Alimentação e obesidade de crianças na fase pré-escolar: significados atribuídos pelos pais / Children's food and obesity in the pre-school phase: meanings assigned by parents / Alimentos y obesidad de los niños en la fase preescolar: significados por los padres

Objetivos: Avaliar a percepção dos pais de crianças com sobrepeso ou obesidade, em relação à qualidade da alimentação dos seus filhos, na fase pré-escolar. Método: Estudo descritivo e qualitativo, realizado por meio de entrevistas semi-estruturadas, com pais de crianças com sobrepeso ou obesas matriculadas em um Centro Municipal de Educação Infantil (CEMEI) e cadastrado nas Estratégias de Saúde da Família (ESF's) do município de Divinópolis-MG. Resultados: Em relação à caracterização dos pais, todos eram do sexo feminino. A faixa etária alternou entre 22 a 45 anos. A partir da análise dos dados, as categorias elencadas foram: Alimentação inadequada; Tecnologia e sedentarismo; A subestimação do sobre peso; Prevenção e tratamento da obesidade infantil nas ESF. Conclusão: Identificou-se a necessidade de um melhor preparo por parte dos profissionais de saúde em relação a correta nutrição das crianças e também um envolvimento entre esses profissionais, os pais e a escola.(AU)

Objectives: To evaluate the perception of parents of overweight or obese children, in relation to the quality of their children's food, in the preschool phase. Method: Descriptive and qualitative study, carried out through semi-structured interviews, with parents of overweight or obese children enrolled in a Municipal Center for Early Childhood Education (CEMEI) and registered in the Family Health Strategies (ESF's) in the municipality of Divinópolis -MG. Results: Regarding the characterization of the parents, all were female. The age group alternated between 22 to 45 years. From the data analysis, the categories listed were: Inadequate food; Technology and sedentary lifestyle; The underestimation of overweight; Prevention and treatment of childhood obesity in the FHS. Conclusion: There was a need for better preparation by health professionals in relation to the correct nutrition of children and also an involvement between these professionals, parents and the school.(AU)

Objetivos: Evaluar la percepción de los padres de niños con sobrepeso u obesidad, en relación a la calidad de la alimentación de sus hijos, en la etapa preescolar. Método: Estudio descriptivo y cualitativo, realizado a través de entrevistas semiestructuradas, con padres de niños con sobrepeso u obesidad inscritos en un Centro Municipal de Educación Infantil (CEMEI) y registrados en las Estrategias de Salud de la Familia (ESF's) del municipio de Divinópolis. -MG. Resultados: En cuanto a la caracterización de los padres, todos fueron del sexo femenino. El grupo de edad alternaba entre 22 y 45 años. Del análisis de datos, las categorías enumeradas fueron: Alimentos inadecuados; Tecnología y estilo de vida sedentario; La subestimación del sobrepeso; Prevención y tratamiento de la obesidad infantil en la ESF. Conclusión: Se identificó la necesidad de una mejor preparación por parte de los profesionales de la salud en relación a la correcta nutrición de los niños y también una participación entre estos profesionales, los padres y la escuela.(AU)

Competencias de la enfermera en instituciones educativas: una mirada desde los gestores educativos / Competências da enfermeira nas instituições educacionais: uma visão dos gestores da educação / Competencies of the nurse in educational institutions: a look from educational managers

Resumen OBJETIVO Describir y analizar los atributos de las competencias de la enfermera en el cuidado de los escolares vista por los gestores de instituciones educativas. MÉTODO Estudio cualitativo descriptivo-exploratorio. Siete directores de instituciones educativas de Trujillo (Perú) participaron en una entrevista no estructurada, durante el primer semestre del año 2016 y se utilizó el análisis de discurso oral. RESULTADOS Categorías empíricas: La enfermera en la promoción de la salud de la comunidad educativa; La enfermera en la prevención de la enfermedad en la comunidad educativa; La enfermera escolar articulando salud-educación en el cotidiano de vida de los escolares. CONSIDERACIONES FINALES El estudio contribuye al sustento conceptual de las competencias de la enfermera escolar para la acción intersectorial salud-educación y el establecimiento de políticas de promoción de salud de los escolares dentro las instituciones educativas.

Resumo OBJETIVO Descrever e analisar os atributos das competências da enfermeira escolar no cuidado escolares a partir da perspectiva dos gestores de instituições de ensino. MÉTODO Estudo qualitativo descritivo-exploratório: Sete diretores de instituições de ensino em Trujillo (Peru), participaram em uma entrevista no estruturada e se utilizou a análise de depoimentos orais. RESULTADOS Os resultados reportam as categorias empíricas: a enfermeira na promoção da saúde da comunidade educativa; a enfermeira na prevenção de doenças da comunidade educativa; A enfermeira escolar articulando a saúde e a educação no cotidiano do escolar. CONSIDERAÇÕES FINAIS O estudo contribui ao marco conceitual das competências da enfermeira escolar para a ação inter setorial em saúde-educação e para o estabelecimento de políticas na promoção da saúde dos escolares no interior das instituições educativas.

