Abstract The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil. health MINABrazil MINA Brazil Sul Acre chisquare chi square women factors 262 26 2 26.2 95%CI 95CI CI 95 (95%CI 24.028.4 240284 24.0 28.4 24 0 28 4 24.0-28.4 adolescents included adjPR1.36 adjPR136 adjPR 1.36 1 36 (adjPR:1.36 1.141.61, 114161 1.14 1.61 , 14 61 1.14-1.61) 1st st quartile adjPR1.40 adjPR140 1.40 40 adjPR:1.40 1.081.80 108180 1.08 1.80 08 80 1.08-1.80 2nd nd adjPR1.37 adjPR137 1.37 37 adjPR:1.37 1.081.74, 108174 1.74 74 1.08-1.74) adjPR3.69 adjPR369 3.69 3 69 (adjPR:3.69 2.984.57, 298457 2.98 4.57 98 57 2.98-4.57) prepregnancy pre adjPR1.28 adjPR128 1.28 (adjPR:1.28 CI95% CI95 1.041.57, 104157 1.04 1.57 04 1.04-1.57) adjPR1.25 adjPR125 1.25 25 (adjPR:1.25 1.071.46 107146 1.07 1.46 07 46 1.07-1.46 adjPR1.42 adjPR142 1.42 42 (adjPR:1.42 1.211.66. 121166 1.21 1.66 . 21 66 1.21-1.66) Poverty 26. 9 028 24.028. 24028 240 24. 284 28. 24.0-28. adjPR1 adjPR1.3 adjPR13 136 1.3 (adjPR:1.3 141 1.141.61 11416 114 1.1 161 1.6 6 1.14-1.61 adjPR1.4 adjPR14 140 1.4 adjPR:1.4 081 1.081.8 10818 108 1.0 180 1.8 8 1.08-1.8 137 adjPR:1.3 1.081.74 10817 174 1.7 7 1.08-1.74 adjPR3 adjPR3.6 adjPR36 369 3.6 (adjPR:3.6 984 2.984.57 29845 298 2.9 457 4.5 5 2.98-4.57 adjPR1.2 adjPR12 128 1.2 (adjPR:1.2 CI9 041 1.041.57 10415 104 157 1.5 1.04-1.57 125 071 1.071.4 10714 107 146 1.07-1.4 142 (adjPR:1.4 211 1.211.66 12116 121 166 1.21-1.66 02 24.028 2402 24.0-28 adjPR1. 13 1. (adjPR:1. 1.141.6 1141 11 16 1.14-1.6 adjPR:1. 1.081. 1081 10 18 1.08-1. 1.081.7 17 1.08-1.7 adjPR3. 3. (adjPR:3. 2.984.5 2984 29 2. 45 4. 2.98-4.5 12 1.041.5 1041 15 1.04-1.5 1.071. 1071 1.07-1. 1.211.6 1211 1.21-1.6 24.02 24.0-2 (adjPR:1 1.141. 1.14-1. adjPR:1 1.081 1.08-1 (adjPR:3 2.984. 2.98-4. 1.041. 1.04-1. 1.071 1.07-1 1.211. 1.21-1. 24.0- (adjPR: 1.141 1.14-1 adjPR: 1.08- 2.984 2.98-4 1.041 1.04-1 1.07- 1.211 1.21-1 (adjPR 1.14- 2.98- 1.04- 1.21-

Resumo O objetivo do estudo foi investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal. Trata-se de uma análise de dados da linha de base da coorte de nascimentos MINA-Brasil conduzida no município de Cruzeiro do Sul, estado do Acre. Utilizou-se teste qui-quadrado para comparar características das puérperas adolescentes com as adultas e modelos múltiplos de regressão de Poisson com variância robusta para avaliar fatores associados. Entre as puérperas estudadas, 26,2% (IC95%: 24,0-28,4) eram adolescentes. Os fatores associados ao parto na adolescência foram ter nove anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de seis consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Pobreza, baixa escolaridade, primigestação, baixo IMC pré-gestacional, infecção urinária na gestação e menor número de consultas de pré-natal foram associados ao parto na adolescência em município da região Norte do Brasil. neonatal Tratase Trata se MINABrasil MINA Brasil Sul Acre Utilizouse Utilizou quiquadrado qui quadrado estudadas 262 26 2 26,2 IC95% IC95 IC (IC95% 24,028,4 240284 24,0 28,4 24 0 28 4 24,0-28,4 RPaj1,36 RPaj136 RPaj 1,36 1 36 (RPaj:1,36 1,141,61, 114161 1,14 1,61 , 14 61 1,14-1,61) 1° (1 quartil RPaj1,40 RPaj140 1,40 40 RPaj:1,40 1,081,80 108180 1,08 1,80 08 80 1,08-1,80 2° (2 RPaj1,37 RPaj137 1,37 37 RPaj:1,37 1,081,74, 108174 1,74 74 1,08-1,74) RPaj3,69 RPaj369 3,69 3 69 (RPaj:3,69 2,984,57, 298457 2,98 4,57 98 57 2,98-4,57) prégestacional pré gestacional RPaj1,28 RPaj128 1,28 (RPaj:1,28 1,041,57, 104157 1,04 1,57 04 1,04-1,57) RPaj1,25 RPaj125 1,25 25 (RPaj:1,25 1,071,46 107146 1,07 1,46 07 46 1,07-1,46 prénatal natal RPaj1,42 RPaj142 1,42 42 (RPaj:1,42 1,211,66. 121166 1,21 1,66 . 21 66 1,21-1,66) Pobreza escolaridade primigestação prégestacional, gestacional, 26, IC9 (IC95 028 24,028, 24028 240 24, 284 28, 24,0-28, RPaj1 RPaj1,3 RPaj13 136 1,3 (RPaj:1,3 141 1,141,61 11416 114 1,1 161 1,6 6 1,14-1,61 ( RPaj1,4 RPaj14 140 1,4 RPaj:1,4 081 1,081,8 10818 108 1,0 180 1,8 8 1,08-1,8 137 RPaj:1,3 1,081,74 10817 174 1,7 7 1,08-1,74 RPaj3 RPaj3,6 RPaj36 369 3,6 (RPaj:3,6 984 2,984,57 29845 298 2,9 457 4,5 9 5 2,98-4,57 RPaj1,2 RPaj12 128 1,2 (RPaj:1,2 041 1,041,57 10415 104 157 1,5 1,04-1,57 125 071 1,071,4 10714 107 146 1,07-1,4 142 (RPaj:1,4 211 1,211,66 12116 121 166 1,21-1,66 (IC9 02 24,028 2402 24,0-28 RPaj1, 13 1, (RPaj:1, 1,141,6 1141 11 16 1,14-1,6 RPaj:1, 1,081, 1081 10 18 1,08-1, 1,081,7 17 1,08-1,7 RPaj3, 3, (RPaj:3, 2,984,5 2984 29 2, 45 4, 2,98-4,5 12 1,041,5 1041 15 1,04-1,5 1,071, 1071 1,07-1, 1,211,6 1211 1,21-1,6 (IC 24,02 24,0-2 (RPaj:1 1,141, 1,14-1, RPaj:1 1,081 1,08-1 (RPaj:3 2,984, 2,98-4, 1,041, 1,04-1, 1,071 1,07-1 1,211, 1,21-1, 24,0- (RPaj: 1,141 1,14-1 RPaj: 1,08- 2,984 2,98-4 1,041 1,04-1 1,07- 1,211 1,21-1 (RPaj 1,14- 2,98- 1,04- 1,21-

