Tendências temporais e projeções de cesariana no Brasil, macrorregiões administrativas e unidades federativas / Temporal trends and projections of caesarean sections in Brazil, its administrative macro-regions, and federative units

Resumo Os estudos de tendência sobre a via de nascimento no Brasil têm revelado um cenário de sucessivos aumentos lineares nas proporções de cesariana. Entretanto, a possibilidade de mudanças na evolução temporal da via cirúrgica não tem sido considerada. Dessa forma, objetivou-se verificar possíveis pontos de inflexão na proporção de cesarianas no Brasil, macrorregiões e unidades federativas, bem como estimar suas projeções para o ano de 2030. Utilizou-se a série temporal com as cesarianas notificadas no Departamento de Informática do SUS no período de 1994 a 2019. Foram utilizados modelos autorregressivos integrados de médias móveis e de regressão joinpoint para obtenção de projeções e de tendências das proporções de cesariana, respectivamente. As proporções de cesarianas apresentaram tendência significativa de aumento ao longo dos 26 anos de estudo em todos os níveis de agregação. Por outro lado, quando se considera a formação de segmentos, observa-se tendência de estabilização no país e nas regiões Sul e Centro-Oeste, a partir de 2012. Norte e Nordeste apresentaram tendência de aumento e o Sudeste, de queda significativa. Projeções indicam que no ano de 2030, 57,4% dos nascimentos no país ocorrerão por via cirúrgica e que nas regiões Sudeste e Sul, serão observadas proporções superiores a 70%.

Abstract Trend studies on the model of birth in Brazil show a scenario of successive linear increases in cesarean rates. However, they ignore possible changes in the temporal evolution of this delivery modality. Thus, this study aimed to evaluate possible inflection points in cesarean rates in Brazil, its macro-regions, and federated units, as well as to estimate projections for 2030. A time series with information on cesarean sections from 1994 to 2019 from the SUS Department of Informatics was used. Autoregressive integrated moving average and joinpoint regression models were used to obtain cesarean rate projections and trends, respectively. Caesarean rates showed a significant upward trend over the 26 study years at all levels of aggregation. On the other hand, when considering the formation of segments, a stabilization trend was observed both in the country and in the South and Midwest regions, starting in 2012. Rates tended to increase in North and Northeast and significantly decrease in Southeast. Projections show that in 2030, 57.4% of births in Brazil will be cesarean, with rates higher than 70% in Southeast and South regions.

Associação entre qualidade de vida, aspectos cognitivos, medo de cair e risco de queda em idosos com Parkinson / Association between quality of life, cognitive aspects, fear of falling and risk of falling in elderly individuals with Parkinson

INTRODUÇÃO: A Doença de Parkinson (DP) é responsável por gerar déficits no equilíbrio e distúrbios cognitivos que refletem na capacidade funcional e podem aumentar a propensão a quedas em idosos. OBJETIVO: Avaliar a associação entre qualidade de vida, aspectos cognitivos, medo de cair e risco de queda em idosos com DP. MÉTODO: Estudo observacional transversal. A caracterização dos sinais e sintomas motores foi realizada através da Moviment Disorder Society ­ Unified Parkinson's Disease Rating Scale (MDS-UPDRS parte III). O Parkinson's Disease Questionnaire (PDQ-39), o Mini-Exame do Estado Mental (MEEM) e o Montreal Cognitive Assessment (MoCA) também foram aplicados. O medo de cair foi mensurado pela Escala Internacional de Eficácia de Quedas (FES-I) e o risco de queda foi avaliado através do teste Timed Up and Go (TUG), do Teste de Alcance Funcional (TAF) e do teste de Sentar e Levantar (SL). A associação de Spearman foi usada para TUG, PDQ-39, MEEM, MoCA e FES-I, enquanto a associação de Pearson foi usada para TAF e SL, com p < 0,05. RESULTADOS: 29 participantes foram incluídos (70,14 ± 8,81 anos). O PDQ-39 apresentou associação significativa, inversa e regular com o TAF, enquanto o MEEM e o MoCA apresentaram uma associação significativa, inversa e forte com os testes TUG e SL. FES-I foi associado ao TUG e SL. CONCLUSÃO: A qualidade de vida, os aspectos cognitivos e o medo de cair estão correlacionados com o risco de queda em idosos com DP.

