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Padrões adequados de lactação e alimentação infantil, e fatores associados, em crianças dos 0-59 meses filhas de mulheres VIH+, em São Tomé e Príncipe
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Contextualização: A OMS e UNICEF recomendam que as crianças expostas ao VIH em países de baixo rendimento, devem receber aleitamento materno exclusivo nos primeiros 6 meses de vida e a partir dessa idade devem receber alimentos complementares apropriados e continuar a amamentação até aos 24 meses ou mais, a par do TARV materno. Em circunstâncias onde a família queira optar por leite artificial, essa opção só deverá ser aconselhada se for segura, viável, acessível, sustentável e aceitável (AVASS). Em São Tomé e Príncipe, a prevalência de VIH (em 2014) na população era de 0,5% e a cobertura do TARV em 2017 era de 78,2%. Dados sobre a alimentação infantil para a população geral no país indicam práticas inadequadas, com apenas 22,5% das crianças a atingir uma dieta mínima aceitável e 73,8% em aleitamento materno exclusivo (também em 2014). O aconselhamento por profissionais de saúde a mães VIH+ sobre lactação e alimentação infantil é essencial no contexto do país, para eliminar a transmissão vertical e garantir os melhores resultados de saúde e crescimento neste grupo vulnerável.
Objetivo: Determinar as frequências de práticas de lactação e alimentação infantil adequados, e analisar fatores associados, em crianças dos 0-59 meses filhas de mulheres VIH+, em São Tomé e Príncipe.
Metodologia: Estudo observacional, quantitativo, de corte transversal e censitário. Foram utilizados dados secundários referentes a variáveis sociodemográficas, de saúde pré-natal da mãe, de saúde e antropometria da criança e das práticas alimentares da criança, incluindo os alimentos consumidos nas 24h anteriores. A população estudada consiste em 79 crianças com 0-59 meses de idade filhas de mulheres VIH+ identificadas pelo Programa Nacional de Luta contra o SIDA. Para caracterizar as variáveis foi feita uma análise de estatística descritiva; para analisar a associação entre a variável dependente (ter ou não uma dieta mínima aceitável) e as variáveis independentes foi usado o teste de Qui-Quadrado ou de Fisher. Usou-se um nível de significância entre 5% e 10%.
Resultados: Das 79 crianças, a maioria é do sexo feminino (58,2%), reside em áreas urbanas (75,9%) e 87,7% das mães têm algum nível de escolarização. No entanto, apenas 5,3% dos agregados familiares conseguiriam fornecer uma alimentação de substituição AVASS à criança exposta ao VIH, caso optassem por não amamentar. Apesar da boa adesão aos serviços de saúde, com uma mediana de 8 consultas pré-natal das mães, apenas 51,3% recebeu aconselhamento por um profissional de saúde sobre lactação e VIH. Ainda assim, 73,7% das mães têm um conhecimento mínimo sobre ALCP e PTMF. Entre as crianças menores de 6 meses, 68,8% beneficiava do aleitamento materno exclusivo, enquanto apenas 25,4% das maiores de 6 meses tinha uma dieta mínima aceitável, indicador este que estava associado com o meio de residência (p=0,088) e o nível de escolaridade da mãe (p=0,094). Os grupos de alimentos que estavam associados com o alcance da dieta mínima aceitável foram o leite materno (p=0,012), as frutas e vegetais ricos em vitamina A (p=0,000) e outras frutas e vegetais (p=0,093).
Conclusão: Os resultados do estudo reforçam a importância de um ambiente que promova as recomendações da OMS e UNICEF sobre ALCP em contexto de VIH. O investimento em políticas de saúde, formação dos profissionais de saúde para um aconselhamento adequado e constante, e geração de evidências onde existem lacunas de conhecimento, são essenciais para alcançar melhores resultados de saúde e nutrição em crianças filhas de mulheres VIH+, no país.
