural and socioeconomicfactors determine practices that are frequently detachedfrom reality. This study describes the socioeconomicprofile of children living in rural areas, and assesses thebehavioral changes of their mothers, occurring in responseto the implementation of educational workshops. Thiswas a participative research with a qualitative approach,undertook in the Tuina district, in the municipality ofMassapê - CE, Brazil. Nine mothers of malnourishedchildren younger than four years were the informants.Data collection occurred during participant observation,interviews and educational workshops in the period fromOctober/2006 through March/2007. Bardin`s thematiccategorical analysis (2007) was used. The following categoriesof data arose after home visits: eating habits in thecountryside and malnutrition concepts. The educationalworkshops addressed issues related to child malnutrition,such as breastfeeding, healthy eating, intestinal parasites,hygiene and intestinal infection. Although the mothersare available to look after their malnourished children,they are not knowledgeable enough, health educationstrategies to improve the quality of life of malnourishedchildren being necessary.