Effectiveness of nutrition centers in Ceara state, northeastern Brazil
Efectividad de los centros de nutrición del estado de Ceará, nordeste del Brasil
Rev. panam. salud pública; 4 (6), 1998
Publication year: 1998
Childhood malnutrition has been a major, long-standing health concern in northeastern Brazil. In response, during 1992-1994, the state government of Ceará, with financial support from the World Bank, established 34 new nutrition centers. During 1996 an evaluation of the centers was conducted to determine their effectiveness in treating children with malnutrition and to identify weaknesses in the system and possible solutions. Also evaluated were the adequacy of resources, admission and discharge criteria, staff training, and community satisfaction. Effectiveness was found to be low. Treatment procedures did not conform with World Health Organization recommendations. Rates of weight gain were inadequate, and the mean duration of rehabilitation-8.7 months- was too long. Case fatality in two centers was unacceptably high, 40 per cent and more. Entry and exit criteria for rehabilitation were ill defined, resulting in some non-malnourished children being enrolled. Few staff were adequately trained; knowledge was weak, especially about case management; and mothers were not effectively instructed. Recommendations include setting objectives for the centers, improving referral systems, standardizing entry criteria, improving case management, and establishing performance indicators
La malnutrición ha sido por largo tiempo un preocupante problema de salud en la
región nordeste del Brasil. Para responder a esta situación, en el período de 1992 a 1994 el gobierno estatal de Ceará recibió apoyo del Banco Mundial para establecer 34 centros de nutrición. En 1996 se llevó a cabo una evaluación de los centros para precisar su efectividad en el tratamiento de niños malnutridos, los puntos débiles del sistema y posibles soluciones. También se evaluaron la suficiencia de los recursos, los criterios de admisión y alta, la capacitación de los empleados y la satisfacción de la comunidad. La efectividad resultó ser baja. Los procedimientos de tratamiento no correspondían a las recomendaciones de la Organización Mundial de la Salud. Las tasas de aumento de peso eran inadecuadas y la duración media del período de rehabilitación —8,7 meses—
demasiado larga.