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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">Despite the overall decline in percentage over years&#44; stunting remains a public health challenge and concern worldwide&#44; with 149 million children under five years of age being stunted&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> One of the major contributors to stunting is undernutrition from conception to the 2<span class="elsevierStyleSup">nd</span> birthday&#44; a time that represents a critical window for fetal and infant growth and development&#46; Maternal factors&#44; pregnancy outcomes&#44; poverty&#44; limited access to health services&#44; food insecurity&#44; and poor hygiene conditions may also contribute to this condition&#44; alongside socio-economic&#44; commercial&#44; and political contexts&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Child stunting exerts short- and long-term effects on individuals and societies&#46; They include increased mortality&#44; poor cognition&#44; and educational performance&#44; susceptibility to non-communicable diseases&#44; low adult wages&#44; and lost productivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4&#8211;6</span></a> Prevention and appropriate management of child undernutrition must be prioritized to ensure child survival and physical and intellectual development and to avoid the rise of non-communicable diseases&#46; Tracking the progress toward the achievement of nutrition targets at national and sub-national levels is an important task in public health as it helps policymakers to identify priority areas of action and to develop proper strategies to address chronic undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Unfortunately&#44; data are sometimes sparse&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">In this issue of the Jornal de Pediatria&#44; Corr&#234;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> characterize the temporal tendency of the prevalence of stunting among children under five years of age&#44; assisted by the Unified Health System&#44; in the Brazilian North Region and for each of its states&#44; using secondary data from the Food and Nutritional Surveillance System &#40;SISVAN&#41; for the years 2008 to 2017&#46; The Prais-Winsten regression model was used with and without variable adjustment for SISVAN coverage to also investigate the relationship between the temporal tendency toward stunting and the SISVAN coverage&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">The Authors contribute to updating the epidemiological evidence on child stunting in the Brazilian Northern Region both as a whole and for each state&#46; Beyond confirming the precarious nutritional status in the area&#44; the results evidence regional differences in stunting prevalence&#44; thereby the need for differentiating strategies to cope with chronic undernutrition based on local contexts&#46; The iniquities of access to health services due to geographical characteristics and the lack of infrastructures likely explain partly the situation&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> A large analysis in 67 low- and middle-income countries showed that&#44; despite declining stunting prevalence&#44; socioeconomic inequalities continue while rural-urban inequalities are decreasing over time&#46; A major limitation of this analysis was the lack of recent data from populous countries&#44; including Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> The influence of socioeconomic status and the rural-urban gap should be monitored closely to tackle the inequalities&#44; especially nowadays when climate change&#44; the COVID-19 pandemic&#44; and the wheat crisis are widening the gaps and disrupting health&#44; nutrition&#44; and protection services&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0004" class="elsevierStylePara elsevierViewall">Corr&#234;a and colleagues<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> highlight the key role of a computerized system of accurate&#44; regular&#44; and frequent collection and interpretation of growth curves and nutritional status records within Primary Health Care&#44; as a tool enabling to continuously generate information on nutritional status and food consumption&#44; in order to identify children at nutritional risk in a rapid and low-cost manner&#46; Notably&#44; the Authors find a strong negative association between the SISVAN coverage and the prevalence of child stunting&#46; This result indicates the potentially positive impact of such a type of system not only on the early identification of the nutritional risk but also on the prevention of the related morbidities and the organization of nutritional and health care&#44; suggesting the need for further improvement of the SISVAN coverage&#46; The exclusion of 27 municipalities from the analyses due to data inconsistency&#44; 19 of them concentrated in the state of Tocantins&#44; underlines the need not only for a quantitative but also a qualitative improvement of the data collection system&#46; Homogeneous distribution of trained health professionals involved in data collection would reduce statistical bias and improve the understanding of regional differences&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Monitoring the health and nutrition situation of populations and groups over time is helpful&#46; However&#44; it is worthy underlying that in order to establish targeted and effective interventions to tackle child chronic malnutrition&#44; it is paramount to investigate the key determinants and drivers of stunting so that individual countries can learn what works or not &#40;i&#46;e&#46;&#44; enablers and&#47;or barriers&#41; in nutrition and health programs&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">The work by Corr&#234;a and colleagues<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> provides useful inputs for future research in the field and informs policymakers and program planners&#46; Results point out the importance of implementing nutritional and health surveillance&#59; strengthening the health care network&#59; investigating more in-depth associations between trends of this form of chronic undernutrition and determining factors&#59; tackling the problem of socioeconomic and environmental inequities for achieving the reduction in the prevalence of child stunting&#46;</p></span>"
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Editorial
Temporal trend of child stunting prevalence and Food and Nutritional Surveillance System
Cristiana Bertia,
Corresponding author
, Adriano La Vecchiab
a Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
