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Miranda WDD, Guimarães EADA, Campos DS, Luz ZMPD. National Vitamin A Supplementation Program in primary care: what is the reality in Minas Gerais, Brazil? CIENCIA & SAUDE COLETIVA 2023; 28:2323-2333. [PMID: 37531540 DOI: 10.1590/1413-81232023288.05922023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 04/17/2023] [Indexed: 08/04/2023] Open
Abstract
The present study aimed to evaluate the National Vitamin A Supplementation Program in Minas Gerais, adopting the mixed sequential explanatory method. The quantitative approach adopted the multidimensional instrument per the components of vitamin A supplementation and food and nutrition education. We employed an analysis matrix with parameters to define the implementation as adequate, partially adequate, inadequate, and critical. We used semi-structured interviews in the qualitative approach. The "process" dimension was better evaluated than the "structure", with an implementation level (IL) of 84.6% and 78.5%, respectively. The Program's strengths include supplementation planning, achieving goals, recording information, supporting breastfeeding, and the performance of Community Health Workers. Weaknesses are fragmented work, analysis of information limits, access to the Program's actions, implementation of educational actions, and lack of or insufficient availability of nutritionists and training. The Program's reality only partially considered health promotion actions and focused on vitamin A supplementation. Implementing food and nutritional education actions is imperative to face vitamin A deficiency.
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Affiliation(s)
- Wanessa Debôrtoli de Miranda
- Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
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Dallazen C, Tietzmann DC, da Silva SA, Nilson EAF, Gonçalves VSS, Lang RMF, Crispim SP, Moreira JD, Garcia SC, Vítolo MR. Vitamin A deficiency and associated risk factors in children aged 12-59 months living in poorest municipalities in the South Region of Brazil. Public Health Nutr 2023; 26:132-142. [PMID: 35125127 PMCID: PMC11077461 DOI: 10.1017/s1368980022000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/20/2021] [Accepted: 02/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate the prevalence of vitamin A deficiency (VAD) in children and associated risk factors. DESIGN Analysis of data from a cross-sectional multicentre study performed in the primary care units of the municipalities from January to June 2015. The children's legal guardians answered a socio-economic questionnaire, and the children's blood samples were obtained by venipuncture. Plasma retinol was determined by HPLC. Plasma retinol values of <0·70 μmol/l were considered VDA. Poisson multiple regression with robust variance was used. Values of P < 0·05 were considered significant. The data were analysed in the SPSS software, 21.0. SETTING Forty-eight poorest municipalities in the South Region of Brazil. PARTICIPANTS Children (n 1503) aged 12-59 months. RESULTS The prevalence of VAD in the sample was 1·9 % (95 % CI (0·5, 6·8)). The following risk factors were associated with the outcome in the final explanatory model: family received Bolsa Familia program benefits (PR = 3·19; 95 % CI (1·69, 6·02)), child was not being breastfed (PR = 5·22; 95 % CI (1·68, 16·18)) and stunting (PR = 4·75; 95 % CI (2·10, 10·73)). CONCLUSIONS VAD did not represent a public health problem for children living in socio-economically vulnerable municipalities in the South Region of Brazil, suggesting a new panorama of this nutritional deficiency even in regions of low socio-economic conditions in these three states. Thus, in view of the current nutritional transition scenario, it is necessary to continuously monitor and improve public policies related to vitamin A supplementation in the country.
