(In) Efetividade do Programa Nacional de Suplementação de Ferro : fatores relacionados aos gestores municipais, aos profissionais de saúde e à população beneficiária

Abstract

Anemia is a common deficiency throughout the world, its main cause, iron deficiency, is the most prevalent nutritional deficiency in the world. Were studied twelve municipalities in the region North of the State of Alagoas, having intended to investigate the prevalence of anaemia in pregnant women and children and to investigate the reasons for (in) effectiveness of the national programme of iron supplementation (PNSF).The data collection occurred in three modules: population receiving the PNSF, children 6 to 18 months and pregnant women blood sample collection, and held the determination of hemoglobin to assess the prevalence of anaemia in the Group; Programme Manager, Coordinator of the PNSF in the municipality; and finally, health care professionals who work in basic care. In all modules were applied questionnaires drawn up in the search following the Manual of the PNSF. Were interviewed 1,446 families, totaling a sample of 6,446 individuals residing in the northern municipalities of Alagoas. Of the total of 90 individuals, pregnant women, 157 children were in the range from 0 to 60 months. The prevalence of anaemia in pregnant women was 46.8%, there were no cases of severe anaemia, 41.8% were cases of mild anemia and 5.1% of moderate anaemia. In children 6 to 60 months, the prevalence of anemia was 51.7%, 39.4% of mild anemia, 9.8% from moderate anaemia and 2.5% of children with severe anaemia. In pregnant women there were not significant risk factors. The child's age was a significant factor for occurrence of anemia, children under one year are eight times more likely to be anemic that children over one year. The questionnaires of the PNSF in pregnant women and children demonstrated little knowledge about the programme, the importance of supplementation and information about food sources of iron, as well as foods that interfere with the absorption of iron, positively or negatively. The coordinators of the PNSF are mostly healthcare professionals (90%) that Act on other programs in the municipality, half operate also in vitamin A supplementation program, any other act in basic care or outside a Coordinator acts in school meals. The involvement in all activities of the PNSF occurs with only two of the coordinators. The causes of the inefficiency of the programme for coordinators: the lack of interest of the population; the lack of the supplement; lack of training of health staff and lack of supervision in the implementation of the programme. Helth professionals belive that the PNSF has not been effective: lack of the supplement; lack of interest of the population; lack of interest of local and/or federal managers; lack of training of the teams; lack of health professionals with a commitment to the objectives of the programme. Both coordinators as health workers blamed the lack of success of the programme to beneficiaries and the lack of the add-in, as the two most cited. Despite the importance of nutritional guidance to the PNSF the minority of the population received this type of guidance. It has been suggested from this study that systematically a Food guidance programme staff of the family health Programme aimed at increasing access of the population with adequate information and directed to fight this nutritional deficiency.