Evaluation of impact of the National Program of Iron Supplementation on non anemic infants, Viçosa, MG / Avaliação do impacto do Programa Nacional de Suplementação de Ferro em lactentes não anêmicos,Viçosa, MG

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The limited success of prophylaxis programs of iron deficiency anemia on infants force to the need of programs evaluation researches in order to improve health public policies related to that lack. On this way, this work aimed to evaluate the impact of the National Program of Iron Supplementation on non anemic infants from 6 to 18 months of age (PNSF) attended by Family Health Teams (ESF) of Viçosa, MG. It was carried out a study of population in a prospective, qualitative and quantitative approach with prophylactic intervention. The evaluation took place in the beginning of the study and six months later, in which hemoglobin dosage (portable B- Hemoglobinometer) were accomplished besides an anthropometric and dietetic test and a socioeconomic survey were applied. An interview was given by mothers/responsible person who had children supplemented by PNSF and were helped by those ESF health professionals who coordinate the program. Mothers interviews were recorded first and transcriptd later. It was utilized a content analysis of Bardin (1977) and Minayo (2006) to verify the reports. The impact indicators used were: anemia incidence, hemoglobin average, side effects and adherence to the supplements. The statistical analysis was made using the software EPI INFO version 6.04, SPSS version 15.0. The level of nullity hypothesis rejection was 0.05. The anemic children were put on the way to get medical assistance, being excluded from this study. The non anemic children were divided in two supplementation groups: - dosage established by PNSF - 25mg iron/week, dosage recommended by the Brazilian Society of Pediatrics (SBP) - 1mg iron/kg of weight/day. Among 327 children evaluated initially, 227 non anemic were selected, which corresponds to 40.5% of children registered and attended by ESF of municipality. From this total, 133 children were supplemented by PNSF and 94 remaining by SBP. As for impact of PNSF, it was observed low adhesion to supplementation, because only 51.9% of children had completed the study, besides high incidence of anemia for the group with low (55.6%) and for the high adhesion (39.2). Compared to mothers/responsible persons for children with high adhesion (5.9%), a higher percentage of mother/responsible person for children with low adhesion to PNSF did not report any preventive action related to anemia (20.5%); low percentage of mothers/responsible person knew ferrous sulphate was a way to prevent anemia (7.8% for group with high adhesion and 5.1% for group with low adhesion). As main reasons for interrupting supplementation precociously, there were lack of orientation and follow up directly from health service (42.9%). As to PNSF implantation, it was observed lack of competence and sensitiveness from part of professionals and mothers regarding the program and anemia; moreover failure on monitoring/following up by professionals. A comparison between the group of children supplemented by SBP (n=94) and by PNSF (n=133) showed homogeneity as for economical, biological and healthy variables previous to the intervention. After six months of the first evaluation, it was observed higher average of hemoglobin for group SBP, when it is compared to the PNSF group (11.66 +- 1.25 and 10.95+- 1.41, respectively, p=0.014) besides lower incidence of anemia (20.59% and 43.48%, respectively, p=0.023). As for the variables adherence to supplement, side effects and severe anemia, significant differences were not observed. The PNSF implantation showed operational problems that reduced the impact produced by itself such as insufficiency of established dosage, professionals not well prepared to promote health education, work as a team and monitor/follow the program. The daily dosage recommended by SBP showed to be more effective to prevent anemia on infants as compared to that dosage utilized by PNSF. It is suggested a review of the weekly dosage recommended by PNSF, better information to mothers/responsible and professionals regarding anemia prevention, as well as a follow up by health professionals as routine, including the perception of people involved on iron supplementation to get part in scheming, monitoring and evaluation processes of programs in order to improve impact of intervention.

ASSUNTO(S)

nutricao iron deficiency anemia anemia ferropriva programa saúde da família sulfato ferroso lactentes infants family health program

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