b Università degli Studi di Milano, Milan, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">Despite the overall decline in percentage over years&#44; stunting remains a public health challenge and concern worldwide&#44; with 149 million children under five years of age being stunted&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> One of the major contributors to stunting is undernutrition from conception to the 2<span class="elsevierStyleSup">nd</span> birthday&#44; a time that represents a critical window for fetal and infant growth and development&#46; Maternal factors&#44; pregnancy outcomes&#44; poverty&#44; limited access to health services&#44; food insecurity&#44; and poor hygiene conditions may also contribute to this condition&#44; alongside socio-economic&#44; commercial&#44; and political contexts&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> Child stunting exerts short- and long-term effects on individuals and societies&#46; They include increased mortality&#44; poor cognition&#44; and educational performance&#44; susceptibility to non-communicable diseases&#44; low adult wages&#44; and lost productivity&#46;<a class="elsevierStyleCrossRefs" href="#bib0004"><span class="elsevierStyleSup">4&#8211;6</span></a> Prevention and appropriate management of child undernutrition must be prioritized to ensure child survival and physical and intellectual development and to avoid the rise of non-communicable diseases&#46; Tracking the progress toward the achievement of nutrition targets at national and sub-national levels is an important task in public health as it helps policymakers to identify priority areas of action and to develop proper strategies to address chronic undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Unfortunately&#44; data are sometimes sparse&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">In this issue of the Jornal de Pediatria&#44; Corr&#234;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> characterize the temporal tendency of the prevalence of stunting among children under five years of age&#44; assisted by the Unified Health System&#44; in the Brazilian North Region and for each of its states&#44; using secondary data from the Food and Nutritional Surveillance System &#40;SISVAN&#41; for the years 2008 to 2017&#46; The Prais-Winsten regression model was used with and without variable adjustment for SISVAN coverage to also investigate the relationship between the temporal tendency toward stunting and the SISVAN coverage&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">The Authors contribute to updating the epidemiological evidence on child stunting in the Brazilian Northern Region both as a whole and for each state&#46; Beyond confirming the precarious nutritional status in the area&#44; the results evidence regional differences in stunting prevalence&#44; thereby the need for differentiating strategies to cope with chronic undernutrition based on local contexts&#46; The iniquities of access to health services due to geographical characteristics and the lack of infrastructures likely explain partly the situation&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> A large analysis in 67 low- and middle-income countries showed that&#44; despite declining stunting prevalence&#44; socioeconomic inequalities continue while rural-urban inequalities are decreasing over time&#46; A major limitation of this analysis was the lack of recent data from populous countries&#44; including Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> The influence of socioeconomic status and the rural-urban gap should be monitored closely to tackle the inequalities&#44; especially nowadays when climate change&#44; the COVID-19 pandemic&#44; and the wheat crisis are widening the gaps and disrupting health&#44; nutrition&#44; and protection services&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a></p><p id="para0004" class="elsevierStylePara elsevierViewall">Corr&#234;a and colleagues<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> highlight the key role of a computerized system of accurate&#44; regular&#44; and frequent collection and interpretation of growth curves and nutritional status records within Primary Health Care&#44; as a tool enabling to continuously generate information on nutritional status and food consumption&#44; in order to identify children at nutritional risk in a rapid and low-cost manner&#46; Notably&#44; the Authors find a strong negative association between the SISVAN coverage and the prevalence of child stunting&#46; This result indicates the potentially positive impact of such a type of system not only on the early identification of the nutritional risk but also on the prevention of the related morbidities and the organization of nutritional and health care&#44; suggesting the need for further improvement of the SISVAN coverage&#46; The exclusion of 27 municipalities from the analyses due to data inconsistency&#44; 19 of them concentrated in the state of Tocantins&#44; underlines the need not only for a quantitative but also a qualitative improvement of the data collection system&#46; Homogeneous distribution of trained health professionals involved in data collection would reduce statistical bias and improve the understanding of regional differences&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">Monitoring the health and nutrition situation of populations and groups over time is helpful&#46; However&#44; it is worthy underlying that in order to establish targeted and effective interventions to tackle child chronic malnutrition&#44; it is paramount to investigate the key determinants and drivers of stunting so that individual countries can learn what works or not &#40;i&#46;e&#46;&#44; enablers and&#47;or barriers&#41; in nutrition and health programs&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">The work by Corr&#234;a and colleagues<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> provides useful inputs for future research in the field and informs policymakers and program planners&#46; Results point out the importance of implementing nutritional and health surveillance&#59; strengthening the health care network&#59; investigating more in-depth associations between trends of this form of chronic undernutrition and determining factors&#59; tackling the problem of socioeconomic and environmental inequities for achieving the reduction in the prevalence of child stunting&#46;</p></span>"
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Article information
ISSN: 00217557
Original language: English
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