Dietary intake and health outcomes among young children attending 2 urban day-care centers

Objective To assess the impact of the Child and Adult Care Food Program (CACFP) on diet and 3 health outcomes—weight-for-height status, dental caries (tooth decay) score, and number of days of illness—among preschool children attending 2 urban day care centers.

Design Dietary intake and health outcome measures were assessed and compared for children attending 2 day-care centers in an urban community. Data were obtained for 14 days of dietary intake, which were analyzed for energy and 15 nutrients and 6 food groups; anthropometric measures, including weight-for-height; dental caries; and days of illness.

Subjects/setting Forty 3- to 5-year-old black children from 2 day-care centers participated. One center participates in the CACFP. At the other center, children bring all meals and snacks from home.

Statistical analyses performed Data from the 2 groups of children were compared using parametric and nonparametric t tests.

Results Children receiving CACFP meals at day care had significantly higher mean daily intakes of vitamin A (804±191 vs 595±268 retinol equivalents), riboflavin (1.45±0.32 vs 1.21±0.22 mg), and calcium (714±180 vs 503±143 mg) than the children who brought all of their meals and snacks from home. Children who received CACFP meals also consumed significantly more servings of milk (2.9±0.9 servings vs 1.5±0.7) and vegetables (1.8±0.5 vs 1.2±0.5 servings) and significantly fewer servings of fats/sweets (4.6±1.3 vs 5.4±1.1 servings) than children who brought their meals. Weight-for-height status and dental caries scores did not differ between the 2 groups. Children from the center participating in the CACFP have significantly fewer days of illness (median 6.5 vs 10.5 days) than children from the nonparticipating center.

Applications Nutritious meals provided by the CACFP can improve diets and may promote health among young, urban children. Registered dietitians can contribute to food assistance programs by intervening to enhance the quality of meals served and by examining the impact of participation on measures of diet quality and diet-related health outcomes. J Am Diet Assoc. 1999;99:1529–1535.     

Prevalence of Giardia lamblia and risk factors for infection among children attending day-care facilities in Denver

A sample of children in the toddler age group was surveyed in Denver, CO, to determine the prevalence of Giardia lamblia and to identify risk factors for the intestinal disease. The sample consisted of 236 children attending day-care centers (DCC) and 79 who were not attending. Thirty-eight children (16 percent) attending DCCs and 7 (9 percent) who had not were positive for G. lamblia in stool samples. Risk factors for those attending DCC facilities included increasing duration of attendance, time per week attending DCCs, low family income, and large family size. The only risk factor for those not attending DCC facilities was travel to Colorado mountains. Multivariate analysis showed that risk factors for all children in the sample included travel to Colorado mountains, large family size, and attending DCC facilities. Infection was not associated with symptoms.     

Energy balance and physical activity in obese children attending day-care centres

OBJECTIVE: To evaluate energy balance and physical activity in obese preschool children attending day-care centres. DESIGN: Cross-sectional study. SUBJECTS: Twenty-four 3-5 years old obese children selected at random from four different day-care centres in Santiago City, Chile. Total energy expenditure (TEE) was measured by doubly labelled water and physical activity as recorded by TRITRAC R3D motion sensor. Energy intake was assessed by measuring food intake while at the centre, along with the recording of additional food intake in the home. RESULTS: Obese children had a 5.4% higher weighed energy intake than their energy requirements 2001. Energy intake during the week was 7716+/-1092 kJ/day and 7401+/-1023 kJ/day in boys and girls, respectively. Minimal activity was higher in the day-care centres (62%) compared to 52% during the weekend at home. Light activity was higher during the weekend at home than during the week (25 versus 20%), but moderate-intense activity was similar (3-5%). CONCLUSIONS: Reduction in dietary energy provided at the day-care centres helps to balance energy requirements during the week. Obese children had marked sedentary characteristics with regards to physical activity, although children are more active at home in weekends. This situation suggests that educators and parents need to improve children's physical activity levels and nutrition habits.     

Pertussis infection in fully vaccinated children in day-care centers, Israel

We tested 46 fully vaccinated children in two day-care centers in Israel who were exposed to a fatal case of pertussis infection. Only two of five children who tested positive for Bordetella pertussis met the World Health Organization's case definition for pertussis. Vaccinated children may be asymptomatic reservoirs for infection.     

Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus isolated from the nasopharynx of healthy children attending day-care centres in the Czech Republic

Nasopharyngeal carriage of potential pathogens was studied in 425 healthy 3- to 6-year-old children attending 16 day-care centres (DCCs) in nine Czech cities during the winter 2004-2005. The overall carriage of pathogens was 62.8% (Streptococcus pneumoniae, 38.1%; Haemophilus influenzae, 24.9%; Moraxella catarrhalis, 22.1%; Staphylococcus aureus, 16%). An age-related downward trend was observed for colonization with respiratory pathogens in contrast to Staph. aureus whose carriage was significantly higher among older children. The following serotypes of colonizing S. pneumoniae were the most predominant: 23F (20.6%), 6A (15.1%), 6B (12.7%), 18C (7.8%), 15B and 19F (6% each). The majority (94.3%) of H. influenzae isolates were non-typable; among capsulated isolates, serotype b was not found. Decreased susceptibility to penicillin was determined in 3% of pneumococci; 4.6% of H. influenzae strains and 85.1% of M. catarrhalis strains produced beta-lactamase. As for non-beta-lactam antibiotics, pneumococci resistant to trimethoprim-sulphamethoxazole were the most common (15.7%) among the attendees.     

