OBJETIVO: Avaliar o impacto de treinamento baseado na Iniciativa Hospital Amigo da Criança sobre práticas relacionadas à amamentação na maternidade e freqüências de aleitamento materno nos primeiros 6 meses de vida. MÉTODOS: Foram treinadas 90% das auxiliares de enfermagem e parteiras de duas maternidades (A e B) de Palmares (PE). Foram entrevistadas 334 mães nas primeiras 48 horas e 10 dias após o parto, para avaliar práticas que estimulam a amamentação nas maternidades e o cumprimento do quarto ao 10º passo da Iniciativa Hospital Amigo da Criança. Uma subamostra de 166 mães recebeu sete visitas domiciliares, para avaliar as freqüências do aleitamento materno nos 6 primeiros meses de vida. Os resultados foram comparados com os de estudo de coorte realizado na área em 1998. RESULTADOS: O desempenho da maternidade B foi melhor que o da maternidade A quanto às práticas que promovem o aleitamento materno relacionadas aos passos avaliados e quanto às freqüências de amamentação exclusiva. Comparação com coorte histórica evidenciou melhora nas práticas relacionadas à amamentação nas maternidades e aumento nas freqüências do aleitamento materno exclusivo (de 21,2 para 70%), nas primeiras 48 horas após o parto e durante os 6 primeiros meses de vida. CONCLUSÕES: O treinamento promoveu mudanças parciais em algumas práticas relacionadas à amamentação, repercutindo de forma positiva sobre as freqüências de aleitamento materno e aleitamento materno exclusivo nas maternidades. Contudo, não houve mudanças expressivas nessas freqüências ao longo dos 6 meses de vida, sugerindo a necessidade de intervenções efetivas no apoio ao aleitamento exclusivo nos serviços de saúde e na comunidade.

OBJECTIVE: To evaluate the impact of training based on the Baby Friendly Hospital Initiative on breastfeeding practices in maternity wards and during the first 6 months of life. METHODS: Ninety percent of nursing auxiliaries and midwives were trained at two institutions (A and B) in Palmares, Pernambuco state. Three hundred and thirty-four mothers were interviewed within the first 48 hours and 10 days after childbirth to evaluate breastfeeding practices at the maternities and fulfillment of steps 4 through 10 of the Baby Friendly Hospital Initiative. A subset of 166 mothers received seven home visits to evaluate breastfeeding practices throughout the first 6 months of life and to compare results with those of a cohort study conducted in the area in 1998. RESULTS: The performance of maternity B was significantly better than that of maternity A, from steps 4 to 10 and also in terms of exclusive breastfeeding and offering less water or tea to infants (p < 0.001). The comparison with a previous cohort study demonstrated an improvement in breastfeeding practices at the maternity wards and an increase of exclusive breastfeeding prevalence (from 21.2 to 70%), during the first 48 hours after delivery and throughout the first 6 months. CONCLUSIONS: The training promoted partial change to some practices related to breastfeeding, having a positive effect on total and exclusive breastfeeding at the maternity wards. However, there was no significant change to these practices over the first 6 months of life, suggesting the need for effective interventions to support exclusive breastfeeding in the health sector and in the community.

OBJETIVOS: apresentar as características socioeconômicas e demográficas, o perfil nutricional de crianças ao nascer e aos 12 meses de vida, além dos dados longitudinais sobre aleitamento, diarréia e situação vacinal durante o primeiro ano de vida. MÉTODOS: uma amostra de 652 recém-nascidos foi recrutada de setembro de 1997 a agosto de 1998 e acompanhada durante os primeiros 18 meses de vida. Essas crianças residiam nas áreas urbanas de quatro municípios da zona da mata meridional de Pernambuco. A coleta de dados foi realizada através de visitas domiciliares. RESULTADOS: cerca de 60% das famílias tinham uma renda per capita £ ½ salário mínimo e 41% das mães referiam menos de quatro anos de escolaridade. A mediana do aleitamento materno exclusivo e total foi de 0 dias e 94 dias, respectivamente. A incidência da diarréia foi de dois episódios/criança/ano nos primeiros 12 meses de vida e a prevalência de déficit peso/idade e comprimento/idade (<-2 escores z) aos 12 meses foram de 6,8% e 11%, respectivamente. Apenas 66% das crianças aos 12 meses tinham completado o esquema vacinal. CONCLUSÕES: o desenvolvimento desta pesquisa prospectiva contribuirá para uma maior compreensão dos problemas de saúde e nutrição da população infantil e para o adequado planejamento de intervenções na área.

OBJECTIVES: to demonstrate social, economic features and demographics of the nutritional profile of children at birth and at 12 months old, in addition to comprehensive data on breast-feeding, diarrhea and vaccination status in the first year of life. METHODS: a sample of 652 newborns were selected from September 1997 to August 1998 and followed-up during the first 18 months of life. These children lived in the urban areas of four municipalities South of Pernambuco. Data collection was performed through house visits. RESULTS: approximately 60% of the families had a per capita income £ ½ of the minimum wage and 41% of the mothers had less than four years of schooling. The median of exclusive and total breast-feeding was of 0 and 94 days respectively. Diarrhea incidence was of two episodes/per child/per age (< -2 scores z) and at 12 months was of 6,8% and 11% respectively. Only 66% of the children had their vaccination schedule completed at 12 months old. CONCLUSIONS: the development of this prospective research will contribute to a more in-depth understanding of the health and nutrition problems of children and to adequate intervention planning in that area.

