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
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
