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A morfologia da cidade e as influências na saúde pública, um estudo na Cidade da Praia, Cabo Verde
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Introdução:. No processo de globalização, as cidades têm sido vistas como sinónimo de bem-estar social, cultural e material. Neste sentido a cidade deve assegurar adequadas infraestruturas, facilitando a mobilidade, garantir a segurança e a produtividade. Devido ao aumento da população urbana, nos países em desenvolvimento, as cidades africanas são caracterizadas por expansão periférica, ausência de planeamento urbano, proliferação de economias dominadas por atividades e assentamentos informais, com limitação de acessos aos serviços e infraestruturas. Estudos sobre a saúde dos residentes em cidades africanas ainda são escassos. Neste trabalho estuda-se a Cidade da Praia - capital de Cabo Verde com cerca de 136.295 habitantes, segundo dados de 2015. Este país tem enfrentado um aumento das doenças crónicas não transmissíveis.
Objetivo: Compreender como a morfologia da cidade da Praia, Cabo Verde, pode condicionar a adoção de estilos de vida saudáveis e influenciar a saúde dos seus residentes ao nível do excesso de peso e obesidade em três unidades urbanas.
Métodos: Estudo intraurbano que decorreu na Cidade da Praia em Cabo-Verde. O método de amostragem foi aleatório baseado em coordenadas geográficas. O estudo iniciou-se pela análise da morfologia da cidade, caracterizando-a e subdividindo-a em três unidades urbanas (formal, transição e informal). Numa amostra de 1912 residentes, foi aplicado um questionário que refletiu as características do espaço urbano, aspetos socioeconómicos, estilo de vida onde se inclui o padrão alimentar e atividade física. Para melhor se caracterizar o estado e ingestão nutricional, foram efetuadas medições antropométricas e recordatório alimentar de 24h, para uma subamostra (n=599). Foram analisadas as relações entre a dieta, atividade física e estado nutricional com algumas variáveis ligadas ao espaço urbano, através de modelos Log-lineares.
Resultados: No que se refere à análise do espaço urbano, a necessidade de maior segurança, foi relata maioritariamente pelos residentes das unidades urbanas informal (76,2%) e formal (62,1%). Quando analisada por sexo, verifica-se que são as mulheres da unidade urbana informal, que mais reportam esta necessidade (78,7%) (p<0,001). Relativamente à necessidade de equipamentos foi inumerado o centro de saúde nas unidades urbanas informal e de transição. Relativamente à classificação da unidade urbana sobre questões económico-sociais, verifica-se um desfavorecimento significativo da unidade urbana informal em relação ao desemprego (93,2%), assaltos/violência (62,5%) e o custo de vida (59,1%). No que diz respeito à prática de atividade física no lazer, observou-se um gradiente decrescente da unidade urbana formal
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(40,6%) para a informal (30,4%), tendo as mulheres desfavorecimento relativamente aos homens. Quanto à avaliação do estado nutricional auto reportado (n=1912) observou-se na unidade informal que 44,4% dos participantes apresentavam pré - obesidade e obesidade. De acordo com o índice de massa corporal real e percentagem de massa gorda, as percentagens de excesso de peso/ obesidade e excesso de gordura/obesidade, para a subamostra, foram 54,7% e 62,9% respetivamente, sem diferenças entre unidades urbanas. Quanto à variedade da dieta 87,3% foram classificados com uma dieta pouco variada (n=1912). Relativamente à distribuição nutricional (n=599) a dieta é hiperlipídica (39,9% valor energético total (VET/dia), hipoglucídica (40,9% VET/dia), hipersalina (3156,2 mg/dia). O consumo de sódio foi estatisticamente superior na unidade urbana informal (3787,7 mg/dia). Ao explorar as associações para as diversas variáveis analisadas, a variável variedade da dieta e custo de vida apresentaram relações com o sexo e as unidades urbanas em estudo, bem como, a atividade física e a necessidade de segurança na cidade. Por fim, quando se analisa a capacidade do meio em análise com a multifuncionalidade da cidade, a pré - obesidade e obesidade, o sexo e o centro de saúde têm uma relação com os três padrões de ocupação da cidade.
Conclusões: O presente estudo revelou um desfavorecimento dos participantes na unidade urbana informal, em termos socioeconómicos e de alguns resultados em saúde. A morfologia da cidade parece ser uma condicionante, na perceção que a população adquire sobre a existência e necessidade de equipamentos e infraestruturas, potenciando ou minimizando as desigualdades sociais, de saúde e dos estilos de vida dos seus residentes.
