Thesis (Mnutr)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Pregnancy and growth have been found to have a detrimental effect on the micronutrient status of adolescent girls. Dietary studies in adolescents have shown serious shortfalls in their dietary iron and folate intake. The competition for nutrients between the fetus and a pregnant adolescent may carry the risk of complications such as intrauterine growth retardation, pre-eclampsia, both maternal and fetal intrapartum mortality, the increased risk of birth injuries and low birth weight. The aim of the study was to assess the nutritional status of rural black, pregnant teenagers attending the antenatal clinic at Siloam Hospital in the Limpopo Province, with special emphasis on iron and folic acid intake, and evaluation of the newborn babies in terms of weight status and neural tube defects. The nutritional status was determined in 40 pregnant and 40 non-pregnant adolescent girls. The pregnant girls were selected during their first visit to the antenatal clinic, and the non-pregnant girls were selected from nearby schools. The demographic and dietary history questionnaires were used to collect information from the subjects. The dietary intake of the subjects was collected by the completion of a pre-tested quantified food frequency questionnaire. The anthropometric questionnaire was used to get information from the pregnant adolescents and the control group. The infant anthropometric measurements questionnaire provided information on the infant and the outcome of birth. Blood was collected from the pregnant adolescent girls and the control subjects. Anaemia was observed in 57.5% of the pregnant and 27.5% of the non-pregnant adolescents (haemoglobin <Il g/dl and <12 g/dl, respectively). The prevalence of low serum ferritin « 12 ug/L) and low transferrin saturation « 16%) was high in both the pregnant (30% and 60% respectively) and the non-pregnant adolescents (17% and 72.5% respectively). Iron deficiency was observed in 45% of the pregnant girls and 35% of the control subjects. The prevalence of iron deficiency anaemia in the pregnant girls (30%) and the control subjects (22.5%) was high. Low red blood cell folate in pregnant and non-pregnant girls was uncommon. Low serum vitamin BI2 was common in most of the pregnant girls. Analysis of the quantitative food frequency questionnaire (QFFQ) that was completed for 80 of the pregnant and non-pregnant girls showed that 55% had low dietary iron intakes «67% of the RDA) (p = 0.7307). Forty-five percent of the pregnant girls reported taking iron supplements. The QFFQ showed 20% of pregnant girls with low intake of folate (p = 0.0577). Forty-five percent of pregnant girls also reported taking folate supplements. Anthropometric measurements of pregnant girls and their dietary intake could not be correlated to the birth outcome. The social profile of the subjects did not seem to influence their iron and folate status and the outcome of pregnancy. The findings in this study showed that pregnant adolescents appeared to be similar to the non-pregnant adolescent girls socio-economically, anthropometric and nutritionally. We recommend that educational programmes targeted at adolescents and teenagers in the Siloam area should reach girls that could potentially fall pregnant. An educational programme must include: reproductive needs (avoidance of sex or safe sex); nutritional needs, especially targeted at improving nutritional status to meet future reproductive needs; early booking at the antenatal clinic and effective supplementation during pregnancy. The need to improve the dietary and nutrient intake of the adolescent girls should be addressed within the current framework of the Integrated Nutrition Programme (!NP). A food fortification programme with essential micronutrients such as iron, folic acid, zinc and Vitamin A to improve the micronutrient status should be promoted among the adolescent girls. / AFRIKAANSE OPSOMMING: Daar is bevind dat swangerskap en groei 'n nadelige effek het op die mikronutriëntstatus van vroulike adolessente. Dieetstudies in adolessente het ernstige tekortkominge in dieetyster- en folaatinnames getoon. Die kompetisie vir nutriente tussen die fetus en die swanger adolessent kan verantwoordelik wees vir komplikasies soos intra-uterine groeivertraging, preeklampsie, verhoogde mortaliteit van beide moeder en baba tydens kraam, 'n verhoogde risiko vir geboortebeserings en lae geboortegewig. Die doel van die studie was om die