Malnutrition and associated factors among quilombola children under 60 months of age in two cities of the state of Maranhão, Brazil

Silveira, Victor Nogueira da Cruz; Padilha, Luana Lopes; Frota, Maria Tereza Borges Araújo

doi:10.1590/1413-81232020257.21482018

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ARTICLE • Ciênc. saúde coletiva 25 (7) • July 2020 • https://doi.org/10.1590/1413-81232020257.21482018 copy

Malnutrition and associated factors among quilombola children under 60 months of age in two cities of the state of Maranhão, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To evaluate the prevalence of malnutrition in children under 60 months of age living in quilombo remnant communities of two municipalities in the state of Maranhão and their associated factors. Methods: This is a cross-sectional study conducted with a sample of 372 children in August 2015. Socioeconomic, demographic, maternal and child information were collected. The anthropometry followed the one proposed by the World Health Organization. Height-for-age and weight-for-height rates were calculated using Anthro software version 3.2.2. Poisson regression was performed with a robust variance for the association of malnutrition with the studied variables, using Stata software version 14.0. Results: Child malnutrition was high for height-for-age (15.1%) and weight-for-height (7%). Children whose mothers had a short height (< 1.497 m) were more likely to have height-for-age deficits (p < 0.05). No variables were statistically associated with low weight-for-height. Conclusion: Child malnutrition persists as a public health problem in vulnerable regions, and maternal factors such as low maternal height may explain the short stature of the children. The need for actions to address this nutritional deviation is pointed out.

Key words
Preschoolers; Child malnutrition; Black people

Variables/categories	n	%
Child's gender
Male	182	48.92
Female	190	51.08
Head of the household's gender
Male	180	48.39
Female	192	51.61
Head of household's schooling
0 - 4 years	191	51.34
> 4 years	160	43.01
No information	21	5.65
Head of household's work relationship
Not working	74	19.89
Retired	15	4.03
Informal	242	65.05
Formal	40	10.75
No information	01	0.27
Household income
< 1 minimum wage	266	71.51
≥ 1 minimum wage	102	27.42
No information	04	1.08
Family Grant Program
Yes	307	85.53
No	07	1.88
No information	58	15.59
Brazil's Economic Classification Criteria
Class C	32	8.60
Class D	171	45.97
Class E	148	39.78
No information	21	5.65
Sanitary sewage
Public network / Septic tank	42	11.35
Rudimentary cesspit / Ditch / Open-air	328	88.65
No information	02	0.54
Water origin
Public network	18	4.84
Well / Water-hole / Claypit / Water truck	354	95.16
Water treatment
With treatment	178	47.85
Filtered or without treatment	194	52.15
Total number of people living at home
1 - 5 people	242	65.05
6 or more people	130	34.95
Waste disposal
Urban collection	01	0.27
Burned / Buried	347	93.28
Open-air dumping	24	6.45
Total	372	100.00

Variables / categories	N	%
Maternal age
> 19 years	319	85.75
≤ 19 years	53	14.25
Self-referred maternal skin color
White	16	4.30
Brown / Black	354	95.16
No information	02	0.54
Maternal height (n=248)
1º (1.415 - 1.497m)	127	34.14
2º (1.497 - 1.533m)	121	32.53
3º (1.533 - 1.67m)	124	33.33
Maternal BMI
Underweight	20	5.38
Eutrophy	191	51.34
Overweight	83	22.31
Obesity	49	13.17
No information*	29	7.80
Family Health Strategy
Yes	60	16.13
No	309	83.06
No information	03	0.81
Community Health Worker's visit
Yes	334	89.78
No	38	10.22
Total breastfeeding
Yes	365	98.12
No	06	1.61
No information	01	0.27
Exclusive breastfeeding
Did not receive food before 6 months	228	61.29
Received food before 6 months	115	30.91
No information	29	7.80
Birth weight (n = 317)
< 2500 g	36	9.68
≥ 2500 g	281	75.54
No information	55	14.78
Diarrhea in the last two weeks
Yes	327	87.90
No	45	12.10
Cough
Yes	190	51.08
No	182	48.92
Total	372	100.00

