title: Challenges in the management of nutritional disorders and communicable diseases in child day care centers: a quantitative and qualitative approach.
abstract: In Brazil, although many children from low income families attend day care centers with appropriate hygiene practices and food programs, they have nutritional disorders and communicable diseases. This quantitative and qualitative cross-sectional study identified staff challenges in child day care centers and suggested alternative activity management to prevent nutritional disorders and communicable diseases. The study included 71 nursery teachers and 270 children from public and philanthropic day care centers (teacher to child ratios of 1:2.57 and 1:6.40, respectively). Interviews and focus groups were conducted with teachers and parents, and anthropometry and blood samples were drawn from the children by digital puncture. Children in philanthropic child day care centers were more likely to be hospitalized due to communicable diseases. Teachers from philanthropic child day care centers had lower age, income and education and higher work responsibilities based on the number of children and working time. The focus groups characterized institutions with organized routines, standard food practices, difficulties with caretaking, and lack of training to provide healthcare to children. Strategies to improve children's health in day care settings should focus on training of teachers about healthcare and nutrition.
authors.affiliation: 1. University of Santo Amaro, São Paulo, Brazil.|2. Department of Pediatrics, Federal University of São Paulo, Brazil.
authors.forename: Tulio
authors.initials: T
authors.lastname: Konstantyner
authors.affiliation: 3. Department of Epidemiology, Faculty of Public Health, Federal University of São Paulo, Brazil.
authors.forename: Thais Cláudia Roma de Oliveira
authors.initials: TC
authors.lastname: Konstantyner
authors.affiliation: 4. Department of Food Science, Federal University of Lavras, Minas Gerais, Brazil.
authors.forename: Maysa Helena Aguiar
authors.initials: MH
authors.lastname: Toloni
authors.affiliation: 5. Faculty of Nutrition, Federal University of Alagoas, Maceió, Brazil.
authors.forename: Giovana
authors.initials: G
authors.lastname: Longo-Silva
authors.affiliation: 1. University of Santo Amaro, São Paulo, Brazil.
authors.forename: José Augusto de Aguiar Carrazedo
authors.initials: JA
authors.lastname: Taddei
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002656:Child Day Care Centers; D002675:Child, Preschool; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D009748:Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control; D009752:Nutritional Status; D011203:Poverty; D036301:Qualitative Research; D000078329:Workforce
keywords: children; communicable disease; nutrition; qualitative public health