effek van voedingstatus by swart, swanger tieners by die voorgeboortekliniek in Siloam Hospital in die Limpopo-provinsie te bepaal, met spesifieke verwysing na die yster- en foliensuurinname, asook die evaluering van die pasgebore babas in terme van gewig en neurale buis defekte. Die voedingstatus van 40 swanger en 40 nie-swanger adolessente meisies IS bepaal. Die swanger meisies is ewekansig geselekteer gedurende die eerste besoek aan die voorgeboortekliniek , en die nie-swanger meisies is geselekteer by nabygeleë skole. Die demografiese en dieetgeskiedenisvraelyste is gebruik om inligting van die proefpersone in te samel. Voorafgetoetste gekwantifiseerde voedselfrekwensie vraelyste is gebruik om die voedselinname van proefpersone te bepaal. Antropometriese vraelyste is gebruik om antropometriese inligting van die swanger adolessente en die kontrole groep. Die antropometriese vraelys vir babas is gebruik om inligting ten opsigte van die baba aan te teken asook die verloop van die swangerskap. Bloedmonsters is van die swanger tieners en die kontrole groep ingesamel. Anemie is waargeneem by 57.5% van die swanger en 27.5% van die nie-swanger adolessente (hemoglobien <Il g/dl en <12 g/dl onderskeidelik). Die voorkoms van lae serum ferritien « 12 ugIL) en lae transferrienversadiging « 16%) was hoog by beide die swanger (30% en 60%) en die nie-swanger adolessente (17.5% en 72.5% onderskeidelik). Ystergebrek is in 45% van die swanger meisies en in 35% van die kontrole groep waargeneem. Die voorkoms van ystergebrekanemie in die swanger meisies (30%) en die kontrole groep (22.5%) was hoog. Lae rooibloedselfolaat by swanger en nie-swanger meisies is nie algemeen waargeneem nie. Lae serum vitamien B12 was algemeen by die meeste swanger meisies. Ontleding van die gekwantifiseerde voedselfrekwensievraelys (KVFV) wat vir 80 van die swanger en nie-swanger meisies voltooi is, het getoon dat 55% 'n lae dieetysterinname gehad het «67% van die ADT) (p=0.7307). Vyf-en- veertig persent van die swanger meisies het bevestig dat hulle ystersupplemente gebruik het. Die gekwantifiseerde voedselfrekwensievraelys (KVFV) het getoon dat 20% van die swanger meisies 'n lae folaatinname het (0.0577). Vyf-en-veertig persent van die swanger meisies het ook genoem dat hulle folaatsupplemente gebruik het. Die antropometriese metings van swanger meisies en dieetinname kon nie gekorreleer word met die verloop van die geboorte nie. Dit blyk dat die sosiale profiel van die meisies nie 'n effek op die yster- en folaatstatus en op die verloop van swangerskap gehad het nie. Die bevindinge van hierdie studie toon dat swanger en nie-swanger adolessente meisies sosio-ekonomies, antropometries en nutrisioneel dieselfde voorkom. Dit word aanbeveel dat voorligtingsprogramme vir adolessente en tieners in die Siloam-area meisies moet bereik wat moontlik swanger sal word. 'n Voorligtingprogram moet die volgende insluit: reproduktiewe behoeftes (vermyding van seks of veilige seks); voedingbehoeftes, veral geteiken om voedingstatus te verbeter om ten einde toekomstige voorplantingsbehoeftes te vervul; vroeë besoeke aan die voorgeboortekliniek en effektiewe supplementering gedurende swangerskap. Die behoefte om die dieet en nutriëntinname van adolessente meisies te verbeter moet binne die huidige raamwerk van die Geintegreerde Voedingsprogram aangespreek word. 'n Voedselfortfiseringsprogram met essensiële mikronutriënte soos yster, foliensuur, sink en vitamien A om die mikronutriëntstatus van adolessente meisies te verbeter, moet bevorder word.

The objective this study is verify the efficiency and occurrence of collateral effects with the use of carbonyl iron powder, in the form of chewable tablets, in order to enable the use of an alternative to the conventional treatment of iron deficiency anemia with ferrous sulfate, for children under 6 years of age. The intervention proposed for the treatment of iron deficiency anemia in children almost always consists of ferrous sulfate drops that do not have the desired effectiveness. Several studies have proven the low adherence to the treatment due to collateral effects of the medication (gastrointestinal intolerance, alterations in color and consistency of stools, impregnation of iron in diapers and teeth), to the prolonged daily administration in the form of drops, to the metallic taste, as well as to socio-cultural aspects. In choosing the preparation, the content of the iron ion, tolerance, absorption, effectiveness and cost must all be