Corrêa A M, da Silva e Gonçalves N N, Gonçalves A, Leite G P, Padovani C R
UNICAMP, Departamento de Medicina Preventiva e Social, Faculdade de Ciências Médicas, Campinas, São Paulo, Brasil.
Rev Panam Salud Publica. 1999 Jul;6(1):26-33. doi: 10.1590/s1020-49891999000600004.
The nutritional status of Brazilians has improved over the last three decades. Still, little is known about the role played by nutritional assistance programs that public institutions and philanthropic organizations provide for low-income preschool children, who face greater nutritional risk. Therefore, we carried out a quasi-experimental study to evaluate the nutritional impact of the municipal preschool nutritional assistance program in the city of Sorocaba, São Paulo, Brazil. Over the course of a year, we performed quarterly measurements of weight and height on 444 children, whose ages ranged from 3 months to 6 years. In this population, 164 children were assisted by the preschool nutritional program (intervention group), and 280 children were not (nonintervention group). The children in the nonintervention group were identified by a special census for that purpose; they did not attend the preschool but lived nearby. After obtaining informed consent and carrying out a pretest, professionals and university students interviewed the mothers of the participating children, following standard techniques and conditions. Anthropometric measurements were done by teams of two interviewers, one of whom was a permanent member of the team, using equipment calibrated by the appropriate regional technical organization. The correspondence between the first measurement and subsequent measurements was evaluated by stratifying the population into three groups by z scores for weight-for-age and for weight-for-height, using U.S. National Center for Health Statistics reference curves. The z score groupings were established at the beginning of the study for three different age groups: younger than 24 months, 24-36 months, and older than 36 months. The two study groups (intervention and nonintervention) were similar sociodemographically, with the following exceptions: maternal employment (more of the mothers of children in the intervention group had jobs outside the home); age (children in the intervention group were significantly older); nutritional status (it was worse in the intervention group); and prevalence of hospital admittance (it was higher in the intervention group). After just the first three months of the study, 32% of the children in the intervention group had moved to a higher nutritional stratum, whereas only 13% of children in the nonintervention group had shown improved nutritional status. The difference in favor of the intervention group increased with the length of the intervention and was higher among older children. These results show that the preschool nutritional assistance program helped to improve the assisted children's nutritional status.
在过去三十年里，巴西人的营养状况有所改善。然而，对于公共机构和慈善组织为面临更大营养风险的低收入学龄前儿童提供的营养援助项目所发挥的作用，我们却知之甚少。因此，我们开展了一项准实验研究，以评估巴西圣保罗州索罗卡巴市的市政学龄前儿童营养援助项目对营养状况的影响。在一年的时间里，我们对444名年龄在3个月至6岁之间的儿童进行了季度体重和身高测量。在这个群体中，164名儿童接受了学龄前儿童营养项目的援助（干预组），280名儿童未接受援助（非干预组）。非干预组的儿童是通过为此目的进行的一次特别普查确定的；他们没有上幼儿园，但住在附近。在获得知情同意并进行预测试后，专业人员和大学生按照标准技术和条件对参与儿童的母亲进行了访谈。人体测量由两名访谈员组成的团队进行，其中一名是团队的固定成员，使用由适当的地区技术组织校准的设备。通过使用美国国家卫生统计中心的参考曲线，根据年龄别体重和身高别体重的z评分将人群分为三组，评估第一次测量与后续测量之间的一致性。在研究开始时，针对三个不同年龄组建立了z评分分组：24个月以下、24至36个月、36个月以上。两个研究组（干预组和非干预组）在社会人口统计学方面相似，但有以下例外情况：母亲就业情况（干预组中更多儿童的母亲有家庭以外的工作）；年龄（干预组中的儿童年龄明显更大）；营养状况（干预组更差）；以及住院率（干预组更高）。仅在研究的前三个月后，干预组中32%的儿童营养状况提升到了更高水平，而非干预组中只有13%的儿童营养状况有所改善。有利于干预组的差异随着干预时间的延长而增加，并且在年龄较大的儿童中更高。这些结果表明，学龄前儿童营养援助项目有助于改善受援助儿童的营养状况。