INTRODUCTION: Parkinson's Disease (PD) is responsible for impairment in balance and cognitive disorders that reflect on functional capacity and may increase the risk of falls in the elderly. OBJECTIVE: Evaluate the association between quality of life, cognitive aspects, fear of falling, and risk of falling in elderly people with PD. METHOD: This is a cross-sectional study. Motor signs and symptoms of PD were assessed by the Movement Disorder Society ­ Unified Parkinson's Disease Rating Scale (MDS-UPDRS part III). The Parkinson's Disease Questionnaire (PDQ-39), the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA) were also applied. The fear of falling was measured by the Falls Efficacy Scale - International (FES-I), and the risk of falling was assessed by the Timed Up and Go (TUG) test, Functional Reach Test (FRT), and Sit and Stand test (SS). Spearman's association was used for TUG, PDQ39, MMSE, MoCA, and FES-I, while Pearson's association was used for FRT, SS, and other variables, with p <0.05. RESULTS: 29 participants were included (70.14 ±8.81 years). PDQ-39 showed a significant, inverse, and regular association with the FRT, while MMSE and MoCA showed a significant, inverse, and strong association with the TUG and SS tests. FES-I was associated with TUG and SS. CONCLUSION: Quality of life, cognitive aspects, and fear of falling were associated with the risk of falling in elderly people with PD.

Risk of Cognitive Impairment in Patients With Parkinson’s Disease With Visual Hallucinations and Subjective Cognitive Complaints

Background@#and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). @*Methods@#Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. @*Results@#At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). @*Conclusions@#VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.

Desigualdade racial e regional na tendência temporal do déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos / Racial and regional inequality in the temporal trend of stunting and excess weight in Brazilian children under five years of age

RESUMO Objetivo: Analisar a ocorrência de desigualdade racial e regional na tendência temporal das prevalências de déficit de estatura e excesso de peso de crianças brasileiras menores de cinco anos ao longo dos anos de 2008-2018. Métodos: Estudo ecológico de série temporal com dados do Sistema de Vigilância Alimentar e Nutricional das prevalências de déficit de estatura e excesso de peso em crianças menores de 5 anos de acordo com raça/cor, região e ano. Para avaliar diferenças entre prevalências medianas por ano dos desfechos, realizou-se teste de Kruskal-Wallis. Análises de regressão linear foram propostas para avaliar tendências das prevalências dos desfechos ao longo dos anos. Resultados: No Brasil, as crianças pretas apresentaram tendência de crescimento do excesso de peso (β=4,611; p=0,042). Entre as crianças pretas, houve aumento ao longo dos anos do déficit de estatura no Sudeste (β=3,960; p=0,014) e queda no Sul (β=-4,654; p=0,022). No Brasil e na maioria das regiões, a prevalência mediana do déficit de estatura foi maior nas crianças pretas do que nas brancas (12,86 vs. 11,54%, p<0,001). No Sudeste e Sul, as crianças pretas também apresentaram as maiores prevalências de excesso de peso (15,48 e 15,99%, respectivamente). Conclusão: Crianças de regiões menos desenvolvidas do Brasil e pretas apresentaram maior vulnerabilidade para dupla carga de má nutrição.