Abstract The present study aimed to investigate the socioeconomic and obstetric characteristics of adolescent mothers and the complications they cause to maternal and neonatal health. This baseline data analysis of the MINA-Brazil birth cohort was conducted in the municipality of Cruzeiro do Sul, state of Acre, Brazil. The chi-square test was used to compare characteristics of adolescent and adult postpartum women, and multiple Poisson regression models with robust variance were used to assess associated factors. Among the postpartum women, 26.2% (95%CI: 24.0-28.4) were adolescents. Factors associated with childbirth in adolescence included: nine years or less of schooling (adjPR:1.36; 95%CI: 1.14-1.61), belongs to the lowest quartiles of the wealth index (1st quartile: adjPR:1.40; 95%CI: 1.08-1.80) (2nd quartile: adjPR:1.37; 95%CI: 1.08-1.74), primigravidae (adjPR:3.69; 95%CI: 2.98-4.57), low pre-pregnancy BMI (adjPR:1.28; CI95%: 1.04-1.57), urinary tract infection during pregnancy (adjPR:1.25; CI95%: 1.07-1.46) and less than six prenatal consultations (adjPR:1.42; 95%CI: 1.21-1.66). Poverty, little schooling, primigravidae, low pre-pregnancy BMI, urinary tract infection during pregnancy and few prenatal consultations were associated with childbirth during adolescence in a municipality in the Northern region of Brazil.

Resumo O objetivo do estudo foi investigar as características socioeconômicas e obstétricas de parturientes adolescentes e suas complicações sobre a saúde materna e neonatal. Trata-se de uma análise de dados da linha de base da coorte de nascimentos MINA-Brasil conduzida no município de Cruzeiro do Sul, estado do Acre. Utilizou-se teste qui-quadrado para comparar características das puérperas adolescentes com as adultas e modelos múltiplos de regressão de Poisson com variância robusta para avaliar fatores associados. Entre as puérperas estudadas, 26,2% (IC95%: 24,0-28,4) eram adolescentes. Os fatores associados ao parto na adolescência foram ter nove anos ou menos de estudo (RPaj:1,36; IC95%: 1,14-1,61), pertencer aos menores quartis do índice de riqueza (1° quartil: RPaj:1,40; IC95%: 1,08-1,80) (2° quartil: RPaj:1,37; IC95%: 1,08-1,74), ser primigesta (RPaj:3,69; IC95%: 2,98-4,57), baixo IMC pré-gestacional (RPaj:1,28; IC95%: 1,04-1,57), infecção urinária na gravidez (RPaj:1,25; IC95%: 1,07-1,46) e menos de seis consultas de pré-natal (RPaj:1,42; IC95%: 1,21-1,66). Pobreza, baixa escolaridade, primigestação, baixo IMC pré-gestacional, infecção urinária na gestação e menor número de consultas de pré-natal foram associados ao parto na adolescência em município da região Norte do Brasil.

ABSTRACT Objectives To describe the perception of mothers on the use and acceptability of sachets with multiple micronutrients in powder form (MNP) on complementary feeding to prevent childhood anemia. Method Qualitative study with thirteen focus groups conducted with 79 mothers of children 9-12 months of age attending at primary health care in four Brazilian cities. The focus groups were conducted three months after the beginning of the use of sachets. Results The prior guidance by health professionals facilitated the mothers' understanding of the importance of using micronutrients in powder and provided clarification. Many mothers compared the use of MNP with ferrous sulfate syrup, which some mothers identified as responsible for side effects in their children (diarrhea, vomiting, grayish teeth), and had low acceptance by children. The main difficulties reported by some mothers were related to hardening of the stool and changes in taste noted in their children using the sachet in liquid food inappropriate for fortification with MNP. Conclusions We conclude that most mothers perceived good acceptance of the sachet of micronutrients by children.

RESUMEN Objetivo Verificar la percepción de las madres sobre el uso y la aceptabilidad de los sobres con polvos de micronutrientes múltiples (MNP) en la alimentación complementaria para prevenir la anemia en la infancia. Método Estudio cualitativo con trece grupos focales realizado con 79 madres de niños de 9 a 12 meses atendidos en la atención primaria de salud en cuatro ciudades brasileñas. Los grupos focales se realizaron tres meses después de comenzar a usar los sobres. Resultados Orientaciones previas de profesionales de la salud facilitaron la comprensión de las madres sobre la importancia del uso de micronutrientes en polvo y aclararon dudas. Muchas madres compararon el uso de MNP con sulfato ferroso en jarabe identificado por las madres como responsable de efectos secundarios en los niños (diarrea, vómitos, tinción de dientes) y baja aceptación por parte de los niños. Las principales dificultades relatadas por algunas madres estaban relacionadas con el endurecimiento de las heces y el sabor alterado de los alimentos percibido por algunos niños después de usar el sobre en alimentos líquidos no aptos para la fortificación con MNP. Conclusiones La mayoría de las madres percibieron una buena aceptación del sobre de micronutrientes por parte de los niños.

RESUMO Objetivo Verificar a percepção de mães sobre o uso e aceitabilidade de sachês com múltiplos micronutrientes em pó (MNP) na alimentação complementar para prevenção de anemia na infância. Método Estudo qualitativo com treze grupos focais conduzidos com 79 mães de crianças de 9 a 12 meses de idade atendidas na atenção básica à saúde em quatro cidades brasileiras. Os grupos focais foram realizados três meses após o início do uso dos sachês. Resultados Orientação prévia por parte dos profissionais de saúde facilitou a compreensão das mães sobre a importância do uso dos micronutrientes em pó e o esclarecimento de dúvidas. Muitas mães compararam o uso de MNP ao sulfato ferroso em xarope identificado pelas mães como responsável por efeitos colaterais às crianças (diarreia, vômitos, coloração nos dentes) e baixa aceitação por parte das crianças. As principais dificuldades relatadas por algumas mães foram relacionadas ao endurecimento das fezes e ao sabor alterado da comida percebido por algumas crianças após o uso do sachê em alimentos líquidos inadequados à fortificação com MNP. Conclusões A maioria das mães percebeu boa aceitação do sachê de micronutrientes pelas crianças.

ABSTRACT OBJECTIVE To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required. (BF (HC old sciences PubMed Lilacs, Lilacs , (Lilacs) Scopus 01 201 19 2021 evaluators 4229 4 229 4,22 identified crosssectional, crosssectional cross sectional, sectional cross-sectional casecontrol. casecontrol case control. control case-control frequency duration method differences zscore z score SD (WHO 2007, 2007 2007) parameters life However (2007 required (Lilacs 0 20 202 422 22 4,2 200 (200 42 4, (20 (2 (

ABSTRACT Vaccination coverage has been dropping in Brazil and other countries. In addition, immune responses after vaccination may not be homogeneous, varying according to sociodemographic and clinical factors. Understanding the determinants of incomplete vaccination and negative antibody test results may contribute to the development of strategies to improve vaccination effectiveness. In this study, we aimed to investigate the frequency of vaccine adherence, factors associated with incomplete vaccination for measles, mumps, rubella (MMR) and hepatitis A, and factors associated with the seronegative test results for measles, mumps and hepatitis A at 2 years of age. This was a population-based cohort that addressed health conditions and mother/infant nutrition in Cruzeiro do Sul city, Brazil. Vaccination data were obtained from official certificates of immunization. The children underwent blood collection at the two-year-old follow-up visit; the samples were analyzed using commercially available kits to measure seropositivity for measles, mumps, and hepatitis A. We used modified Poisson regression models adjusted for covariates to identify factors associated with incomplete vaccination and negative serology after vaccination. Out of the 825 children included in the study, adherence to the vaccine was 90.6% for MMR, 76.7% for the MMRV (MMR + varicella), and 74.9% for the hepatitis A vaccine. For MMR, after the adjustment for covariates, factors associated with incomplete vaccination included: white-skinned mother; paid maternity leave; raising more than one child; lower number of antenatal consultations; and attending childcare. For hepatitis A, the factors included: white-skinned mother and not having a cohabiting partner. The factors with statistically significant association with a negative antibody test result included: receiving Bolsa Familia allowance for measles and mumps; incomplete vaccination for measles; and vitamin A deficiency for mumps. Strategies to improve the efficiency of vaccine programs are urgently needed. These include improvements in communication about vaccine safety and efficacy, and amplification of access to primary care facilities, prioritizing children exposed to the sociodemographic factors identified in this study. Additionally, sociodemographic factors and vitamin A deficiency may impact the immune responses to vaccines, leading to an increased risk of potentially severe and preventable diseases. countries addition homogeneous effectiveness study MMR age populationbased population based motherinfant infant city immunization twoyearold two year old followup follow up visit 82 906 90 6 90.6 767 76 7 76.7 varicella, varicella , varicella) 749 74 9 74.9 whiteskinned white skinned leave child consultations childcare partner needed efficacy facilities Additionally vaccines diseases 8 90. 76. 74.

ABSTRACT OBJECTIVE: This study aimed to describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study. METHODS: Prevalence of maternal anemia was estimated at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children, examined at ages one, two (Hb < 110 g/L), and five (Hb < 115 g/L). Moreover, ferritin, soluble transferrin receptor, and C-reactive protein concentrations were measured in mothers at delivery and in their 1- and 2-year-old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]). RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At one year of age (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. At two years of age (n = 761), these values decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively; at five years of age (n = 655), 5.2% (3.6–7.2%) were anemic. Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultra-processed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for children's age and household wealth index. CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria to prevent and treat anemia in Amazonian children. OBJECTIVE populationbased population based METHODS hemoglobin Hb [Hb 11 g/L gL g L MINABrazil MINA Brazil g/L, , g/L. . Moreover ferritin receptor Creactive C reactive 2yearold yearold old adjusted RRa. RRa [RRa]) RESULTS 95 CI (CI irondeficiency 173 17 3 17.3 14.0–21.0%, 140210 14.0–21.0% 14 0 21 (14.0–21.0%) 426 42 6 42.6 38.0–47.2%, 380472 38.0–47.2% 38 47 (38.0–47.2%) 87 8 7 8.7 6.3–11.6%, 63116 6.3–11.6 %, (6.3–11.6)% n 462. 462 462) 646, 646 646) 422 42.2 38.7–45.8% 387458 45 (38.7–45.8% anemic 384 4 38.4 34.6–42.3% 346423 34 (34.6–42.3% irondeficient, irondeficient deficient, deficient iron-deficient 263 26 26. 23.0–29.9 230299 23 29 9 (23.0–29.9 761, 761 761) 128 12 12.8 10.6–15.2%, 106152 10.6–15.2% 10 15 (10.6–15.2%) 181 18 18.1 15.5–21.1%, 155211 15.5–21.1% 5 (15.5–21.1%) 41 4.1 2.8–5.7%, 2857 2.8–5.7% (2.8–5.7%) 655, 655 655) 52 5.2 3.6–7.2% 3672 (3.6–7.2% 2.19 219 19 95%CI 95CI 1.84–2.60 184260 84 60 ultraprocessed ultra processed (UPF 1.56 156 56 1.14–2.13 114213 13 schooling 1.67 167 67 1.17–2.39, 117239 1.17–2.39 39 1.17–2.39) 2.25 225 25 (2.25 1.30–3.87, 130387 1.30–3.87 30 1.30–3.87) 2.15 215 (2.15 1.47–3.15, 147315 1.47–3.15 1.47–3.15) childrens s index CONCLUSIONS Amazon intake [RRa] 17. 14021 14.0–21.0 (14.0–21.0% 42. 38047 38.0–47.2 (38.0–47.2% 8. 6.3–11.6% 6311 6.3–11. % (6.3–11.6) 46 64 38.7–45.8 38745 (38.7–45.8 38. 34.6–42.3 34642 (34.6–42.3 23.0–29. 23029 (23.0–29. 76 12. 10615 10.6–15.2 (10.6–15.2% 18. 15521 15.5–21.1 (15.5–21.1% 4. 285 2.8–5.7 (2.8–5.7% 65 5. 3.6–7.2 367 (3.6–7.2 2.1 1.84–2.6 18426 1.5 1.14–2.1 11421 1.6 16 11723 1.17–2.3 2.2 22 (2.2 13038 1.30–3.8 (2.1 14731 1.47–3.1 [RRa 1402 14.0–21. (14.0–21.0 3804 38.0–47. (38.0–47.2 631 6.3–11 (6.3–11.6 38.7–45. 3874 (38.7–45. 34.6–42. 3464 (34.6–42. 23.0–29 2302 (23.0–29 1061 10.6–15. (10.6–15.2 1552 15.5–21. (15.5–21.1 28 2.8–5. (2.8–5.7 3.6–7. 36 (3.6–7. 2. 1.84–2. 1842 1. 1.14–2. 1142 1172 1.17–2. (2. 1303 1.30–3. 1473 1.47–3. 140 14.0–21 (14.0–21. 380 38.0–47 (38.0–47. 63 6.3–1 (6.3–11. 38.7–45 387 (38.7–45 34.6–42 346 (34.6–42 23.0–2 230 (23.0–2 106 10.6–15 (10.6–15. 155 15.5–21 (15.5–21. 2.8–5 (2.8–5. 3.6–7 (3.6–7 1.84–2 184 1.14–2 114 117 1.17–2 (2 130 1.30–3 147 1.47–3 14.0–2 (14.0–21 38.0–4 (38.0–47 6.3– (6.3–11 38.7–4 (38.7–4 34.6–4 (34.6–4 23.0– (23.0– 10.6–1 (10.6–15 15.5–2 (15.5–21 2.8– (2.8–5 3.6– (3.6– 1.84– 1.14– 1.17– ( 1.30– 1.47– 14.0– (14.0–2 38.0– (38.0–4 6.3 (6.3–1 38.7– (38.7– 34.6– (34.6– 23.0 (23.0 10.6– (10.6–1 15.5– (15.5–2 2.8 (2.8– 3.6 (3.6 1.84 1.14 1.17 1.30 1.47 14.0 (14.0– 38.0 (38.0– 6. (6.3– 38.7 (38.7 34.6 (34.6 23. (23. 10.6 (10.6– 15.5 (15.5– (2.8 3. (3. 1.8 1.1 1.3 1.4 14. (14.0 (38.0 (6.3 (38. 34. (34. (23 10. (10.6 15. (15.5 (3 (14. (6. (38 (34 (10. (15. (14 (6 (10 (15 (1

RESUMO OBJETIVO: O objetivo deste estudo foi descrever a prevalência e os preditores de anemia na infância em um estudo de coorte de nascimentos de base populacional amazônica. MÉTODOS: Estimou-se a prevalência de anemia materna no parto (concentração de hemoglobina [Hb] < 110 g/L) em mulheres participantes do estudo de coorte de nascimentos MINA-Brasil e em seus filhos, examinados nas idades um, dois (Hb < 110 g/L) e cinco anos (Hb < 115 g/L). Além disso, as concentrações de ferritina, receptor solúvel de transferrina e proteína C reativa foram medidas em mães no parto e em seus filhos de 1 e 2 anos de idade para estimar a prevalência de deficiência de ferro e sua contribuição para anemia, ajustando para potenciais fatores de confusão por análise de regressão múltipla de Poisson (risco relativo ajustado [RRa]). RESULTADOS: As prevalências com intervalo de confiança (IC) de 95% de anemia materna, deficiência de ferro e anemia ferropriva no parto foram de 17,3% (14,0–21,0%), 42,6% (38,0–47,2%) e 8,7% (6,3–11,6%), respectivamente (n = 462). No primeiro ano de idade (n = 646), 42,2% (38,7–45,8%) das crianças estudadas eram anêmicas, 38,4% (34,6–42,3%) eram deficientes em ferro e 26,3 (23,0–29,9%) tinham anemia ferropriva. Aos dois anos de idade (n = 761), esses valores diminuíram para 12,8% (10,6–15,2%), 18,1% (15,5–21,1%) e 4,1% (2,8–5,7%), respectivamente; aos cinco anos de idade (n = 655), 5,2% (3,6–7,2%) eram anêmicos. A deficiência de ferro (RRa = 2,19, IC95%: 1,84–2,60) e consumo de alimentos ultraprocessados (AUP) (RRa = 1,56, IC95%: 1,14–2,13) foram contribuintes significantes para anemia no 1° ano de idade, após ajuste para escolaridade materna. Aos 2 anos, a anemia associou-se significativamente à anemia materna no parto (RRa = 1,67; IC95%: 1,17–2,39), malária desde o nascimento (2,25; 1,30–3,87) e deficiência de ferro (2,15; 1,47–3,15), após ajuste para idade das crianças e índice de riqueza familiar. CONCLUSÕES: A anemia continua sendo altamente prevalente durante a gravidez e a primeira infância na Amazônia. Políticas públicas de saúde devem abordar a deficiência de ferro, o consumo de AUP, a anemia materna e a malária para prevenir e tratar a anemia em crianças amazônicas. OBJETIVO amazônica MÉTODOS Estimouse Estimou se concentração Hb [Hb 11 g/L gL g L MINABrasil MINA Brasil g/L. . disso ferritina risco RRa. RRa [RRa]) RESULTADOS IC (IC 95 173 17 3 17,3 14,0–21,0%, 140210 14,0–21,0% , 14 0 21 (14,0–21,0%) 426 42 6 42,6 38,0–47,2% 380472 38 47 (38,0–47,2% 87 8 7 8,7 6,3–11,6%, 63116 6,3–11,6% (6,3–11,6%) n 462. 462 462) 646, 646 646) 422 42,2 38,7–45,8% 387458 45 (38,7–45,8% anêmicas 384 4 38,4 34,6–42,3% 346423 34 (34,6–42,3% 263 26 26, 23,0–29,9% 230299 23 29 9 (23,0–29,9% 761, 761 761) 128 12 12,8 10,6–15,2%, 106152 10,6–15,2% 10 15 (10,6–15,2%) 181 18 18,1 15,5–21,1% 155211 5 (15,5–21,1% 41 4,1 2,8–5,7%, 2857 2,8–5,7% (2,8–5,7%) 655, 655 655) 52 5,2 3,6–7,2% 3672 (3,6–7,2% anêmicos 219 19 2,19 IC95% IC95 1,84–2,60 184260 84 60 AUP (AUP 156 56 1,56 1,14–2,13 114213 13 associouse associou 1,67 167 67 1,17–2,39, 117239 1,17–2,39 39 1,17–2,39) 2,25 225 25 (2,25 1,30–3,87 130387 30 2,15 215 (2,15 1,47–3,15, 147315 1,47–3,15 1,47–3,15) familiar CONCLUSÕES Amazônia amazônicas [RRa] 17, 14021 14,0–21,0 (14,0–21,0% 42, 38,0–47,2 38047 (38,0–47,2 8, 6311 6,3–11,6 (6,3–11,6% 46 64 38,7–45,8 38745 (38,7–45,8 38, 34,6–42,3 34642 (34,6–42,3 23,0–29,9 23029 (23,0–29,9 76 12, 10615 10,6–15,2 (10,6–15,2% 18, 15,5–21,1 15521 (15,5–21,1 4, 285 2,8–5,7 (2,8–5,7% 65 5, 3,6–7,2 367 (3,6–7,2 2,1 IC9 1,84–2,6 18426 1,5 1,14–2,1 11421 1,6 16 11723 1,17–2,3 2,2 22 (2,2 1,30–3,8 13038 (2,1 14731 1,47–3,1 [RRa 1402 14,0–21, (14,0–21,0 38,0–47, 3804 (38,0–47, 631 6,3–11, (6,3–11,6 38,7–45, 3874 (38,7–45, 34,6–42, 3464 (34,6–42, 23,0–29, 2302 (23,0–29, 1061 10,6–15, (10,6–15,2 15,5–21, 1552 (15,5–21, 28 2,8–5, (2,8–5,7 3,6–7, 36 (3,6–7, 2, 1,84–2, 1842 1, 1,14–2, 1142 1172 1,17–2, (2, 1,30–3, 1303 1473 1,47–3, 140 14,0–21 (14,0–21, 38,0–47 380 (38,0–47 63 6,3–11 (6,3–11, 38,7–45 387 (38,7–45 34,6–42 346 (34,6–42 23,0–29 230 (23,0–29 106 10,6–15 (10,6–15, 15,5–21 155 (15,5–21 2,8–5 (2,8–5, 3,6–7 (3,6–7 1,84–2 184 1,14–2 114 117 1,17–2 (2 1,30–3 130 147 1,47–3 14,0–2 (14,0–21 38,0–4 (38,0–4 6,3–1 (6,3–11 38,7–4 (38,7–4 34,6–4 (34,6–4 23,0–2 (23,0–2 10,6–1 (10,6–15 15,5–2 (15,5–2 2,8– (2,8–5 3,6– (3,6– 1,84– 1,14– 1,17– ( 1,30– 1,47– 14,0– (14,0–2 38,0– (38,0– 6,3– (6,3–1 38,7– (38,7– 34,6– (34,6– 23,0– (23,0– 10,6– (10,6–1 15,5– (15,5– 2,8 (2,8– 3,6 (3,6 1,84 1,14 1,17 1,30 1,47 14,0 (14,0– 38,0 (38,0 6,3 (6,3– 38,7 (38,7 34,6 (34,6 23,0 (23,0 10,6 (10,6– 15,5 (15,5 (2,8 3, (3, 1,8 1,1 1,3 1,4 14, (14,0 (38, 6, (6,3 34, (34, 23, (23, 10, (10,6 15, (15, (3 (14, (38 (6, (34 (23 (10, (15 (14 (6 (10 (1

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices. OBJECTIVE (EBF (BF METHODS 1143 143 1,14 motherchild child MINABrazil MINA Brazil (MINA-Brazil used July 2015June June 2015 2016 followup follow up postpartum analysis KaplanMeier Kaplan Meier models RESULTS 95% 95 (95 95%CI 95CI CI [95%CI] 33 (95%CI 30.2–36.0 302360 30 36 0 108 10 8 10.8 8.9–12.9, 89129 8.9–12.9 , 9 12 8.9–12.9) respectively firsttime time 147 47 1.4 1.19–1.80, 119180 1.19–1.80 19 80 1.19–1.80) 170 70 1.7 1.23–2.36, 123236 1.23–2.36 23 1.23–2.36) 179 79 1.44–2.23 144223 44 1.15–2.52. 115252 1.15–2.52 . 15 52 1.15–2.52) 679 67 67.9 64.9–70.8, 649708 64.9–70.8 64 64.9–70.8) 293 29 29.3 26.4–32.4, 264324 26.4–32.4 26 4 32 26.4–32.4) 17 7 0.9–2.8 0928 123 1.2 1.01–1.49, 101149 1.01–1.49 01 49 1.01–1.49) 466 66 4.6 2.99–7.26, 299726 2.99–7.26 99 2.99–7.26) 276 76 2.7 1.64–4.66. 164466 1.64–4.66 1.64–4.66) CONCLUSIONS Organization 114 14 1,1 201 (9 [95%CI 30.2–36. 30236 10. 8912 8.9–12. 1. 11918 1.19–1.8 12323 1.23–2.3 1.44–2.2 14422 11525 1.15–2.5 67. 64970 64.9–70. 29. 26432 26.4–32. 0.9–2. 092 10114 1.01–1.4 46 4. 29972 2.99–7.2 27 2. 16446 1.64–4.6 11 20 ( 30.2–36 3023 891 8.9–12 1191 1.19–1. 1232 1.23–2. 1.44–2. 1442 1152 1.15–2. 6497 64.9–70 2643 26.4–32 0.9–2 09 1011 1.01–1. 2997 2.99–7. 1644 1.64–4. 30.2–3 302 89 8.9–1 119 1.19–1 1.23–2 1.44–2 144 115 1.15–2 649 64.9–7 264 26.4–3 0.9– 101 1.01–1 299 2.99–7 164 1.64–4 30.2– 8.9– 1.19– 1.23– 1.44– 1.15– 64.9– 26.4– 0.9 1.01– 2.99– 16 1.64– 30.2 8.9 1.19 1.44 1.15 64.9 26.4 0. 1.01 2.99 1.64 30. 8. 1.1 64. 26. 1.0 2.9 1.6

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015–junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2–36,0) e 10,8% (IC95%: 8,9–12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19–1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23–2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44–2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15–2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9–70,8), 29,3% (IC95%: 26,4–32,4) e 1,7% (IC95%: 0,9–2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01–1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99–7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64–4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno. OBJETIVO (AME (AM MÉTODOS 1143 143 1.14 mãefilho mãe filho MaternoInfantil Materno Infantil MINABrasil. MINABrasil MINA Brasil . (MINA-Brasil) julho 2015junho junho 2015 2016 pósparto pós KaplanMeier. KaplanMeier Kaplan Meier. Meier Kaplan-Meier estendidos RESULTADOS intervalo 95 IC95% IC95 IC [IC95%] 33 (IC95% 30,2–36,0 302360 30 36 0 108 10 8 10,8 8,9–12,9, 89129 8,9–12,9 , 9 12 8,9–12,9) respectivamente 147 47 1,4 1,19–1,80, 119180 1,19–1,80 19 80 1,19–1,80) recémnascidos recém nascidos prélácteos pré lácteos 170 70 1,7 1,23–2,36, 123236 1,23–2,36 23 1,23–2,36) 179 79 1,44–2,23 144223 44 1,15–2,52. 115252 1,15–2,52 15 52 1,15–2,52) 679 67 67,9 64,9–70,8, 649708 64,9–70,8 64 64,9–70,8) 293 29 29,3 26,4–32,4 264324 26 4 32 17 7 0,9–2,8 0928 123 1,2 1,01–1,49, 101149 1,01–1,49 01 49 1,01–1,49) 466 66 4,6 2,99–7,26 299726 99 276 76 2,7 1,64–4,66. 164466 1,64–4,66 1,64–4,66) CONCLUSÕES Saúde 114 14 1.1 (MINA-Brasil 201 IC9 [IC95% (IC95 30,2–36, 30236 10, 8912 8,9–12, 11918 1,19–1,8 12323 1,23–2,3 1,44–2,2 14422 11525 1,15–2,5 67, 64970 64,9–70, 29, 26,4–32, 26432 0,9–2, 092 10114 1,01–1,4 46 4, 2,99–7,2 29972 27 2, 16446 1,64–4,6 11 1. 20 [IC95 (IC9 30,2–36 3023 891 8,9–12 1191 1,19–1, 1232 1,23–2, 1,44–2, 1442 1152 1,15–2, 6497 64,9–70 26,4–32 2643 0,9–2 09 1011 1,01–1, 2,99–7, 2997 1644 1,64–4, [IC9 (IC 30,2–3 302 89 8,9–1 119 1,19–1 1,23–2 1,44–2 144 115 1,15–2 649 64,9–7 26,4–3 264 0,9– 101 1,01–1 2,99–7 299 164 1,64–4 [IC 30,2– 8,9– 1,19– 1,23– 1,44– 1,15– 64,9– 26,4– 0,9 1,01– 2,99– 16 1,64– 30,2 8,9 1,19 1,44 1,15 64,9 26,4 0, 1,01 2,99 1,64 30, 8, 1,1 64, 26, 1,0 2,9 1,6

ABSTRACT OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 to 0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 to 0.56), and during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35 to 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 to 0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition. OBJECTIVE birthtochildhood lengthheight length height zscores z scores METHODS 61 MINABrazil MINA Brazil used Zscores Z (HAZ (WAZ standards Birthtochildhood Birth 95 95%CI 95CI CI (95%CI 25th th quantiles analysis RESULTS HAZ, 023 0 23 0.23 011 11 0.1 035 35 031 31 0.31 019 19 0.43. 043 0.43 . 43 0.43) 082 82 0.82 030 30 0.30 013 13 0.56, 056 0.56 , 56 0.56) 059 59 0.59 0.3 0.83 083 83 054 54 0.54 015 15 0.93. 093 0.93 93 0.93) CONCLUSION malnutrition 6 9 02 2 0.2 01 1 0. 03 3 04 0.4 4 08 8 0.8 05 0.5 5 09 0.9

RESUMO OBJETIVO: Investigar a autocorrelação do crescimento linear e ganho de peso do nascimento até a infância considerando a distribuição de escores z de comprimento/estatura e peso por idade e de acordo com a riqueza domiciliar. MÉTODOS: Foram utilizados dados de 614 crianças do Estudo MINA-Brasil com medições antropométricas realizadas do nascimento até os cinco anos de idade. Escores z foram calculados para comprimento/estatura (HAZ) e peso (WAZ) seguindo padrões internacionais. A autocorrelação ou estabilidade da adequação do estado nutricional do nascimento à infância foi estimada por meio de modelos de regressão quantílica para HAZ e WAZ, separadamente, extraindo-se coeficientes e intervalos de confiança de 95% (IC95%) nos quantis 25, 50 e 75. Em uma análise de subgrupo, estimou-se a autocorrelação entre o nascimento até os dois anos de idade, e entre dois e cinco anos de idade. Para investigar disparidades na autocorrelação, termos de interação entre índices de riqueza familiar (ao nascer e aos cinco anos de idade) e escores z de tamanho do recém-nascido foram incluídos nos modelos. RESULTADOS: Os coeficientes de autocorrelação foram significantes e tiveram magnitude semelhante ao longo da distribuição dos índices antropométricos aos cinco anos de idade (HAZ, quantil 50: 0,23, IC95%: 0,11 a 0,35; WAZ, quantil 50: 0,31, IC95%: 0,19 a 0,43). Maior estabilidade do estado nutricional foi observada entre dois e cinco anos, com coeficientes acima de 0,82. Autocorrelação significantemente maior do crescimento linear foi observada entre as crianças de domicílios mais ricos, tanto ao nascer, nos limites inferiores da distribuição HAZ (quantil 25: 0,30, IC95%: 0,13 a 0,56) e durante a infância, em toda a distribuição HAZ aos cinco anos. Para o ganho de peso, observou-se uma autocorrelação mais forte nos limites superiores da distribuição do WAZ aos cinco anos de idade entre as crianças de domicílios mais ricos ao nascer (quantil 75: 0,59, IC95%: 0,35 a 0,83) e durante a infância (quantil 75: 0,54, IC95%: 0,15 a 0,93). CONCLUSÃO: Houve autocorrelação significante de HAZ e WAZ desde o nascimento, com indicação de substancial estabilidade do estado nutricional entre os dois e cinco anos de idade. A autocorrelação diferencial de acordo com a riqueza domiciliar deve ser considerada para o planejamento de intervenções precoces para prevenir a má nutrição. OBJETIVO comprimentoestatura comprimento estatura MÉTODOS 61 MINABrasil MINA Brasil (HAZ (WAZ internacionais separadamente extraindose extraindo se 95 IC95% IC95 IC (IC95% 25 5 75 subgrupo estimouse estimou recémnascido recém nascido RESULTADOS HAZ, 023 0 23 0,23 011 11 0,1 035 35 031 31 0,31 019 19 0,43. 043 0,43 . 43 0,43) 082 82 0,82 030 30 0,30 013 13 0,56 056 56 observouse observou 059 59 0,59 0,3 0,83 083 83 054 54 0,54 015 15 0,93. 093 0,93 93 0,93) CONCLUSÃO nutrição 6 9 IC9 (IC95 2 7 02 0,2 01 1 0, 03 3 04 0,4 4 08 8 0,8 0,5 05 09 0,9 (IC9 (IC

ABSTRACT OBJECTIVE: To identify longitudinal patterns of maternal depression between three months and five years after child's birth, to examine predictor variables for these trajectories, and to evaluate whether distinct depression trajectories predict offspring mental health problems at age 5 years. METHODS: We used data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6–8 months, and 1 and 2 years after delivery. Mental health problems in 5-year-old children were evaluated with the Strengths and Difficulties Questionnaire (SDQ) reported by parents. Trajectories of maternal depression were calculated using a group-based modelling approach. RESULTS: We identified four trajectories of maternal depressive symptoms: "low" (67.1%), "increasing" (11.5%), "decreasing" (17.4%), and "high-chronic" (4.0%). Women in the "high/chronic" trajectory were the poorest, least educated, and oldest compared with women in the other trajectory groups. Also, they were more frequently multiparous and reported smoking and having attended fewer prenatal consultations during pregnancy. In the adjusted analyses, the odds ratio of any SDQ disorder was 3.23 (95%CI: 2.00–5.22) and 2.87 (95%CI: 1.09–7.57) times higher among children of mothers belonging to the "increasing" and "high-chronic" trajectory groups, respectively, compared with those of mothers in the "low" depressive symptoms group. These differences were not explained by maternal and child characteristics included in multivariate analyses. CONCLUSIONS: We identified poorer mental health outcomes for children of mothers assigned to the "chronic/severe" and "increasing" depressive symptoms trajectories. Prevention and treatment initiatives to avoid the adverse short, medium, and long-term effects of maternal depression on offspring development should focus on women belonging to these groups. OBJECTIVE childs s METHODS MINABrazil MINA Brazil (MINA-Brazil study populationbased population based Amazon EPDS (EPDS 68 6 8 6– delivery 5yearold yearold year old (SDQ parents groupbased group approach RESULTS low "low 67.1%, 671 67.1% , 67 (67.1%) increasing "increasing 11.5%, 115 11.5% 11 (11.5%) decreasing "decreasing 17.4%, 174 17.4% 17 4 (17.4%) highchronic high chronic "high-chronic 4.0%. 40 4.0% . 0 (4.0%) high/chronic "high/chronic poorest educated groups Also pregnancy analyses 323 23 3.2 95%CI 95CI CI 95 (95%CI 2.00–5.22 200522 00 22 287 87 2.8 1.09–7.57 109757 09 7 57 respectively CONCLUSIONS chronic/severe chronicsevere severe "chronic/severe short medium longterm long term 67.1 (67.1% 11.5 (11.5% 17.4 (17.4% 4.0 (4.0% 32 3. 9 2.00–5.2 20052 28 2. 1.09–7.5 10975 67. (67.1 11. (11.5 17. (17.4 4. (4.0 2.00–5. 2005 1.09–7. 1097 (67. (11. (17. (4. 2.00–5 200 1.09–7 109 (67 (11 (17 (4 2.00– 20 1.09– 10 (6 (1 ( 2.00 1.09 2.0 1.0 1.

RESUMO OBJETIVO: Identificar padrões longitudinais de depressão materna entre três meses e cinco anos após o nascimento de seus filhos, analisar variáveis preditoras dessas trajetórias e avaliar se trajetórias distintas de depressão predizem problemas de saúde mental infantil aos cinco anos de idade. MÉTODOS: Utilizou-se dados do estudo sobre saúde e nutrição materno infantil no Acre (MINA-Brasil), uma coorte de nascimentos de base populacional na Amazônia ocidental brasileira. Os sintomas depressivos maternos foram avaliados pela Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 3 e 6–8 meses e 1 e 2 anos após o parto. Problemas de saúde mental em crianças com cinco anos de idade foram avaliados pelo Questionário de Capacidades e Dificuldades (SDQ– Strengths and Difficulties Questionnaire), respondido pelos pais. As trajetórias de depressão materna foram calculadas usando uma abordagem de modelagem baseada em grupos. RESULTADOS: Foram identificadas quatro trajetórias de sintomas depressivos maternos: "baixa" (67,1%), "crescente" (11,5%), "decrescente" (17,4%) e "alta-crônica" (4,0%). As mulheres na trajetória "alta/crônica" eram mais pobres, menos escolarizadas, mais velhas e multíparas e relataram tabagismo com maior frequência e menor número de consultas de pré-natal durante a gestação do que as demais. Nas análises ajustadas, a razão de chances de qualquer transtorno do SDQ foi 3,23 (IC95%:2,00–5,22) e 2,87 (IC95%: 1,09–7,57) vezes maior entre os filhos de mães nos grupos de trajetória "crescente" e "alta-crônica", respectivamente, do que de mães do grupo de sintomas depressivos "baixos". As características maternas e infantis incluídas nas análises multivariadas foram incapazes de explicar essas diferenças. CONCLUSÕES: Identificou-se piores desfechos de saúde mental para filhos de mães atribuídas às trajetórias "crônica/grave" e "crescente" de sintomas depressivos. Iniciativas de prevenção e tratamento para evitar os efeitos adversos a curto, médio e longo prazo da depressão materna sobre o desenvolvimento de seus filhos devem se concentrar principalmente nas mulheres nesses grupos. OBJETIVO MÉTODOS Utilizouse Utilizou MINABrasil, MINABrasil MINA Brasil , (MINA-Brasil) brasileira Pósparto Pós parto EPDS (EPDS 68 6 8 6– SDQ– (SDQ Questionnaire, Questionnaire Questionnaire) pais RESULTADOS baixa "baixa 67,1%, 671 67,1% 67 (67,1%) crescente "crescente 11,5%, 115 11,5% 11 5 (11,5%) decrescente "decrescente 17,4% 174 17 4 (17,4% altacrônica alta crônica "alta-crônica 4,0%. 40 4,0% . 0 (4,0%) alta/crônica "alta/crônica pobres escolarizadas prénatal pré natal demais ajustadas 323 23 3,2 IC95%2,00–5,22 IC95200522 IC IC95% 2,00–5,22 IC95 00 22 (IC95%:2,00–5,22 287 87 2,8 (IC95% 1,09–7,57 109757 09 7 57 altacrônica, respectivamente baixos. baixos "baixos" diferenças CONCLUSÕES Identificouse Identificou crônica/grave crônicagrave grave "crônica/grave curto (MINA-Brasil 67,1 (67,1% 11,5 (11,5% 17,4 (17,4 4,0 (4,0% 32 3, IC95%2,00–5,2 IC9520052 200522 2,00–5,2 IC9 (IC95%:2,00–5,2 28 2, (IC95 1,09–7,5 10975 "baixos 67, (67,1 11, (11,5 17, (17, 4, (4,0 IC95%2,00–5, IC952005 20052 2,00–5, (IC95%:2,00–5, (IC9 1,09–7, 1097 (67, (11, (17 (4, IC95%2,00–5 IC95200 2005 2,00–5 (IC95%:2,00–5 (IC 1,09–7 109 (67 (11 (1 (4 IC95%2,00– IC9520 200 2,00– (IC95%:2,00– 1,09– 10 (6 ( IC95%2,00 IC952 20 2,00 (IC95%:2,00 1,09 IC95%2,0 2,0 (IC95%:2,0 1,0 IC95%2, (IC95%:2, 1, IC95%2 (IC95%:2

