Implementação da estratégia NUTRISUS: a experiência de quem fez
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Data
2017-04-10
Autores
Oliveira, Gabriele Caldas de [UNIFESP]
Orientadores
Bandoni, Daniel Henrique [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
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Resumo
Entre as causas de anemia em mulheres e crianças no mundo,
aproximadamente 50% e 42% respectivamente estão relacionadas à deficiência de
ferro, podendo variar de acordo com a região. Crianças entre os 6-24 meses passam
a necessitar de fontes de ferro adicionais advindas da alimentação para suprir a
demanda devido ao intenso crescimento nessa faixa etária. Quando há consumo
insuficiente de alimentos-fonte de ferro e/ou de baixa biodisponibilidade aumenta o
risco para a ocorrência de anemia por deficiência de ferro. As intervenções com
micronutrientes em pó (MNP) trazem uma alternativa para a adição de ferro e outros
micronutrientes na nutrição infantil permitindo a fortificação de qualquer alimento
semissólido em diversos locais. A partir de 2014 o Programa Saúde na Escola (PSE)
incorpora a Estratégia NutriSUS: fortificação da alimentação infantil com
micronutrientes (vitaminas e minerais) em pó como uma de suas ações e passa a
ser implementada em Unidades de Educação Infantil (UEI) do Brasil para crianças
na faixa etária de 6 a 48 meses. Em políticas públicas, a avaliação da etapa de
implementação é uma importante ferramenta que permite transformação e
aprendizado da política e stakeholders de modo a trazer benefícios para a
sociedade. O presente estudo tem como objetivo avaliar a experiência de
implementação da Estratégia NutriSUS: fortificação da alimentação infantil com
micronutrientes (vitaminas e minerais) em pó nas Unidades de Educação Infantil da
Região Metropolitana da Baixada Santista (RMBS). Trata-se de um estudo
transversal realizado nos municípios que implementaram a Estratégia NutriSUS no
ano de 2015 na RMBS. A amostra do estudo foi constituída por 23 UEI de dois
municípios da região. Os instrumentos para a coleta de dados foram quatro
questionários direcionados para os responsáveis pela Estratégia na Secretaria de
Educação e de Saúde de cada município e para os gestores de unidade e
funcionários responsáveis pela administração do sachê de cada UEI. Também foram
produzidos diários de campo após cada entrevista realizada. A análise dos dados
qualitativos foi feita por meio da análise de conteúdo temática e dos dados
quantitativos por meio da frequência para descrever a amostra e as respostas das
questões fechadas. Com a avaliação foi possível identificar que a implementação da
Estratégia NutriSUS na RMBS foi considerada uma experiência negativa pelos
implementadores. Duas questões foram importantes influenciadoras das
considerações negativas quanto a essa experiência: a falta de intersetorialidade e a
comunicação malsucedida para a introdução da Estratégia. Não houve um trabalho
de sensibilização e comunicação efetivo para a introdução da Estratégia NutriSUS e
a intersetorialidade prevista na formulação da ação não foi efetuada em sua
implementação. Identificou-se compreensão das necessidades nutricionais
específicas da faixa etária do público alvo, porém mantinham-se dúvidas quanto à
fortificação com micronutrientes em pó. A avaliação dessa experiência de
implementação construiu hipóteses sobre a recepção e construção da Estratégia
NutriSUS pelos implementadores da RMBS e oferece ferramentas para o
desenvolvimento dessa política pública, além de servir como fundação para novas
avaliações.