ABSTRACT Objective: To analyze the occurrence of racial and regional inequality in the temporal trend of the prevalence of stunting and overweight in Brazilian children under five years of age over the years 2008-2018. Methods: An ecological time-series study with data from the Food and Nutrition Surveillance System on the prevalence of stunting and overweight in children under five years old according to race/skin color, region, and year. To assess differences between median prevalence per year of outcomes, the Kruskal-Wallis test was performed. Linear regression analyses were proposed to assess trends in the prevalence of outcomes over the years. Results: In Brazil, black children tended to be overweight (β=4.611; p=0.042). Among black children, there was an increase over the years in stunting in the Southeast (β=3.960; p=0.014) and a decrease in the South (β=-4.654; p=0.022). In Brazil and in most regions, the median prevalence of stunting was higher in black children than in white ones (12.86 vs. 11.54%, p<0.001). In the Southeast and South, black children also had the highest prevalence of overweight (15.48 and 15.99%, respectively). Conclusion: Children from less developed regions of Brazil and of black skin color/race were more vulnerable to a double burden of malnutrition.

Clinical-epidemiological characteristics and survival of cases of severe acute respiratory syndrome (SARS) due to COVID-19, according to the COVID-19 vaccination schedule in Brazil, 2021-2022: a prospective study / Características clinico-epidemiológicas y sobrevida de casos de síndrome respiratoria aguda grave (SRAG) por COVID-19, según esquema vacunal contra COVID-19 en Brasil, 2021-2022: estudo prospectivo / Características clínico-epidemiológicas e sobrevida de casos de síndrome respiratória aguda grave (SRAG) por covid-19, segundo esquema vacinal contra covid-19 no Brasil, 2021-2022: estudo prospectivo

ABSTRACT Objective To analyze the clinical and sociodemographic characteristics and survival of individuals with severe acute respiratory syndrome due to COVID-19 according to the COVID-19 vaccination schedule, Brazil, 2021-2022. Methods This was a cohort study based on data from the Influenza Epidemiological Surveillance Information System; the Kaplan-Meier and Survival Tree methods were used to analyze survival. Results Among the 559,866 hospitalized cases, a higher proportion of vaccinated individuals was found among female (15.0%), elderly people aged ≥ 80 (34.5%), people from the Southeast region (15.7%), those who did not undergo respiratory support (21.2%) and those who did progress to death (15.2%); the survival curve showed that risk of death for unvaccinated individuals was higher in all age groups (p-value < 0.001); elderly people aged ≥ 80, who did not undergo mechanical ventilation and who had a booster dose had lower risk when compared to their peers who had two doses or were unvaccinated (hazard ratio = 0.64; 95%CI 0.62;0.67). Conclusion Lowest risk of death was found in vaccinated individuals, especially those who had two doses or a booster dose as well.

RESUMEN Objetivo Analizar las características clínicas, sociodemográficas y supervivencia de individuos con síndrome respiratoria aguda grave por COVID-19, según el esquema de vacunación contra COVID-19, Brasil, 2021-2022. Métodos Estudio de cohorte con datos del Sistema de Informação de Vigilância Epidemiológica de la Gripe; se utilizó el método de Kaplan-Meier y el árbol de supervivencia para analizar la supervivencia. Resultados Entre los 559.866 casos hospitalizados, se observó una mayor proporción de vacunados entre el sexo femenino (15,0%), ancianos ≥ 80 (34,5%), región Sudeste (15,7%), quienes no recibieron soporte ventilatorio (21,2%) y no fallecidos (15,2%); la curva de supervivencia mostró que los no inmunizados presentaron un mayor riesgo de óbito en todos los grupos de edad (p-valor < 0,001); los ancianos ≥ 80, que no recibieron ventilación mecánica, con dosis de refuerzo, tienen un menor riesgo en comparación con sus pares con dos dosis o no vacunados (HR = 0,64; IC95% 0,62;0,67). Conclusión El menor riesgo de óbito se observó en individuos vacunados, especialmente aquellos con dos dosis o refuerzo.