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Affiliation(s)
- Camila Dallazen
- Nutrition Research Group (NUPEN), Federal University of Health Sciences of Porto Alegre, Sarmento Leite 245, Porto Alegre90050-170, Brazil
| | - Daniela Cardoso Tietzmann
- Nutrition Research Group (NUPEN), Federal University of Health Sciences of Porto Alegre, Sarmento Leite 245, Porto Alegre90050-170, Brazil
| | | | | | | | | | | | | | | | - Márcia Regina Vítolo
- Nutrition Research Group (NUPEN), Federal University of Health Sciences of Porto Alegre, Sarmento Leite 245, Porto Alegre90050-170, Brazil
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de Miranda WD, Guimarães EAA, Campos DS, Antero LS, Beltão NRM, da Luz ZMP. [Vitamin A Supplementation Program in Brazil: evaluability assessmentPrograma Nacional de Suplementación de Vitamina A en Brasil: un estudio de evaluación]. Rev Panam Salud Publica 2019; 42:e182. [PMID: 31093210 PMCID: PMC6385853 DOI: 10.26633/rpsp.2018.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/07/2018] [Indexed: 11/24/2022] Open
Abstract
Objetivo Descrever as etapas do estudo de avaliabilidade do Programa Nacional de Suplementação de Vitamina A (PNSVA) no Brasil. Métodos Estudo com abordagem qualitativa que adotou como referencial o sistema de sete elementos proposto por Thurston e Ramaliu. Foram realizados análise de documentos, revisão teórica sobre o PNSVA e encontros com referências técnicas para a elaboração da linha do tempo e modelos teórico e lógico do Programa. O modelo lógico subsidiou a elaboração de dois questionários a serem utilizados para avaliar a implantação do PNSVA. Foi realizada a validação de conteúdo das perguntas avaliativas dos questionários por meio da técnica Delphi. Resultados O estudo possibilitou compreender a evolução das estratégias para prevenção e controle da deficiência de vitamina A no país, além do funcionamento do PNSVA e seu contexto externo. O modelo lógico revelou-se uma ferramenta valiosa para identificar áreas específicas que devem ser priorizadas em avaliações futuras. A validação dos questionários indicou que esses instrumentos abordam questões necessárias para a avaliação da implantação do Programa em municípios. A etapa da técnica Delphi foi de grande importância para guiar ajustes pertinentes quanto ao conteúdo e à forma de apresentação de algumas questões, o que certamente aumentará o poder analítico da ferramenta. Conclusão O estudo de avaliabilidade apontou a possibilidade de avaliações posteriores do PNSVA. Espera-se que os resultados desta investigação auxiliem futuras avaliações em países que adotam ações semelhantes às do Brasil.
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Affiliation(s)
| | | | | | - Laís Santos Antero
- Secretaria de Estado de Saúde de Minas Gerais (SES - MG), Belo Horizonte (MG), Brasil
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TELES LFDS, PAIVA ADA, LUZIA LA, LIMA-FERREIRA FELD, CARVALHO CMRGD, RONDÓ PHDC. The relationship between serum retinol concentrations and subclinical infection in rural Brazilian children. REV NUTR 2018. [DOI: 10.1590/1678-98652018000300004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To evaluate the relationship between serum retinol concentrations and subclinical infection in children from rural settlements. Methods A cross-sectional population-based study was carried out in nine rural settlements in the northeastern region of Brazil, involving 118 children aged 6 to 59 months. The relationship between serum retinol and C-Reactive Protein levels, an important marker of infectious and inflammatory processes, was investigated by multiple linear regression, controlling for demographic, socioeconomic and nutritional variables. Serum retinol and C-Reactive Protein were measured, respectively, by High Performance Liquid Chromatography and immunoturbidimetric assay in automated equipment. Results Vitamin A deficiency (retinol <0.70μmol/L) was identified in 9.3% of the children. C-Reactive Protein was the only predictor of retinol concentrations in the final regression model, causing a 0.728μmol/L reduction in retinol concentrations in the studied children (p=0.008). Conclusion Vitamin A deficiency is a problem of mild/moderate severity and measures to control infectious diseases in this population are fundamental to prevent and/or combat this problem.
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Harding KL, Aguayo VM, Masters WA, Webb P. Education and micronutrient deficiencies: an ecological study exploring interactions between women's schooling and children's micronutrient status. BMC Public Health 2018; 18:470. [PMID: 29636013 PMCID: PMC5894221 DOI: 10.1186/s12889-018-5312-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background Formal education can be a nutrition-sensitive intervention that supports the scale-up and impact of nutrition-specific actions. Maternal education has long been linked to child survival, growth, and development while adult earnings and nutrition are tied to years in school as a child. However, less is known about the relationship between maternal education and the micronutrient status of children, women and the general population. Methods Using country-level data and an ecological study design, we explored the global associations between women’s educational attainment and: a) anemia and vitamin A deficiency (VAD) in children aged 6–59 months; b) anemia in non-pregnant women; and c) zinc deficiency, urinary iodine excretion (UIE), and the proportion of infants protected against iodine deficiency in the general population Cross-sectional relationships (2005–2013) were assessed using linear regression models. Results Percentage of women without schooling was negatively associated with all outcomes. Number of years of schooling among women was positively associated with all outcomes except for UIE and the proportion of infants protected against iodine deficiency. Income level was a significant effect modifier of the effect of years of women’s schooling on child anemia as well as of the proportion of women without formal education on zinc deficiency in the population. The relationship was strongest in low-income countries for child anemia, and was not significant in upper middle-income countries. For zinc deficiency, the relationship was not significant in low or lower middle income countries, which may suggest that a minimum threshold of resources needs to be reached before education can influence zinc status. Conclusions While relationships between maternal schooling and micronutrient outcomes vary around the globe, more schooling is generally linked to lower rates of deficiency. These findings draw policy-relevant connections between formal education and anemia and micronutrient status globally. It is necessary to examine the mechanisms through which this relationship may be working at both household and country level. Electronic supplementary material The online version of this article (10.1186/s12889-018-5312-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kassandra L Harding
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA. .,Yale School of Public Health, Yale University, 135 College Street, New Haven, CT, 06510, USA.
