Anemia em crianças e mães de creches públicas de Natividade (RJ):prevalência, fatores de risco e validade do exame clínico palidez palmar.

Abstract

Descriptive study of a transversal cut, carried out between October 2006 and December 2006, to determine global prevalence and age group in anemic children enrolled in registered Day Care Centers and the evaluations of the risk factors. The same evaluations for the prevalence of anemia was also preformed in the respective biological mothers and evaluated the efficacy of the clinical examination of Palmar Pallor in the diagnosis of anemia, carried out by two (2) trained examiners within the IMIC (Integrated Management of Childhood Illnesses) norms, front to the gold standard laboratorial method. Three hundred and sixteen (316) children, taken from six public day-care centers in the city of Natividade (RIO DE JANEIRO), and two hundred and forty two (242) biological mothers were evaluated. The hemoglobin was obtained through capilar blood samples and verified in a portable hemoglobinometer, HemoCueR. The children in the age group between 6 and 59 months and pregnant mothers with hemoglobin < 11.0 g/dL were consideredanemic, children age > 60 months with hemoglobin results of < 11.5 g/dL and among nonpregnant mothers, hemoglobin < 12.0 g/dL. For the definition of stages of anemia, the following categories were used: server anemia (Hemoglobin < 7.0 g/dL), moderate anemia (Hemoglobin .7.0 and < 10.0 g/dL) and mild anemia (hemoglobin . 10.0 g/dL). Weight and height were collected being expressed in Z-scores and the data on social-economic and schooling of mothers and children were obtained through interviews with parents and / or guardians. The statisticalanalysis were carried out by through Kruskal-Wallis testing and of qui-square using Yates correction, and the coefficients of Pearson and Kappa, the multi-varied linear regression, values of sensitivity and the specification. Between the 316 children evaluated, mean age of 45.3 months } 20.1, 52.2% were male children and 47.5% female children. Of the 242 mothers, 14 were pregnant (4.4%) and the mean age being 26.7years } 5.9. The prevalence of global anemia among the children was of 43.7%, being that 85.6% at the age of < 12 months (64.2% moderate /severe), 66% between 12 and 24 and 60 months (47.2% moderate /severe), 40.6% between 24 and 60 months. Among the mothers, the total prevalence was of 40,1%, being that 100% betweenpregnant (64.3% moderate/severe) and 36.4% among the non-pregnant mothers (33.3% moderate/severe). 1,7% of the non-anemic children had acute malnutrition and the values of chronic malnutrition were 4.3% among the anemic and 3.6% among the non-anemic. The significative statistic for the risk factor associated to anemia in children was the age of the child. In relation to the clinical examination of Palmar Pallor in the diagnosis of anemia in children, examiner I obtained a sensitivity of 52,9% (IC95%: 44,2 . 61,4) and specification of 52,8% (IC95%:45,2 . 60,3) and examiner II observed a sensitivity of 73,2% (IC95%: 64,9 . 80.2) andspecification of 38,2% (IC95%:31,1 . 45,8). The values of the Kappa coefficient rate varied from 0.12 to 20 between the two examiners. The anemia caused in the needy children and mothers of the public day-care centers in Natividade (RJ) is considered a serious public health problem(>40%), with a larger magnitude among the younger than 24 months and the pregnant mothers. The law results of sensitivity and specification, as well as, the clinical diagnosis between the two examiners, do not allow the substitution of the laboratorial examination of the hemoglobin for aphysical examination based on the context of the needy community observed in this study.