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Biomedical subjects

C G Victora

Publications and source records attributed to C G Victora.

At least 55 records · Page 3Linked to original sources
PubMed1999

Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study.

OBJECTIVE: To determine whether breast feeding protects infants against pneumonia and whether the protection varies with age. DESIGN: Nested case-control study. SETTING: Pelotas, southern Brazil. SUBJECTS: Cases were 152 infants aged 28-364 days who had been admitted to hospital for pneumonia. Controls were 2391 cases in a population based case-control study. MAIN OUTCOME MEASURE: Odds ratio of admission for pneumonia according to type of milk consumed (breast milk alone, breast and formula milk, or formula milk and other fluids only), use of fluid supplements apart from formula milk, and use of solid supplements. RESULTS: Infants who were not being breast fed were 17 times more likely than those being breast fed without formula milk to be admitted to hospital for pneumonia (95% confidence interval 7.7 to 36.0). This relative risk was 61 (19.0 to 195.5) for children under 3 months old, decreasing to 10 (2.8 to 36. 2) thereafter. Supplementation with solids was associated with a relative risk of 13.4 (7.6 to 23.5) for all infants and 175 (21.8 to 1405.1) for those under 3 months old. CONCLUSION: Breast feeding protects young children against pneumonia, especially in the first months of life. These results may be used for targeting intervention campaigns at the most vulnerable age groups.

Brazil↗
PubMed1999

Potential interventions for the prevention of childhood pneumonia in developing countries: improving nutrition.

Acute respiratory infections are the leading cause of childhood death in developing countries. Current efforts at mortality control focus on case management and immunization, but other preventive strategies may have a broader and more sustainable effect. This review, commissioned by the World Health Organization, examines the relations between pneumonia and nutritional factors and estimates the potential effect of nutritional interventions. Low birth weight, malnutrition (as assessed through anthropometry), and lack of breast-feeding appear to be important risk factors for childhood pneumonia, and nutritional interventions may have a sizeable effect in reducing deaths from pneumonia. For all regions except Latin America, interventions to prevent malnutrition and low birth weight look more promising than does breast-feeding promotion. In Latin America, breast-feeding promotion would have an effect similar to that of improving birth weights, whereas interventions to prevent malnutrition are likely to have less of an effect. These findings emphasize the need for tailoring interventions to specific national and even local conditions.

Breast Feeding↗
PubMed1999

Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact.

The question of why to evaluate a programme is seldom discussed in the literature. The present paper argues that the answer to this question is essential for choosing an appropriate evaluation design. The discussion is centered on summative evaluations of large-scale programme effectiveness, drawing upon examples from the fields of health and nutrition but the findings may be applicable to other subject areas. The main objective of an evaluation is to influence decisions. How complex and precise the evaluation must be depends on who the decision maker is and on what types of decisions will be taken as a consequence of the findings. Different decision makers demand not only different types of information but also vary in their requirements of how informative and precise the findings must be. Both complex and simple evaluations, however, should be equally rigorous in relating the design to the decisions. Based on the types of decisions that may be taken, a framework is proposed for deciding upon appropriate evaluation designs. Its first axis concerns the indicators of interest, whether these refer to provision or utilization of services, coverage or impact measures. The second axis refers to the type of inference to be made, whether this is a statement of adequacy, plausibility or probability. In addition to the above framework, other factors affect the choice of an evaluation design, including the efficacy of the intervention, the field of knowledge, timing and costs. Regarding the latter, decision makers should be made aware that evaluation costs increase rapidly with complexity so that often a compromise must be reached. Examples are given of how to use the two classification axes, as well as these additional factors, for helping decision makers and evaluators translate the need for evaluation--the why--into the appropriate design--the how.

Child, Preschool↗
PubMed1999

Increased blood pressure in adolescents who were small for gestational age at birth: a cohort study in Brazil.

