Revista de Saúde Pública (Apr 2002)
Capacidade materna de cuidar e desnutrição infantil Mother's ability of childcare and children malnutrition
Abstract
OBJETIVOS: Identificar e medir a magnitude do risco de desnutrição associada a fatores determinantes da capacidade materna de cuidado infantil: estrutura familiar, escolaridade, trabalho, saúde física e saúde mental maternas. MÉTODOS: Delineou-se um estudo de casos e controles. Foram selecionados 101 casos (crianças com peso/idade abaixo do percentil 5) e 200 controles (crianças com peso/idade acima do percentil 25) mediante inquéritos antropométricos realizados durante três "Dias Nacionais de Vacinação", em 1996 e 1997. Os dados foram obtidos em entrevistas realizadas nos domicílios com as mães das crianças. Para detectar o efeito-líquido de cada fator em estudo, realizou-se análise de regressão logística multivariada e hierarquizada. Tais fatores e as possíveis variáveis de controle foram agrupados em blocos, ordenados segundo a precedência com que influiriam sobre o estado nutricional infantil. Adotaram-se pOBJECTIVES: To identify and measure the risk of malnutrition associated to determining indicators of mother's ability of childcare: familial structure, education level, work, maternal physical and mental health. METHODS: A case-control study was performed. Cases (101 children whose weight/age was below 5th percentile) and controls (200 children whose weight/age was above 25th percentile) were selected using anthropometric surveys during three vaccination campaigns in 1996 and 1997. Data was collected by interviewing the children's mothers at home. To detect the net effect of each factor studied, multivariate hierarchical analyses were carried out. The factors investigated and possible control variables were grouped in blocks, arranged according to order they affected the child's nutritional status. In order to identify the control variables a p<0.20 (univariate analyses) was assumed and to identify associations between a given factor and malnutrition a p<0.05 was assumed. RESULTS: Malnutrition risk factors identified are: (a) adverse familial structure, indicated by single parenting (OR=2.2; 95%CI, 1.1-4.5); (b) hospitalization of the mother during pregnancy (OR=3.5; 95%CI, 1.6-7.7); (c) mother's poor mental health, determined by the presence of 3 to 4 symptoms of depression included in the SRQ-20 (OR=3.1; 95%CI, 0.9-10.3); and (d) family stress factors, suggestive signs of alcoholism in at least one family member (OR=2.1; 95%CI, 1.2-3.9). In addition to these factors, child's age at the time the mother resumed/started working was also independently associated to malnutrition. However, it produced mixed effects: for children aged 4 to 12 months, the mothers' resuming work resulted in a protection factor whereas their resuming later tended to increase the risk of malnutrition. CONCLUSIONS: It was evidenced that the factors that define the mother's ability of child care affect the child's nutritional status.
Keywords
