Healthcare and unhealthy eating among children aged under two years: data from the National Health Survey, Brazil, 2013

Abstract Objectives: to examine indicators relating to access to child health care and markers of unhealthy patterns of eating in Brazilian children aged under two years and to set these in the context of the National Health System 's current child healthcare agenda. Methods: a descriptive cross-sectional study using data from the 2013 National Health Survey. Prevalences and confidence intervals of 95% (CI95%) were estimated for the total population, Brazilian macroregions and urban or rural location of household. Results: a first medical consult before the seventh day of life was reported in only 28.7% of children. Supervision of growth and child development was carried out primarily at basic health units (57.2%; CI95%: 54.8-59.6). Theneonatal screening, newborn hearing screening and red reflex tests were conducted with a frequency of 70.8% (CI95%: 69.0-72.7), 56.0% (CI95%: 53.8-58.3) and 51.1% (CI95%: 48.9-53.3), respectively. Disparities were found in preventive health care, with lower access among children living in rural households or in the North and Northeast regions. Soda consumption was reported for 32.3% and consumption of biscuits or cake for 60.8% of children,indicating premature introduction of unhealthy foods into the child's diet. Conclusions: the findingspoint to disparities in access to child healthcare and a high prevalence of unhealthy eating habits in infancy.摘要 研究目的：探讨巴西两岁以下儿童的儿童保健服务可及性相关指标与不健康饮食模式标志物，并结合国家卫生系统（National Health System）现行儿童保健议程展开分析。 研究方法：本研究为描述性横断面研究，数据取自2013年全国健康调查（National Health Survey）。针对研究总体人群、巴西宏观区域以及家庭城乡居住区位，分别估算了患病率与95%置信区间（CI95%）。 研究结果：仅28.7%的儿童在出生后7日内完成首次医疗咨询。儿童生长发育监测主要在基层卫生单位（basic health units）开展，占比达57.2%（95%CI：54.8~59.6）。新生儿筛查、新生儿听力筛查以及红光反射测试的实施率分别为70.8%（95%CI：69.0~72.7）、56.0%（95%CI：53.8~58.3）与51.1%（95%CI：48.9~53.3）。研究发现预防性保健服务存在可及性差异：居住在农村家庭或巴西北部、东北部地区的儿童，其保健服务可及性相对更低。32.3%的儿童存在含糖汽水摄入行为，60.8%的儿童食用饼干或蛋糕，提示不健康食品过早被引入儿童膳食结构。 研究结论：本研究结果显示，巴西两岁以下儿童的儿童保健服务可及性存在不均衡性，且婴幼儿不健康饮食习惯的患病率较高。