Risk factors for incomplete vaccination in children less than 18 months of age attending the nurseries of day-care centres in Sao Paulo, Brazil

To estimate the proportion of children in day-care centres with incomplete vaccination and to identify associated risk factors, we conducted a cross-sectional study among 258 children less than 18 months of age attending public and philanthropic day-care centres in the city of Sao Paulo, Brazil. Interviews, blood collection and anthropometry were performed. Unconditional logistic regression was adjusted for incomplete vaccination risk factors. 10.9% of children had incomplete vaccination. Children who were born prematurely (OR = 4.27; p = 0.004), or were malnourished (OR = 4.99; p = 0.049), or lived in inadequate housing (OR = 2.88; p = 0.039), or whose mothers had had poor prenatal care (OR = 4.98; p = 0.040) were more likely to have incomplete vaccination. Opportunities are being missed to identify children with incomplete vaccination; strategies to enhance vaccination coverage should pay special attention to the needs of families living in inadequate housing; and health promotion actions in primary health facilities and day-care centres should be performed as concomitant activities.     

Cryptosporidium oocysts in immunocompetent children: Epidemiologic investigations in the day-care centers of Poitiers,France

The recent discovery of self-resolving Cryptosporidium infection in immunocompetent patients has aroused growing interest in this parasite, which has thus far been known to affect mainly immunodeficient individuals. Following the hospitalization of two children attending the same day-care center in February 1986 Cryptosporidium oocysts were found in the stools of one of them. This led to an epidemiological investigation to assess the frequency of Cryptosporidium oocysts, in the stools of children attending the 7 day-care centers in the city of Poitiers, France. Testing for Cryptosporidium oocysts was performed on formalinized stools, after smear staining by the modified Ziehl-Neelsen procedure. Each positive stool was also submitted to virological and bacteriological examination. Stool specimens from 235 children were studied: 9 (3.89/6) of them had Cryptosporidium oocysts in their stools. Four of the children had diarrhea, and 5 (2.2%) were asymptomatic. The existence of healthy carriers should lead to caution in the interpretation of stool parasitology.     

Cost-effectiveness of live-attenuated influenza vaccine, trivalent in preventing influenza in young children attending day-care centres

Vaccinating children at day-care may be a cost-effective approach for improving influenza immunization rates in this high-risk group. This study uses influenza attack-rate data from a randomized, blinded, placebo-controlled clinical trial of live-attenuated influenza vaccine, trivalent in day-care centres from two consecutive influenza seasons, one with a moderate attack rate (H1N1 dominant) and one with a high attack rate (H3N2 dominant). Costs were measured in US dollars. In the moderate attack-rate season (vaccinated, 2.2%; placebo, 13.4%), vaccination saved US$ 5.47 per child in societal costs. In the high attack-rate season (vaccinated, 4.7%; placebo, 32.1%), vaccination led to a societal costs savings of US$ 144.44 per child.     

Communitywide shigellosis: control of an outbreak and risk factors in child day-care centers.

OBJECTIVES. The study's objectives were to assess (1) control of a community outbreak of shigellosis through the promotion of handwashing, (2) risk factors in day-care centers, and (3) shigellosis attributable to attendance at a day-care center. METHODS. In 1991, an outbreak of Shigella sonnei infections occurred in Lexington-Fayette County, Ky; 14 licensed child day-care centers were involved. Communitywide promotion of hand washing was instituted along with diarrhea surveillance. A case-control study compared day-care centers that had confirmed cases of shigellosis with centers that had none. A family transmission study determined those cases attributable to attendance at day-care centers. RESULTS. The outbreak abated 3 weeks after the interventions' initiation. Day-care centers with outbreaks were more likely than those with no cases to have a food handler who changed diapers and to provide transportation for children from their homes to the center. These centers also had a higher toddler-to-toilet ratio than control centers (21 vs 12). In 58% of families with shigellosis, the first person with diarrhea during the outbreak was a child younger than 6 years; 92% of diarrheal illnesses among these children were attributable to day-care attendance. CONCLUSIONS. Community involvement in increasing hand washing most likely resulted in control of this shigellosis outbreak. Diarrhea prevention strategies in day-care centers could prevent substantial communitywide disease.     