considered. Carbonyl iron powder is obtained by decomposition of Fe pentacarbonyl at high temperatures, resulting in extremely pure elemental Fe (Fe0), in the form of non-toxic micro-spheres of 4-7/μm, with bioavailability in relation to 58-70% ferrous sulfate and it does not confer a metallic taste to the preparation. An open randomized clinical assay was carried out. The group studied (CA) received Carbonyl Iron and the control group (SF) received a solution of Ferrous Sulfate, both at a dose of 5mg/Kg/day, for 90 days. Seventy-three children from Family Health Units (FHU) of Santa Maria, Brazil, participated in the study. Blood was collected at 0, 30 and 90 days of treatment. The hemograms were carried out in STKS (Coulter, USA), serum iron and TIBC, by colorimetric assay and ferritin by immunometric assay. The data was analyzed with the EpiInfo program, version 3.3.2, from CDC/USA. The increase in Hb after 30 days of treatment was of 1.3g/dl (SD 0.92) for group CA and of 1.2g/dl (SD 1.13) for group SF (p>0.05). After 90 days of treatment, CA had favorable results for Ht, MCV, MCH, TIBC and ferritin (p<0.05). None of the children from group CA presented side effects, in group SF, 62% of the children presented diarrhea and/or experienced vomiting. The number of children from the control group who continued to present a level of Hb lower than 11g/dl was two-fold that of the group that received carbonyl iron. Based on the results demonstrating the same effectiveness at 30 days as for the standard ferrous sulfate and the superior results at 90 days of treatment, together with the safety (low toxicity) and excellent acceptance, carbonyl iron should be considered an important option for the therapeutic treatment of iron deficiency anemia in children under the age of six. / O objetivo deste estudo é verificar a eficácia, ocorrência de efeitos colaterais e aceitação de ferro carbonila em pó, na forma de comprimidos mastigáveis, para possibilitar uma alternativa ao tratamento convencional da anemia ferropriva com sulfato ferroso, para crianças menores de seis anos. A intervenção proposta para tratamento da anemia ferropriva de crianças, quase na totalidade das vezes, consiste em gotas de sulfato ferroso que não tem tido efetividade desejada. Vários estudos comprovam a baixa adesão ao tratamento em virtude dos efeitos colaterais do medicamento (intolerância gastrintestinal, alterações na cor e consistência das fezes, impregnação de ferro nas fraldas e dentes), do esquema de administração em dose diária por tempo prolongado, do sabor metálico do medicamento, além de aspectos socioculturais. Na escolha do preparado, deve ser considerado o conteúdo do íon ferro, tolerância, absorção intestinal, eficácia e custo. O ferro carbonila em pó é obtido pela decomposição a altas temperaturas do ferro pentacarbonil, resultando em ferro elementar (Fe0) extremamente puro, em forma de micro-esferas de 4-7/μm, com boa biodisponibilidade, não tóxico e sem conferir sabor metálico às preparações. O desenho do estudo foi um ensaio clínico, randomizado, aberto. O grupo estudo (CA) recebeu comprimidos mastigáveis de Ferro Carbonila; o grupo controle (SF) recebeu solução de Sulfato Ferroso, na dose de 5mg/Kg/dia, por 90 dias. Participaram do estudo 73 crianças com diagnóstico comprovado de anemia ferropriva, atendidas em USFs de Santa Maria, RS. Foram realizadas coletas de sangue nos tempos 0, 30 e 90 dias de tratamento. Os hemogramas foram realizados em STKS Coulter, Ferro sérico e Capacidade Total de Ligação do Ferro, por química úmida (colorimetria) e Ferritina por quimioluminescência, todos por automação. Os dados analisados com programa EpiInfo, versão 3.3.2, do CDC/USA. O incremento de Hb após 30 dias de tratamento foi de 1,3g/dl (dp 0,92) no grupo CA e 1,2g/dl (dp 1,13) no grupo SF (p>0,05). Após 90 dias de tratamento, as médias do Ht, VCM, HCM, CTLF e ferritina são significativamente melhores no grupo CA (p<0,005). Nenhuma criança do grupo CA apresentou efeitos colaterais. No grupo SF, 62% tiveram diarréia e/ou vômito. O número de crianças que permanecia com Hb < 11g/dl, no grupo controle, era o dobro do que no grupo recebendo ferro carbonila. Pelos resultados de eficácia em 30 dias similares ao padrão sulfato ferroso e a superioridade em 90 dias de tratamento, aliados a segurança (baixa toxicidade) e ótima aceitação, o ferro carbonila deve ser considerado como uma importante opção terapêutica para tratamento da anemia ferropriva, de crianças menores de seis anos de idade.

