Health inequalities: child development in different social groups

A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis.

Results:

The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone.

Conclusion:

The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.

DESCRIPTORS
Child Development; Child Health; Health Status Disparities; Social Determinants of Health; Primary Care Nursing

Variables		Total (n=348)		ACDM (n=101)		P-Value ^† † Chi-squared Test.
Variables		n	%	n	%	P-Value ^† † Chi-squared Test.
Social Block
Social Groups						0.04
	SG1	70	20.1	12	11.9
	SG2	141	40.5	43	42.6
	SG3+4	137	39.4	46	45.5
Income transfer program						0.09
	No	275	79.0	74	73.3
	Yes	73	21.0	27	26.7

Variables		Total (n=348)		AMDI (n=101)		Valor p ^† † Chi-squared Test.
Variables		n	%	n	%	Valor p ^† † Chi-squared Test.
Maternal/paternal Block
Age range of the father ^* * Variables with losses; (years)						0.44
	<30	139	49.1	36	44.4
	30-39	106	37.5	35	43.2
	≥40	38	13.4	10	12.4
Education of the father ^* * Variables with losses; (years)						0.98
	<8	71	24.5	20	24.4
	≥8	219	75.5	62	75.6
Age range of the mother ^* * Variables with losses; (years)						0.23
	<20	43	12.8	7	7.2
	20-29	174	51.9	52	53.6
	≥30	118	35.2	38	32.2
Education of the mother ^* * Variables with losses; (years)						0.18
	<8	77	22.4	27	28.0
	≥8	267	77.6	73	72.0
Mother works out of the home ^* * Variables with losses;						0.61
	No	212	61.4	60	59.4
	Yes	133	38.6	41	40.6
No. of children						0.22
	1	147	42.2	38	37.6
	2	106	30.5	29	28.7
	≥3	95	27.3	34	33.7
Pre-natal care and delivery Block
No. of pre-natal care appointments ^* * Variables with losses;						0.86
	<6	33	9.6	10	10.0
	≥6	312	90.4	90	90.0
Delivery type ^* * Variables with losses;						0.44
	Vaginal	163	47.2	50	50.5
	Cesarean	182	52.8	49	49.5

Variables		Total (n=348)		ACDM (n=101)		P-Value ^† † Chi-squared Test.
Variables		n	%	n	%	P-Value ^† † Chi-squared Test.
Child Block
Age range ^* * Variables with losses; (months)						<0.001
	<12	211	60.63	35	16.59
	≥12	137	39.37	66	48.18
Gender						0.97
	Female	158	45.4	46	45.5
	Male	190	54.6	55	54.5
Birthweight						0.03
	<2500g	42	12.1	18	17.8
	≥2500g	306	87.9	83	82.2
Attends Daycare ^* * Variables with losses;						0.83
	No	301	86.7	87	86.1
	Yes	46	13.3	14	13.9
Hospitalization in the last 12 months ^* * Variables with losses;						0.02
	No	305	88.4	83	82.2
	Yes	40	11.6	18	17.8
Breastfeed						<0.001
	No	160	46.0	63	62.4
	Yes	188	54.0	38	37.6
Current nutritional status ^* * Variables with losses;						0.24
	Eutrophic	209	61.5	67	66.3
	Low weight	24	7.0	6	5.9
	Overweight	107	31.5	25	27.8

Variables		Univariate Analysis^‡ ‡ Logistic regression.		Final Multiple Analysis^‡ ‡ Logistic regression.
Variables		OR (95% CI)	P>\|z\|	OR (95% CI)	P>\|z\|
1 - Social Block
Social Groups
	SG1	1		1
	SG2	2.12(1.03-4.34)	0.04	2.37(1.05-5.35)	0.03
	SG3+4	2.44(1.19- 4.99)	0.01	2.64(1.18- 5.91)	0.01
2 - Maternal/paternal Block
Age range of the mother ^* * Variables with losses; (years)
	<20	1		1
	20-29	2.19(0.91-5.24)	0.07	2.04(0.78-5.31)	0.14
	≥30	2.44(0.99-5.99)	0.05	1.17(0.39-3.45)	0.19
3 - Pre-natal care and delivery Block
No. of pre-natal appointments ^* * Variables with losses;
	≥6	1		1
	<6	1.07(0.38-1.85)	0.18	0.75(0.31-1.82)	0.53
4 - Child Block
Age range (months) ^* * Variables with losses;
	<12	1		1
	≥12	4.67(2.85-7.65)	<0.001	4.17(2.45-7.08)	<0.001
Current nutritional status ^* * Variables with losses;
	Eutrophic	1		1
	Low weight	0.70(0.26-1.86)	0.48	0.70(0.21-2.36)	0.57
	Overweight	0.64(0.37-1.10)	0.10	0.64(0.35-1.16)	0.14

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Clariana Vitória Ramos de Oliveira, 6 Arizona Terrace Arlington/Massachusetts, United States Zipcode 02474 clarivitoria@gmail.com

Brasil

Brasil

Health inequalities: child development in different social groups* * Extracted from the thesis: “Avaliação do Desenvolvimento Infantil com Foco nos Determinantes Sociais”, Escola de Enfermagem, Universidade de São Paulo, 2018.

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Health inequalities: child development in different social groups^* * Extracted from the thesis: “Avaliação do Desenvolvimento Infantil com Foco nos Determinantes Sociais”, Escola de Enfermagem, Universidade de São Paulo, 2018.