This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed.

Artigo submetido em 22.01.02, aceito em 15.04.02. ResumoObjetivo: apresentar uma revisão sobre os principais fatores determinantes da anemia em crianças menores de cinco anos. Fontes de dados:foram utilizadas as informações de artigos publicados em revistas científicas nacionais e internacionais indexadas, livros técnicos e publicações de organizações internacionais.Síntese dos dados: a anemia constitui o problema nutricional de maior magnitude no mundo, sendo as crianças menores de cinco anos um dos grupos populacionais de maior risco. Como qualquer problema de saúde pública, sua origem é multicausal e, desta maneira, tenta-se nesse artigo interpretar a sua relação direta ou indireta com seus possíveis fatores determinantes, e os principais achados concordantes ou discordantes nos estudos epidemiológicos. Dentre esses fatores encontram-se as condições socioeconômicas, as condições de assistência à saúde da criança, seu estado nutricional, a presença de morbidades, o consumo alimentar e os fatores biológicos. Destacam-se o papel da dieta, no que diz respeito ao consumo e biodisponibilidade de ferro, e a idade da criança como os principais determinantes.Conclusões: tendo em vista a magnitude do problema e a abrangência de seus fatores de risco revisados neste trabalho, tornase necessária a implementação de medidas urgentes de prevenção e tratamento da anemia ferropriva. É importante ressaltar que uma única estratégia poderá ter pouco sucesso se outras medidas não forem tomadas simultaneamente, sendo relevante o papel da educação alimentar, juntamente com outras ações implementadas. As crianças menores de dois anos e as que residem em áreas rurais e carentes devem ser priorizadas nos programas de combate à anemia.J Pediatr (Rio J) 2002; 78 (4):269-78: anemia, hemoglobina, fatores determinantes, criança. AbstractObjective: to present a review about the main determining factors of anemia in children under 5 years old.Source of data: information was collected from articles published in indexed national and international scientific journals, technical books and publications of international organizations. Summary of the findings:anemia constitutes the world's nutritional problem of great magnitude, and children under 5 years old form the group with the highest risk. Similarly to any other public health problem, the origin of anemia is multi-causal. Therefore, in this article the attempt is to interpret its direct or indirect relation with possible determinant factors and the main concordant or discordant findings in epidemiological studies. Social and economic conditions, child's health care conditions, child's nutritional state, presence of morbidity, food consumption and biological aspects are among these factors. The role of the diet is emphasized with respect to the consumption and bioavailability of iron, and child's age as the main determinants.Conclusions: bearing in mind the magnitude of the problem and the extent of its risk factors reviewed in this study, the implementation of urgent prevention and treatment...

In 1997, the prevalence of anaemia was 40·9 % among children aged 6 -59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6-59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6 -23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8·3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3·3, serum retinol 2·7, diarrhoea 2·4, water treatment 1·7, sanitation 1·3 and low birth-weight 0·5 %. The final model explained 23·4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged ,2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

OBJECTIVE:To estimate the prevalence of anemia and to identify its associated factors in children aged 6-59 months. METHODS:This was a cross-sectional study on data from the Third Health and Nutrition Survey of the State of Pernambuco, Northeastern Brazil, with a representative sample of 1,403 children from urban and rural areas. Anemia was diagnosed by means of hemoglobin assays. Multivariate analysis was performed though a hierarchical model, using robust-variance Poisson regression to estimate the prevalence ratio as a function of the following variables: biological factors, morbidity, child nutritional state, socioeconomic factors, housing, sanitation and maternal factors. RESULTS:The weighted prevalence of anemia was 32.8% overall: 31.5% in urban areas and 36.6% in rural areas. In urban areas, anemia was signifi cantly associated with maternal education, consumer goods, number of children less than fi ve years old in the home, drinking water treatment, maternal age, maternal anemia and the child's age. In rural areas, only maternal age and the child's age were signifi cantly associated with anemia. CONCLUSIONS:The prevalence of anemia in children in Pernambuco was similar in urban and rural areas. The factors associated with anemia that are presented here should be taken into consideration in planning effective measures for its control.

ResumoObjetivo: Este estudo tem como objetivo identificar, utilizando modelagem estatística, os fatores de risco da anemia em crianças de 6 a 59 meses de idade no estado de Pernambuco, contemplando aspectos socioeconômicos e da dieta.Métodos: A amostra constou de 746 crianças de 6 a 59 meses do estado de Pernambuco, nas quais foram realizados dosagem de hemoglobina e inquérito dietético recordatório de 24 horas. Foi analisado o risco de anemia em relação às variáveis socioeconômicas e de consumo alimentar, utilizando modelos de análise multivariada. AbstractObjective: The objective of this study was to use statistical modeling to identify risk factors for anemia in children aged 6 to 59 months in the state of Pernambuco, covering socioeconomic and dietary aspects. Methods:The sample comprised 746 children aged between 6 and 59 months from the state of Pernambuco. Their hemoglobin was assayed and a 24-hour dietary recall performed. Risk of anemia was analyzed with relation to socioeconomic variables and to dietary intakes, using multivariate analysis models. Results:The risk factors for anemia were: a high proportion of calories from cow's milk, low density of nonheme iron, low age and low maternal educational level; age was the most prominent factor, with children under 24 months exhibiting 3.61 times greater risk of being anemic than the older children. Conclusions:This study confirms the need for a clear picture of the dietary intake of children in Brazil, in order that associations with anemia can be better understood. Our results revealed that the dietary factors which were most responsible for risk of anemia were a greater proportion of calories from cow's milk and lower density of nonheme iron, in addition to age below 24 months and low maternal educational level.J Pediatr (Rio J). 2007;83(1):39-46: Iron deficiency anemia, epidemiology, risk factors, food intake, child nutrition. IntroduçãoA anemia ferropriva resulta da interação de múltiplos fatores etiológicos que levam a um desequilíbrio entre as necessidades do organismo e a quantidade absorvida de ferro.Os fatores de risco da anemia mais citados na literatura são baixa renda familiar e escolaridade materna, falta de acesso aos serviços de saúde, precariedade nas condições de saneamento e a dieta inadequada em ferro [1][2][3][4]

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The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother-child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.

In terms of public health, the prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries.