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[Child health in the states of Ceara, Rio Grande do Norte and Sergipe, Brazil: description of a methodology for community diagnosis] A saude das criancas dos estados do Ceara, Rio Grande do Norte e Sergipe, Brasil: descricao de uma metodologia para diagnosticos comunitarios.
Revista de Saude Publica / Journal of Public Health. 1991 Jun; 25(3):218-25.From 1987 to 1989, UNICEF collaborated with state and municipal health organs of the Brazilian states of Ceara (C), Rio Grande do Norte (R), and Sergipe (S) in order to realize a community diagnosis of maternal-child health care. The estimation of mortality required investigating women aged 15-49 visiting 8000 households, examining 4513 children <3 years old. In R and S, a sample of 1000 children <5 was used to estimate most common health problems. In these states, 1920 households were visited, and a questionnaire served for collection of demographic and socioeconomic data. Children were weighed, and a modified AHRTAG anthropometer served for measuring body length. About 1/4 to 1/3 of children were first-born. In C, 19.3% of children were seventh-born or higher, almost double the rate of the other 2 states. Income, literacy rate of parents, living conditions, and availability of running water indicators were much worse in C. 34.8% of the women in C had not received prenatal care; this figure was 15.7% in S an R, respectively. In C, only 24.3% of the mothers had received 6 or more prenatal care checkups vs. about 1/2 in the other states. Hospital deliveries reached 64.8% in C vs. almost 90% in the other states. In C, breast feeding was more prevalent: 83% were breast feeding for 1 month and 27.1% for 12 months. Malnutrition indicated by height and age was 27.6% in C vs. 16.1% in S and 14/2% in R. There was a clear association between family income and nutritional deficits of height/age and weight/age indicators. In C, malnutrition was higher in all income groups. Diarrhea incidence was 12% in C vs. 7.3% in S and 6/4% in R. A lower percentage used rehydration in C. 9.9% of children in C had been hospitalized in the previous 12 months vs. 6.2% in S and 6.9% in R. Coughing, fever and respiratory difficulties ran to 8.6% in C. Only 42.4% had full vaccination in C vs. 61.7% in S and 71.3% in R. 30/5% had been weighed in C in the previous 3 months vs. 45.1% in S and 44.2% in R.
[Unpublished] 1991. Presented at the Society for Epidemiologic Research 24th Annual Meeting, Buffalo, New York, June 11-14, 1991. 12,  p.Health workers use anthropometry to determine the nutritional status of children. The accepted international growth reference curves provide the bases for the indices which include weight for height (W/H), height for age (H/A) and weight for age (W/A). Health workers must interpret these indices with caution, however. For example, W/H and H/A represent different physiological and biological processes while W/A combines the 2 processes. Further Z-scores, percentiles, or percent of median may be used as the scale for the indices and each scale has different statistical features. Specifically, Z-scores and percentiles acknowledge smoothed normalized distributions around the median, but the percent-of-median ignores the distribution around the median. Some researchers suggest using Z-scores rather than percentiles or percent-of-median since statisticians can interpret them more clearly and can calculate the proportion of children in the reference population who fall above or below a cut off point more easily. This cutoff should be only used to screen children who are likely to be malnourished since not all children below a cutoff are indeed malnourished. Some researchers have identified a leading limitation of the CDC/WHO based indices. A disjunction exists where the 2 smoothed based curves based on a population of <36 month old children from Ohio (longitudinal data) and another population of 2-18 year old children (cross sectional health surveys) meet. Further there is a reduction in age specific prevalences at 24 months. Thus some researchers recommend that anthropometry data be presented on an age specific basis, if age information is accurate. They further suggest that, if comparing data from different geographic areas, researchers should standardize age to have a summary measure. If age is not known the W/H summary measure should include 2 groups: <85 cm and =or+ 85 cm.