Teses e Dissertações

• Teses
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HOUSEHOLD TRIALS WITH VERY SMALL SAMPLES PREDICT RESPONSES TO NUTRITION COUNSELING INTERVENTION Household trials were conducted to test acceptability and feasibility of the recommendations to be delivered to the mothers at the context of a randomized intervention, implemented in Pelotas, Brazil. A first home visit was paid to assess child health and feeding problems. In a second visit, the mother was encouraged to selected one or two recommendations to try out over the coming five days. The last visit was used to assess mothers’ experiences in attempting to implement the recommendations. Non-exclusive breastfeeding, use of bottle, monotonous diet and low energy density of foods were the most common problems. The most frequently selected recommendations were those aiming to increase energy density of foods. Mothers generally reported positive responses to the recommendations. The household trials highlighted the acceptability and feasibility of the planned recommendations, and correctly predicted the changes that were most successfully implemented by mothers in the large intervention study.Key words: trials of improved practices (TIPs), household trial (HHT), dietary behavior change, nutrition counseling, child feeding, dietary intervention

INTERVENÇÕES NUTRICIONAIS E CRESCIMENTO INFANTIL EM CRIANÇAS DE ATÉ DOIS ANOS DE IDADE: UMA REVISÃO SISTEM�TICA

O objetivo desse estudo foi reunir evidências sobre a eficácia de intervenções nutricionais sobre o crescimento infantil. Através de revisão sistemática da literatura, em bases eletrônicas (Medline, Lilacs e MedCarib), rastrearam-se estudos de intervenção nutricional dirigidos a crianças menores de dois anos, publicados entre 1980 e 2002. Os descritores usados foram “nutrition�, “child�, “trial�, “intervention�, “growth�, “infant�, “programs�, “impact�, “counseling�, “support�, “body height� e “body weight�. Busca adicional foi feita através das referências dos artigos localizados. Foram encontradas quatorze intervenções que utilizaram suplemento e/ou aconselhamento nutricional. A maioria evidenciou impacto positivo no crescimento, quando aplicada no primeiro ano de vida. Afastado o viés de publicação, o aconselhamento teve a vantagem adicional de melhorar as práticas maternas e dos profissionais de saúde em nutrição e alimentação infantis. Palavras-chave: revisão sistemática, intervenção, nutrição, criança, crescimento

NUTRITION COUNSELING INCREASES WEIGHT GAIN AMONG BRAZILIAN CHILDREN To assess the impact on child growth of the nutrition counseling component of the Integrated Management of Childhood Illnesses (IMCI) strategy, a randomized trial was implemented. All 28 government health centers in a southern Brazil city were paired according to baseline nutritional indicators. One center from each pair was randomly selected and its doctors received a 20-hour training in nutrition counseling. Thirty-three doctors were included and 12-13 patients from each doctor, aged under 18 months, were recruited. The study included testing the knowledge of doctors, observing consultations and visiting the children at home 8, 45 and 180 days after the initial consultation. Maternal knowledge, practices and adherence to nutritional recommendations were assessed, and anthropometric measurements were taken. Daylong dietary intake was evaluated on a subsample of children. Doctors in the intervention group had better knowledge of child nutrition, and improved assessment and counseling practices. Maternal recall of recommendations was higher in the intervention than in the control group, as was satisfaction with the consultation. Reported use of recommended foods was also increased. Daily fat intake was higher in the intervention than in the control group; mean daily intakes of energy and zinc tended to also improve. Children aged 12 months or older presented improved weight gains and a positive but non-significant improvement in length. Nutrition counseling training improved doctors’ performances, maternal practices, and the diets and weight gain of children. The randomized design with blind outcome evaluation strongly supports a causal link. These results should be replicated in other settings.Key words: child growth, nutrition counseling, randomized trial