Low Maternal Schooling Research Articles

Factors associated to fetal death in Cuiabá, Mato Grosso

Abstract Objectives: to investigate the causes and the factors associated to fetal death in Cuiaba, Mato Grosso, 2006-2010. Methods: a population based case-control study in a ratio of 1:3 (300:900), was based on secondary data on Live Births and Mortality Information Systems. A hierarchical logistic regression was used. Results: remains independently associated to fetal death: low maternal schooling (OR=1.58, CI95%=1.02;2.47), low weight (OR=5.59, CI95%=3.22;9.70) gestational age <37 weeks (OR=9.34, CI95%=5.38;16.21), previous fetal death (OR=6.65, CI95%=4.35;10.15). The type of cesarean delivery remained as a protective factor (OR=0.35, CI95%=0.24;0.54). The main causes of fetal deaths were by unspecified cause (15.4%), followed by maternal hypertensive disorders (14.7%). The fetal mortality rate (TMF) decreased from 10.0 in 2006 to 7.5 deaths per thousand births in 2010 (decreased 24.5%). The TMF during the study period was below the goal set for 2030 by the World Health Organization. Conclusions: approximately one third of fetal deaths causes were potentially avoidable. Factors such as low maternal schooling, low birth weight, prematurity and previous fetal death history constitute as main determinants for fetal deaths in Cuiaba and suggests that socioeconomic situation still determines quality care for pregnant women and that actions should be directed to improve prenatal care.

Correlates of self-reported weekday sleep duration in adolescents: the 18-year follow-up of the 1993 Pelotas (Brazil) Birth Cohort Study

ObjectiveTo investigate factors associated with sleep duration in adolescence. MethodsData are from the 1993 Pelotas Birth Cohort Study of 5249 live births. Of these individuals, 4563 were located for follow-up at 18 years of age, and 4106 agreed to be interviewed (follow-up rate 81.3%). Sleep duration was continuously assessed by survey as hours per weekday. Additional covariates were collected during the perinatal period and at the 11- and 18-year follow-ups. Linear regression models were used to estimate associations between sleep duration and its hypothesized influences. All analyses were sex-stratified. ResultsThe average sleep duration among participants was 8.4 hours (standard deviation 1.9). Longer sleep duration at 18 years of age was associated with the following perinatal factors: low maternal schooling, low family income, maternal black skin color, and low birth weight; and with the following factors measured at 18 years of age: being out of school, low achieved schooling, low family income, absence of depressive symptoms, and high screen time. ConclusionSocial and demographic variables may play an important role in determining adolescents' sleep duration, but the nature of these relationships in Brazil may differ from those observed in higher-income contexts.

Maternal Psychosocial and Environmental Factors Associated With Infant Impaired Development in Sao Paulo, Brazil: A Population-Based Birth Cohort Study

Background: Early life experiences have important consequences on health and human capital throughout life. The development is the result of interaction between the child's biological characteristics and cultural and social factors on which it is inserted. Biological factors that cause developmental delay associated with environmental factors increase the chance of the infant having an inappropriate development. This shows the importance of studies assessing factors related to child development. Objective: The aim was to characterize the neurological development of children 6-8 months ago through the Bayley scale in a population-based sample, then estimate the prevalence of delay and identifying psychosocial and environmental risk factors. Method: A longitudinal epidemiological study of birth cohort study in a group of 368 infants and their mothers. Two moments of assessment were considered: a) at the beginning of the third trimester of gestation and b) when the infants were 6-8 months of age. The study aims to examine the neurological development of the children considered for the study through the Bayley scale, to estimate the prevalence of delay in a population-based sample and, finally, to identifying maternal psychosocial and environmental risk factors. Results: Indicated that maternal stress factors (i.e. anxiety and substance disorder during pregnancy, lower maternal schooling and economic class) were associated with lower cognitive development in infants. Conclusion: This study shows the importance of screening to identify possible developmental delays, for subsequent intervention programs to prevent or minimize future hazards and allow the child to develop to their full potential.

