The impact of breastfeeding patterns on regional differences in infant mortality in Germany, 1910

This paper examines the impact of breastfeeding practices on the large regional differences in infant mortality in Germany around 1910. Breastfeeding is strongly negatively associated with infant mortality and remains so after controlling for public health measures and for demographic, economic, and social factors that also affect infant mortality. But it contributes much less to regional differences in infant mortality than do access to medical care, percentage illegitimate and marital fertility. Breastfeeding is less important than these other factors because it affects fewer causes of death and has a smaller impact on cause-specific infant mortality rates. L'auteur étudie l'impact des pratiques d'allaitement sur les grandes différences régionales de mortalité infantile observées en Allemagne aux alentours de 1910. Il existe une association fortement négative entre l'allaitement et la mortalité infantile, même quand on contrôle les facteurs démographiques, économiques, sociaux et de politique sanitaire, qui, eux aussi, affectent la mortalité infantile. Mais les différences régionales de mortalité infantile s'expliquent nettement moins par l'allaitement que par l'accessibilité des soins médicaux, le taux d'illégitimité des naissances et la fécondité légitime. L'allaitement est un facteur de moindre importance que ceux-ci parce qu'il n'a d'impact que sur un petit nombre de causes de décès, et un faible impact sur les taux de mortalité infantile par cause.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42730/1/10680_2005_Article_BF01796777.pd

Impacto da farinha de mandioca fortificada com ferro aminoácido quelato no nível de hemoglobina de pré-escolares Impact of cassava flour fortified with iron amino acid chelate on the hemoglobin level in pre-schools

OBJETIVO: Avaliou-se o impacto da farinha de mandioca fortificada com ferro aminoácido quelato em 80 pré-escolares de uma Unidade Filantrópica de Manaus, AM, distribuídos aleatoriamente em quatro grupos de 20 crianças cada, por um período de 120 dias. MÉTODOS: Foram utilizadas farinha de mandioca sem fortificação (Grupo zero) e fortificada com 1, 2 e 3mg de Fe/dia, correspondendo a quantias diárias de 5, 10 e 15g de farinha, respectivamente, as quais foram distribuídas no horário do almoço, sendo ainda entregue às famílias a quantidade destinada ao consumo do final de semana. O estado nutricional das crianças foi avaliado no início e ao final do experimento, adotando-se como limite discriminatório entre eutrofia/desnutrição o ponto de corte <-2 escores-Z, de acordo com os critérios da Organização Mundial da Saúde, e estabelecendo-se como ponto de corte para a ocorrência de anemia ferropriva o teor de hemoglobina inferior a 11g/dL. RESULTADOS: Houve uma recuperação das crianças com desnutrição crônica ao final do estudo, e ocorreu um aumento significativo (p<5%) dos valores de hemoglobina de todos os pré-escolares, independentemente da concentração de ferro, de 11,4 &plusmn; 0,9g/dL para 12,2 &plusmn; 0,8g/dL. As crianças anêmicas que receberam a farinha de mandioca fortificada com 2mg de Fe/dia foram plenamente recuperadas ao final da pesquisa, demonstrando um bom desempenho desse grupo em relação aos demais. CONCLUSÃO: Sugere-se um estudo duplo cego para a consolidação da recomendação da farinha de mandioca fortificada com ferro na prevenção de anemia ferropriva em pré-escolares da região amazônica.<br>OBJECTIVE: The impact of the cassava flour fortified with iron amino acid chelate was evaluated in 80 pre-scholars of a Philanthropic Unit of Manaus, state of Amazonas, randomly distributed in four groups of 20 children each, for a period of 120 days. METHODS: Cassava flour was used without fortification (group zero) or fortified with 1, 2 and 3mg of Fe/day, corresponding respectively to 5, 10 and 15g of flour/day, which were given to the children at lunch time on weekdays. The equivalent amount was previously distributed to their families for flour intake also during the weekends. In the beginning and at the end of the experiment the children's nutritional status was evaluated, being adopted the cutoff point <-2 Z-scores as a discriminating limit between eutrophy/malnutrition, in agreement with the World Health Organization criteria, as well as being established as a cutoff point for the occurrence of iron deficiency anemia a hemoglobin rate of less than 11g/dL. RESULTS: At the end of this study, children recovered from chronic malnutrition, and a significant increase (p <5%) of the hemoglobin rates, independently of iron concentration, from 11.4&plusmn;0.9g/dL to 12.2&plusmn;0.8g/dL, was observed in all individuals. The formerly anemic children who received cassava flour fortified with 2mg of Fe/day were fully recovered at the end of the research, demonstrating a good performance of this group in relation to the others. CONCLUSION: A double-blind study is suggested for the consolidation of the recommendation of cassava flour fortified with iron in the prevention of iron deficiency anemia in pre-scholars of the Amazon region