Follow-up of the child's motor abilities in day-care centers and pre-schools

The aim was to describe the results of a developmental screening test in a cohort of 30 children attending 3 day-care centers in the city of S?o Paulo and develop hypotheses about these results. Thirty children were evaluated three times, during two years, by using the DDST. In the gross motor area the results improved (Tests of the Signs, 1st to the 3rd evaluation, p= 0.038*). There was a relationship between the age of the child (2 to 3 years) and worst results (Fisher's Exact test, p= 0.013*). In the fine motor area the results improved (Tests of the Signs, 1st to the 2nd evaluation, p= 0.031*). So, the development of motor abilities improved after the children started attending the day-care centers. We must undertake more researches in order to attribute the specific influences of each area: day-care center and/or family.     

The relationship of staff to the incidence of diarrhea in day-care centers

Sixty randomly selected day-care centers in Houston, Texas, were surveyed for cases of diarrhea by weekly telephone calls during the period October 1980 to May 1981. Visits to each day-care center were made upon enrollment and again to collect self-administered questionnaires which had been mailed to the staff of each center. During the eight-month survey, 986 cases of diarrhea were reported, with an average day-care center incidence of 1.15 cases per 100 person-weeks of observation. A significant positive correlation (p less than 0.05 to p less than 0.01) was found between the incidence of diarrhea in a day-care center and each of the following variables reported by the day-care center staff: the average frequency of diapering, the average frequency of working with children less than two years of age, the average frequency of meal preparation, the average frequency of serving food to the children, and the percentage of staff who both diaper and either serve food or prepare meals daily. Day-care centers which accepted children less than two years of age had a 3.55-fold higher incidence of diarrhea compared with centers which did not accept children less than two years of age. Day-care centers in which one or more staff members prepared meals, served food, and diapered children on a daily basis had a 3.28-fold higher incidence of diarrhea compared with centers in which staff did not combine on a daily basis the duties of diapering children with either meal preparation or food service. The results suggest that staff members may play a role in the transmission of diarrhea in day-care centers through diapering, meal preparation, working with children less than two years of age, or a daily combination of diapering and either meal preparation or food service.     

Parents' reports of home and out-of-home injuries among children attending child care centers

Parents of 371 children up to 30 months of age in full time care in 24 child care centers were telephoned to ascertain the number and severity of child injuries occurring both at home and in child care. In addition injury incident reports were collected from six centers. Almost equal numbers of injuries were reported to have occurred at home and in child care. The rate of parent-reported child care injuries was 52 per 100,000 child hours. Only 25 of the 149 separate child care injury events resulted in a medical visit, a rate of 8.8 per 100,000 child hours. Careful matching of center-reported events with those reported by parents revealed very little overlap. The discrepancy was only partly explained by parental notification of child care injuries by centers. More deliberate attention to the communication of information about injury events occurring in child care is indicated if child care injuries are to be prevented.     

Carriage of Haemophilus influenzae among Brazilian children attending day care centers in the era of widespread Hib vaccination

Haemophilus influenzae type b vaccine was introduced into the Immunization Program of Brazil in 1999 and no study has evaluated the impact of Hib vaccination in H. influenzae carriage so far. In June 2010, Brazil introduced the 10-valent pneumococcal nontypeable H. influenzae (NTHi) conjugate vaccine (PHiD-CV). We investigated the prevalence of encapsulated H. influenzae and NTHi isolates in nasopharyngeal samples of 1192 children attending day-care centers in Goiânia, central Brazil. H. influenzae carriage rate was 32.1% and 38.4% of them carried β-lactamase TEM-1 gene. Serotype f (4.6%) was the most frequent encapsulated isolate, type b was recovered in only 0.7% and carriage rate of NTHi was 23.3%. Recurrent acute otitis media and NTHi were independently associated with colonization by β-lactamase producing H. influenzae. Changes in frequency of H. influenzae carriage isolates should be carefully monitored to assess the impact of the PHiD-CV on NTHi carriage in young children.     

Socioeconomic factors affecting the prevalence of obesity among female patients attending primary health centers in Jeddah,Saudi Arabia

A sample of 852 Saudi women who attended the primary health care centers in Jeddah seeking medical care were examined. Obesity was defined as a value for the body mass index (kg/m2) ≥ 25.0. The prevalence of obesity in the examined sample was high (64.3%). Obesity was significantly related to age, marital status, parity, level of education, level of work, women's income levels, who is the householder and the number of servants. There was no significant association between obesity and the following factors: being the only or youngest daughter, inhabitant's number, number of cars, time spent watching television, eating while watching television, number of times per week inviting or being invited to meals, householder's income, and his education or work. Multiple regression analysis indicated that five variables were significant predictors: age, marital status, number of servants, giving birth, and parity. Knowledge of the social factors associated with obesity will help to identify high risk groups. Those most vulnerable to the development of obesity, should then be the focus of a vigorous preventive program.     

Air quality during the winter in Québec day-care centers.

Over 90% of 91 day care centers in greater Montréal, Québec exceeded 1000 ppm of CO2 during January through April 1989. Four variables were independent positive predictors of CO2 levels: the density of children in the center; presence of electric heating; absence of a ventilation system; and building age. High levels of CO2 are associated with respiratory tract and other symptoms. Clear standards and inspection policies should be established for day care center air quality.