nÃo hà / A deficiÃncia de ferro à o distÃrbio nutricional mais prevalente no mundo. No Brasil, a deficiÃncia de ferro tem sido reconhecida como importante causa de anemia hà mais de duas dÃcadas. A anemia ferropriva configura um problema epidemiolÃgico da maior relevÃncia influindo nos gastos pÃblicos de saÃde. Dentre os fatores que contribuem para essa causa està a baixa ingestÃo de ferro que à favorecida por condiÃÃes precÃrias de vida. A fortificaÃÃo com ferro nos alimentos amplamente consumidos pela populaÃÃo vem sendo utilizada como estratÃgia para melhorar a situaÃÃo nutricional nas populaÃÃes de diversos paÃses. O objetivo deste estudo foi avaliar os teores de ferro dos produtos obtidos com farinhas de trigo e milho comercializados no Estado do Cearà por meio do Programa de AvaliaÃÃo do Teor Nutricional do MinistÃrio da SaÃde (PATEN) em um estudo do tipo retrospectivo quantitativo de avaliaÃÃo dos teores de ferro em anÃlises realizadas no LaboratÃrio Central de SaÃde PÃblica do Estado do Cearà (LACEN). A partir de entÃo, buscou-se verificar o atendimento dos produtos comercializados no Estado do Cearà à ResoluÃÃo da Diretoria Colegiada n 344/2002/ANVISA, que torna obrigatÃria a fortificaÃÃo de farinhas de trigo e milho com ferro e Ãcido fÃlico, assim como, comparar dados relativos à prevalÃncia de anemia ferropriva das duas Ãltimas dÃcadas no Brasil. Concluiu-se que aproximadamente 58% das amostras analisadas, nos Ãltimos trÃs anos, foram consideradas insatisfatÃrias em relaÃÃo ao atendimento da RDC n 344/2002/ANVISA, ou seja, possuem teor de ferro menor que 4,2 mg por cada 100 g de farinha. Por sua vez, a prevalÃncia de anemia ferropriva no Brasil nÃo se alterou significativamente ao longo de duas dÃcadas, mesmo com a obrigatoriedade da fortificaÃÃo das farinhas com ferro. / Iron deficiency is the most prevalent nutritional disorder in the world. In Brazil, iron deficiency has been recognized as an important cause of anemia for more than two decades. Iron deficiency anemia sets up an epidemiological problem of great importance that has influenced the health public spending. Among the factors that contribute to this cause is the low intake of iron, influenced by poor living conditions. The iron has been used in foods widely consumed by the population as a strategy to improve the nutritional status of populations in several countries. This study was carried out to evaluate the iron content of wheat and corn flour products available in the State of Cearà through the Nutritional Content Assessment Program of Health Ministry (PATEN) in a quantitative and retrospective kind of study of iron content assessment through analysis realized by the Central Public Laboratory of Ceara State (LACEN). Thus, attempting to verify the compliance of the products sold in the state of Ceara to The Board Resolution Collegiate, RDC N 344/2002/ANVISA, which obligates the fortification of wheat and maize flour with iron and folic acid, as well as to compare the prevalence of iron deficiency anemia in the the last two decades in Brazil. It was concluded that approximately 58% of the samples analyzed in the last three years were considered unsatisfactory in relation to RDC No. 344/2002/ANVISA, ie having iron content of less than 4.2 mg per 100 g of flour. In turn, the prevalence of iron deficiency anemia in Brazil has not changed significantly over the last two decades, even with the mandatory fortification of flour with iron.

A zinco protoporfirina (ZPP) eritrocitária é um metabólito formado pela adição do zinco no sítio do ferro durante a formação da molécula de hemoglobina, quando este último está total ou parcialmente indisponível. O objetivo deste trabalho foi realizar a padronização dos valores da ZPP eritrocitária em bezerros sadios com até um mês de vida, assim como a validade da ZPP como previsora da ocorrência de anemia ferropriva em bezerros neonatos, em comparação com outros métodos. Para tanto foram utilizados 134 bezerros da raça Holandesa, com idades variando do nascimento até 30 dias de vida, provenientes de fazendas produtoras de leite localizadas no Estado de São Paulo, classificados como sadios (67 animais) e anêmicos (67 animais). Os animais foram monitorados por meio de exames físico e complementares (hemograma e reticulocitometria, teores de ferro sérico (FT) e capacidade total de ligação do ferro (CTLF), teores de bilirrubinas e de uréia séricas, e concentrações da ZPP). Durante a padronização do exame, os valores médios encontrados foram: concentração de ZPP eritrocitária das amostras de hemácias não lavadas em até 3 horas após a colheita de sangue de 30 animais sadios - 80,90 &#181;mol ZPP/mol heme; concentração de ZPP eritrocitária, após a lavagem de hemácias, determinadas até 3 horas e 12 horas após colheita de sangue do mesmo grupo - 61,40 &#181;mol ZPP/mol heme e 61,03 &#181;mol ZPP/mol heme, respectivamente. Com base nos resultados obtidos, foi possível concluir que as amostras de sangue colhidas para a mensuração da ZPP podem ser armazenadas, sob refrigeração a 4°C, por até 12 horas após a colheita, sem alterações significativas dos seus valores, sendo recomendável a lavagem das hemácias antes da mensuração dos valores da ZPP eritrocitária devido à presença de substâncias interferentes no plasma do animal. Foi encontrada diferença significativa nas concentrações da ZPP e de todos os componentes do eritrograma, assim como nos teores do metabolismo de ferro entre os animais anêmicos e sadios. As concentrações de bilirrubinas e ureia séricas apresentaram-se no intervalo fisiológico de variação, não interferindo na mensuração da ZPP nos eritrócitos dos bezerros com ou sem anemia. A correlação entre os