Sampling plan and methodological aspects: a household healthcare survey in Piauí

OBJECTIVE

To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring.

METHODS

ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the “non-response” rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5.

CONCLUSION

Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

Nutritional status and metabolic risk in adults: association with diet quality as assessed with ESQUADA

OBJECTIVE

To analyze the association between diet quality assessed with the Diet Quality Scale (ESQUADA) and the nutritional status and metabolic risk in adults.

METHODS

The data included 1,147 adults aged 20 to 59, from the population-based study with complex sampling. Weight, height, tricipital (TSF) and subscapular (SSF) skinfolds, and waist (WC) and mid-arm (MAC) circumferences were measured. Body mass index (BMI) and mid-arm muscle circumference (MAMC) were calculated. Nutritional status and metabolic risk were classified considering BMI and WC values, respectively. Diet quality was assessed with ESQUADA. Data were collected at household using the Epicollect5 application. Diet quality (in scores) was analyzed as continuous data and later categorized. The confidence interval was used for comparison between groups, Fisher's exact test for an association study. Adjusted multiple linear regression models were also estimated. P < 0.05 was adopted for statistical significance.

RESULTS

Overweight prevailed in 60.33% of individuals, especially among women (60.73%). High or very high metabolic risk was more frequent among women with "very good or excellent" diet quality. Higher diet quality score was associated with a reduction in TSF (β = -0.07; 95%CI -0.13 - -0.01) and an increase in MAMC (β = 0.09; 95%CI 0.00 - 0,18) in men and the reduction in weight (β = -0.04; 95%CI -0.07 - -0.01), SSF (β = -0.07; 95%CI -0.13 - -0,00) and WC in women (β = -0.06; 95%CI -0.09 - -0.02).

CONCLUSION

A better diet quality is positively associated with lean mass in men, and negatively with fat mass in men and women.

Breastfeeding: Knowledge Degree Of Community Health Agents

The objective was to investigate the Community Health Agents (CHA) knowledge  in breastfeeding. An analytical cross-sectional study with ACS of both genders that work in the Family Health Strategy. The data were obtained through a questionnaire, including open and closed questions regarding their socioeconomic, professional and breastfeeding knowledge. A total of 116 ACS patients with an average age of 44.2 ± 8.8 years and 14.7 ± 5.2 years of service time participated. Of these, 69.6% reported having performed some training, and only 24.8% and 6.2% obtained a satisfactory knowledge classification, related to important aspects about the technique and management of intercurrences in breastfeeding, respectively. Regarding the answers of the closed questions, which were about general knowledge about breastfeeding, the average number of correct answers was 15.2 ± 3.2 questions, which was significantly higher (p = 0.019) among professionals working in the urban area in Rural areas. In view of the results, there is a need for greater investments in the training of the ACS in breastfeeding, so that they can acquire the necessary knowledge to effectively work with pregnant women and nursing mothers, especially with regard to adequate breastfeeding techniques and treatment of breast complications.