Variables / categories	Height-for-age deficit
Variables / categories	%	Crude PR	p	Adjusted PR	p
Socioeconomic and demographic factors
Child's gender
Male	50.0	0.95	0.844
Female	50.0	1
Child's age
< 24 months	51.8	0.68	0.111	0.65	0.080
≥ 24 months	48.2	1		1
Head of the household's gender
Male Female	39.3 60.7	1 1.44	0.150	1 1.35	0.276
Household income
<1 minimum wage	73.2	1.05	0.866
≥1 minimum wage	26.8	1
Social Class
Class C	1.9	0.16	0.071	0.20	0.115
Class D	45.3	0.73	0.231	0.66	0.101
Class E	52.8	1		1
Maternal schooling
0-4 years	41.1	0.74	0.235
> 4 years	58.9	1
Access to services and housing conditions
Sanitary sewage
Public network/Septic tank	3.6	1	0.077	1
Rudimentary cesspit/Ditch	96.4	3.46		2.49	0.201
Water supply
Public network	3.6	1	0.638
Well/water-hole/clay pit/water truck	96.4	1.37
Drinking water treatment
Treated	41.1	1	0.265
Filtered or untreated	58.9	1.37
Total number of people in the residence
1-5 people	60.7	1	0.432
6 or more people	39.3	1.22
Maternal factors
Maternal age
≤ 19 years	8.9	0.59	0.217
> 19 years	91.1	1
Maternal height (tertile)
1º (1.415 - 1.497m) 2º (1.497 - 1.533m)	60.7 25.1	4.18 1.78	<0.001	4.08 1.73	<0.001
3º (1.533 - 1.67m)	14.3	1		1
Maternal BMI
Underweight	7.8	2.45	0.418
Eutrophy	54.9	1.80
Overweight	29.4	2.21
Obesity	7.8	1
Healthcare and nutrition
Family Health Strategy - ESF
Yes	16.1	1	0.985
No	83.9	1.00
Community Health Worker's visit
Yes	92.9	1	0.410
No	7.1	0.68
Breastfeeding
Yes	98.2	1	0.898
No	1.8	1.13
Exclusive breastfeeding
Yes	66.7	1	0.974
No	33.3	1.00
Characteristics of birth
Birth weight
< 2500 g ≥ 2500 g	18.2 81.8	1.74 1	0.124	0.94 1	0.937
Child's morbidity
Diarrhea in the last two weeks
Yes No	17.9 82.1	1.58 1	0.151	1.49 1	0.193
Cough in the last two weeks
Yes	46.4	0.92	0.717
No	51	1
Fever in the last two weeks
Yes	46.2	1.72	0.130	1.42	0.396
No	53.8	1		1

Variables / categories	Weight-for-height deficit
Variables / categories	%	Crude PR	p	Adjusted PR	p
Socioeconomic and demographic factors
Child's gender
Male	53.9	0.81	0.594
Female	46.1	1
Child's age
< 24 months	23.1	1		1
≥ 24 months	76.9	2.41	0.052	2.34	0.090
Head of the household's gender
Male Female	50 50	1 0.93	0.853
Household income
<1 minimum wage	76.9	1.28	0.581
≥1 minimum wage	23.1	1
Social Class
Class C	3.8	0.35	0.308
Class D	46.2	0.79	0.548
Class E	50	1
Maternal schooling
≤ 4 years	53.8	0.91	0.825
> 4 years	46.2	1
Access to services and housing conditions
Sanitary sewage
Public network/Septic tank	3.8	1
Rudimentary cesspit/Ditch	96.2	3.2	0.247
Water supply
Public network	3.8	1	0.807
Well/water-hole/clay pit/water truck	96.2	1.27
Treated	46.2	1
Filtered or untreated	53.8	1.07	0.847
Total number of people in the residence
1-5 people	57.7	1
6 or more people	42.3	1.38	0.398
Maternal factors	42.3	1.38	0.398
Maternal factors
Maternal age
≤ 19 years	88.5	0.78	0.681
> 19 years	11.5	1
Maternal height (tertile)
1º (1.415 - 1.497m) 2º (1.497 - 1.533m)	53.9 26.9	1.39 0.82	0.045 0.528	2.33 0.78	0.102 0.707
3º (1.533 - 1.67m)	19.2	1		1
Maternal BMI
Underweight	18.2	2.45	0.172	1.61	0.469
Eutrophy	50	0.71	0.541	0.64	0.438
Overweight	13.6	0.44	0.273	0.39	0.195
Obesity	18.2	1		1
Healthcare and nutrition
Family Health Strategy - ESF
Yes	24	1
No	76	0.60	0.260
Community Health Worker's visit
Yes	88.4	1
No	11.6	1.14	0.821
Aleitamento materno exclusivo
Sim	66.7	1
Não	33.3	0.98	0.975
Characteristics of birth
Birth weight
< 2500 g ≥ 2500 g	15 85	1.37 1	0.599
Child's morbidity
Diarrhea in the last two weeks
Yes No	19.2 80.8	1 1.72
Cough in the last two weeks
Yes	42.3	1
No	57.7	0.77	0.495
Fever in the last two weeks
Yes	27.3	1
No	72.7	0.75	0.672

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[1] Collaborations

VNC Silveira worked on the interpretation of the data writing of the article and approval of the version to be published. MTBA Frota worked on the design, critical review of the work and approval of the version to be published. LL Padilha worked on data analysis, critical review of the work and approval of the version to be published.