Abstract OBJECTIVE Describe and analyze the attributes of the nurse competencies in caring of students since the manager look of educational institutions. METHOD Qualitative descriptive-exploratory study. Seven principals of educational institutions of Trujillo (Peru) participates in a non-structured interview during the first semester of 2016 and the analysis of oral discourse was used. RESULTS Empirical categories: The nurse in the promotion of educational community health; The nurse in the prevention of the educational community illness; The student nurse articulating health - education in the everyday life of students. FINAL CONSIDERATIONS This study contributes to the conceptual support of the competencies of the student nurse for the intersectoral health - education action and the setting-up of health with students in the educational institutions.

Primaquina y recurrencias de malaria por Plasmodium vivax. Metanálisis de estudios clínicos controlados / Primaquine and relapses of Plasmodium vivax. Meta analysis of controlled clinical trials

ANTECEDENTES: La primaquina (PQ) se usa contra recurrencias del paludismo vivax (RPV), pero se desconocen varios aspectos posológicos, como la dosis total (DT) eficaz en determinado número de días. OBJETIVO: Comparar regímenes de PQ contra RPV en estudios clínicos controlados (ECC) aleatorios o no aleatorios. METODOLOGÍA: Metanálisis. Se buscó información hasta el 31 de diciembre de 2012 en Lilacs, SciELO, PubMed (Medline), Cochrane Library, Cochrane Infectious Diseases Group, Embase. Se usaron estudios experimentales o ECC, siempre con grupo control concurrente. Se incluyeron estudios con o sin asignación aleatoria, "close label" o "open label", con tratamiento supervisado o no supervisado No se exigió que el estudio estableciera diferencia entre recaída y reinfección mediante pruebas moleculares. Se aplicaron criterios de inclusión y exclusión a los artículos y satisfacer los de inclusión constituyó calidad adecuada para dejarlos en el metanálisis. RESULTADOS: Se completaron 23 ECC, que reunieron los criterios de selección. Evaluamos 4 esquemas de dosis total (DT) dada en determinados días (DT mg número de días): 210 14 = 210 mg en 14 días; 210 7 = 210 mg en 7 días; 45 a 150 mg en 3 a 10 días; 0 (no PQ). La ausencia de PQ llevó a la recurrencia de 34,48% frente a 19,66% con PQ 210 14 (diferencia significativa); 210 14 mostró eficacia igual a la de 210 7. Cada esquema 210 7 y 210 14 es mejor estadísticamente que 45 a 150. CONCLUSIONES: El uso de PQ es necesario para reducir las recurrencias y la DT 210 mg dada en 7 ó en 14 días es la que mejor eficacia tiene pero se requieren más estudios con el esquema 210 7. .

BACKGROUND: Primaquine (PQ) is used against relapses of vivax malaria (RVM) but several aspects about dosage are unknown, as the total effective dose (TD) in a number of days. OBJECTIVE: To compare PQ regimens against RVM in randomized or non randomized controlled clinical trials (CCTs). METHODOLOGY: Meta analysis. Information was sought until 31 December, 2012 in Lilacs, SciELO, PubMed (Medline), Cochrane Library, Cochrane Infectious Diseases Group, Embase. Experimental studies or CCT were used, always with concurrent control group. No matter whether or not the design was randomized, close label, supervised. It is not required that the study established difference between relapse and reinfection by molecular evidence. Inclusion and exclusion criteria for articles were applied and meet the inclusion criteria constituted adequate quality to be left in the meta analysis. RESULTS: 23 ECC with or without random allocation of treatment met the selection criteria. Include four schemes of TD (TD mg number of days): 210 14 = 210 mg in 14 days; 210 7 = 210 mg in 7 days, 45 to 150 mg in 3 to 10 days, 0 (not PQ). If PQ is absent, recurrences occurr 34.48% versus 19.66% with PQ 210 14 (significant difference), 210 14 showed effectiveness equal to that of 210 7. Treatments 210 7 and 210 14 were statistically better than 45 to 150 effectiveness. CONCLUSIONS: The use of PQ is necessary to reduce recurrences and TD 210 mg given at 7 or 14 days is which is more effective but more studies are required to treatment 210 7. .

Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Nutrition: basis for healthy children and mothers in Bangladesh.

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place.