Adverse childhood experiences: Prevalence and related factors in adolescents of a Brazilian birth cohort

Adverse childhood experiences (ACEs) can affect people's health and wellbeing not only at the time the ACE is experienced, but also later in life. The majority of studies on ACEs are carried out in high-income countries and little is known about its prevalence in low and middle-income countries. Thus, the aim of this study was to assess the prevalence of ACEs, associations between ACEs and sociodemographic factors, and the interrelationship between types of ACEs in adolescents of a Brazilian birth cohort. Data from 3,951 adolescents (78.4% of the original cohort) from the 1993 Pelotas Cohort were analyzed. Seven types of ACEs were assessed in those up to 18 years old: physical abuse, sexual abuse, physical neglect, emotional neglect, domestic violence, parental separation and parental death. The most common ACE was parental separation (42%), followed by emotional neglect (19.7%) and domestic violence (10.3%). Approximately 85% of the adolescents experienced at least one ACE, and females reported a higher number of adversities. Several socioeconomic, demographic and family-related characteristics were associated with the occurrence of ACEs, e.g. non-white skin color, low family income, low maternal schooling, absence of mother's partner, maternal smoking, and poor maternal mental health. A strong interrelationship was observed among the ACEs, indicating clustering of risk. These aspects should be considered by health and social care professionals in the prevention and identification of childhood adversities.

The Role of School Social Environment on Dental Caries Experience in 8- to 12-Year-Old Brazilian Children: A Multilevel Analysis

Aim: Although children spend most of their time involved in activities related to school, few studies have focused on the association between school social environment and oral health. This cross-sectional study assessed individual and school-related social environment correlates of dental caries in Brazilian schoolchildren aged 8-12 years. Methods: A sample of children from 20 private and public schools (n = 1,211) was selected. Socio-economic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire. Dental examinations were performed to assess the presence of dental plaque: dental caries experience (DMFT ≥1) and dental caries severity (mean dmf-t/DMF-T). The social school environment was assessed by a questionnaire administered to school coordinators. Multilevel Poisson regression was used to investigate the association between school social environment and dental caries prevalence and experience. Results: The dental caries prevalence was 32.4% (95% confidence interval: 29.7-35.2) and the mean dmf-t/DMF-T was 1.84 (standard deviation: 2.2). Multilevel models showed that the mean dmf-t/DMF-T and DMFT ≥1 were associated with lower maternal schooling and higher levels of dental plaque. For contextual variables, schools offering after-hours sports activities were associated with a lower prevalence of dental caries and a lower mean of dmf-t/DMF-T, while the occurrence of violence and theft episodes was positively associated with dental caries. Conclusions: The school social environment has an influence on dental caries in children. The results suggest that strategies focused on the promotion of healthier environments should be stimulated to reduce inequalities in dental caries.

Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil.

IntroductionVaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.MethodsA census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.ResultsOnly 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95).ConclusionsThis study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

Inadequate prenatal care utilization and associated factors in São Luís, Brazil.

BackgroundOver the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98.MethodsData from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen’s behavioral model of the use of health services: predisposing, enabling and need factors.ResultsOnly 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization.ConclusionsDespite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.

Variables associated with cognitive, behavioral and emotional development: a cohort of schoolchildren

This study aimed to identify possible variables associated with cognitive, behavioral and emotional development in a cohort of school children, based on biological (sex, gestational age and birth weight) and socioeconomic variables (marital status, maternal and paternal education, occupation of head of household, socioeconomic status, and number of household members). We evaluated 790 children born in a cohort of Ribeirão Preto (SP), Brazil, with 10/11 years of age. The Raven Test was used for cognitive assessment and the Strengths and Difficulties Questionnaire was utilized for emotional and behavioral assessment. By means of multivariate logistic regression analysis (CI 95%) we found that: 1) low maternal schooling was associated with behavioral and emotional problems and poor cognitive function, 2) being female was considered as a protective factor against behavioral problems and 3) low birth weight and prematurity were not associated with the outcomes investigated.