valores encontrados dos teores de ferro sérico e da capacidade total de ligação do ferro com as concentrações de ZPP foram: rs = - 0,45, p < 0,001 (ZPP x FT) e rs = 0,51, p < 0,001 (ZPP x CTLF), respectivamente, demonstrando que quanto menores os teores de ferro, maiores serão as concentrações de ZPP. Portanto, a utilização da ZPP como previsora dos quadros de anemia ferropriva em bezerros neonatos com até um mês de vida se mostrou válida e, considerando que a hematofluorometria é um método rápido e não oneroso, pode ser recomendado como exame complementar de rotina. / The zinc protoporphyrin (ZPP) is a metabolic originated by zinc addition in the iron site during the synthesis of hemoglobin molecule, when iron is total or partially unavailable. The aim of this study was to standardize the values of zinc protoporphyrin (ZPP) in erythrocyte of healthy calves until one month of life, and to evaluate this determination as a predictor of the occurrence of iron deficiency anemia in newborn calves, compared with other methods. Therefore, 134 Holstein calves were used, aged from birth to 30 days of life, from dairy farms located in the São Paulo State, splitted into two groups, classified as healthies (67 animals), and anemics (67 animals). The animals were monitored by physical examination and laboratory assessments (complete blood cell count and reticulocytes, serum iron (SI) and total iron binding capacity (TIBC), levels of serum bilirubin and urea, and ZPP levels). During the exam standardization, the mean values found were: erythrocyte ZPP of unwashed erythrocytes within 3 hours after blood sampling of 30 healthy animals - 80.9 &#181;mol ZPP/mol heme; erythrocyte ZPP after washing of red blood cells, determined by 3 hours and 12 hours after blood collection, from the same group were 61.40 &#181;mol ZPP/mol heme and 61.03 &#181;mol ZPP/mol heme, respectively. Based on these results, it was concluded that blood samples taken for measurement of ZPP may be stored under refrigeration at 4 °C for up to 12 hours, without significant changes of the values of erythrocyte ZPP, and it is also advisable to wash the red cells before erythrocyte ZPP values measuring, due to the presence of interfering substances in the animal plasma. A significant difference was found in the ZPP levels and in all erythrogram components, as well as on the levels of iron metabolism between anemic and healthy animals. The bilirubin and serum urea levels remained within physiological variation, does not interfering with the measurement of erythrocyte ZPP of calves with or without anemia. The correlation values between SI and TIBC with ZPP levels were: rs = - 0.45, p < 0.001 (ZPP x SI) and rs = 0.51, p < 0.001 (ZPP x TIBC), respectively, i.e. decreasing biochemical levels of iron metabolism will increase levels of ZPP. Therefore, the use of ZPP as an iron deficiency anemia predictor in newborn calves up to one month of life has proven its validity, and considering hematofluorometry as a quick and inexpensive method, it might be recommended as a routine exam.

Made available in DSpace on 2014-07-29T15:29:07Z (GMT). No. of bitstreams: 1 Marlice Silva Marques.pdf: 752076 bytes, checksum: 6bdca2cf332d84517eaf15c217acc63d (MD5) Previous issue date: 2010-11-26 / Several publications recommend that patients who underwent bariatric surgery is attended by a multidisciplinary team, and have a direct follow-up of a professional nutritionist.The knowledge of the techniques recommended bariatric surgery, the symptom complexes that are affected in patients postoperatively, with the use of an appropriate nutritional interventions is crucial for the prevention of nutritional deficiencies caused by surgical procedure. Objectives:To evaluate the iron nutritional status of individuals undergoing bariatric surgery at the Obesity Surgery Service (SICO), Hospital Santa Genoveva. Methods: We performed two types of studies. The first was a cross-sectional analysis of records of demographics and comorbidities of 198 patients treated at the first consultation with the surgeon from July 2008 to July 2009 and the second was prospective analysis of serum hemoglobin, iron, ferritin ,albumin and vitamin B12,and the dietary intake of iron and protein from 42 individuals in pre-and post-surgery six months after bariatric surgery type Fobi-Capella from January to July 2009.Results:Female gender was the most sought such treatment, with a mean age of 35.16 ± 10.82 years and average BMI of 40.9 ± 6.91 kg/m², hypertension appears very high and during follow-up period found no clinical or biochemical signs of iron deficiency anemia even without the use of iron supplements.Conclusions:The high number of top individuals, with an average age of 35 years, looking for the surgery as an option for treating obesity and high rates of individuals with hypertension do believe that public policies are necessary for greater health impact, aimed at prevention of this epidemic.The fact that individuals have had an intensive nutritional counseling during the pre-and postoperatively may have contributed to patients not anemic in the postoperative. / Várias publicações recomendam que o paciente submetido à cirurgia bariátrica seja cuidado por uma equipe multidisciplinar, e que tenham um acompanhamento direto de um profissional nutricionista. O conhecimento das técnicas cirúrgicas bariátricas preconizadas, dos complexos sintomas que os pacientes são acometidos no pós-operatório, associados à utilização de uma conduta nutricional adequada é fundamental para a prevenção de carências nutricionais decorrentes do procedimento cirúrgico. Objetivos: Avaliar o estado nutricional de ferro dos indivíduos submetidos