Violência entre parceiros íntimos, violência contra a criança e o excesso de peso durante o primeiro ano de vida

Abstract

The aim of this Thesis is to investigate the influence of intimate partners violence (IPV) and violence against children (VAC) on the inadequacy of infant nutritional status in the first year of life. The data analyzed here comes from a prospective cohort that evaluated the growth during the first year of life of newborns followed at health facilities in Rio de Janeiro. Infant nutritional status was assessed using the anthropometric indicators provided by the growth curves developed by the World Health Organization in 2006. IPV and VAC were investigated through the Portuguese versions of the instruments Conflict Tactics Scales Form R and Parent-Child Conflict Tactics Scales, respectively. Other variables related to the mother, baby and the environment in which they live were also included in the analyzes as possible confounders. Associations between IPV, VAC and infant nutritional status were verified at different moments of the first year through logistic or Poisson regression models, where crude and adjusted odds ratios (OR) or relative risks (RR), and their 95% confidence intervals (95%CI), were estimated. Potential confounders were identified using a p-value≤0.20 as cut-off point and, in multivariate analyzes, a p-value≤0.05 was indicative of statistical significance. Two studies are presented as Thesis products: the first, a cohort study, explores the impact of physical intimate partner violence (PIPV) that occurred 12 months prior to the interview of the child's second month of life on excess weight during the first five months; the second, a cross-sectional study, investigates the relationship between the co-occurrence of PIPV and VAC in the 13th month of life and the child s excess weight at the same moment. The results of the first study (cohort) show that the PIPV prior to birth and/or occurred in the first two months of the child's life increased by approximately twice the risk of developing overweight in the fifth month of life (RR=2.39; 95%CI=1.08 5.28; p=0.031). On the other hand, the results of the second study (cross-sectional) shows that, although neither VAC nor PIPV alone were associated with excess weight in this group of children, their co-occurrence doubled the chances of the children being in the risk group for excess weight (OR=2.13; 95%CI=1.03 4.39; p=0.042), even after adjustment. Understanding how IPV and VAC relates to infant nutritional status is an important step in defining a context for intervention. These results identify the family violence, including the co-occurrence of IPV and VAC, as a potential determinant of overweight in childhood and highlight the importance not only of monitoring child growth to identify cases of malnutrition from its early signs, but also of the need for a counseling practice that considers various aspects of family health, including the presence of violence in their lives