Fatores associados à hipovitaminose A em crianças menores de cinco anos

OBJETIVOS: identificar os fatores associados à hipovitaminose A em crianças da região semiárida de Alagoas. MÉTODOS: estudo transversal com amostra probabilística de 551 crianças menores de cinco anos. Os níveis séricos de retinol foram aferidos usando-se cromatografia líquida de alta eficiência. Na identificação da associação entre as variáveis independentes e hipovitaminose A (retinol <20 µg/dL) utilizou-se a razão de prevalência (RP) e respectivo IC95% calculados por regressão de Poisson com ajuste robusto da variância, tanto na análise bruta quanto na ajustada. Nesta, foram incluídas todas as variáveis que naanálise bruta atingiram p<0,1. Associações foram consideradas estatisticamente significantes quando p<0,05. RESULTADOS: a prevalência de hipovitaminose A foi de 45,4% e as variáveis que se mantiveram associadas após análise multivariável foram a baixa escolaridade materna (RP=1,66; IC95%: 1,12-2,44), obaixo peso ao nascer (RP=1,41; IC95%: 1,01-1,98) eter de 12,1 a 24 meses (RP=1,45; IC95%: 1,04-2,02). CONCLUSÕES: evidencia-se a relevância epidemiológica da hipovitaminose A em crianças do semiárido alagoano. Crianças nascidas com baixo peso, com mães de baixa escolaridade e no segundo ano de vida devem receber atenção prioritária.

Seroprevalence and risk factors for Toxocara infection in children from an urban large setting in Northeast Brazil

ObjectivesThis study aimed to standardize an “in house” immunoassay to detect anti-Toxocara IgG antibodies in human serum to estimate the seroprevalence of Toxocara infection, and to identify its potential risk factors in children living in poor areas of Salvador, a large northeastern Brazilian city. MethodsParents of 1309 children answered a questionnaire containing possible risk factor for acquisition of this infection. Blood was collected and the presence of anti-Toxocara IgG antibodies was detected by indirect ELISA using T. canis larval excretory–secretory antigens in sera previously absorbed with Ascaris lumbricoides antigens. ResultsSeroprevalence of Toxocara infection was 48.4%. Children's age, low maternal schooling, contact with dogs and cats, and household located in paved streets were shown to be risk factors for Toxocara infection. ConclusionsThe seroprevalence of Toxocara infection is high among children living in a poor urban setting of Brazil. The association of low maternal education with higher Toxocara infection supports studies showing that low socioeconomic status is a risk factor for the acquisition of this infection as a reflection of hygiene habits of the family. And both infected-dogs and cats may be involved in this parasite transmission in this children population.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition.

BackgroundAnemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the country. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil.MethodsThe survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.ResultsEvaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.ConclusionsThe prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

Escolaridade e padrões de ganho de peso na vida adulta no Brasil: Estudo Pró-Saúde

The aim of the present study was to investigate the association between participant and parental educational status (considered as an indicator of socioeconomic status) and participant pattern of weight gain in adulthood. We analyzed data from 2 582 baseline participants (1999) of Estudo Pró-Saúde (Pro-Health Study), a longitudinal investigation of civil servants from a public university in Rio de Janeiro, Brazil. Self-administered questionnaires were used to identify patterns of weight gain in adulthood. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated for the association between parental and participant educational status and steady weight gain or weight cycling, with stable weight as a reference, using multinomial logistic regression models. For males, lower paternal educational level entailed a chance about 55% lower of weight cycling as compared to stable weight (OR = 0.45; IC95% = 0.26-0.78), whereas lower maternal schooling was related to increased risk of weight cycling, although without reaching statistical significance (OR = 1.68; IC95% = 0.94-3.00). The association between participant educational status and weight history was not statistically significant among men. In women, lower educational status entailed a chance 94% higher of self-reported weight cycling (OR = 1.94; 95% CI = 1.17-3.23), and there was no association between parental educational level and history of weight gain. In this study, changes in weight throughout life, both steady and cyclic, were associated with parental and participant educational status, with major differences between genders.

