Growth and development is considered the best positive indicator of children’s quality of life and well-being. Studies have been carried out in Cuba since the early 20th century and large scale, periodic anthropometric surveys have been regularly conducted by its National Health System to chart modifications in growth patterns of children and adolescents. These surveys have produced national references for the anthropometric indicators most commonly applied in individual assessment of the health and nutritional status of children and adolescents in health care settings. These have also provided data for estimating the magnitude and characteristics of secular growth trends, and for comparing growth of Cuban children with that of children in other countries and with WHO’s proposed growth standards. The data have also served as evidence of persisting social gradients. The most important results include, as positive data, the positive secular trend in school-aged children’s growth of 9.7 cm between 1919 and 2005, with an average increase of 1.1 cm per decade, and, in preschool children, 1.9 and 1.8 cm in boys and girls, respectively, between 1972 and 2015. More recent studies have detected unfavorable changes associated with a marked increase in adiposity and, therefore, in the prevalence of excess weight and obesity. Another interesting result is the gradual movement toward WHO height-for-age standards in preschool children in Havana, verified in surveys conducted in 2005 and 2015.
KEYWORDS Growth and development, growth, child development, children, adolescents, nutrition, obesity, pediatrics, Cuba
The first 1000 days of life constitute a short and exceptionally important period when the foundation is established for children’s growth, development and lifelong health. Cuba has a comprehensive care system for this population that aims to promote the best start in life so that children can reach their highest development potential. This is carried out through the national public health and education systems and also includes elements of health protection, prevention of harm and disease and social welfare for children.
Cuba’s infant mortality rate has remained <5 deaths per 1000 live births for 10 consecutive years, and in 2017 reached 4 per 1000, the lowest rate to date. The mortality rate for children aged <5 years in 2017 was 5.5 per 1000 live births, with a survival rate of 99.5%; low birth weight was 5.1% and vaccination coverage >95%. Among children aged 1 year in Cuba’s Educate Your Child program in 2014, >90% met age-specific indicators in all four developmental domains (intellectual, motor, socioaffective and language). Cuba has universal coverage for antenatal care and, in 2017, 99.9% of births occurred in health institutions. All working mothers receive paid antenatal leave from 34 weeks of gestation, continued through the child’s first year, to facilitate breastfeeding and child care. In 2018, the Cuban government allocated 27% of its national budget to health and social welfare and 21% to education.
KEYWORDS Growth and development, child development, child health services, preventive health services, primary health care, pregnant women, children, child rearing, intersectoral collaboration, Cuba
El notable incremento de las tasas de supervivencia de los niños cubanos ha conducido a nuevos desafíos en la búsqueda continua de mejorar su bienestar y calidad de vida. Solamente se pueden alcanzar estos avances en la medida en que también se mejoren la atención preventiva y la promoción de salud. Este artículo describe el diseño de una estrategia para la atención integral de niños y adolescentes que tiene como base mejorar la calidad de las consultas, definir sus componentes, las actividades específicas según la edad y brindar las pautas para el seguimiento en función de los hallazgos de las consultas. Como complemento a la estrategia, se identifican los indicadores y estándares para la evaluación sistemática de la calidad de la consulta, lo que permite recoger información objetiva y específica de cada consulta individual y la evaluación de las tendencias en el tiempo. Esto, a su vez, permitirá mejorar aún más esta estrategia a largo plazo.
PALABRAS CLAVE Servicios de salud infantil, servicios preventivos de salud, atención primaria de salud, mortalidad infantil, supervivencia, niños, adolescentes, Cuba
The notable rise in survival rates of Cuban children has presented new challenges in the search for continued improvement of their welfare and quality of life. These advances can be achieved only to the extent that preventive care and health promotion are also improved. This article describes the design of a strategy for comprehensive care of children and adolescents based on better quality of well child visits, defining visit components, age-specific activities for each visit, and guidelines for followup based on visit findings. Complementary to the strategy, indicators and standards are identified for systematic evaluation of visit quality, enabling collection of objective and specific information about individual visits and assessment of trends over time, which in turn facilitates further improvements in this strategy over the long term.
KEYWORDS Child health services, preventive health services, primary health care, infant mortality, survival, children, adolescents, Cuba
INTRODUCTION: Rising prevalence of excess weight in children and adolescents is a serious public health problem in both developed and developing countries, associated with a growing burden of chronic non-communicable diseases in youth and adults. In Cuba, population-based growth and development surveys have been conducted since the 1970s, the latest in 2005.
OBJECTIVE: Estimate prevalence of overweight, obesity and high adiposity in children and adolescents aged ≤19 years in Havana, Cuba, in 1972, 1993 and 2005, and describe secular trends in these conditions in the periods observed.
METHODS: A retrospective, descriptive study examined data from growth and development surveys conducted in Havana in 1972, 1993 and 2005, which obtained Body Mass Index (BMI) and left mid-arm fat area (MAFA) in the population aged ≤19 years using probabilistic sampling and comparable methods of anthropometric measurement and data verification, processing and analysis. Age- and sex-specific percentiles were used as cutoff points for diagnosing overweight, obesity and high adiposity in 3 age groups (early childhood: <5 years; childhood: 5–9 years; and adolescence: 10–19 years). Descriptive statistics were used to calculate prevalence, expressed as a percentage of the population surveyed in each nutritional status category, by sex, age group and survey year. Trends were established by comparing prevalence in 3 periods: 1972–1993, 1993–2005 and 1972–2005. Statistical significance of the percentage differences between survey years in each period was calculated using 95% confidence intervals (CI).
RESULTS: Prevalence of excess weight (overweight + obesity) in the study population was 15.3% in 1972, 9.6% in 1993, and 16.4% in 2005, and was more frequent in males but varied by age group and survey year. Prevalence of high adiposity decreased from 13.3% in 1972 to 12.7% in 1993, increasing significantly to 28.8% in 2005. High adiposity was more frequent in males and decreased as age increased, except in children aged <5 years, who had lowest adiposity in 1972. While excess weight predominated over high adiposity in 1972 (15.3% and 13.3%, respectively), this relationship was reversed in 1993 (9.6% excess weight vs 12.7% high adiposity) and continued as a growing trend in 2005 (16.4% excess weight vs 28.8% high adiposity).
CONCLUSIONS: Prevalence of excess weight and high adiposity generally declined during economic crisis and scarcity, and rose as the economy improved. Continued monitoring is required to detect sustained or rising prevalence of these conditions and to develop interventions to reduce health risks.
Keywords Overweight, obesity, adiposity, child, adolescent
Recommended dietary reference intakes (DRI) for energy and nutrients for the Cuban population were first established by the Nutrition and Food Hygiene Institute (INHA, its Spanish acronym) in 1996.[1] International organizations and Cuban public health research subsequently generated a considerable volume of new information on food-based energy and nutrient requirements,[2–4] resulting in the need for a revision. Updated DRIs were therefore compiled by a multidisciplinary group of specialists and published in 2008 by INHA and the Cuban Ministry of Public Health.[5,6]