BACKGROUND: This paper studies the relationship between birthweight for gestational age and blood pressure in adolescents aged 14-15 years in southern Brazil. METHODS: A sample of 1076 adolescents belonging to a cohort of over 6000 children born in 1982 in Pelotas, southern Brazil, was studied in 1997. All households in a sample of 25% of the city's census tracts were visited and all adolescents born in 1982 were interviewed, weighed, and their blood pressures were measured twice. Data from the adolescents were linked to the database through their names and dates of births. RESULTS: High diastolic and systolic pressure (defined as >95th percentile) were significantly more frequent among adolescents who were born below the 10th percentile of birthweight for gestational age. No association was found between high blood pressure and low birthweight or preterm births. In a multiple linear regression analysis, the association between birthweight for gestational age and blood pressure was not statistically significant after adjusting for age, sex, skin colour and family income. However, when the current body mass index and height were added to the model both diastolic and systolic pressure were significantly associated with birthweight for gestational age, and adolescents who were small for gestational age at birth presented a mean elevation of 3.08 mmHg for diastolic pressure and 2.89 mmHg for systolic pressure. CONCLUSIONS: There is an inverse association between birthweight for gestational age and blood pressure during adolescence. This association, however, is only disclosed when the negative confounding effect of the body mass index is controlled for. The same association is not found when the effects of birthweight and gestational age on blood pressure are analysed separately. It appears therefore that the elevation of blood pressure during adolescence only occurs when there was intra-uterine growth retardation.

Adolescent↗
PubMed1999

[Workers' perception of exposure to workload and risks of accidents in a southern Brazilian city].

OBJECTIVE: The study of the association between workers' perceptions of occupational hazards and the risk of occupational accidents. DESIGN: Case control study. POPULATION: The cases were 264 workers who presented a "typical" occupational accident, registered at the National Institute of Social Security in the city of Pelotas, between January and July, 1996. Fatal accidents (two) were excluded, as were those leading to an absence of less than seven days from work. The cases were interviewed in their homes with a standard questionnaire. For each case, three controls were chosen: a fellow-work, a neighbor and a population control. Controls were matched to the cases by age (+/- 5 years) and sex; workers who had suffered an occupational accident in the preceding month were excluded from the control group. All cases and controls were formally employed and lived in the urban area. The data were analyzed using conditional logistic regression. RESULTS AND CONCLUSIONS: The risk of occupational accidents was found to double among workers who reported having faced emergency situations at work, working in high places, facing constant danger or noisy environments. Working in uncomfortable positions or intense physical activities were associated with a 50% increase in risk. The remaining occupational hazards under study were not significantly associated with the risk of accidents. All of the above results were adjusted for confounding factors.

Accidents, Occupational↗
PubMed1999

[Low prevalence of bodyweight-for-height deficit: comparison of stunned and no-stunned Brazilian children].

OBJECTIVES: The aim of this study was to investigate the relationship between abdominal circumference and weight-for-height in children. The average of 18 anthropometric and body proportionality indexes were compared among four groups of children: stunted and non-stunted Brazilians, Peruvians and North-Americans. METHODS: There were studied 386 children aged 6-59 months living in a poor neighborhood in Pelotas, Brazil. Anthropometric measurements (weight, recumbent length or height, sitting height or crown-rump length; head, chest, upper arm and abdominal circumferences; triceps, biceps, subescapular and suprailiac skinfold thickness; biacromial and biiliac breadths) were obtained. Muscle, fat, total upper arm areas, leg length and body proportionality indexes were calculated. RESULTS AND CONCLUSIONS: The study sample showed high levels of morbidity, low parental educational levels, poor access to health services and poor housing conditions. Stunted Brazilian children had lower means for most of the anthropometric measurements when compared to non-stunted Brazilians and North-American children. However, stunted children showed larger abdominal, head and thoracic circumference in relation to their stature than non-stunted children. The low prevalence of weight-for-height among the children of this study is not a result of excess of fat or muscle tissue, and may be partly explained by an increase in head and trunk dimensions (including abdominal circumference) relative to the child's stature.

Abdomen↗
PubMed1999

[Assessment of the performance of Pastoral de Criança, a health support group, in promoting child survival and health education in Criciúma,a city in southern Brazil].

Thousands of children younger than 5 years of age still die all over the world as a result of preventable diseases. Community intervention measures emphasizing primary health and nutritional care have been identified as one of the solutions to this problem. This article describes a population-based cross-sectional study of the Pastoral da Criança, a Roman Catholic health support group in Brazil. The study assesses whether mothers and children assisted by the Pastoral present better health indicators and have a better knowledge of basic child survival actions than non-assisted mothers and children. The study was carried out in 1996 in an urban area of the municipality of Criciúma, in the state of Santa Catarina, in southern Brazil. The sample was composed of 2,208 children under 3 years of age. The adjusted analysis taking into consideration possible confounding factors showed that the presence of the Pastoral was significantly associated with maternal knowledge of appropriate feeding measures during diarrheal episodes, optimal duration of exclusive breast-feeding, implications of feeding powdered milk to infants, correct interpretation of the infant growth curve, and knowledge of the proper vaccination schedule for infants. Participation in the Pastoral was positively associated with longer total breast-feeding duration, later introduction of bottle-feeding, higher frequency of growth monitoring visits in the quarter before the study, and availability in the home of measuring spoons for oral rehydration. No significant association was found between participation in the Pastoral and duration of predominant or exclusive breast-feeding, or correct diarrhea management. The results showed Pastoral actions have a positive effect and also revealed areas in which greater investments are needed. It is recommended that the Pastoral, as well as other similar institutions, give priority to educating mothers on child care and to recruiting mothers early in pregnancy, when the impact of these actions is potentially greater.

Brazil↗
PubMed1998

Caffeine intake and low birth weight: a population-based case-control study.

The authors conducted a matched case-control study to investigate the effects of caffeine intake during pregnancy on birth weight. From January to November 1992, in the first 24 hours after delivery, 1,205 mothers (401 cases and 804 controls) were interviewed and their newborns were examined to assess birth weight and gestational age by means of the method of Capurro et al. (J Pediatr 1978;93:120-2). The cases were children with birth weight < 2,500 g and gestational age > or = 28 weeks. Cases and controls were matched for time of birth and hospital of delivery and were recruited from the four maternity hospitals in Pelotas, southern Brazil. Daily maternal caffeine intake during pregnancy for each trimester was estimated. To assess caffeine intake, 10% of the mothers were reinterviewed at their households and samples of reported information on drip coffee and maté (a caffeine-containing drink widely used in South America) were collected and sent to the laboratory for caffeine determination through liquid chromatography. When instant coffee was reported, the weight of powder was measured using a portable scale, and caffeine intake was estimated from a reference table. Caffeine intake from tea, chocolate, soft drinks, and medicines was estimated from a reference table. Analyses were performed by conditional logistic regression. Crude analyses showed no effect of caffeine on low birth weight, preterm births or intrauterine growth retardation. The results did not change after allowing for confounders.

Beverages↗
PubMed1998

Breast-feeding and growth in Brazilian infants.

A new international growth reference is being prepared based on children who are fed according to World Health Organization recommendations, which entail exclusive breast-feeding for the first 4-6 mo of life. However, the number of exclusively breast-fed infants in most societies is small, so that selection biases may result from using such a population. We examined the variability in linear and soft tissue growth of infants according to their feeding patterns, emphasizing differences between exclusively and predominantly (breast milk plus fluids) breast-fed infants. About 650 infants from a relatively developed urban area in southern Brazil were examined at the ages of 1, 3, 6, and 12 mo, and an additional 800 infants at 6 and 12 mo. At each visit, infants were weighed and measured and a 24-h dietary recall was completed with the infants' caretakers. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean, and confounding. There was little association between feeding pattern and growth in the first month. From 1 to 3 mo, partially breast-fed infants tended to gain more weight, followed by those who were completely weaned. From 3 to 6 mo, fully weaned infants grew fastest in weight and length and exclusively breast-fed infants grew slowest. After 6 mo of age, the growth in length of partially breast-fed and fully weaned infants was similar, but the latter gained more weight. There were virtually no differences between exclusively and predominantly breast-fed infants in the first 6 mo of life. There results suggest that both of these groups may be pooled for the purpose of constructing growth references.

Anthropometry↗
PubMed1998

Length and ponderal index at birth: associations with mortality, hospitalizations, development and post-natal growth in Brazilian infants.

