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Evaluation of a program aimed to reduce
Obesity in pregnant women
Dr. Marcia Erazo
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In late years …
Health problems in the population have changed….
DEFICIT EXCESS
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87 89 91 93 95 97 99 1 3
10
15
20
25
30
35
UnderW Obesity
Prevalence rates undernourished
and obese pregnant women 1987-2002
%
+ 159 %
- 48%
Fuente: MINSAL
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Advisory in healthy lifestyle.
More controls
Strict surveillance Nutritional status during
pregnancy
Stimulating exclusive breast-feeding (6 mo)
Create more support nets
Evaluate this strategy.
NUTRITIONAL INTERVENTION
THROUGH VITAL CYCLE
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Advisory in healthy life
Promote healthy conducts and change habits.
Stimulate self-care.
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Multi-level design
Ministry of Health
H. S.
P. C. C. X
Population
Level 2
Level 1
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Table 1. Population characteristics
Característica Control
P50 (p25 – p75)
Intervention
P50 (p25 – p75)
Age (y.o) 27 (22 -32) 24 (19.7 – 31)
Income (USD) 302 (175 – 350) 336 (191 – 438)
School (tears) 12 (9-12) 12 (10 -12)
Chilbirth (N°) 2 (1 -3) 2 (1 – 2)
Nutritional status beginning
pregnancy
- Underweighted
- Normal
- Overweighted
- Obesity
0.8
47.3
38.6
13.3
1.3
53.4
31.4
13.9
Nutritional status at month 6.
- Underweighted
- Normal
- Overweighted
- Obesity
1.2
37.6
41.1
20.2
0.5
32.1
40.3
27
Calories (kcal) 2151 (1397 – 2670) 2807 (2088 – 3427)
Physical activity (hrs) 2.6 (2-4.5) 4.6 (3.2-5.3)
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Table 2. Weight gain during pregnancy and at month 6
Nutritional status
Control Media (sd)
Intervention Media (sd)
P value *
Underweight Ganancia (Kg) 11, 5 (2,12) 6,8 (0) 0,03
Retención (Kg) 4,00 (4,24) 9,00 (8,48) 0,05
Normal Ganancia (Kg) 12,22 (4,38) 12,8 (3,81) 0,35
Retención (Kg) 2,13 (4,87) 6,6 (5,66) <0,001
Overweight Ganancia (Kg) 19,16 (7,9) 12,07 (4,53) 0,05
Retención (Kg) 2,30 (5,42) 5,55 (5,22) <0,001
Obesity Ganancia (Kg) 7,28 (3,51) 8,90 (5,25) 0,241
Retención (Kg) 2,61 (5,76) -0,52 (6,71) 0,05
Total Ganancia (Kg) 14,19 (4,93) 12,01 (4,48) 0,55
Retención (Kg) 2,27 (5,16) 5,32 (6,11) <0,001
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Tabla 3. Factores de riesgo de no recuperación del estado nutricional al sexto mes post parto.
P value OR 95% CI
Low High
Age ,034 ,960 ,925 ,997
Nutritional status end pregnancy ,000 32,006 13,207 77,567
Nutritional status beginning * Intervention
,005 ,406 ,218 ,757
Intervention ,000 31,810 5,392 187,662
Nutritional status beginning ,000 ,066 ,027 ,160
-2 Log likelihood=432,112.
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Ministry of Health Statistics, 2010
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What happened with advisory?
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NOTHING!!!!
Not prepared: Health system: Have neither time nor human resources for advisory People: They want that professionals tell them what is wrong and what is right!!
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Causal model of obesity and Ministerial
programatic approach
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Results
Diverse interventions and key aspects
Target Population Intervention Key aspects
Diverse population
(Elderly, women, children)
Community agents to
support families
Permanent support to make healthy
choices (food and physical activities)
Schoolchildren Environmental
modification
1 year (or more) of constant
intervention
Healthy food supply at school
Families and educative community
involved
Workers Education and
psychological support
Results improve with an incentive
programme.
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Key aspects to improve Ministerial
Programs
To stimulate higher number of contacts. Use of e-
health.
To educate properly the professionals that will be
involved in the new intervention.
To incorporate the family (community), their thoughts,
culture, fears and expectations in the design of the
strategy (program).
Give clear and understandable indications.
Offer peer-support to those who are been intervened
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Opportunities to improve public policies
aimed to reduce obesity
Program / Strategy Recommendation
Health promotion -National
Strategy
At school level:
At least 1 year of intervention
Involve parents and educational community
Incorporate feeding-nutrtional education and physical activity as a curricular
activity
Increase fruit and vegetable supply
At community level:
Promote community agents that help families to make healthy choices.
Life course intervention aimed
to prevent and control obesity
Stimulate higher number of contacts. Use e-health tools.
Educate properly the professionals that are involved in the intervention.
Give clear and understandable indications.
National childhood Program Incorporate parents. Give them clear and simple instructions about healthy
life-style.
Incorporate healthy living counselling, motivation and support, specially to
families with overweighted children
Visit families at home, understand the culture and the environment where
children live.
Work with community agents
Use e-Health toools to increase the number of contacts with your family.
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We ourselves feel that what we are doing is just a
drop in the ocean, but the ocean would be less
because of that missing drop.
Mother Teresa of Calcutta