RESUMO Objetivo Analisar as características clínicas e sociodemográficas e a sobrevida de indivíduos com síndrome respiratória aguda grave por covid-19, segundo esquema vacinal contra covid-19, Brasil, 2021-2022. Métodos Estudo de coorte, com dados do Sistema de Informação de Vigilância Epidemiológica da Gripe; métodos de Kaplan-Meier e árvore de sobrevivência foram utilizados para analisar a sobrevida. Resultados Dos 559.866 casos internados, observou-se maior proporção de vacinados entre sexo feminino (15,0%), idosos ≥ 80 anos (34,5%), na região Sudeste (15,7%), entre os que não receberam suporte ventilatório (21,2%) e os não evoluídos a óbito (15,2%); na curva de sobrevida, não imunizados apresentaram maior risco de óbito, independentemente da faixa etária (p-valor < 0,001); idosos que não realizaram ventilação mecânica, com dose de reforço, apresentaram menor risco, comparados a seus pares com duas doses ou não imunizados (hazard ratio = 0,64; IC95% 0,62;0,67). Conclusão Observou-se menor risco de ocorrência de óbito nos indivíduos vacinados, especialmente com duas doses ou reforço.

Prevalence of metabolic syndrome in adolescents based on three diagnostic definitions: a cross-sectional study

ABSTRACT Objective: There is no consensus as to the best criterion for the evaluation of metabolic syndrome (MS), impairing the estimation of its prevalence. This study aims to compare MS estimates using three recommended definitions for adolescents based on a cross-sectional study nested in the Consortium of Brazilian Birth Cohorts in São Luís, Maranhão. Subjects and methods: A total of 2,515 adolescents aged between 18 and 19 years were evaluated. The criteria of International Diabetes Federation (IDF) and National Cholesterol Education Program Panel III (NCEP-ATP) modified by Cook and cols. (2003) and De Ferranti and cols. (2004) defined SM. To compare the estimates of MS prevalence, the chi-square, Fisher's exact and Cohen's Kappa index tests were used. Results: Among the 2,064 participants evaluated in the final sample. The prevalence of MS ranged from 4.2% (95% CI: 3.3-5.1) to 10.2% (95% CI: 8.8-11.4). When comparing the estimates of MS prevalence in the total sample and by sex, a statistically significant difference was observed. The agreement between the criteria ranged from 0.42 (CI 95%: 0.35-0.49) to 0.55 (CI 95%: 0.48-0.62) in the total sample, 0.33 (CI 95%: 0.24-0.42) to 0.59 (95%CI: 0.47-0.71) among boys and 0.39 (95% CI: 0.26-0.52) to 0.54 (95% CI: 0.44-0.64) among girls. Conclusion: Different criteria provide different estimates for the prevalence of MS in adolescents, reflecting the importance of establishing a consensus.

Feasibility of three-dimensional CT reconstruction in assessing mandibular fractures: a survey among oral surgeons and dental maxillofacial radiologists

Aim: Evaluation of the reliability of 3D computed tomography (3D-CT) in the diagnosis of mandibular fractures. Methods: A cross-sectional, quantitative and qualitative study was carried out, through the application of a questionnaire for 70 professionals in the area of Oral and Maxillofacial Surgery and Radiology. 3D-CT images of mandibular fractures were delivered to the interviewees along with a questionnaire. Participants answered about the number of traces, the region and the type of fracture. The correct diagnosis, that is, the expected answer, was based on the reports of a specialist in oral and maxillofacial radiology after viewing the images in the axial, sagittal and coronal sections. The resulting data from the interviewees was compared with the expected answer and then, the data was analyzed statistically. Results: In the sample 56.9% were between 22 and 30 years old, 52.8% were oral and maxillofacial surgeons (OMF), 34.7% were residents in OMF surgery and 12.5% OMF radiologists. Each professional answered 15 questions (related to five patients) and 50.8% of the total of these was answered correctly. Specialists in Oral and Maxillofacial Surgery and Traumatology correctly answered 53.9%. Interviewees with experience between 6 and 10 years correctly answered 58.2%. In identifying fracture traces, 46.1% of the questions were answered correctly. In terms of location, 5.6% of interviewees answered wrongly while 14.2% answered wrongly regarding classification. Conclusion: 3D computed tomography did not prove to be a reliable image for diagnosing mandibular fractures when used alone. This made necessary an association with axial, sagittal and coronal tomographic sections