BACKGROUND: Low birthweight infants suffer greater mortality and neonatal morbidity, grow less well in infancy and show poorer psycho-motor development. However, this simple categorization may obscure important differences in aetiology and prognosis between infants born stunted, thin, or both. METHODS: In 1993, all births in Pelotas, Brazil, were enrolled into a prospective study of health and development in infancy. Of 5249 live births, 5160 had length and weight measures at birth, and were classified into tertiles of length and ponderal index. All deaths and hospitalizations were monitored, and suspected developmental delay and attained growth at 12 months were assessed on a subsample of 1364 infants. Logistic regression was used to control for gestational age and socioeconomic status. RESULTS: There was no association between birth length and ponderal index tertiles. After adjusting for gestational age, infants in the lower tertiles of both length and ponderal index presented a 3.8-times higher risk of mortality from day 8 to day 365, and a 2.5-times higher risk of hospitalization compared to infants with greater birth lengths and/or ponderal indices. Suspected developmental delay was associated with length and, less strongly, with ponderal index, but there was no synergism between the two. Infants in the middle and upper tertiles of ponderal index at birth became thinner. CONCLUSIONS: Birth length was strongly associated with development at 12 months, but only infants born both short and thin were at increased risk of mortality and hospitalizations. The combination of the two measures provides a useful classification of the anthropometric status of the newborn.

Adult↗
PubMed1998

The NCHS reference and the growth of breast- and bottle-fed infants.

The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants. We used the NCHS reference to evaluate infant growth in one of the most developed areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4-6 mo, and partially breast-fed thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until approximately 6 mo, after which their growth became slower than that of the NCHS sample. To substantiate this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants and predominantly bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System. In all three cases, weights showed the same pattern as the Brazilian infants-higher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breast-fed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breast-fed or artificially fed infants. This probably results from characteristics of the original sample and from inadequate curve-fitting procedures. The development of an improved international growth reference that reflects the normal infant growth pattern is indicated.

Body Height↗
PubMed1998

[Risk factors for perinatal mortality in Pelotas, a southern city of Brazil, 1993].

INTRODUCTION: Although there was a considerable reduction in infant mortality in Pelotas, Rio Grande do Sul in the last decade, its perinatal causes were reduced only by 28%. The associated factors of these causes were analysed. MATERIAL AND METHOD: All hospital births and perinatal deaths were assessed by daily visits to all the maternity hospitals in the city, throughout 1993 and including the first week of 1994. RESULTS: The perinatal mortality rate was 22.1 per thousand births. The multivariate analysis showed the following risk factors: low socioeconomic level, male sex and maternal age above 35 years. Among multigravidae women, the fetal mortality rate was significantly increased for mothers with a previously low birthweight and a previous stillbirth. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight. CONCLUSIONS: Main risk factors for perinatal mortality: low socioeconomic level, maternal age above 35 years and male sex. For early neonatal mortality the risk was significantly increased by a smaller number of antenatal visits than 5 and low birthweight.

Adult↗
PubMed1998

[Incidence and duration of breast-feeding by type of delivery: a longitudinal study in southeastern of Brazil].

OBJECTIVE: To compare the incidence of breastfeeding according to type of delivery. METHODOLOGY: Population-based cohort study of 655 children born in 1993 and followed up during the first three months of life through home visits. RESULTS: Breastfeeding duration was similar among babies born either by vaginal delivery or by emergency cesarean section. Babies born by elective cesarean section, however, presented a three times higher risk of stopping breastfeeding in the first month of life, after adjusting for possible confounding factors (odds ratio = 3.09; 95% CI 1.3-7.2). The increased risk did not persist into the third month of life. CONCLUSIONS: It is recommended that health services pay special attention, in the promotion of breastfeeding, to babies born by elective cesarean section, as a way to avoid early weaning.

Adult↗
PubMed1998

[Estimating the prevalence of height for age deficits based on the prevalence of weight for age deficits among Brazilian children].

INTRODUCTION: Anthropometry is frequently used for evaluating nutritional status of individuals and populations. In recent years, community surveys have been conducted by health professionals in various regions of Brazil with the objective of complementing the data obtained through nutritional surveillance programs. One important difficulty in conducting these assessments has been measuring height during visits to the homes of survey participants. METHODS: Thirty-eight anthropometric surveys of Brazilian children aged up to 5 years using the National Center for Health Statistics (NCHS) reference were identified. The percentage of children with a Z-score below standard deviations was used to define deficits of weight for age and height for age. RESULTS: Correlation between prevalences of height for age and weight for age deficits were examined. Due to the low prevalence of deficits in weight for height in all surveys, there was a strong correlation between weight for age and height for age at the population level. Approximately 90% of the height for age (H/A) variation was accounted for by that of weight for age (W/A). CONCLUSIONS: Using the equation, (Prevalence H/A) = 0.74 + 2.34 (Prevalence W/A) -0.03 (Prevalence W/A)2 it is possible to estimate the prevalence of height deficits on the basis of prevalence of weight deficits. These results suggest that anthropometric surveys as conducted in Brazil, in the context of health services, can be simplified by measuring weight only, instead of both weight and height.

