Efetividade do Programa Nacional de Suplementação de Ferro: estudo de base populacional com lactentes de 6 a 18 meses do Estado de Alagoas

Abstract

Several factors can cause anemia, among them, the ones originated from nutrient deficiency, with iron deficiency accounting for about half the world’s cases. Due to its high prevalence, its consequences and the existence of effective prevention and control measures, in 2005 it was implemented in Brazil the National Program for Iron Supplementation (PNSF), consisting of nutritional education actions, food fortification and prophylactic supplementation with ferrous sulfate to the most susceptible groups. After more than a decade of its existence, the anemia still maintains high prevalence in the country, and especially in Alagoas, one of the states that is distinguished by presenting the worst socioeconomic indicators among the others Brazilian states. In order to address these issues, the present dissertation was made, which is constituted of a literature review chapter and an original manuscript. The objective is to investigate the effectiveness of PNSF in Alagoas State. It is about a transversal study involving a probabilistic sample of children aged six to 18 months, by means of a household survey conducted in 2014. PNSF effectiveness evaluation followed a model adapted from the one advocated by Donabedian. Specifically, aspects related to the process (compliance with the activities foreseen under the Program) and the results obtained (changes produced on the direct beneficiaries of the action) were evaluated. For the process evaluation, children’s mothers were interviewed following a standard script established in a semi-structured form, with questions regarding aspects related to the actions foreseen by the Program. On the other hand, the results evaluation was performed by analyzing the anemia prevalence time tendency (hemoglobin <11g/dL), which, in addition to the present investigation, data from a similar survey conducted in 2005 was used. The variation occurred between the two studies was expressed as a percentage and the prevalence ratio (PR) and respective 95% confidence interval (95%CI), calculated by Poisson regression with robust variance adjustment. Program coverage (number of children who received ferrous sulfate in the last three months) was considered low (20.5%) and the accession rate to the supplement use (having received, were making use of ferrous sulfate) was also low (47.9%). There were a higher proportion of mothers who received ferrous sulfate (39.6%) among those whose children had a history of anemia. The anemia prevalence in 2005 and 2014 were, respectively, 69.9% and 44.4% (-36.5%, PR=0.64, 95%CI: 0.53-0.76). It was concluded that there was a significant decline in the anemia prevalence, but not enough to deprive it as a serious public health problem. Low coverage and accession rates may explain part of the PNSF low effectiveness in Alagoas, as well as the lack of orientation to mothers. The use of ferrous sulfate for treatment purposes seems to take priority over its use in a preventive way, as recommended in the PNSF rules.