à cirurgia bariátrica no Serviço de Cirurgia da Obesidade (SICO) do Hospital Santa Genoveva. Métodos: Foram realizados dois tipos de estudos. O primeiro foi transversal com análise dos registros dos dados antropométricos e de comorbidades de 198 pacientes atendidos em primeira consulta com o cirurgião no período de julho de 2008 a julho de 2009 e o segundo foi prospectivo com análise dos níveis séricos de hemoglobina, ferro, ferritina,albumina e vitamina B12,e da ingestão alimentar de ferro e de proteína de 42 indivíduos nos períodos pré e seis meses pós-cirurgia submetidos à cirurgia bariátrica tipo Fobi-Capella no período de janeiro a julho de 2009. Resultados: Indivíduos do sexo feminino foram os que mais procuraram este tipo de tratamento, com idade média de 35,16 ± 10,82anos e IMC médio de 40,9± 6,91 kg/m², a hipertensão arterial aparece em altos índices e durante o período de acompanhamento não foi encontrado nenhum sinal clínico ou bioquímico de anemia ferropriva mesmo sem o uso de ferro medicamentoso. Conclusões: O alto número de indivíduos, com uma idade média de 35 anos, procurando pela cirurgia como opção para tratamento da obesidade e o grande índice destes indivíduos com hipertensão arterial faz acreditar que são necessárias políticas públicas de saúde de maior impacto, voltadas para a prevenção desta epidemia. O fato dos indivíduos terem tido um acompanhamento nutricional intensivo durante todo o período pré e pós-operatório pode ter contribuído para os pacientes não apresentarem anemia no período pós-operatório.

Abstract It is estimated that about 22% of all births in Pakistan are low birth weight (&lt;2500g), representing approximately 198,000 births per year. One of the major causes of low birth weight is maternal anemia. In Pakistan approximately 52% of pregnant women are anemic and one of the most common cause of maternal anemia is soil-transmitted helminthic infection. Soil-transmitted helminthiasis is endemic in Pakistan carries the highest burden of infection in Eastern Mediterranean region. Despite the recommendations deworming the mother during pregnancy is not being commonly practiced in routine antenatal care. We hypothesized that there is an association between deworming during pregnancy and low birth weight. For this study, cross sectional analysis of secondary data from the latest Pakistan Demographic Health Survey (PDHS conducted in 2017-18 and released in 2019) was done. Total N=1403 mother and child were included, logistic regression was used to determine the association between deworming during pregnancy and low birth weight after adjusting for potential confounders.  We found no statistically significant association [aOR 0.63, 95% CI (0.21-1.83)] between deworming during pregnancy and low birth weight. Moreover the mothers who belonged to higher socioeconomic status [aOR 0.41, 95% CI (0.22- .76)] and attained higher education [aOR 0.55, 95% CI (0.34- .87)] had reduced odds of having a new born with low birth weight compared to newborn of the women from low socioeconomic status and had no education, respectively. Further research is needed to explore effectiveness of deworming during pregnancy at population level.

No description available.

No description available.

Thesis (M. Tech. (Biomedical Technology)) -- Central University of Technology, Free State, [2014] / Pica is the habitual eating of non-food substances by humans and animals. It has different subgroups and these are defined by the ingested substance. Moreover, geophagia is a type of pica that refers to the consistent eating of mostly earth and earth-like substances such as clay and soil. It is observed in both sexes, all age groups and in different ethnic groups around the world. There are many reasons people give for the practice of geophagia, such as culture, hunger and health being the most prominent. Geophagic materials differ in texture, colour and taste. Soil colour classification according to the Munsell soil classification, which uses hues, values and chroma, sometimes differ with the soil colour being noticeable with the naked eye. However, geophagic clays from Qwa-Qwa are white and contain kaoline. Geophagic materials are believed to augment mineral deficiency, especially magnesium, calcium and iron. Geophagia is practised mainly by females, especially during their child bearing years. Females are more prone to iron deficiency anaemia due to their monthly menstruation cycle. Iron deficiency is the most common cause of anaemia and is classified as hypochromic microcytic anaemia (HMA). This study focused on the health aspect of geophagia. The research question seeks to explore whether there is an association between geophagia and the haematological parameters of iron deficiency anaemia. Geophagia seems to be linked with the occurrence of anaemia, but not iron deficiency anaemia, although it is implied. It is not known if the practice of geophagia causes iron deficiency anaemia or if it is because of iron deficiency anaemia that people practise geophagia. A pilot study was done in 2007, and the results of that study prompted that this study be performed on a bigger scale. The lack of information regarding the quantity, frequency and type of geophagic material consumed the impact of geophagia on haematological parameters and the iron status of the geophagists made it important that the primary existence of the iii relationship be investigated. In addition, research to establish whether there is a relationship between geophagia and haematological parameters of iron deficiency anaemia, has not been undertaken in South Africa, especially on non-pregnant women. Geophagia seems to always be accompanied by the subject