Introdução - A anemia é considerada um dos maiores problemas de saúde pública da atualidade, afetando as populações de quase todos os países, sobretudo aqueles onde predominam padrões dietéticos deficientes e fatores ambientais adversos. Objetivo - Investigar a prevalência e os fatores associados à anemia em crianças menores de cinco anos e mulheres em idade reprodutiva entre a população atendida pela Estratégia da Saúde da Família (ESF), no estado do Maranhão. Métodos Foi realizado um estudo de corte transversal de base populacional. A amostra se constitui de 978 crianças de seis a 59 meses e 978 mulheres de 15 a 49 anos de idade cadastradas na ESF em 21 municípios escolhidos por sorteio sistemático probabilístico entre as quatro macrorregiões e capital do Estado. A coleta de dados foi realizada em entrevistas domiciliares por meio de questionário aplicado junto às mães ou responsáveis pelas crianças, contendo informações sobre a situação socioeconômica e demográfica e de segurança alimentar da família, e das condições de saúde das mulheres e das crianças. Foram medidos peso e altura, para avaliação do estado nutricional e feita a dosagem da concentração de hemoglobina do sangue capilar com leitura imediata pelo hemoglobinômetro portátil Agabe®. A associação entre a anemia e as variáveis foi verificada primeiramente por análise bivariada e posteriormente por regressão de Poisson, segundo modelo hierarquizado. Resultados A prevalência média de anemia entre as mulheres foi de 36, por cento para o estado do Maranhão e 55,1 por cento para a capital, São Luís. Entre as crianças, a prevalência também foi mais elevada na capital (68,7 por cento ) em relação ao estado como um todo (51,6 por cento ). Tanto as mulheres como as crianças apresentaram prevalências mais elevadas na área urbana. O grupo de 6-23 meses de idade foi mais afetado pelo problema (65 por cento ) do que o de 24-59 meses (42 por cento ), assim como aquele cujas mães também apresentavam anemia (63,6 por cento ). A análise de regressão identificou como fatores de risco para a anemia em crianças ter idade inferior a dois anos, presença de anemia materna, coabitação de três ou mais crianças menores de cinco anos no domicílio e residir na capital do estado. Para as mulheres os fatores de risco associados à anemia foram morar na capital e estar acima do peso. Conclusões As elevadas prevalências de anemia encontradas em crianças e mulheres no Maranhão a configuram como um problema de saúde pública entre a população atendida pela ESF. É necessária a busca de intervenções factíveis de serem aplicadas uma vez que, tanto o Programa Nacional de Suplementação do Ferro, para lactentes, como o de fortificação das farinhas de trigo e de milho vigentes no Brasil não conseguiram fazer com que a prevalência avaliada através dos grupos crianças e mulheres em idade fértil esteja no limite aceitável. Igualmente há que considerar que dos fatores de risco detectados poucos são susceptíveis a modificação e estão relacionados ao consumo de alimentos e seus fatores determinantes / Introduction - Anemia is considered one of the greatest public health problems today, affecting populations of almost all countries, especially those where lacking dietary patterns and adverse environmental factors predominate. Objective - To investigate the prevalence and factors associated with anemia in children under five and women of childbearing age in the state of Maranhão. Methods - A cross-sectional study was carried out. The sample was comprised of 978 children aged six to 59 months and 978 women aged 15 to 49 years old enrolled in Family Health Strategy (FHS) in 21 counties selected by systematic random probability among the four geographical regions of the state and the capital. Data collection was performed on household interviews through questionnaire applied to mothers or childrens caretakers, containing information on demographic and socioeconomic status and household food security, and women and childrens health conditions. Weight and height were measured to assess nutritional status and followed by hemoglobin concentration of the blood capillary with immediate reading by Agabe ® portable hemoglobin. The association between anemia and the variables was checked first by bivariate analysis, followed by Poisson regression with a hierarchical model. Results - The prevalence of anemia among women was 36.0 per cent for the state of Maranhão and 55.1 per cent for capital, São Luís. Among children, the prevalence was also higher in the capital (68.7 per cent ) compared to the state as a whole (51.6 per cent ). Both women and children had a higher prevalence in urban areas. The group of 6-23 months of age was most affected by the problem (65 per cent ) than that of 24-59 months (42 per cent ), as one whose mothers also had anemia (63.6 per cent ). The regression analysis identified as risk factors for anemia in children age less than two years, the presence of maternal anemia, cohabitation of three or more children under five at home and reside in the capital. For women the risk factors associated with anemia were living in the capital and being overweight. Conclusions - The high prevalence of anemia in children and women found in Maranhão configure anemia as a public health among the population served by the FHS. It requires the implementation of feasible intervention measures for the control and prevention of this disease once, both, the National Iron Supplementation for infants, such as the fortification of wheat and corn flour current in Brazil failed to make the prevalence evaluated through children and childbearing age groups is on the acceptable limits. Its also necessary to consider that among the risk factors identified few are susceptible to modification and are related to food consumption and its determinants