| | - Victor M Aguayo
- UNICEF Nutrition Programme, Programme Division, New York, NY, USA
| | - William A Masters
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
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Lima DB, Damiani LP, Fujimori E. DEFICIÊNCIA DE VITAMINA A EM CRIANÇAS BRASILEIRAS E VARIÁVEIS ASSOCIADAS. REVISTA PAULISTA DE PEDIATRIA 2018; 36:176-185. [PMID: 29617474 PMCID: PMC6038778 DOI: 10.1590/1984-0462/;2018;36;2;00013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/27/2017] [Indexed: 11/21/2022]
Abstract
RESUMO Objetivo: Analisar variáveis associadas à deficiência de vitamina A (DVA) em crianças brasileiras de 6 a 59 meses de idade, considerando um modelo hierárquico de determinação. Métodos: Trata-se de um recorte da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS), realizada em 2006. A análise dos dados incluiu 3.417 crianças de seis a 59 meses com dados de retinol. A DVA foi definida como retinol sérico <0,7 mmol/L. Realizaram-se análises univariada e ajustada por regressão múltipla de Poisson, com nível de significância de 5%, utilizando-se modelo hierárquico de determinação que considerou três blocos de variáveis: vinculadas aos processos estruturais da sociedade (variáveis socioeconômicas e demográficas); ao ambiente imediato da criança (variáveis maternas, de segurança e consumo alimentar); e individuais (características biológicas da criança). Os dados foram expressos em razão de prevalência (RP). Resultados: Após ajuste para variáveis de confusão, permaneceram associadas à DVA: residir no Sudeste [RP=1,59; IC95% 1,19-2,17] e no Nordeste [RP=1,56; IC95% 1,16-2,15]; em zona urbana [RP=1,31; IC95% 1,02-1,72]; ter mãe com idade ≥36 anos [RP=2,28; IC95% 1,37-3,98]; sendo proteção consumir carne pelo menos uma vez nos últimos sete dias [RP=0,24; IC95% 0,13-0,42]. Conclusões: As principais variáveis associadas à DVA no país relacionam-se aos processos estruturais da sociedade e ao ambiente imediato da criança, e não aos individuais.
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Abizari AR, Azupogo F, Brouwer ID. Subclinical inflammation influences the association between vitamin A- and iron status among schoolchildren in Ghana. PLoS One 2017; 12:e0170747. [PMID: 28152069 PMCID: PMC5289472 DOI: 10.1371/journal.pone.0170747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In resource-poor settings, micronutrient deficiencies such as vitamin A deficiency may co-exist with iron-deficiency. In this study we assessed the iron and vitamin A status of schoolchildren and the association between vitamin A and iron status. METHODS A cross-sectional design using the baseline data of a dietary intervention trial conducted among randomly selected 5-12 years old schoolchildren (n = 224) from 2 rural schools in northern Ghana. Hemoglobin (Hb), serum ferritin (SF) and serum transferrin receptor (sTfR) concentrations were used as measures of iron status. Retinol binding protein (RBP) was used as a measure of vitamin A status. Subclinical inflammation (SCI) was measured using C-reactive protein (CRP) and α1-acid glycoprotein (AGP) concentrations. We examined the cross-sectional association between vitamin A and iron status biomarkers with multiple linear regressions. RESULTS The proportions of schoolchildren with anemia (WHO criteria), iron-deficiency (ID, SF <15μg/l and/or sTfR >8.5mg/l) and iron-deficiency anemia (IDA, concurrent anemia and ID) were 63.8%, 68.3% and 46.4% respectively. Low or marginal vitamin A status (0.70 μmol/l ≤ RBP < 1.05μmol/l) was present in 48.2% while 37.5% of the schoolchildren had vitamin A deficiency (VAD, RBP <0.70 μmol/l). The prevalence of SCI as well as concurrent VAD and ID were 48.7% and 25% respectively. RBP was associated with Hb (β = 7.2, P = 0.05) but not SF (β = 20.7, P = 0.33) and sTfR concentration (β = 12.0, P = 0.63). In the presence of SCI, RBP was not associated with hemoglobin status but a significant positive association was observed among children without SCI. CONCLUSIONS The study shows that RBP is significantly associated with Hb concentration but not with SF and sTfR. The observed relationship between RBP and Hb is only significant in the absence of SCI.
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Affiliation(s)
- Abdul-Razak Abizari
- Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Fusta Azupogo
- Department of Family and Consumer Science, Faculty of Agriculture, University for Development Studies, Tamale, Ghana
| | - Inge D. Brouwer
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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