Training in complementary feeding counselling of healthcare workers and its influence on maternal behaviours and child growth: a cluster-randomized controlled trial in Lahore, Pakistan.

Malnutrition is common among children aged 6-24 months in developing countries. It increases the risk of mortality. Interventions to improve infant-feeding hold the promise of reducing malnutrition among these children. A study in Brazil has shown the success of training in communication and counselling skills among health workers in improving the nutritional status of young children. Questions were raised whether the method used in the study in Brazil would also be effective when applied in other countries. The aim of the present study was to reduce growth faltering in young children through proper nutrition-promotion techniques. The objective of the study was to determine the efficacy of training health workers in nutrition counselling in enhancing their communication skills and performance, improving feeding practices, and reducing growth faltering in children aged 6-24 months. A cluster-randomized controlled trial was carried out. The method used in this study was a replica of the method in a similar study in Pelotas, Brazil. Forty health centres were paired, and one centre of each pair was randomly allocated to the intervention group, and the other to the control group. The Integrated Management of Childhood Illness (IMCI) module-'Counsel the mother'-was used for training health workers in the health centres in the intervention group. Data from 36 paired health centres and 375 mothers and their children aged 6-24 months recruited from these health centres following consultation with health workers were included in analysis. Independent observers, masked to the intervention status, examined the performance of health workers within the first month after training. Mother-child pairs were visited at home within two weeks, 45 days, and 180 days after recruitment. Information was recorded on the feeding practices, recall of the recommendations of health workers, and sociodemographic variables at these home-visits. Weight and length of the child were measured at each contact. The communication skills and consultation performance of health workers were significantly better in the intervention group than in the control group. The mothers' recall of the recommendation of health workers and reported infant-feeding practices were also significantly better in the intervention group than in the control group, even 180 days after the recruitment consultation. Growth faltering was less in the intervention group, with the largest effect observed among children in the age-group of 12 + months. These results indicate that training in IMCI feeding counselling can enhance the communication skills and performance of health workers. Improved feeding practices of counselled mothers can, in turn, reduce growth faltering in their children.

Aconselhamento em alimentação infantil: um estudo de intervenção / Infant and young child feeding counseling: an intervention study

OBJETIVO: Avaliar a efetividade do Curso Integrado de Aconselhamento em Alimentação Infantil na transformação de conhecimentos, atitudes e práticas de pediatras e nutricionistas da rede municipal de saúde de São Paulo. MÉTODOS: Estudo de intervenção randomizado com 29 profissionais no grupo intervenção e 27 no grupo controle. Entrevistadores previamente capacitados coletaram dados dos profissionais nas unidades de saúde antes da intervenção e 2 meses após. Utilizaram-se três instrumentos para avaliar o perfil do profissional, seus conhecimentos e um roteiro de observação clínica. Para análise, utilizaram-se o teste de Kruskal-Wallis para amostras independentes e o método de Tukey. RESULTADOS: Quanto ao conhecimento, observou-se melhora no grupo intervenção (p < 0,001) para o conjunto das questões e para amamentação (p = 0,004); HIV e alimentação infantil (p = 0,049); alimentação complementar (p = 0,012); e aconselhamento em alimentação infantil (p = 0,004). Quanto ao desempenho, verificou-se que, após a intervenção, houve melhora significativa no grupo intervenção em anamnese alimentar (p < 0,001). CONCLUSÕES: Este curso foi efetivo em propiciar aumento de conhecimento e melhora de desempenho na anamnese alimentar, mas o mesmo não se obteve para habilidades de aconselhamento.

OBJECTIVE: To evaluate the effectiveness of an integrated infant and young child feeding counseling course for transforming the knowledge, attitudes and practices of pediatricians and nutritionists working for the municipal health system of São Paulo, Brazil. METHODS: A randomized intervention study enrolling 29 professionals in the intervention group and 27 in the control group. Interviewers were trained in advance to collect data on the professionals working at health centers, before and 2 months after the intervention. Three research instruments were used, the first was to assess the profile of each professional, the second assessed their knowledge and the third was a clinical observation protocol. Analysis was performed using the Kruskal-Wallis test for independent samples and the Tukey method. RESULTS: The results for the knowledge questionnaire showed improvements in the intervention group (p < 0.001) for the whole questionnaire and for questions on breastfeeding (p = 0.004); HIV and infant and young child feeding (p = 0.049); complementary feeding (p = 0.012); and counseling in infant and young child feeding (p = 0.004). In terms of performance, it was observed that the intervention group had significantly improved their dietary anamnesis after the intervention (p < 0.001). CONCLUSIONS: This course effectively promoted an increase in knowledge and improvements in dietary anamnesis performance, but the same was not true of counseling skills.