Vulnerabilidade social e condições de nutrição e saúde de mulheres e crianças: diferenciais entre a população quilombola e a população geral do estado de Alagoas

Abstract

This thesis was developed with the aim of comparing the nutrition and health conditions between quilombola and non-quilombola women and children in the state of Alagoas. To meet the proposed objective, the results chapter is presented in the form of two original articles. Both articles were based on two independent population-based household surveys carried out in the state of Alagoas in 2015 and 2018, involving, respectively, non-quilombola women and children under 5 years of age (State Survey) and quilombola women and children (Quilombola Survey). The State Survey was carried out in 20 of the 102 municipalities in Alagoas, including the state capital, Maceió, while the Quilombola Survey involved 50% (n=34) of the communities of quilombos (CRQs) in Alagoas. Environmental, demographic, socioeconomic, reproductive, and related to women's lifestyle and health, and maternal and child-related data were obtained from structured forms. Anthropometric measurements of women and of the mother-child binomial, and measurement of women's blood pressure were also performed in both surveys. The factors associated with the outcomes were identified by multivariate analysis, according to the theoretical determination model for the hierarchical selection of variables for each outcome. The first article compared the prevalence and factors associated with excess weight and systemic arterial hypertension (SAH) in the two scenarios. Overweight was defined by BMI ≥25 kg/m² and SAH by systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or current use of antihypertensive medication. A total of 4,627 women aged 20 to 49 years were evaluated, of which 1,474 were quilombolas and 3,153 were nonquilombolas. The prevalence of overweight (66.8% vs. 62.4%; p=0.005) was higher in quilombola women. There was no difference in the prevalence of hypertension between the groups (23.1% vs. 22.1%; p=0,447). Factors associated with excess weight in quilombola women were: age > 30 years old, presence of severe food insecurity, early menarche (< 12 years of age), having children, and having hypertension. Among non-quilombolas, in addition to age >30 years old, early menarche (< 12 years of age), having children, and presenting hypertension, schooling ≤8 years, and alcohol consumption were also conditions associated with overweight. As for hypertension, the factors associated among quilombolas were: age > 30 years old, education level ≤ 8 years, early menarche (< 12 years years of age), and overweight. Among non-quilombola women, in addition to age > 30 years old, education level ≤ 8 years, and overweight, the presence of severe food insecurity and having had a health problem in the last 15 days were also associated with hypertension. The objective of the second article was to compare the nutritional status and factors associated with stunting, overweight, and anemia among quilombola and non-quilombola children in the state of Alagoas. Anemia was diagnosed when hemoglobin <11.0 g/dL and anthropometric conditions defined by the classification proposed by Ferreira. The sample involved 1,546 children under 5 years old, 555 from quilombolas, and 991 from non-quilombolas. The prevalence of stunting (6.5% vs. 3.5%, p=0.008) and anemia (38.3% vs. 27.4% p<0.001) were higher in quilombola children compared to non-quilombola children. On the other hand, the prevalence of overweight was higher among non-quilombola children: 9.6% vs. 14.1% (p=0.009), respectively. Among quilombola children, the factors associated with stuning were: wealth index below the median, low maternal height, and low birth weight. In addition to low birth weight and low maternal height, among non-quilombola children, other factors associated with stuning was: and age ≤ 24 months. The presence of moderate food insecurity, age ≤ 24 months, and high birth weight were factors associated with overweight among quilombola children. Among non-quilombolas, being overweight was associated with an increase in quartiles of maternal BMI, and high birth weight. As for anemia, the associated factors among the quilombolas were: maternal age (<20 years), age ≤ 24 months, male gender, and health problem in the last 30 days. Among non-quilombolas, maternal education (≤ 8 years), and age ≤ 24 months were factors associated with anemia. We concluded that, in line with the assumptions of social determination in the health and disease process, the socioeconomic disadvantages to which quilombolas women and children are historically subjected reverberate nowadays, as observed by the presence of worse nutrition and health profile. We hoped that these results will be used to guide public policies aimed at facing these conditions, which must consider that, in the state with the worst socioeconomic indicators in the country, quilombola women and children survive in an even more vulnerable scenario.