Menu ENN Search

Treatment of undernutrition in urban Brazil

Summary of research1

In Brazil, 6% of children aged less than 5 years suffer from height-forage (HAZ) deficit, while the prevalence of this condition is higher (8.2%) among the poorest sector of the population. Moreover, the prevalence of HAZ and weight-for-age (WAZ) deficits among children in the 5-9 years age range is 6.8% and 4.1% respectively. In addition, population growth in the last three decades has been intense leading to massive urbanisation, competition for resources and urban poverty. This has led to increased violence, undernutrition and family breakdown. In order to tackle this problem, the Federal University of Sao Paolo created the Centre of Nutrition Recovery and Education (CREN) in 1994 with the objectives of developing: i) methodologies for the nutritional recovery of children with respect to weight and, in particular, stature and ii) approaches for direct intervention in the complex socioeconomic and familial situation of impoverished urban areas.

More than 1000 undernourished children are assisted annually by CREN in a day hospital (n=50), in an out-patient clinic (n=700) or directly in the community (n=300) depending on the degree of undernutrition and accessibility of the centre. Children accepted into the dayhospital regime originate either from impoverished communities or from public health units and comprise those who have been diagnosed with primary undernutrition and who cannot be rehabilitated in out-patient clinics or by home visits. The routine weekday schedule at CREN comprises five daily meals together with recreational and educational activities (including hygiene practices), sleeping time after lunch and periodic medical examinations. Sick children are treated as appropriate. Children receive protein-rich food as well as vitamin supplements and prophylactic doses of iron until they are 24 months old. Children are discharged and redirected to day nurseries or preschools after effective recovery from undernutrition, i.e. when the HAZ and WAZ parameters are normalised (zscore >-1). Weight-for-height z scores and mid upper arm circumference (MUAC) are not used.

A recently published study by researchers from CREN set out to build a life table and determine the factors related to the time of treatment of undernourished children at a nutritional rehabilitation centre in Sao Paolo. The subjects for the study were undernourished children (n=228) from the southern slums of Sao Paolo who had received treatment at CREN under a day hospital regime between the years of 1994 and 2009. The average age of the children at admission was 24.45 months.

Nutritional status was assessed from WAZ, HAZ and Body Mass Index (BMI)- for-age z-scores, while neuro-psycho motor development was classified according to the milestones of childhood development. Life tables, Kaplan-Meier survival curves and Cox multiple regression models were employed in data analysis. The Kaplan-Meier curves of survival analysis showed statistically significant differences in the periods of treatment at CREN between children presenting different degrees of neuropsychomotor development (log-rank = 6.621; P = 0.037). Estimates based on multivariate Cox model revealed that children aged = 24 months at the time of admission exhibited a lower probability of nutritional rehabilitation (hazard ratio (HR) = 0.49, P = 0.046) at the end of the period compared with infants aged up to 12 months. In spite of this, it was observed that increases in HAZ were greater than in WAZ. The positive effects were observed even in children aged =24 months at the time of admission, although the magnitude of such recovery was inferior to that shown by younger individuals. Children presenting slow development were better rehabilitated in comparison with those exhibiting adequate evolution (HR = 4.48; P = 0.023). The authors believe that the positive results obtained with children presenting with delayed neuro-psychomotor development are associated with greater severity of their nutritional condition, as well as their lower age at admission compared with the other group. No significant effects of sex, degree of undernutrition or birth weight on the probability of nutritional rehabilitation were found.

The authors concluded that age and neuro-psychomotor developmental status at the time of admission to CREN are critical factors in determining the duration of treatment. These findings demonstrate the importance of early nutritional recovery and indicate that the treatment should preferentially start before the age of 24 months. Linear catch-up has also been achieved for older children at CREN, but at a lower speed and after an extended period of treatment.

Show footnotes

1Fernandes M et al (2011). A 15 year study on the treatment of undernourished children at a nutrition rehabilitation centre (CREN), Brazil. Public Health Nutrition: 15 (6), pp 1108-1116

More like this

FEX: Relapse after treatment for moderate acute malnutrition: Risk factors and interventions to prevent it

Summary of presentation1 based on published research2 View this article as a pdf By Heather Stobaugh and Mark Manary Dr Heather Stobaugh has a PhD in Food Policy and Applied...