Introdução - A anemia é considerada um dos maiores problemas de saúde pública da atualidade, afetando as populações de quase todos os países, sobretudo aqueles onde predominam padrões dietéticos deficientes e fatores ambientais adversos. Objetivo - Investigar a prevalência e os fatores associados à anemia em crianças menores de cinco anos e mulheres em idade reprodutiva entre a população atendida pela Estratégia da Saúde da Família (ESF), no estado do Maranhão. Métodos Foi realizado um estudo de corte transversal de base populacional. A amostra se constitui de 978 crianças de seis a 59 meses e 978 mulheres de 15 a 49 anos de idade cadastradas na ESF em 21 municípios escolhidos por sorteio sistemático probabilístico entre as quatro macrorregiões e capital do Estado. A coleta de dados foi realizada em entrevistas domiciliares por meio de questionário aplicado junto às mães ou responsáveis pelas crianças, contendo informações sobre a situação socioeconômica e demográfica e de segurança alimentar da família, e das condições de saúde das mulheres e das crianças. Foram medidos peso e altura, para avaliação do estado nutricional e feita a dosagem da concentração de hemoglobina do sangue capilar com leitura imediata pelo hemoglobinômetro portátil Agabe®. A associação entre a anemia e as variáveis foi verificada primeiramente por análise bivariada e posteriormente por regressão de Poisson, segundo modelo hierarquizado. Resultados A prevalência média de anemia entre as mulheres foi de 36, por cento para o estado do Maranhão e 55,1 por cento para a capital, São Luís. Entre as crianças, a prevalência também foi mais elevada na capital (68,7 por cento ) em relação ao estado como um todo (51,6 por cento ). Tanto as mulheres como as crianças apresentaram prevalências mais elevadas na área urbana. O grupo de 6-23 meses de idade foi mais afetado pelo problema (65 por cento ) do que o de 24-59 meses (42 por cento ), assim como aquele cujas mães também apresentavam anemia (63,6 por cento ). A análise de regressão identificou como fatores de risco para a anemia em crianças ter idade inferior a dois anos, presença de anemia materna, coabitação de três ou mais crianças menores de cinco anos no domicílio e residir na capital do estado. Para as mulheres os fatores de risco associados à anemia foram morar na capital e estar acima do peso. Conclusões As elevadas prevalências de anemia encontradas em crianças e mulheres no Maranhão a configuram como um problema de saúde pública entre a população atendida pela ESF. É necessária a busca de intervenções factíveis de serem aplicadas uma vez que, tanto o Programa Nacional de Suplementação do Ferro, para lactentes, como o de fortificação das farinhas de trigo e de milho vigentes no Brasil não conseguiram fazer com que a prevalência avaliada através dos grupos crianças e mulheres em idade fértil esteja no limite aceitável. Igualmente há que considerar que dos fatores de risco detectados poucos são susceptíveis a modificação e estão relacionados ao consumo de alimentos e seus fatores determinantes / Introduction - Anemia is considered one of the greatest public health problems today, affecting populations of almost all countries, especially those where lacking dietary patterns and adverse environmental factors predominate. Objective - To investigate the prevalence and factors associated with anemia in children under five and women of childbearing age in the state of Maranhão. Methods - A cross-sectional study was carried out. The sample was comprised of 978 children aged six to 59 months and 978 women aged 15 to 49 years old enrolled in Family Health Strategy (FHS) in 21 counties selected by systematic random probability among the four geographical regions of the state and the capital. Data collection was performed on household interviews through questionnaire applied to mothers or childrens caretakers, containing information on demographic and socioeconomic status and household food security, and women and childrens health conditions. Weight and height were measured to assess nutritional status and followed by hemoglobin concentration of the blood capillary with immediate reading by Agabe ® portable hemoglobin. The association between anemia and the variables was checked first by bivariate analysis, followed by Poisson regression with a hierarchical model. Results - The prevalence of anemia among women was 36.0 per cent for the state of Maranhão and 55.1 per cent for capital, São Luís. Among children, the prevalence was also higher in the capital (68.7 per cent ) compared to the state as a whole (51.6 per cent ). Both women and children had a higher prevalence in urban areas. The group of 6-23 months of age was most affected by the problem (65 per cent ) than that of 24-59 months (42 per cent ), as one whose mothers also had anemia (63.6 per cent ). The regression analysis identified as risk factors for anemia in children age less than two years, the presence of maternal anemia, cohabitation of three or more children under five at home and reside in the capital. For women the risk factors associated with anemia were living in the capital and being overweight. Conclusions - The high prevalence of anemia in children and women found in Maranhão configure anemia as a public health among the population served by the FHS. It requires the implementation of feasible intervention measures for the control and prevention of this disease once, both, the National Iron Supplementation for infants, such as the fortification of wheat and corn flour current in Brazil failed to make the prevalence evaluated through children and childbearing age groups is on the acceptable limits. Its also necessary to consider that among the risk factors identified few are susceptible to modification and are related to food consumption and its determinants

Introducción: En Perú se han implementado políticas públicas para brindar asistencia alimentaria, dentro de ellos, los Comedores Populares. Sin embargo, poco se conoce de un posible incremento en el exceso de peso en su población beneficiaria. Materiales y métodos: Se realizó un análisis secundario de la Encuesta Demográfica y de Salud Familiar de los años 2014 y 2018. La muestra estuvo constituida por mujeres en edad fértil entre los 15 y 45 años. La variable de resultado fue la presencia de exceso de peso, la cual fue categorizada de dos formas. 1) Como variable categórica siguiendo las recomendaciones de la OMS en Delgadez (<18.5), Normal (18.5 - 24.9), Sobrepeso (>=25 - 29.9), Obesidad (>=30). 2) Como una variable dicotómica en presencia o no exceso de peso (IMC >= 25). El ser beneficiarios de comedores populares se definió a través de la pregunta “¿Algún miembro de su hogar recibe ayuda alimentaria o nutricional del Programa Social Comedor Popular?, del cuestionario de la ENDES. Resultados: De un total de 59 844 registros, 57 055 fueron analizados, (2014, n= 23 532; 2018, n=33 532). Las mujeres beneficiarias de CP eran para el 2014 (n=375) y para el 2018 (n=564). Para el 2014, se evidenció una asociación significativa entre el exceso de peso y el ser beneficiarias de CP (RP = 1.14 IC 95%: 1.05 - 1.23). Asimismo, se encontró mayor riesgo de padecer exceso de peso y algunas variables demográficas, entre ellas la edad, donde se evidenció que las mujeres mayores de 40 años tuvieron mayor probabilidad de tener exceso de peso (RP = 2.19 IC 95% 1.99 - 2.41), de igual forma, el tener un nivel socioeconómico medio se asocia a una mayor probabilidad de sobrepeso/obesidad (RP = 1.23 IC 95%: 1.16 - 1.31). Conclusión: En beneficiarias de comedores populares hubo una mayor prevalencia de exceso de peso en relación a las no beneficiarias. En cuanto al modelo de diferencias en diferencias reportó ausencia de cambios en las asociaciones en los años 2014 y 2018. Finalmente, se recomienda efectuar más estudios, donde se pueda evaluar el efecto de los CP desde todos sus componentes, ello con la finalidad de proponer intervenciones dirigidas exclusivamente a la problemática encontrada. / Introduction: In Peru, public policies have been implemented to provide food assistance, among them the Popular soup kitchens (PC). However, little is known of a possible increase in the excess weight in its beneficiary population. Materials and methods: A secondary analysis of the Demographic and Family Health Survey for the years 2014 and 2018 was carried out. The sample consisted of women of childbearing age between 15 and 45 years. The outcome variable was the presence of excess weight, which was categorized in two ways. 1) As a categorical variable following the WHO recommendations for Thinness (<18.5), Normal (18.5 - 24.9), Overweight (> = 25 - 29.9), Obesity (> = 30). 2) As a dichotomous variable in the presence or not of excess weight (BMI> = 25). Being beneficiaries of soup kitchens was defined through the question “Does any member of your household receive food or nutritional aid from the Social Comedor Popular Program? of the ENDES questionnaire. Results: Of a total of 59,844 records, 57,055 were analyzed, (2014, n = 23,532; 2018, n = 33,532). The women beneficiaries of CP were for 2014 (n = 375) and for 2018 (n = 564). For 2014, a significant association between excess weight and being beneficiaries of PC was evidenced (PR = 1.14 95% IC: 1.05-1.23). Likewise, there was a greater risk of being overweight and some demographic variables, including age, where it was evidenced that women over 40 years of age were more likely to be overweight (PR = 2.19 95% IC: 1.99 - 2.41). Similarly, having a medium socioeconomic level is associated with a greater probability of being overweight/ obesity (PR = 1.23 95% IC: 1.16-1.31). Conclusion: In beneficiaries of soup kitchens there was a higher prevalence of excess weight in relation to non-beneficiaries. Regarding the model of differences in differences, it reported absence of changes in the associations in the years 2014 and 2018. Finally, it is recommended to carry out more studies, where the effect of the PC can be evaluated from all its components, in order to propose interventions aimed exclusively at the problem encountered. / Tesis