Risk factors for infant mortality in a municipality in southern Brazil: a comparison of two cohorts using hierarchical analysis

This study compared risk factors for infant mortality in 2000-2001 and 2007-2008 in Londrina, Paraná State, Brazil. Data on live births and infant deaths were linked in a single database, and a hierarchical regression model was used. Distal risk factors for infant mortality in 2000-2001 were maternal age < 20 or ≥ 35 years and lower maternal schooling. In 2007-2008, maternal age ≥ 35 or < 20 years were risk factors, while low schooling appeared as a protective factor. The following intermediate factors were associated with increased infant mortality in 2000-2001: multiple pregnancy, history of stillbirth, and insufficient number of prenatal visits, while cesarean delivery was a protective factor. Multiple pregnancy was the only intermediate risk factor in 2007-2008. All of the proximal factors were associated with higher infant mortality in 2000-2001, but only gestational age and 5-minute Apgar in 2007-2008. The risk factors for infant mortality changed from the first to the second cohort, which may be related to the expansion of social policies and primary care and changes in the reproductive and social patterns of Brazilian women.

All by Myself? Independence and Coordination During Distress Episodes from 14 to 24 Months Among Latino Children

Growing research suggests that socialization toward independence with a focus on ‘separate individuality’ may be a culture specific rather than universal socialization goal. Among Latino families, children of mothers high in formal schooling have shown more independent and less coordinated patterns of interaction than children of mothers low in formal schooling. This longitudinal research explored the balance between independence and coordination during mother–child interaction around distress by examining age-related changes and within-group variation among Latino children. Fifty Latino dyads were videotaped during unstructured interactions in their homes at 14 and 24 months of age. Episodes of distress were identified and then classified according to individual contributions and coordination (e.g. [child] independent, mother-led, coordinated). Coordinated and independent resolutions were the most frequent type at both ages. To examine the balance between these for each child, a proportion of episodes resolved in each type was calculated. Children in both groups (high maternal schooling, low maternal schooling) increased in coordination, but only children with higher maternal schooling also increased in independent resolutions. Copyright © 2012 John Wiley & Sons, Ltd.

Prevalência de retenção escolar e fatores associados em adolescentes da coorte de nascimentos de 1993 em Pelotas, Brasil

To evaluate the occurrence of grade retention until 11 years of age and the factors associated with retention. This prospective study included 4 452 adolescents from the 1993 city of Pelotas birth cohort (state of Rio Grande do Sul, Brazil). This sample represents 87.5% of the original cohort. Grade retention was defined as the repetition of at least one school grade until the date of the interview. The following independent variables were analyzed: sex, skin color, birth weight, ownership of goods, age, maternal schooling, type of school (private, state, or city), age at school entry, and employment. The overall frequency of grade retention was 36.3%, vs. 42.8% for boys and 30.0% for girls. The adjusted analysis showed that the lower the level of maternal schooling, ownership of goods, and birth weight, the higher the risk of grade retention for both boys and girls. Black/brown adolescents, those studying in public schools, and those who were 7 years of age or older at school entry had a higher risk of grade retention. For boys, childhood labor was associated with grade retention. Low socioeconomic and low maternal schooling levels were the factors most strongly associated with grade retention. Strategies to reduce this situation must take into account demographic and socioeconomic characteristics.