of iron deficiency anaemia and especially its prevalence in females. The bigger geophagia project was therefore an ideal opportunity to do a specific survey on geophagic women. This was a cross-sectional study, consisting of 36 control women and 47 geophagic women, aged between 18-45 years. The participants completed a questionnaire to determine the geophagic practices, which included the colour of the clay, how frequent the clay was consumed, how much was consumed and for how long it has been consumed. Nutritional status was assessed using a food frequency questionnaire. Blood was drawn to assess the haematological and iron status of the participants. The participants of the study were within the required age range, with no significant difference between the groups (p-value=0.7914). The most consumed colour of clay was white and white clay contains kaoline, which has the ability to absorb iron in the duodenum. The majority of the participants consumed 40 grams of clay on a daily basis, with most of the participants having done so for 5 years. Diet was ruled out as the cause of iron deficiency. The haematological parameters indicated that the geophagic group (43%) were inclined to have hypochromic microcytic anaemia, while a small percentage of control groups (8%) had HMA; this was revealed by the red cell parameters and red cell indices. In addition, the odds ratio for the haematological results revealed that the probability of a geophagic person developing anaemia was two times greater than that of a non-geophagic person. Platelet results partially ruled out bleeding as a cause of anaemia. The median red cell distribution width indicated that the iv geophagic group was inclined to have anisocytosis. The geophagic group was found to have iron deficiency (75%), whilst the control group had a small percentage with iron deficiency (22%), which was validated by the serum ferritin, serum iron and saturated transferrin (chemical analysis). The odds ratio revealed that the probability of a geophagic person being iron deficient is 3 times greater than that of a non-geophagic person. The strongest association is seen with iron study findings, because being iron deficient showed the highest odd ratio than the association with red cell morphology and even haemoglobin. Thus, participants were more iron deficient than suffering from iron deficiency anaemia. Inflammatory and parasitic indicators proved that inflammation and infection was uncommon in both groups, and therefore did not compromise the credibility of the iron study results. Inflammatory indicators (white blood cells, erythrocyte sedimentation rate and C-reactive protein) ruled out inflammation, whilst eosinophil count showed no indication of parasitic infection for both geophagic and control groups. To conclude, the study found that an association exists between geophagia and haematological parameters of iron deficiency anaemia amongst geophagic women in Qwa-Qwa, in that geophagic material contributes to iron deficiency anaemia.

Introdução: Anemia por carência alimentar de ferro é a deficiência nutricional mais freqüente e preocupante do ponto de vista da saúde coletiva. Afeta principalmente crianças, gestantes e mulheres em idade fértil. Apesar das medidas de intervenção para prevenção e controle da anemia no Brasil, estudos mostram que as prevalências ainda continuam elevadas. Objetivo: Investigar a situação da anemia e seus determinantes em mães e filhos no Brasil, considerando o contexto familiar. Método: Pesquisa transversal de abordagem quantitativa, que utilizou o banco de dados da Pesquisa Nacional de Demografia e Saúde da Mulher e da Criança (PNDS) 2006. Foram utilizados dois questionários com informações básicas sobre o domicílio e seus moradores e informações detalhadas sobre o público-alvo, mulheres de 15 a 49 anos e seus filhos menores de 5 anos. Aproximadamente 40% dos domicílios foram selecionados para coleta de sangue das mulheres, porém todas as crianças nascidas a partir de janeiro de 2001 tiveram o sangue colhido, desde que filhos biológicos da entrevistada. Análise de hemoglobina foi realizada em 5.915 mulheres e 4.558 crianças. Este estudo analisou 1.476 pares, considerando a mãe e apenas uma criança. O programa Statistical Package for Social Science (SPSS versão 18.0) foi utilizado para análise dos dados, que analisou anemia em mães e/ou filhos, mães e filhos isoladamente e constou das etapas univariada e múltipla. Resultados: A ocorrência de anemia foi de 36,8% em mães e/ou filhos, 23,4% nas mães e 17,0% nos filhos. Mães apresentaram chance 1,49 vezes maior de ter anemia do que os filhos, e não se verificou associação entre anemia nas mães e nos filhos (p=0,478). Na análise múltipla, mães e/ou filhos que residiam nas regiões Nordeste e Centro-Oeste apresentaram chance 2,24 e 1,70 vezes maior, respectivamente, em relação às da região Sul; a chance também foi estatisticamente maior (1,78 vezes) para o par com insegurança alimentar (sentiu fome) e em que a mãe realizou consulta de puerpério (1,39 vezes); primiparidade mostrou-se como fator de proteção. Anemia nas mães também se associou com macrorregião de residência, com chance 2,39 vezes maior para as da região Nordeste em relação às da região Sul; mães com insegurança alimentar, que realizaram consulta de puerpério e tiveram pelo menos uma doença também apresentaram chance 50% maior para anemia. Nas crianças, anemia associou-se com insegurança e consumo alimentar, sendo que aquelas que ingeriram multimistura e leite fresco com água nas últimas 24 horas apresentaram chance 2,49 e 1,69 vezes maior para anemia, respectivamente, assim como crianças que não ingeriram lanche da tarde no dia