The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017

Corrêa, Ester Mourão; Gallo, Caroline de Oliveira; Antunes, José Leopoldo Ferreira; Jaime, Patrícia Constante

doi:10.1016/j.jped.2022.07.006

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ORIGINAL ARTICLE • J. Pediatr. (Rio J.) 99 (2) • Mar-Apr 2023 • https://doi.org/10.1016/j.jped.2022.07.006 copy

The tendency of stunting among children under five in the Northern Region of Brazil, according to the Food and Nutrition Surveillance System, 2008-2017

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the temporal tendency of stunting prevalence among children under five years of age registered in the Food and Nutritional Surveillance System (SISVAN) in the Brazilian Northern Region, from 2008 to 2017.

Methods:

Ecological time-series study with data from SISVAN. The annual variation rate for the prevalence of undernutrition, measured by the presence of stunting (low height-for-age index), was estimated for the Northern Region and for each of its states using the Prais-Winsten regression model with and without variable adjustment for SISVAN coverage to explore the relationship between these variables.

Results:

The Northern Region showed a tendency toward the reduction of chronic child stunting, with an annual variation of -5.30% (95%CI -9.64; -0.77) in the period studied. The states of Acre (-7.19%; 95%CI -12.31; -1.77), Pará (-4.86%; 95%CI -9.44; -0.03), and Tocantins (-6.22%; 95%CI -9.88; -2.41) showed a tendency to reduce the prevalence of stunting, while the other four states showed stability during the period. A strong negative correlation was found between SISVAN coverage and the prevalence of stunting in the states of Acre (beta: -0.725), Amazonas (beta: -0.874), Pará (beta: -0.841), and Tocantins (beta: -0.871), indicating that the increase in system coverage is associated with a reduction of stunting.

Conclusions:

There is a tendency toward a reduction in the prevalence of stunting particularly in three states and in the North Region as a whole, from 2008 to 2017. The coverage by the system was associated with a reduction in the prevalence of child stunting in four states.

KEYWORDS
Stunting; Primary Health Care; Nutrition Policy; Information Systems

States	Estimation of the prevalence of stunting (%)^a a Prevalence of stunting (%) = (sum of the total number of children in municipalities with stunting/sum of the total number of children from the municipalities registered in SISVAN)*100.										Annual Percentage Variation (95%CI)^b b Values of annual percentage variation (APV) and their respective confidence intervals (95%CI) were obtained by Prais-Winsten regression, without adjusting the model for the SISVAN's cov erage variable, and were estimated by the formula: APV=(−1+[10^β])×100 .	p-value^c c p-value of Prais-Winsten regression.	Tendency
States	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017		p-value^c c p-value of Prais-Winsten regression.	Tendency
Northern Region/FU	23.3	23.8	22.3	21.7	19.3	21.8	20.6	17.9	18.1	18.6	-3.13 (-4.14;-2.10)	< 0.001	Reduction
Acre	22.2	21.4	22.5	21.9	21.3	20.5	22.2	18.0	19.0	17.0	-2.56 (-3.79;-1.31)	< 0.001	Reduction
Amapá	23.1	23.1	22.3	21.9	20.1	22.2	25.2	21.3	22.3	22.7	-0.05 (-1.54; 1.46)	>0.05	Stability
Amazonas	26.5	27.4	26.1	25.6	22.6	23.5	22.6	19.7	19.9	21.0	-3.79 (-4.71;-2.87)	< 0.001	Reduction
Pará	25.9	26.6	23.6	22.7	20.5	23.3	20.9	18.2	18.7	19.2	-4.02 (-5.21;-2.82)	< 0.001	Reduction
Rondônia	10.8	11.4	11.3	11.1	10.6	11.3	11.2	12.1	9.5	10.3	-0.79 (-2.18; 0.62)	>0.05	Stability
Roraima	19.0	20.1	19.5	19.7	16.8	27.5	27.0	16.9	16.5	17.7	-0.77 (-6.02; 4.7-)	>0.05	Stability
Tocantins	16.2	16.6	16.4	15.6	14.3	14.4	14.9	14.0	14.0	13.2	-2.37 (-3.16;-1.57)	< 0.001	Reduction

States	Without adjustment for SISVAN coverage			With adjustment for SISVAN coverage
States	Annual Percentage Variation % (95%CI)^a a Values of annual percentage variation (APV) and their respective confidence intervals (95%CI) were obtained by Prais-Winsten regression, with and without the adjustment of the model for the SISVAN’s coverage variable, and were estimated by the formula: APV=(−1+[10^β])×100.	p-value^b b p-value of the Prais-Winsten regression.	Tendency	Annual Percentage Variation % (95%CI)^a a Values of annual percentage variation (APV) and their respective confidence intervals (95%CI) were obtained by Prais-Winsten regression, with and without the adjustment of the model for the SISVAN’s coverage variable, and were estimated by the formula: APV=(−1+[10^β])×100.	p-value^b b p-value of the Prais-Winsten regression.	Tendency
Region North	-3.13 (-4.14; -2.10)	< 0.001	Reduction	-5.30 (-9.64; -0.77)	0.028	Reduction
Acre	-2.56 (-3.79; -1.31)	< 0.001	Reduction	-7.19 (-12.31; -1.77)	0.017	Reduction
Amapá	-0.05 (-1.54; 1.46)	> 0.05	Stability	-3.68 (-7.38; 0.17)	0.058	Stability
Amazonas	-3.79 (-4.71; -2.87)	< 0.001	Reduction	-4.01 (-7.99; 0.15)	0.056	Stability
Pará	-4.02 (-5.21; -2.82)	< 0.001	Reduction	-4.86 (-9.44; -0.03)	0.049	Reduction
Rondônia	-0.79 (-2.18; 0.62)	> 0.05	Stability	-1.18 (-7.53; 5.61)	0.685	Stability
Roraima	-0.77 (-6.02; 4.77)	> 0.05	Stability	0.51 (-11.05; 13.56)	0.925	Stability
Tocantins	-2.37 (-3.16; -1.57)	< 0.001	Reduction	-6.22 (-9.88; -2.41)	0.007	Reduction

States	Standardized regression coefficient^a a Value of the standardized coefficient obtained from the simple linear regression model.	p-value^b b p-value of simple linear regression.
Northern Region	-0.813	0.004
Acre	-0.725	0.018
Amapá	0.141	0.697
Amazonas	-0.874	0.001
Pará	-0.841	0.002
Rondônia	-0.330	0.352
Roraima	-0.173	0.632
Tocantins	-0.871	0.001

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[1] * Corresponding author. E-mail: caroline.gallo@alumni.usp.br (CO. Gallo).