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      Coverage and educational actions related to the national vitamin A supplementation program: a study in children from the state of Alagoas ☆☆ ☆☆☆ Translated title: Cobertura e ações educativas no âmbito do programa nacional de suplementação de vitamina A: estudo em crianças do estado de Alagoas

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          Abstract

          Objectives

          To estimate the coverage of the National Vitamin A Supplementation Program (Programa Nacional de Suplementação de Vitamina A) in children from Alagoas, to identify factors associated with this coverage, and to analyze the adequacy of nutrition education actions.

          Methods

          Household survey involving a representative probabilistic sample of children aged 6 to 59 months from Alagoas and their mothers (n = 509). Coverage was defined by the percentage of children with supplementation records in the last semester. The association between the independent variables (socioeconomic, demographic, and health) and the National Vitamin A Supplementation Program coverage was analyzed based on the prevalence ratio and its 95% CI. The mothers’ knowledge of questions related to vitamin A was considered as an indicator of the adequacy of nutrition education actions.

          Results

          Program coverage was 91.9% in children aged 6-11.9 months and 38.6% in children aged 12-59 months. In the adjusted analysis, the factors that were associated with greater coverage were: age between 6-11.9 months (PR = 2.50, 95% CI: 2.10-2.96), living in rural areas (PR = 1.45, 95% CI: 1.20-1.76) and living in a house with ≤ 4 rooms (PR = 1.33, 95% CI: 1.09-1.63). Only 26.1% of the mothers were able to mention some food source of vitamin A and only 19.2% were aware of the consequences of vitamin deficiency for health.

          Conclusions

          The National Vitamin A Supplementation Program coverage is below the targets set by the Ministry of Health (except for children < 12 months). The factors associated with greater coverage indicate an adequate focus of the program. The nutrition education activities have not demonstrated satisfactory results. This information should guide actions to improve the program.

          Resumo

          Objetivos

          Estimar a cobertura do Programa Nacional de Suplementação de Vitamina A em crianças de Alagoas, identificar fatores associados a essa cobertura e analisar a adequação das ações das ações de educação nutricional.

          Métodos

          Inquérito domiciliar que envolveu amostra probabilística representativa das crianças de 6 a 59 meses de Alagoas e suas mães (n = 509). A cobertura foi definida pelo percentual de crianças com registro de suplementação no último semestre. A associação entre as variáveis independentes (socioeconômicas, demográficas e de saúde) e a cobertura do Programa Nacional de Suplementação de Vitamina A foi analisada com base na razão de prevalência e seu IC95%. O conhecimento das mães sobre questões relacionadas à vitamina A foi assumido como indicador da adequação das ações de educação nutricional.

          Resultados

          A cobertura do programa foi de 91,9% entre crianças de 6-11,9 meses e de 38,6% entre as de 12-59 meses. Na análise ajustada, os fatores que se associaram à maior cobertura foram ter idade entre 6-11,9 meses (RP = 2,50; IC95%: 2,10-2,96), residir em zona rural (RP = 1,45; IC95%: 1,20-1,76) e morar em domicílio com ≤ 4 cômodos (RP = 1,33; IC95%: 1,09-1,63). Somente 26,1% das mães souberam citar algum alimento fonte de vitamina A e apenas 19,2% conheciam as consequências da deficiência dessa vitamina para a saúde.

          Conclusões

          A cobertura do Programa Nacional de Suplementação de Vitamina A encontra-se aquém das metas estabelecidas pelo Ministério da Saúde (exceto para crianças < 12 meses). Os fatores associados à maior cobertura evidenciam adequada focalização do programa. As atividades de educação nutricional não ocorrem de forma satisfatória. Essas informações devem nortear ações de aperfeiçoamento do programa.

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          Most cited references24

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          The quality of care. How can it be assessed?

          Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known.
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            Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys.

            Vitamin A deficiency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6-59 months. We aimed to estimate trends in the prevalence of vitamin A deficiency between 1991 and 2013 and its mortality burden in low-income and middle-income countries.
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              Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age.

              Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence.
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                Author and article information

                Contributors
                Journal
                J Pediatr (Rio J)
                J Pediatr (Rio J)
                Jornal de Pediatria
                Elsevier
                0021-7557
                1678-4782
                12 October 2018
                Mar-Apr 2020
                12 October 2018
                : 96
                : 2
                : 184-192
                Affiliations
                [a ]Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Programa de Pós-Graduação em Nutrição, Maceió, AL, Brazil
                [b ]Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Pós-Graduação em Epidemiologia, Maceió, AL, Brazil
                [c ]Universidade Federal do Amazonas (UFAM), Instituto de Saúde e Biotecnologia/Coari, Ciências da Saúde - Curso de Nutrição, Manaus, AM, Brazil
                [d ]Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Saúde da Criança e do Adolescente, Maceió, AL, Brazil
                Author notes
                [* ]Corresponding author. haroldo.ufal@ 123456gmail.com
                Article
                S0021-7557(18)30542-4
                10.1016/j.jped.2018.08.006
                9432251
                30321494
                de1ec3d1-5f09-4cbd-88b9-2e603dd1b759
                © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 6 May 2018
                : 15 August 2018
                Categories
                Original Article

                public health,vitamin a,supplementation,health evaluation,brazil,saúde pública,vitamina a,suplementação,avaliação em saúde,brasil

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