anterior e que ingeriram arroz menos de 4 vezes na semana (chance 1,57 e 2,38 vezes maior, respectivamente); primiparidade materna revelou-se como fator de proteção. Conclusões: A ocorrência de anemia em mães e/ou filhos é maior nas macrorregiões menos desenvolvidas e em famílias com insegurança alimentar, o que evidencia a determinação social dessa carência nutricional. É mais freqüente nas mães e não se associa à ocorrência de anemia nos filhos. Nas mães, anemia associa-se com variáveis socioeconômicas, demográficas e insegurança alimentar. Nas crianças, anemia se associa apenas com insegurança e consumo alimentar. Os resultados indicam que embora mães e filhos estejam expostos aos mesmos determinantes sociais e ambientais que aumentam a suscetibilidade para anemia, as restrições alimentares ocasionadas por condições socioeconômicas e demográficas desfavoráveis têm maior impacto nas mães, em virtude da maior necessidade orgânica de ferro da mulher em idade fértil e provável proteção e cuidado das mães para com os filhos. Indica também que independente da condição socioeconômica, a alimentação inadequada da criança torna-a mais susceptível à anemia. Tais resultados podem estar atrelados também a um efeito positivo do Programa Nacional de Suplementação de Ferro, embora apenas um quarto das crianças de 6 a 24 meses tivesse recebido ferro nos últimos seis meses, o que indica a necessidade de melhorias na operacionalização do programa. / Introduction: Anemia an iron deficiency, is the most frequent and worrisome nutritional deficiency from the standpoint of public health. It mainly affects children, pregnant women and women of childbearing age. Despite the intervention measures for prevention and control of anemia in Brazil, studies shows that prevalence rates are high. Objective: Investigate the situation of anemia and its determinants in mothers and children in Brazil, considering the family context. Method: Quantitative cross-sectional survey, that used the database of the national survey of demography and health of women and children (PNDS) 2006. This information was collected through two questionnaires, with basic information about the home and its residents and also detailed information about the target audience women between 15 to 49 years and children under 5 years. The study evaluated approximately 15.000 women and 5.000 children, with a representative sample of five brazilian regions in urban and rural context. Approximately 40% of households had been selected for blood sampling of women, and all children born from January 2001 had the blood sampling taken provided they were biological children of the interviewees. Hemoglobin analysis was performed in 5.915 women and 4.558 children. This study looked at 1.476 pairs, considering the mother and only one children. The Statistical Package Program for Social Science (SPSS version 18.0) was used for data analysis, which examined anemia in mothers and/or children, mothers and children separately and consisted of univariate and multiple steps. Results: The occurrence of anemia was 36.8% in mothers and/or children, 23.4% of mothers and 17.0% in children. Mothers were 1.49 times more likely to have anemia than children, there was no association between anemia in mothers and children (p=0.478 ). In multiple regression analysis, mothers and/or children residing in the Northeast and Midwest had odds 2,24 and 1,70 times higher, respectively, in relation to the south; the chance was also statistically higher (1,78 times) for those with food insecurity and those in which the mother held a puerperal consultation (1,39 times); primiparity shown as protective factor. Anemia in mothers was also associated with the region of residence, with 2,39 times more chances for the Northeast than in mothers in the South; mothers with food insecurity, who performed a puerperal consultation and had at least one disease, also were 50% more likely to have anemia. In children, anemia was associated with insecurity and food consumption, and those who ate a mixture of water and fresh milk in the last 24 hours had a chance (2,49 and 1,69 times) to be more likely to develop anemia, respectively, as well as children who did not eat an afternoon snack on the last day and ate rice 4 times less in the week (odds 1,57 and 2,38 times higher for anemia, respectively), maternal primiparity proved to be a protector factor. Conclusions: The occurrence of anemia in mothers and/or children is higher in less develop macro-regions and among families with food insecurity, highlights the social causes of nutritional deficiency. It is more frequent in mothers and not associated with anemia in children. In mothers, anemia is associated with socioeconomic, demographic and food insecurity. In children, anemia is associated only with insecurity and food consumption. This result indicates that although there is evidence of mothers and children are exposed to the same social and environmental causes that increase susceptibility to anemia, dietary restrictions and their nutritional consequences caused by unfavorable demographic and socioeconomic conditions will have a greater impact on mothers, owing to the greater need for organic iron in women of childbearing age and protection and care of their mothers to the children. It also indicates that regardless of socioeconomic status, whether the childs diet is inadequate, it will be more susceptible to anemia. The results can be linked also to a positive effect of the National Iron Supplementation, although only one quarter of children aged 6 to 24 months had received iron in the last six months, which indicates the need for improvements in the operation of the program.