Introducción La anemia en mujeres en edad fértil sigue siendo un problema de salud pública a nivel mundial. Las intervenciones con enfoque biomédico no son suficientes para solucionar dicho problema, ya que también está ligada a los determinantes sociales. Objetivo Determinar la desigualdad en la distribución en prevalencia de anemia en mujeres en edad fértil a nivel mundial en los años 2000, 2005, 2010 y 2015. Métodos Se realizó un estudio ecológico a nivel mundial. Se utilizó la base de datos del Banco Mundial para los años 2000, 2005, 2010 y 2015; de donde se obtuvo la prevalencia de anemia en mujeres en edad fértil y los indicadores sociales gasto en salud per cápita y expectativa de vida al nacer. Se calcularon las métricas estándar de brecha y gradiente de desigualdad social en la prevalencia de anemia. Resultados La distribución en la prevalencia de anemia en mujeres en edad fértil a nivel mundial es desigual. La prevalencia es mayor en los países con menor expectativa de vida al nacer y gasto en salud. El 20% de países con menor expectativa de vida al nacer y gasto en salud per cápita concentran el 30% de la prevalencia de anemia en mujeres en edad fértil. Conclusiones La desigualdad en la prevalencia de anemia ha disminuido a nivel mundial. Es importante considerar los determinantes sociales, para seguir disminuyendo la desigualdad y por ende la prevalencia de anemia. Es importante mejorar las estrategias que se están tomando actualmente. / Introduction Anemia in women of childbearing age continues to be a public health problem worldwide. Interventions with a biomedical approach are not enough to solve this problem since it is also linked to social determinants. Objective To determine the inequality in the distribution in the prevalence of anemia in women of childbearing age worldwide in the years 2000, 2005, 2010 and 2015. Methods A worldwide ecological study was carried out. The World Bank database was used for the years 2000, 2005, 2010 and 2015; from which the prevalence of anemia in women of childbearing age and the social indicators for health expenditure per capita and life expectancy at birth were obtained. The standard metrics of gap and gradient of social inequality in the prevalence of anemia were calculated. Results The distribution in the prevalence of anemia in women of childbearing age is unequal worldwide. The prevalence is higher in countries with lower life expectancy at birth and health spending. The 20% of countries with the lowest life expectancy at birth and health spending per capita account for 30% of the prevalence of anemia in women of childbearing age. Conclusions Inequality in the prevalence of anemia has decreased worldwide. It is important to consider social determinants, to continue reducing inequality and therefore the prevalence of anemia. It is important to improve the strategies that are currently being taken. / Tesis

The study was done to assess the information and care the men and women have on PCC and develop strategies that could improve provision of PCC that could advance maternal and newborn outcome after pregnancy in Malawi. Most for the interventions to improve pregnancy outcome are done too late in Malawi but there is an opportunity during preconception period to plan to improve the health of the couple so that the goal of a healthy mother and baby is attained. The objectives were to: explore and describe the knowledge men and women of childbearing age have on HTSP and PCC, identify variables that influence men and women to acquire appropriate knowledge on PCC and finally to develop strategies that could assist provision of PCC in developing countries like Malawi. Adverse issues that affect the couples could be addressed promptly before the occurrence of pregnancy. A quantitative non-experimental descriptive-correlation design method was used to determine the knowledge men and women of childbearing have on HTSP and PCC. A structured questionnaire was used to collect data from 300 men and women of childbearing age. The target population for the study was prospective parents that are couples that have an intention to conceive, women of childbearing age that could be accessible at family planning, gyneacological and under-five clinics between the ages of 18-35 years. A questionnaire was adapted from a study conducted in Texas. SPSS version 20 was used to analyse the data by generating frequencies and chi- square. Kruskal Wallis test was used to determine relationship between variables and knowledge on preconception care. The constructs examined were psychological preparation, reproductive health care and the physical care that are provided to ensure a healthy pregnancy outcome. With a 100% response rate the findings indicated a gap of information and care on PCC.Services on PCC were not available in the clinics which indicated a great need to empower health care providers on PCC that could reduce maternal and neonatal mortality rate. The findings were used to develop relevant preconception strategies that would assist health providers to give PCC that would improve maternal and newborn outcomes in Malawi. / D. Litt. et Phil. (Health Studies)