Desigualdade de raça/cor e estado nutricional de crianças beneficiárias do Programa Bolsa Família no Maranhão e no Brasil / Race/color inequality and nutritional status of children beneficiary from the Bolsa FamíliaProgram in the state of Maranhão and in Brazil

Introdução: Segmentos populacionais não-brancos sofrem reconhecida desvantagem socioeconômica, além do componente da desigualdade racial que intensifica a vulnerabilidade desses grupos. Objetivo: Analisar o estado nutricional de acordo com raça/cor e região geográfica entre crianças maranhenses e brasileiras beneficiárias do PBF. Métodos: Estudo descritivo com dados do estado nutricional de crianças menores de cinco anos beneficiárias do PBF acompanhadas pelo Sistema de Vigilância Alimentar e Nutricional em 2017 no Brasil. Resultados: A raça/cor indígena apresentou as maiores prevalências de desnutrição em todas as regiões avaliadas e as menores prevalências de excesso de peso, exceto na Região Sul. As raças/cor preta e amarela apresentaram as maiores prevalências de desnutrição conseguintes. As raças/cor amarela e branca também figuraram com elevadas prevalências de excesso de peso. O Maranhão obteve prevalências de desnutrição e excesso de peso superiores e inferiores, respectivamente, ao Brasil em todas as raças/cor. Conclusões: Os resultados deste estudo apontam a existência de desigualdade de raça/cor no estado nutricional das crianças avaliadas. Destaca-se a maior vulnerabilidade das crianças indígenas à desnutrição.

Introduction: Non-white population segments suffer recognized socioeconomic disadvantage, in addition to the racial inequality component that intensifies the vulnerability of these groups. Objective: to analyze the nutritional status according to race/color and geographic region among children from Maranhão and Brazilian beneficiaries of the PBF. Methods: Descriptive study with data on the nutritional status of children under five years of age who are beneficiaries of the PBF followed by the Food and Nutritional Surveillance System in 2017 in Brazil. Results: The indigenous race/color had the highest prevalence of malnutrition in all regions evaluated and the lowest prevalence of overweight, except in the South region. The black and yellow races/color had the highest prevalence of malnutrition as a result. The yellow and white races/color also featured high prevalence of overweight. Maranhão had higher and lower prevalences of malnutrition and overweight, respectively, than Brazil in all races/color. Conclusions: The results of this study point to the existence of racial/color inequality in the nutritional status of the evaluated children. The greater vulnerability of indigenous children to malnutrition is highlighted.

Fatores associados ao elevado percentual de gordura corporal em indivíduos fisicamente ativos / Factors associated with the high body fat percentage in physically active individuals

Introdução: O exercício físico é praticado com diversos objetivos, destacando-se a promoção na mudança da composição corporal, com a redução de gordura e aumento de massa magra. Assim, compreender os fatores que podem estar associados nesta modificação se torna relevante. Objetivo: Analisar os fatores demográficos, estilo de vida, bioquímico, alimentares e de treinamento associados ao percentual de gordura corporal em praticantes de exercício físico em academias. Materiais e Métodos: Estudo transversal com 143 praticantes de exercícios físicos saudáveis, de ambos os sexos. Características sociodemográficas e estilo de vida foram obtidas através da aplicação de questionário. O consumo alimentar foi obtido através de registros alimentares de 24h, considerando as médias de três dias. A composição corporal foi avaliada por meio de avaliação antropométrica e pelo teste de bioimpedância elétrica. A análise estatística contemplou o teste de Shapiro Wilk para verificação da normalidade; o qui-quadrado e exato de Fisher foram usados para avaliar a associação entre as variáveis categóricas e a variável resposta e os testes de Mann-Whitney e t de Student para as contínuas. A regressão de Poisson com variância robusta foi usada para determinar as associações entre variáveis estudadas. O software Stata versão 14.0 foi usado para análise estatística, tendo sido adotado o valor de p <0,05. Resultados: A prevalência de gordura corporal elevada foi de 49,3% nos homens e 79,2% nas mulheres. Os fatores associados foram o maior consumo de proteína e fibras nas mulheres e a concentração de monócitos nos homens. Conclusão: Apesar de se tratar de público fisicamente ativo, observou-se elevado percentual de gordura entre os participantes do estudo e os fatores associados reforçam o caráter multietiológico deste indicador. (AU)