Age Factors↗
PubMed1998

[Epidemiology of drug use during the first three months of life in a urban area of southern Brazil].

INTRODUCTION: The few studies on the use of medicines in children point to excessive use, and in these studies, physicians are those mainly responsible for the prescription of medicines. In order to get to know the patterns of consumption medicines better, a study was made in children in their first three months of life, according to social biological, food pattern and use of health services of variables. METHOD: The patterns of the use of medicines during the first three months of life in 655 urban children born in Pelotas, Brazil, in 1993, were described. Information on the use of medicines was collected during a two-week period in the first and third month of life. RESULTS: The use of medicines was reported by 65% of mothers at the 1st and 69% at the 3rd month of life. Seventeen per cent of children consumed three or more different medicines during those periods. Fixed combinations of three or more components-which was taken as an indicator of the poor of medicines quality-were consumed by 14% of the children at the 1st and 19% at the 3rd months of life. At the latter age, 20% of children had used a given medicine for one month or more. At the first month follow-up, Benzalkonium Chloride + Normal Saline Solution (nasal drops), Nystatin Mixture and Dimethicone + Homotropine were the most frequently used medicines. At the third month they were, Aspirin, Benzalkonium Chloride + Normal Saline Solution and Dimethicone + Homatropine. The main reasons for taking medicines were cramps at the first month and colds at the third. At the first month follow-up, children with three or more siblings used 64% less medicines than the older ones. Children who were not breast-fed at the end of the first month showed a 75% greater risk of use of medicines. Similar results were observed at the third month follow-up. Some of the medicines used were not recommendable for children. CONCLUSION: Since early age children are submitted to an intense use of medicines for almost every conceivable reason, with the risk of potential side-effects and the possible lead to medicine or other drugs addiction.

Age Factors↗
PubMed1998

Vitamin K prophylaxis in less developed countries: policy issues and relevance to breastfeeding promotion.

Vitamin K prophylaxis prevents hemorrhagic disease of the newborn. The present review estimates the potential magnitude of this problem in less developed countries, assessing the need for prophylaxis, along with its cost-effectiveness and feasibility. Late hemorrhagic disease, occurring between 2 and 12 weeks, often leads to death or permanent disability. Its median incidence in developed countries is 7 per 100,000 births. Incidences in less developed countries may be much higher. Three incidence scenarios are proposed and the corresponding losses of disability-adjusted life-years (DALYs) calculated. Under the intermediate scenario, late hemorrhagic disease accounts for 0.1% to 0.2% of DALYs lost to children less than 5 years of age. Assuming a cost of +1.00 per injection, each DALY saved would cost +133. Decisions on prophylaxis must be made on a national basis, considering mortality levels and causes, health budgets, and feasibility. Comparison with the impact of diseases prevented by breast-feeding shows that concern with hemorrhagic disease should not affect breast-feeding promotion efforts, although strategies for supplementing breast-fed infants must be explored.

Breast Feeding↗
PubMed1997

Environmental tobacco smoke and breastfeeding duration.

The effect of smoking on breastfeeding duration was investigated in a population-based birth cohort study of 1,098 Brazilian infants. There were few losses to follow-up (3.2%) in the first 6 months. Maternal smoking was strongly associated with breastfeeding duration, even after adjustment for confounding. Compared with nonsmokers, mothers smoking 20 or more cigarettes daily presented an odds ratio of 1.94 for breastfeeding for less than 6 months. Environmental tobacco smoke was also an independent risk factor. After adjustment for maternal smoking and other confounders, households where more than 10 cigarettes were smoked daily by persons other than the mother presented an odds ratio of 1.48 compared with those without smokers. These results remained unchanged after stratification for maternal smoking. This is the first report of a possible effect of environmental tobacco smoke on breastfeeding duration.

Adult↗