A avaliação do desenvolvimento infantil: um desafio interdisciplinar

OBJETIVO: Avaliar o desenvolvimento de crianças de 2 meses a 2 anos de idade por meio da Atenção Integrada às Doenças Prevalentes na Infância (AIDPI), no contexto do Programa de Educação pelo Trabalho em Saúde (PET-Saúde). MÉTODO: Estudo transversal realizado com 122 crianças, com idades entre 2 meses e 2 anos, da área de abrangência do Centro de Saúde São Bernardo (CSSB) - Belo Horizonte (MG), em 2009. Os dados relativos ao desenvolvimento foram obtidos através da aplicação de dois questionários: AIDPI e Caderneta de Saúde da Criança (CSC). Foram comparadas as classificações do desenvolvimento pela AIDPI e pela CSC, a associação entre atraso do desenvolvimento e as variáveis estudadas. RESULTADOS: As características com maior frequência na população estudada foram a baixa escolaridade das mães (62,1%), seguida de parentes com deficiência mental (71,3%) e problemas na gestação (71,3%). A AIDPI evidenciou que 61,5% da população estudada encontra-se normal com fator de risco, 16,4% normal sem fator de risco, 11,5% com possível atraso e 10,7% com provável atraso do desenvolvimento infantil. A concordância observada entre a classificação da AIDPI e da CSC foi de 0,34, coeficiente Kappa igual a - 0,12 (p = 0,98). Não houve associação estatisticamente significativa entre as variáveis analisadas (frequenta creches; convívio com problemas emocionais; escolaridade da mãe; idade gestacional; e peso ao nascer) e atraso possível/provável do desenvolvimento identificado pela AIDPI. CONCLUSÃO: O PET-Saúde, como proposta de integração da educação pelo trabalho, permitiu uma oportunidade de convivência e troca de experiências entre alunos e profissionais de diferentes áreas de atuação, trabalhando em um projeto comum.

Dor dentária e fatores associados em adolescentes brasileiros: a Pesquisa Nacional de Saúde do Escolar (PeNSE), Brasil, 2009

The aim of this study was to assess the prevalence of dental pain and associated socio-demographic and behavioral factors in Brazilian adolescents, using data from the National School-Based Health Survey (PeNSE), Brazil, 2009. The survey was conducted by the Brazilian Institute of Geography and Statistics (IBGE) and Ministry of Health in students 11 to 17 years of age or older in the 27 State capitals, using a self-administered questionnaire. Analyses included Poisson regression following a hierarchical approach. Prevalence of dental pain in the sample (n = 54,985) in the previous six months was 17.8% (95%CI: 17.5-18.1). Higher prevalence was associated with female gender, age 14 years and over, racial self-identification as black, brown, or indigenous, enrollment in public schools, lower maternal schooling, not living with the mother, history of smoking or drinking, less frequent toothbrushing, and heavy consumption of sweets and soft drinks. Dental pain was thus associated with socio-demographic factors and health-related behaviors.

Ambiente domiciliar e alterações do desenvolvimento em crianças de comunidade da periferia de São Luís - MA

The main bonds of infants in early childhood are established in the home environment. The home is fundamental for providing stimuli that can influence the development of the child. A cross-sectional study was conducted in a low income community in the outskirts of the city of São Luís to analyze the provision of stimuli in the home environment of 2-year-old children and the potential association with retardation in child development. A random sample of 176 2-year-old children registered in community outpatient healthcare departments was assessed. Two validated instruments were used, namely the Home Observation for Measurement of the Environment (HOME) Inventory and the Gesell Measurement of Development Scale. Data were gathered in the homes. Logistic regressions were carried out taking the Home Inventory (low or average/high) and the Gesell Scale (suspicion of delay/normal) as outcome variables. Low family income, low maternal and paternal schooling, number of residents, number of children < 5 years old and small number of rooms in the house were considered risk factors for low Home scores, which were associated with the suspicion of development delay. The quality and quantity of environmental stimuli in the family context proved to be essential for the development of the children evaluated.

Child and adolescent labor and smoking: a cross-sectional study in southern Brazil

This cross-sectional study assessed the association between smoking and child and adolescent labor among 3,269 individuals 10 to 17 years of age in Pelotas, Rio Grande do Sul State, in southern Brazil (excluding higher income census tracts) in 1998. Adjusted hierarchical analysis was performed using Poisson regression. Prevalence of child labor was 13.8%. Current smoking prevalence was 6.3% in the sample as a whole (15.7% among working versus 3.4% among non-working children). In the multivariate analysis, smoking was significantly associated with child labor, with a prevalence ratio of 1.75 (95%CI: 1.30-2.36). Smoking was also associated with family characteristics (lower maternal schooling, mother currently without husband/partner, household members with alcohol or drug problems, single mother, and history of serious injuries), and the children's characteristics (age greater than 16 years, inadequate school performance, and externalizing behavior). The findings point to smoking as one of the harmful consequences of child labor and suggest the workplace as an appropriate target for smoking prevention.

This Month in Gastroenterology

This Month in Gastroenterology