Introduction: Physical exercise is practiced with several objectives, especially the promotion of changes in body composition, with fat reduction and increase in lean mass. Thus, understanding the factors that may be associated with this modification becomes relevant. Objective: To analyze demographic, lifestyle, biochemical, dietary, and training factors associated with the percentage of body fat in practitioners of physical exercise in gyms. Materials and Methods: Cross-sectional study with 143 healthy physical exercise practitioners, of both sexes. Sociodemographic characteristics and lifestyle were obtained through the application of a questionnaire. Food consumption was obtained through 24-hour food records, considering the averages of three days. Body composition was assessed using anthropometric assessment and the electrical bioimpedance test. The statistical analysis included the Shapiro Wilk test to verify normality, the chi-square and Fisher's exact test were used to assess the association between categorical variables and the response variable and the Mann-Whitney and Student t tests for the continuous variables. Poisson regression with robust variance was used to determine the associations between studied variables. Stata software version 14.0 was used for statistical analysis and a value of p <0.05 was adopted. Results: The prevalence of high body fat was 49.3% in men and 79.2% in women. The associated factors were the higher consumption of protein and fibers in women and the concentration of monocytes in men. Conclusion: Despite being a physically active public, a high percentage of fat was observed among the study participants and the associated factors reinforce the multi-etiological character of this indicator. (AU)

Desnutrição e fatores associados em crianças quilombolas menores de 60 meses em dois municípios do estado do Maranhão, Brasil / Malnutrition and associated factors among quilombola children under 60 months of age in two cities of the state of Maranhão, Brazil

Resumo O objetivo deste artigo é avaliar a prevalência de desnutrição em crianças menores de 60 meses residentes em comunidades remanescentes de quilombos de dois municípios do estado do Maranhão e seus fatores associados. Estudo transversal com amostra de 372 crianças realizado em agosto de 2015. Foram coletadas informações socioeconômicas, demográficas, maternas e das crianças. A antropometria seguiu o proposto pela Organização Mundial da Saúde. Foram calculados os índices estatura para idade e peso para estatura utilizando o software Anthro versão 3.2.2. Foi realizada regressão de Poisson com variância robusta para a associação da desnutrição com as variáveis estudadas, utilizando o software Stata versão 14.0. A desnutrição em crianças foi elevada segundo a estatura-por-idade (15,1%) e peso-para-estatura (7%). Crianças cujas mães possuíam baixa estatura (< 1,497 m) apresentaram mais chances de possuírem déficit de estatura-para-idade (p < 0,05). Nenhuma variável se associou estatisticamente ao baixo peso-para-estatura. A desnutrição infantil persiste como problema de saúde pública em regiões vulneráveis e os fatores maternos como a baixa estatura materna podem explicar a baixa estatura dos filhos. Aponta-se para a necessidade de ações de enfrentamento deste desvio nutricional.

Abstract Objective: To evaluate the prevalence of malnutrition in children under 60 months of age living in quilombo remnant communities of two municipalities in the state of Maranhão and their associated factors. Methods: This is a cross-sectional study conducted with a sample of 372 children in August 2015. Socioeconomic, demographic, maternal and child information were collected. The anthropometry followed the one proposed by the World Health Organization. Height-for-age and weight-for-height rates were calculated using Anthro software version 3.2.2. Poisson regression was performed with a robust variance for the association of malnutrition with the studied variables, using Stata software version 14.0. Results: Child malnutrition was high for height-for-age (15.1%) and weight-for-height (7%). Children whose mothers had a short height (< 1.497 m) were more likely to have height-for-age deficits (p < 0.05). No variables were statistically associated with low weight-for-height. Conclusion: Child malnutrition persists as a public health problem in vulnerable regions, and maternal factors such as low maternal height may explain the short stature of the children. The need for actions to address this nutritional deviation is pointed out.