ABSTRACT Introduction: In the globalization process, cities have been regarded as a synonym of social, cultural and material welfare. In that sense, cities must ensure adequate infrastructure, enabling mobility, ensuring safety and productivity. Due to the increase of urban population in developing countries, African cities are characterized by a peripheral expansion, lack of urban planning, proliferation of an economy dominated by informal activities, with limited access to services and infrastructure. Studies regarding the health of residents in African cities are still scarce. This work will study an African city - Praia – the capital and largest city of Cape Verde, with 136.295 habitants approximately in 2015. This country has faced a rise of chronic noncommunicable diseases. Objective: To unnderstand how the morphology of Praia, Cape Verde, affects the adoption of healthy lifestyles and influences the health of its residents, in terms of overweight and obesity, in three urban units. Methods: This intra-urban study took place in Praia in Cape Verde. A random sampling method using geographical coordinates was applied. The study began by analyzing the city’s morphology, characterizing it and subdividing it into three urban units (formal, transitioning and informal). A questionnaire was applied in a sample of 1912 residents, addressing the physiognomies of the urban space, socio-economic aspects, lifestyle which included the dietary pattern and physical activity. Aiming towards a better depiction of the nutritional status and intake, anthropometric measurements and 24-hour diet recalls were completed in a subsample (n=599). The relationships between diet, physical activity and nutritional status was analyzed, along with some variables linked to urban space, using Log-linear models. Results: Regarding the urban’s space analysis, the need for greater security, was reported mostly by the residents in the informal (76.2%) and formal (62.1%) urban units. Analyzing by gender, it appears that the women in the informal urban unit, are the ones who report this need the most (78.7%) (p<0.001). Regarding the need for equipment, the Health Center was listed in the informal and transition urban units. Concerning the urban unit’s perception of socioeconomic issues, there is a significant disadvantage of the informal urban unit in matters of unemployment situation (93.2%), robbery/violence (62.5%) and cost of living (59.1%). With regards to practice of physical activity during leisure time, a decreasing gradient was observed from the formal urban unit (40.6%) to the informal (30.4%), with women at a disadvantage when compared to men. As for the self-reported nutritional status (n= 1912), 44.4% of x participants in the informal unit were overweight or obese. According to the measured body mass index and percentage of body fat, the subsample’s proportion of overweight/obesity and excess fat/obesity, was 54.7% and 62.9%, repectively, with no differences observed between urban units. As for the diet variaty 87,3% were considered to have a low variety diet (n= 1912). Regarding the nutritional distribution (n = 599), the diet is hyperlipidic (39,9% total energy value (TEV /day), hyperglucidic (40.9% TEV/day), hypersaline (3156.2 mg/day). The sodium intake were statistically higher in the informal urban unit (3787.7 mg/day). When exploring the relationships between the many variables analyzed, it was noted that the variables “diet variety” and “cost of living”, are intrinsically associated with gender and the urban units studied, as well as, the practice of physical activity and the need for safety. Finally, when analyzing the capabilities of the studied area, with the city’s multifunctionality, overweight and obesity, gender and Health Center display an association with the three city’s occupancy patterns. Conclusions: The present study highlighted a disadvantage of the participants in the informal urban unit, regarding their socioeconomic status and some of the health outcomes. The morphology of the city seems to condition the residents’ accquired perception on the need for equipment and infrastructures, enhancing or minimizing social, health and lifestyle inequalities of its residents.
ABSTRACT Introduction: In the globalization process, cities have been regarded as a synonym of social, cultural and material welfare. In that sense, cities must ensure adequate infrastructure, enabling mobility, ensuring safety and productivity. Due to the increase of urban population in developing countries, African cities are characterized by a peripheral expansion, lack of urban planning, proliferation of an economy dominated by informal activities, with limited access to services and infrastructure. Studies regarding the health of residents in African cities are still scarce. This work will study an African city - Praia – the capital and largest city of Cape Verde, with 136.295 habitants approximately in 2015. This country has faced a rise of chronic noncommunicable diseases. Objective: To unnderstand how the morphology of Praia, Cape Verde, affects the adoption of healthy lifestyles and influences the health of its residents, in terms of overweight and obesity, in three urban units. Methods: This intra-urban study took place in Praia in Cape Verde. A random sampling method using geographical coordinates was applied. The study began by analyzing the city’s morphology, characterizing it and subdividing it into three urban units (formal, transitioning and informal). A questionnaire was applied in a sample of 1912 residents, addressing the physiognomies of the urban space, socio-economic aspects, lifestyle which included the dietary pattern and physical activity. Aiming towards a better depiction of the nutritional status and intake, anthropometric measurements and 24-hour diet recalls were completed in a subsample (n=599). The relationships between diet, physical activity and nutritional status was analyzed, along with some variables linked to urban space, using Log-linear models. Results: Regarding the urban’s space analysis, the need for greater security, was reported mostly by the residents in the informal (76.2%) and formal (62.1%) urban units. Analyzing by gender, it appears that the women in the informal urban unit, are the ones who report this need the most (78.7%) (p<0.001). Regarding the need for equipment, the Health Center was listed in the informal and transition urban units. Concerning the urban unit’s perception of socioeconomic issues, there is a significant disadvantage of the informal urban unit in matters of unemployment situation (93.2%), robbery/violence (62.5%) and cost of living (59.1%). With regards to practice of physical activity during leisure time, a decreasing gradient was observed from the formal urban unit (40.6%) to the informal (30.4%), with women at a disadvantage when compared to men. As for the self-reported nutritional status (n= 1912), 44.4% of x participants in the informal unit were overweight or obese. According to the measured body mass index and percentage of body fat, the subsample’s proportion of overweight/obesity and excess fat/obesity, was 54.7% and 62.9%, repectively, with no differences observed between urban units. As for the diet variaty 87,3% were considered to have a low variety diet (n= 1912). Regarding the nutritional distribution (n = 599), the diet is hyperlipidic (39,9% total energy value (TEV /day), hyperglucidic (40.9% TEV/day), hypersaline (3156.2 mg/day). The sodium intake were statistically higher in the informal urban unit (3787.7 mg/day). When exploring the relationships between the many variables analyzed, it was noted that the variables “diet variety” and “cost of living”, are intrinsically associated with gender and the urban units studied, as well as, the practice of physical activity and the need for safety. Finally, when analyzing the capabilities of the studied area, with the city’s multifunctionality, overweight and obesity, gender and Health Center display an association with the three city’s occupancy patterns. Conclusions: The present study highlighted a disadvantage of the participants in the informal urban unit, regarding their socioeconomic status and some of the health outcomes. The morphology of the city seems to condition the residents’ accquired perception on the need for equipment and infrastructures, enhancing or minimizing social, health and lifestyle inequalities of its residents.
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Saúde pública Nutrição Estilos de vida Obesidade Planeamento urbano Morfologia da cidade