Objective. To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there. Methods. In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomly selected to represent the state and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census lists, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were selected. Blood was collected by venipuncture, and hemoglobin was measured with a portable hemoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution. Results. The prevalence of anemia among children 6-59 months old was 40.9% for the state as a whole. Prevalence in the metropolitan region of Recife was 39.6%, and it was 35.9% in the urban interior. The rural interior had the highest prevalence, 51.4%. Prevalence was twice as high in children aged 6-23 months as among those 24-59 months old, 61.8% vs. 31.0% (chi² = 77.9, P < 0.001). The mean hemoglobin concentrations in the younger and older age groups were 10.4 g/dL (standard deviation (SD) = 1.5) and 11.4 g/dL (SD = 1.4), respectively. There was no statistically significant difference between the sexes in terms of prevalence. Conclusions. 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.

Objetivos. Determinar la prevalencia de la anemia en niños de 6 a 59 meses en Pernambuco, un estado del nordeste de Brasil, con el fin de ayudar a establecer las políticas de salud y nutrición. Métodos. En 1997 se determinaron las concentraciones de hemoglobina en una muestra representativa de 777 niños. El proceso de muestreo se realizó en tres fases. Primero se seleccionaron aleatoriamente 18 municipios representativos del estado y de sus tres zonas geográficas (la región metropolitana de Recife, el interior urbano y el interior rural). A continuación, utilizando las listas del censo, se seleccionaron aleatoriamente 45 sectores censales. Finalmente, se seleccionaron 777 niños de 6 a 59 meses de edad. La sangre se recogió por punción venosa y la hemoglobina se midió con un hemoglobinómetro portátil. En el análisis, la prevalencia fue ponderada en función de la distribución de edad del censo. Resultados. La prevalencia de la anemia entre los niños de 6 a 59 meses fue del 40,9% en todo el estado, del 39,6% en el área metropolitana de Recife, del 35,9% en el interior urbano y del 51,4% en el interior rural. La prevalencia fue dos veces mayor en los niños de 6 a 23 meses que en los de 24 a 59 meses: 61,8% frente a 31,0% (ji² = 77,9, P < 0,001). Las concentraciones medias (± una desviación estándar) de hemoglobina en estos dos grupos fueron de 10,4 ± 1,5 y 11,4 ± 1,4 g/dL, respectivamente. La prevalencia no mostró diferencias estadísticamente significativas entre los dos sexos. Conclusiones. Este ha sido el primer estudio de ámbito estatal realizado en Brasil sobre la prevalencia de la anemia en niños pequeños. La muy alta prevalencia de la anemia en los niños estudiados en Pernambuco, especialmente en los del grupo de 6 a 23 meses, requiere intervenciones de salud pública.

Childhood malnutrition has been a major, long-standing health concern in northeastern Brazil. In response, during 1992_1994, the state government of Ceará, with financial support from the World Bank, established 34 new nutrition centers. During 1996 an evaluation of the centers was conducted to determine their effectiveness in treating children with malnutrition and to identify weaknesses in the system and possible solutions. Also evaluated were the adequacy of resources, admission and discharge criteria, staff training, and community satisfaction. Effectiveness was found to be low. Treatment procedures did not conform with World Health Organization recommendations. Rates of weight gain were inadequate, and the mean duration of rehabilitation-8.7 months-was too long. Case fatality in two centers was unacceptably high, 40% and more. Entry and exit criteria for rehabilitation were ill defined, resulting in some nonmalnourished children being enrolled. Few staff were adequately trained; knowledge was weak, especially about case management; and mothers were not effectively instructed. Recommendations include setting objectives for the centers, improving referral systems, standardizing entry criteria, improving case management, and establishing performance indicators.

La malnutrición ha sido por largo tiempo un preocupante problema de salud en la región nordeste del Brasil. Para responder a esta situación, en el período de 1992 a 1994 el gobierno estatal de Ceará recibió apoyo del Banco Mundial para establecer 34 centros de nutrición. En 1996 se llevó a cabo una evaluación de los centros para precisar su efectividad en el tratamiento de niños malnutridos, los puntos débiles del sistema y posibles soluciones. También se evaluaron la suficiencia de los recursos, los criterios de admisión y alta, la capacitación de los empleados y la satisfacción de la comunidad. La efectividad resultó ser baja. Los procedimientos de tratamiento no correspondían a las recomendaciones de la Organización Mundial de la Salud. Las tasas de aumento de peso eran inadecuadas y la duración media del período de rehabilitación -8,7 meses- demasiado larga. La tasa de letalidad en dos centros era inadmisiblemente alta: 40% y más. Los criterios de admisión y alta estaban mal definidos, por lo que había niños no malnutridos bajo tratamiento. La mayor parte del personal carecía de capacitación adecuada y contaba con pocos conocimientos, especialmente sobre el manejo de casos; además, las madres no estaban recibiendo instrucción apropiada. En consecuencia, se recomendó fijar objetivos para los centros, estandarizar los criterios de admisión, mejorar el manejo de casos y establecer indicadores de resultados.