ABSTRACT Background: The WHO/UNICEF recommend exclusive breastfeeding for the first 6 months of life, followed by appropriate complementary feeding and continued breastfeeding until 24 months or beyond, in low-income countries for infants exposed to HIV. In São Tomé and Príncipe, with a 0.5% HIV prevalence and 78.2% maternal antiretroviral therapy (ART) coverage in 2017, there are concerning inadequate infant feeding practices, with only 22.5% of children achieving a minimum acceptable diet and 73.8% exclusively breastfed. Adequate counseling by healthcare professionals to HIV+ mothers on infant and young child feeding is crucial to eliminate vertical transmission and ensure optimal health and growth outcomes for this vulnerable group. Objective: To determine and analyze the frequencies of appropriate lactation and infant feeding practices, and associated factors, in children aged 0-59 months born to HIV+ women in São Tomé and Príncipe. Methodology: Observational, quantitative, cross-sectional, and census study. Secondary data related to sociodemographic variables, maternal prenatal health, child health and anthropometry, and child feeding practices, including foods consumed in the past 24 hours, were utilized. The study population consists of 79 children aged 0-59 months, born to HIV-positive women identified by the National HIV/AIDS Control Program. Descriptive statistical analysis was performed to characterize the variables. To analyze the association between the dependent variable (having or not having a minimum acceptable diet) and the independent variables, the Chi-Square test or Fisher's exact test was used. A significance level between 5% and 10% was applied. Results: Of the 79 children, the majority are female (58.2%), reside in urban areas (75.9%), and 87.7% of the mothers have some level of education. However, only 5.3% of the households would be able to provide HIV-exposed children with appropriate replacement feeding if they chose not to breastfeed. Despite good adherence to healthcare services, with a median of 8 prenatal visits for mothers, only 51.3% received counseling from a healthcare professional on lactation and HIV. Nevertheless, 73.7% of mothers have basic knowledge about appropriate complementary feeding practices (ACFP) and postnatal transmission of HIV. Among children under 6 months, 68.8% benefited from exclusive breastfeeding, while only 25.4% of those older than 6 months had a minimum acceptable diet, a factor associated with the residence environment (p=0.088) and mother's level of education (p=0.094). Food groups associated with achieving a minimum acceptable diet were breast milk (p=0.012), fruits and vegetables rich in vitamin A (p=0.000), and other fruits and vegetables (p=0.093). Conclusion: The study underscores the importance of an environment that promotes WHO/UNICEF recommendations on appropriate feeding practices in the context of HIV. Investment in health policies, healthcare professional training for continuous and adequate counseling, and generation of evidence in knowledge gaps are essential to achieve better health and nutrition outcomes for children born to HIV+ mothers in the country.
ABSTRACT Background: The WHO/UNICEF recommend exclusive breastfeeding for the first 6 months of life, followed by appropriate complementary feeding and continued breastfeeding until 24 months or beyond, in low-income countries for infants exposed to HIV. In São Tomé and Príncipe, with a 0.5% HIV prevalence and 78.2% maternal antiretroviral therapy (ART) coverage in 2017, there are concerning inadequate infant feeding practices, with only 22.5% of children achieving a minimum acceptable diet and 73.8% exclusively breastfed. Adequate counseling by healthcare professionals to HIV+ mothers on infant and young child feeding is crucial to eliminate vertical transmission and ensure optimal health and growth outcomes for this vulnerable group. Objective: To determine and analyze the frequencies of appropriate lactation and infant feeding practices, and associated factors, in children aged 0-59 months born to HIV+ women in São Tomé and Príncipe. Methodology: Observational, quantitative, cross-sectional, and census study. Secondary data related to sociodemographic variables, maternal prenatal health, child health and anthropometry, and child feeding practices, including foods consumed in the past 24 hours, were utilized. The study population consists of 79 children aged 0-59 months, born to HIV-positive women identified by the National HIV/AIDS Control Program. Descriptive statistical analysis was performed to characterize the variables. To analyze the association between the dependent variable (having or not having a minimum acceptable diet) and the independent variables, the Chi-Square test or Fisher's exact test was used. A significance level between 5% and 10% was applied. Results: Of the 79 children, the majority are female (58.2%), reside in urban areas (75.9%), and 87.7% of the mothers have some level of education. However, only 5.3% of the households would be able to provide HIV-exposed children with appropriate replacement feeding if they chose not to breastfeed. Despite good adherence to healthcare services, with a median of 8 prenatal visits for mothers, only 51.3% received counseling from a healthcare professional on lactation and HIV. Nevertheless, 73.7% of mothers have basic knowledge about appropriate complementary feeding practices (ACFP) and postnatal transmission of HIV. Among children under 6 months, 68.8% benefited from exclusive breastfeeding, while only 25.4% of those older than 6 months had a minimum acceptable diet, a factor associated with the residence environment (p=0.088) and mother's level of education (p=0.094). Food groups associated with achieving a minimum acceptable diet were breast milk (p=0.012), fruits and vegetables rich in vitamin A (p=0.000), and other fruits and vegetables (p=0.093). Conclusion: The study underscores the importance of an environment that promotes WHO/UNICEF recommendations on appropriate feeding practices in the context of HIV. Investment in health policies, healthcare professional training for continuous and adequate counseling, and generation of evidence in knowledge gaps are essential to achieve better health and nutrition outcomes for children born to HIV+ mothers in the country.
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Saúde pública Alimentação de lactentes Sida São Tomé e Príncipe