ABSTRACT OBJECTIVE: To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic. METHODS: Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach's alpha coefficient and McDonald's omega for each scale. RESULTS: According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61). CONCLUSIONS: Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon. OBJECTIVE SDQP P (SDQ-P covid19 covid 19 covid-1 pandemic METHODS MINABrazil MINA Brazil (MINA-Brazil populationbased Amazon used 202 fiveyear year followup follow up 69 49.4% 494 49 4 (49.4 girls. girls . girls) 2 subscales symptoms hyperactivityinattention hyperactivity inattention hyperactivity/inattention behavior cutoffs offs norms Moreover sample Cronbachs Cronbach s McDonalds McDonald scale RESULTS distribution 10 scores 18%. 18 18% (18%) fivefactor factor 0.60 060 0 60 (0.6 0.40, 040 0.40 , 40 0.40) 0.61. 061 0.61 61 0.61) CONCLUSIONS covid1 1 covid- 20 6 49.4 (49. (18% 0.6 06 (0. 04 0.4 49. (49 (18 0. (0 (4 (1 (

RESUMO OBJETIVO: Descrever a frequência de problemas de comportamento e a consistência interna da versão para os pais do Questionário de Capacidades e Dificuldades (SDQ-P) em crianças pré-escolares da Amazônia durante a pandemia de covid-19. MÉTODOS: Foram utilizados dados do estudo de saúde e nutrição Materno-Infantil no Acre (MINA-Brasil), uma coorte de nascimentos de base populacional na Amazônia Ocidental Brasileira. O SDQ-P foi aplicado aos pais e cuidadores em 2021 na visita de acompanhamento de cinco anos de 695 crianças (49,4% das quais eram meninas). Esse instrumento é um breve questionário de rastreamento comportamental composto por 25 itens reorganizados em cinco subescalas: sintomas emocionais, problemas de conduta, hiperatividade/desatenção, problemas de relacionamento com colegas e comportamento pró-social. Os casos de problemas de comportamento foram definidos de acordo com os pontos de corte originais do SDQ, baseados nas normas do Reino Unido. Além disso, os pontos de corte foram estimados com base nos percentis dos resultados do SDQ-P da amostra do nosso estudo. A consistência interna foi avaliada pelo cálculo do coeficiente alfa de Cronbach e ômega de McDonald para cada escala. RESULTADOS: De acordo com os pontos de corte baseados na distribuição da população estudada, 10% de todas as crianças apresentaram escores totais de dificuldade elevados ou muito elevados, o que quase dobrou quando os pontos de corte originais do SDQ, baseados nas normas do Reino Unido, foram utilizados (18%). Este estudo também encontrou diferenças nas demais escalas. Comparados às meninas, os meninos apresentaram maiores médias de problemas de externalização e menores médias de comportamento pró-social. O modelo de cinco fatores apresentou consistência interna dos itens moderada para todas as escalas (0,60 ≤ α ≤ 0,40), exceto para a escala de pontuação total de dificuldades, a qual foi considerada substancial (α > 0,61). CONCLUSÕES: Nossos resultados apoiam a utilidade do SDQ em nossa população de estudo e reforçam a necessidade de estratégias e desenvolvimento de políticas para o cuidado em saúde mental no início da vida na Amazônia. OBJETIVO SDQP P (SDQ-P préescolares pré escolares covid19. covid19 covid 19. 19 covid-19 MÉTODOS MaternoInfantil Materno Infantil MINABrasil, MINABrasil MINA Brasil , (MINA-Brasil) Brasileira 202 69 49,4% 494 49 4 (49,4 meninas. meninas . meninas) 2 subescalas emocionais conduta hiperatividadedesatenção hiperatividade desatenção hiperatividade/desatenção prósocial. prósocial pró social. social pró-social Unido disso RESULTADOS estudada 10 18%. 18 18% (18%) 0,60 060 0 60 (0,6 0,40, 040 0,40 40 0,40) dificuldades 0,61. 061 0,61 61 0,61) CONCLUSÕES covid1 1 covid-1 (MINA-Brasil 20 6 49,4 (49, (18% 0,6 06 (0, 04 0,4 covid- 49, (49 (18 0, (0 (4 (1 (

ABSTRACT OBJECTIVE To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required.

ABSTRACT OBJECTIVE: To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children. METHODS: Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models. RESULTS: EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66). CONCLUSIONS: EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.

RESUMO OBJETIVO: Descrever a prevalência e os fatores associados às práticas de aleitamento materno exclusivo (AME) e continuado (AM) entre crianças amazônicas. MÉTODOS: Foram utilizados dados de 1.143 pares mãe-filho registrados na coorte de nascimento Materno-Infantil no Acre (MINA-Brasil). As informações sobre AME e AM foram coletadas após o parto (julho de 2015–junho de 2016) e durante as consultas de acompanhamento com 1 e 6 meses pós-parto e com 1, 2 e 5 anos de idade. A análise longitudinal considerou a duração do AME e AM como desfechos. A probabilidade das práticas de aleitamento materno foi estimada pela análise de sobrevida de Kaplan-Meier. As associações entre as variáveis preditoras basais e os desfechos entre crianças nascidas a termo foram avaliadas por modelos de regressão de Cox estendidos. RESULTADOS: As frequências de AME (intervalo de confiança de 95% [IC95%]) aos 3 e 6 meses de idade foram de 33% (IC95%: 30,2–36,0) e 10,8% (IC95%: 8,9–12,9), respectivamente. A razão de risco ajustada para preditores de interrupção precoce do AME foi: ser primípara = 1,47 (IC95%: 1,19–1,80), alimentar recém-nascidos com pré-lácteos = 1,70 (IC95%: 1,23–2,36), usar chupeta na primeira semana de vida = 1,79 (IC95%: 1,44–2,23) e apresentar diarreia nas duas primeiras semanas de vida = 1,70 (IC95%: 1,15–2,52). A frequência do AM continuado foi de 67,9% (IC95%: 64,9–70,8), 29,3% (IC95%: 26,4–32,4) e 1,7% (IC95%: 0,9–2,8) aos 1, 2 e 5 anos de idade, respectivamente. A razão de risco ajustada para preditores de cessação precoce do AM foi: sexo masculino = 1,23 (IC95%: 1,01–1,49), uso de chupeta na primeira semana de vida = 4,66 (IC95%: 2,99–7,26) e AME menor que 3 meses = 2,76 (IC95%: 1,64–4,66). CONCLUSÕES: A duração do AME e do AM continuado entre crianças amazônicas é consideravelmente menor do que as recomendações da Organização Mundial da Saúde. Preditores significativos das práticas de aleitamento materno devem ser considerados na avaliação das estratégias locais para alcançar práticas ideais de aleitamento materno.