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Population health data available in Angola are often insufficient to guide the planning of health interventions. To address this gap, the goal of the present study was to investigate the health of mothers and infants in a suburban municipality in Luanda (Cacuaco), in order to provide a baseline for future comparisons. This was a prevalence study investigating infants younger than 2 years of age and their mothers. Mothers were interviewed, and children’s height and weight were measured. Of 749 mothers interviewed, 98.5 % (95 % CI 98.2-99.1 %) had at least one prenatal visit and 51.7 % (95 % CI 47.4-56.3 %) had a health card. Most mothers with a health card had their first prenatal visit before the 20th week of pregnancy, and had at least four prenatal visits; 81.1 % (95 % CI 78.3-84.1 %) of mothers also had their child’s health card. Prevalence of exclusive breastfeeding at 6 months was 19 % (95 % CI 16.2-23.1 %). Prevalence of low height-for-age and low BMI-for-age were 32 and 6 %, respectively. Mothers with higher education levels were more likely to have had their first prenatal visit earlier, to have had more prenatal visits, to have given birth at a health facility, and to have her own and her child’s health cards. Results showed a high prevalence of prenatal care and a low frequency of acute malnutrition. Maternal education level, among factors studied, was the predominant correlate of more positive health behaviors. These findings suggest important progress of mother and child health in Cacuaco, and may serve as a baseline for the planning of health interventions. © 2013 The Author(s).
The study was conducted in Cacuaco, one of the seven municipalities of Luanda, the capital of Angola. The population of Cacuaco is estimated at 700,000, and the city is divided into three administrative regions: Cacuaco Sede (137,000 inhabitants), Kikolo (480,000 inhabitants) and Funda (81,000 inhabitants). A reference public health service was located in Cacuaco Sede, a smaller health center was located in Kikolo, and a number of private health centers and units administrated by non-governmental organizations were also found in the districts studied. This prevalence study was conducted on children younger than 2 years as well as on their mothers. Data was collected from August 1st to September 26th, 2010. A sample of 700 children enables the estimation of the prevalence of the main outcomes studied, assuming a variation of 10–40 % (corresponding to the prevalence of low BMI-for-age and low height-for-age, respectively), with 5 % precision, and considering a cluster design effect of 1.5. All children younger than 2 years (from 0 to 1 year, 11 months and 29 days) who lived in the study area were eligible for the study; those whose mothers had lived in the district for less than a year or did not live with the child were excluded. If more than one child younger than 2 years lived in the same household, the older child was included in the study. In the case of twins, only the firstborn was included. Participant loss was considered when the mother was absent on at least three interviewer visits to the household, and refusals to participate were considered when mothers did not agree to take part in the study. Participants were recruited from four districts, of which two were in Kikolo (Boa Esperança and Balumuca) and two in Cacuaco Sede (Bate Chapa and Forno do Sal). Districts were selected based on the following criteria: availability of neighborhood maps, authorization by resident committees and safety for researchers walking around the area. To facilitate data collection, the districts were divided into microareas with approximately 100 families each. The first microarea to be sampled in each district was randomly selected, and data was then collected in areas surrounding the initial location, until the target sample size was attained. One household in each microarea was randomly selected as a starting point for the survey, and every third house to the right of the index house was then visited by the interviewers, who consisted of a team of 16 Angolan individuals who completed a 5-day intensive training course prior to the study. The training involved simulated interviews and pilot questionnaire. After training was completed, four teams were assembled, each of which had one field coordinator, four interviewers and one area supervisor. Two representatives from the local health department also provided support to the research team. The coordinators were responsible for identifying eligible children, and the interviewers for administering a structured questionnaire to the children’s mothers. Coordinators also collected data from the children’s health cards and the mother’s pregnancy card, and measured children’s height and weight using stadiometers and digital scales. All questionnaires were reviewed and coded by field coordinators on the same day the interviews were conducted. Demographic, socioeconomic, and health data were collected from mothers and children, as was information regarding patterns of health facility use. Data regarding prenatal care, immunization and children’s weight monitoring were obtained from the mother’s information, as well as from the records in the mother’s pregnancy card and the child’s health card. However, only the health card information was used in data analysis, as these data were more reliable. The presence of hypochlorite and mosquito bednets in the homes was also assessed by the interviewers. The Kessner Index [6] modified by Takeda [7] was used to measure the quality of prenatal care. According to these criteria, prenatal care is considered adequate when initiated before the 20th week of gestation, and when the mother had at least six health care visits throughout the pregnancy. Post-natal care was considered adequate when it was obtained within 7 days of childbirth. Immunization was assessed based on local vaccination calendars. Vaccines were considered delayed when they were not recorded on the health cards, or when the children were over 1 month older than the recommended age for receiving a given vaccine. The same 1 month delay was considered for adequacy of child’s weight monitoring. The growth curves on the child’s health card were used as reference, where weight was expected to be recorded at birth, and at 2, 4, 6, 9, 12 and 18 months of age. Exclusive breastfeeding was assessed in children between 0 and 6 months, and breastfeeding at 12 months was assessed in children aged from 12 to 15.9 months [8, 9]. Socioeconomic status was scored according to the system proposed by Krefis et al. [10]. The variables included in the socioeconomic status index were: type of material from which the house was built, access to piped water, electricity, and the presence of a bathroom inside the house. Families received a score ranging from 0 to 10, where scores below five were indicative of lower socioeconomic status, and scores between six and ten points suggested higher socioeconomic status. Parental educational level was ascertained as the grade year of schooling attained. Questionnaires were coded, scanned and entered into a database using the Teleform® software package. Frequencies were obtained using the SPSS software, version 18.0, and prevalence ratios were calculated using the Stata 9 software. The association between socioeconomic status, maternal education level and health outcomes (having a health card, time of the first prenatal visit, number of visits throughout the pregnancy, all children being alive, interval between childbirth and child immunization) was investigated using Pearson’s Chi square test, with significance considered at p < 0.05, and controlling for the cluster design effect. The present study was conducted as part of the project entitled Developing PHC services in Angola: a proposal for the assessment of PACS in Luanda, which was approved by the Research Ethics Committee of the Federal University of Rio Grande do Sul. Data collection was also authorized by the Luanda Province Health Department. All participating mothers signed an informed consent document prior to being interviewed for the present study.
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