Food and nutrition actions for the maternal and child population in primary healthcare: comparative analysis of municipalities in the Metropolitan Region of <i>Baixada Santista, São Paulo</i>, Brazil

SATO, Yukari; MATA, Mayline Menezes da; MEDEIROS, Maria Angélica Tavares de

doi:10.1590/1678-9865202235e210230

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ORIGINAL • Rev. Nutr. 35 • 2022 • https://doi.org/10.1590/1678-9865202235e210230 copy

Food and nutrition actions for the maternal and child population in primary healthcare: comparative analysis of municipalities in the Metropolitan Region of Baixada Santista, São Paulo, Brazil

Ações de alimentação e nutrição à população maternoinfantil na Atenção Primária à Saúde: análise comparativa em municípios da Região Metropolitana da Baixada Santista, São Paulo, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

Characterize and comparatively analyse the organization of nutritional attention to prenatal care, the puerperium period and breastfeeding, in primary health care, in two municipalities of Baixada Santista, São Paulo, Brazil.

Methods

This was an exploratory-analytical study of family health units and the mixed basic care units of Cubatão (n=17) and Guarujá (n=14). For this purpose, seven domains of the Nutritional Attention Assessment Instrument in Primary Health Care were used. Descriptive analysis and the Mann-Whitney and Pearson’s chi-square tests were performed.

Results

In the comparison between the municipalities, the best scores were obtained in Guarujá. Statistically significant differences were found for the following indicators: support for nutritional attention actions: infrastructure and permanent education (<0.001); food and nutritional surveillance (<0.001); nutritional attention focused on prenatal care (<0.001); and nutritional attention focused on postpartum care and breastfeeding (0.012). Nutritional attention actions for mother-infant groups were more frequent in the city of Guarujá, which compared with Cubatão, achieved better scores for the nutritional attention evaluation indicators.

Conclusion

The municipality of Guarujá had better indicators of infrastructure and permanent education, food and nutrition surveillance, and puerperal and breastfeeding nutritional care. However, weaknesses persist in the organization of nutritional care in the two cities studied, especially regarding the work process.

Keywords:
Primary health care; Nutrition policy; Nutritionists; Prenatal care; Postpartum period

Variables	Municipality
	Guarujá		Cubatão
	n	%	n	%
Active nutritionist	12	85.7	10	58.8
Nutritional care through a teaching-service partnership	0	0.0	1	5.9
Intersectoral actions for food and nutrition education	13	92.9	8	47.1
Identification of regional customs and food traditions	10	71.4	13	76.5
Mapping of areas at risk of food and nutritional insecurity	12	85.7	8	47.1
Periodic collection of nutritional status data from users	14	100.0	17	100.0
Periodic collection of food consumption data from users	13	92.9	4	23.5
Home visits	14	100.0	17	100.0
Participation of a nutritionist in the identification of nutritional care demands	12	85.7	6	35.3
Nutritional care for families in the Bolsa Família Program	1	7.1	0	0.0
Nutritional care for pregnant women by medical referral	12	85.7	9	52.9
Approach to breastfeeding during prenatal care	14	100.0	17	100.0
Guidance on healthy eating during pregnancy	14	100.0	16	94.1
Guidance on micronutrient supplementation during pregnancy	14	100.0	17	100.0
Recording of anthropometric data for the gestational curve	14	100.0	16	94.1
Identification of breastfeeding practices in the postpartum period	14	100.0	16	94.1
Evaluation of the nutritional status of postpartum women	14	100.0	12	70.6
Prescription of iron supplementation up to three months after delivery	13	92.9	14	82.4
Calculation of the daily weight gain of new borns	14	100.0	14	82.4
Incentive to exclusively breastfeed up to six months and complementarily breastfeed until two years of age at the first new-born consultation	14	100.0	17	100.0

Variables	Municipality		Descriptive levels*
Variables	Guarujá	Cubatão	Descriptive levels*
Indicator 2
Mean	14.71	9.53
Standard deviation Median	2.97 15.50	1.50 10.00	<0.001
1st quartile	12.00	9.00
3rd quartile Indicator 3	16.00	11.00
Mean	1.57	1.00
Standard deviation Median	0.65 2,00	1.00 1.00	0.117
1st quartile	1,00	0.00
3rd quartile Indicator 5	2,00	2.00
Mean	23.93	18.59
Standard deviation Median	1.94 23.50	1.28 18.00	<0.001
1st quartile	23.00	18.00
3rd quartile Indicator 6	25.00	19.00
Mean	22.29	20.00
Standard deviation Median	1.27 22.50	1.32 20.00	<0.001
1st quartile	22.00	19.00
3rd quartile Indicator 7	23.00	21.00
Mean	25.50	21.18
Standard deviation Median	4.49 27.00	5.67 24.00	0.012
1st quartile	27.00	15.00
3rd quartile	27.75	26.00

Indicator	Description	Maximum score
Indicator 2 - Support for nutritional care actions	Infrastructure and permanent education	20
Indicator 3 - Intersectoriality	Development of actions for nutritional care and food and nutrition education through a teaching-service partnership	3
^* * A score was not assigned for Indicator 4 because it was a categorical variable and did not allow the calculation of a score; therefore, a binary result was generated. Source: Prepared by the authors based on the IAAN in Primary Health Care [20]. Indicator 4 - Social control	Participation of a nutritionist or other professional in social control; monitoring and evaluation of food and nutrition actions jointly by a representative of users and health teams	^* * A score was not assigned for Indicator 4 because it was a categorical variable and did not allow the calculation of a score; therefore, a binary result was generated. Source: Prepared by the authors based on the IAAN in Primary Health Care [20].
Indicator 5 - Food and nutrition surveillance	Strategies and actions used to identify, monitor and address demands for nutritional attention and food and nutritional insecurity in the territory	31
Indicator 6 - Prenatal nutritional care	Individual nutritional care, nutritional monitoring, and breastfeeding	25
Indicator 7 - Nutritional care for the puerperium period and breastfeeding	Procedures performed during home visits, nutritional care for postpartum women and new-borns, and actions to encourage and protect exclusive breastfeeding for up to 6 months	28

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[1] Correspondence to: MAT MEDEIROS. E-mail: <angelica.medeiros@unifesp.br>.