Challenges in the management of nutritional disorders and communicable diseases in child day care centers: a quantitative and qualitative approach

Day care attendance during the first 12 months of life and occurrence of infectious morbidities and symptoms

OBJECTIVE

To investigate the occurrence of infectious morbidities according to day care attendance during the first year of life.

METHODS

This was a cross-sectional analysis of data from the 12-month follow-up of a medium-sized city birth cohort from children born in 2015, in the Southern Brazil. Main exposure variables were day care attendance from 0 to 11 months of age, type of day care center (public or private), and age at entering day care. Health outcomes were classified as follows: "non-specific respiratory symptoms," "upper respiratory tract infection," "lower respiratory tract infection," "flu/cold," "diarrhea," or "no health problem," considering the two weeks prior to the interview administered at 12 months of life. Associations were assessed using Poisson regression adjusted by demographic, behavioral, and socioeconomic variables.

RESULTS

The sample included 4018 children. Day care attendance was associated with all classifications of health outcomes mentioned above, except for flu/cold. These were stronger among children who entered day care at an age closer to the outcome time-point. An example are the results for lower respiratory tract infection and diarrhea, with adjusted prevalence ratios of 2.79 (95% CI: 1.67-4.64) and 2.04 (95% CI: 1.48-2.82), respectively, for those who entered day care after 8 months of age when compared with those who never attended day care.

CONCLUSIONS

The present study consistently demonstrated the association between day care attendance and higher occurrence of infectious morbidities and symptoms at 12 months of life. Hence, measures to prevent infectious diseases should give special attention to children attending day care centers.

PRACTICES OF MOTHERS AND CAREGIVERS IN THE IMPLEMENTATION OF THE TEN STEPS FOR HEALTHY FEEDING

ABSTRACT Objective: to evaluate the practices of mothers and caregivers regarding the diet of children under one year of age, according to the recommendations of the ten steps for healthy feeding. Method: a cross-sectional, analytical study. A total of 151 mothers or caregivers of children aged 12-23 months and 29 days who were registered in the Basic Health Units of the IV Health District in Recife, Pernambuco, Brazil, were interviewed between July and September 2015. For the purpose of analysis a ten-step compliance score for healthy feeding was constructed. Poisson regression with robust variance was performed to identify the determinants of inadequate feeding practices. Results: the median of the steps was 20%. Paid maternal work outside the home, not living with the partner and performing less than seven childcare consultations were determinants of inadequate feeding practices. Conclusion: The practices of the mothers and caregivers in relation to children's diet were considered inadequate due to the low compliance regarding the number of accomplished steps.