FEX: MUAC outperforms weight-based measures of nutritional status in children with diarrhoea

Summary of research1 Location: Bangladesh What we know: Undernutrition and diarrhoea often present concurrently in children. Weight is affected by hydration status; there is...

Resource: Full breastfeeding and hospitalization as a result of infections in the first year of life

Refernence: Paricio Talayero JM, Lizan-Garcia M, Otero Puime A, Benlloch Muncharaz MJ et al. Pediatrics. 2006 Jul;118(1):e92-99 Abstract OBJECTIVE. Our objective was to...

FEX: Follow-up of post-discharge growth and mortality after treatment for SAM in Malawi

Summary of research1 Location: Malawi What we know: There are limited data on long term outcomes following discharge from SAM treatment; what exists is largely pre-HIV....

FEX: WASH interventions and their effects on the nutritional status of children

Summary of research1 Location: Global What we know: Water, sanitation and hygiene (WASH) interventions are frequently implemented to improve health and reduce infectious...

FEX: WHO consultation on management of moderate malnutrition in U5s

The WHO, in collaboration with UNICEF, WFP and UNHCR, hosted a second consultation to discuss the programmatic aspects of the management of moderate malnutrition in children...

FEX: MUAC vs WHZ in predicting mortality in hospitalised children under five years of age

Summary of research1 This research contributes to the evidence base regarding which anthropometric indicators identify malnourished sick children most at risk of death. Low...

FEX: Antibiotics as part of the management of severe acute malnutrition

Summary of published research1 Mothers receive instruction on how to adminster antibiotics Location: Malawi What we know already: There is a high prevalence of clinically...

FEX: Nutritional rehabilitation of infants < 6 months with severe acute malnutrition

Summary of published research1 Location: India What we know: There is a significant burden of acute malnutrition in infants under 6 months of age in nutritionally vulnerable...

FEX: Improving screening for malnourished children at high risk of death

Research snapshot1 The purpose of this study was to investigate whether children with concurrent wasting and stunting (WaSt) require therapeutic feeding and to better...

FEX: Nutritional Status of HIV+ Pre-School Children in South Africa

Summary of unpublished research Nursing health professional doing clinical investigation at Livningstone Hospital By Liana Steenkamp, Dr Jill von der Marwitz, and Charlene...

FEX: Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+)

Summary of research * Location: Cameroon. What we know: A wide range of nutritional products are currently used to treat MAM; there is no definitive consensus on the most...

FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group

ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...

en-net: Use of "acute" for children >5 and adults

When referring to malnutrition among children >5 years old and adults, as measured by weight-for-height, BMI-for-age, BMI, MUAC, or nutritional edema, should the term "acute "...

FEX: Effect of nutrition survey ‘cleaning criteria’ on estimates of malnutrition prevalence and disease burden: secondary data analysis

Summary of research1 Location: Global What we know: Standardised methods for collection and reporting malnutrition prevalence data in nutrition surveys are used. What this...

FEX: Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition

Child eating BP100 in Freetown TFC. By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...

FEX: Relationships between wasting and stunting and their concurrent occurrence in Ghanaian pre-school children

Summary of research* Location: Ghana. What we know: Wasting is a short-term health issue, but repeated episodes may lead to stunting (long-term or chronic malnutrition). This...

FEX: Implementation of a field study of body composition among infants and young children in sub-Saharan Africa

View this article as a pdf By Ezekiel Mupere, John Mukisa, Lynnth Turyagyenda, Peace Aber, Luke S Uebelhoer, Celine Bourdon, Robert Bandsma, Emmanuel Chimwezi, Jonathan C...

en-net: Why do I need to adjust for age and sex of children again if z score calculation already involved gender and sex in its calculation?

Hello,

I have already z score using WHO anthropometric survey analyzer.

One question arised was that why do I need to still control for gender and age in my...

FEX: Deterioration of children with MAM who have no access to supplementary feeding programmes

James P, Sadler K, Wondafrash M, Argaw A, Luo H, Geleta B, et al. (2016) Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience...

Close

Reference this page

Treatment of undernutrition in urban Brazil. Field Exchange 44, December 2012. p29. www.ennonline.net/fex/44/treatment

(ENN_4334)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.