Among the causes of anemia in women and children in the world, approximately 50% and 42% respectively are related to iron deficiency and may vary depending on the region. Children between the 6-24 months need additional iron sources coming from the food supply to meet the demand due to the intense growth in this age range. When there are insufficient consumption of food source of iron and/or low bioavailability increases the risk to the occurrence of iron deficiency anemia. Interventions with micronutrient powder (MNP) bring an alternative to the addition of iron and other micronutrients in infant nutrition allowing the fortification of any semisolid food in various locations. From 2014 the Health in Schools Program incorporates the NutriSUS Strategy: child food fortification with micronutrients (vitamins and minerals) powder as one of its actions and it is implemented in children's education units (CEU) of Brazil for kids in the age range from 6 to 48 months. In public policies, the evaluation of the Implementation step is an important tool that allows transformation and learning of politics and Stakeholders bringing benefits to society. The present study aims to evaluate the experience of implementing the NutriSUS Strategy: child food fortification with micronutrients (vitamins and minerals) powder in the children's education units of the Metropolitan Region of the Baixada Santista (MRBS). This is a transversal study carried out in the municipalities that implemented the NutriSUS Strategy in the year 2015 in MRBS. The sample of the study was made up of 23 CEU from two municipalities in the region. The instruments for the collection of data were four questionnaires directed to those responsible for the strategy in the Department of Education and of Health of each municipality and to the unit managers and officials responsible for the administration of the sachet of each CEU. Field diaries were also produced after each interview. The qualitative data analysis was carried out through the thematic analysis of content and quantitative data by means of the frequency for describe the sample and the answers of the closed questions. With the evaluation it was possible to identify that the implementation of NutriSUS Strategy in MRBS was considered a negative experience by the implementers. Two issues were important influencing the negative considerations in this experience: the lack of intersectoriality and the unsuccessful communication for the introduction of the strategy. There was no effective awareness and communication work for the introduction of the NutriSUS strategy and the intersectoriality provided in the formulation of the action was not effected in its implementation. It was identified understanding of the needs of the nutritional specific to the age range of the target audience, but there were doubts about the fortification with powdered micronutrients. The assessment of this implementation experience has built assumptions about the reception and construction of the NutriSUS strategy by the implementers of MRBS and offers tools for the development of this public policy, besides serving as foundation for new evaluations.
Among the causes of anemia in women and children in the world, approximately 50% and 42% respectively are related to iron deficiency and may vary depending on the region. Children between the 6-24 months need additional iron sources coming from the food supply to meet the demand due to the intense growth in this age range. When there are insufficient consumption of food source of iron and/or low bioavailability increases the risk to the occurrence of iron deficiency anemia. Interventions with micronutrient powder (MNP) bring an alternative to the addition of iron and other micronutrients in infant nutrition allowing the fortification of any semisolid food in various locations. From 2014 the Health in Schools Program incorporates the NutriSUS Strategy: child food fortification with micronutrients (vitamins and minerals) powder as one of its actions and it is implemented in children's education units (CEU) of Brazil for kids in the age range from 6 to 48 months. In public policies, the evaluation of the Implementation step is an important tool that allows transformation and learning of politics and Stakeholders bringing benefits to society. The present study aims to evaluate the experience of implementing the NutriSUS Strategy: child food fortification with micronutrients (vitamins and minerals) powder in the children's education units of the Metropolitan Region of the Baixada Santista (MRBS). This is a transversal study carried out in the municipalities that implemented the NutriSUS Strategy in the year 2015 in MRBS. The sample of the study was made up of 23 CEU from two municipalities in the region. The instruments for the collection of data were four questionnaires directed to those responsible for the strategy in the Department of Education and of Health of each municipality and to the unit managers and officials responsible for the administration of the sachet of each CEU. Field diaries were also produced after each interview. The qualitative data analysis was carried out through the thematic analysis of content and quantitative data by means of the frequency for describe the sample and the answers of the closed questions. With the evaluation it was possible to identify that the implementation of NutriSUS Strategy in MRBS was considered a negative experience by the implementers. Two issues were important influencing the negative considerations in this experience: the lack of intersectoriality and the unsuccessful communication for the introduction of the strategy. There was no effective awareness and communication work for the introduction of the NutriSUS strategy and the intersectoriality provided in the formulation of the action was not effected in its implementation. It was identified understanding of the needs of the nutritional specific to the age range of the target audience, but there were doubts about the fortification with powdered micronutrients. The assessment of this implementation experience has built assumptions about the reception and construction of the NutriSUS strategy by the implementers of MRBS and offers tools for the development of this public policy, besides serving as foundation for new evaluations.
Descrição
Citação
OLIVEIRA, Gabriele Caldas de. Implementação da estratégia NUTRISUS: a experiência de quem fez. 2017.77 f. Dissertação (Mestrado) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2017.