• Child-care attendance and common morbidity: evidence of association in the literature and questions of design Current Comments

    Barros, Aluísio J. D.

    Abstract in Portuguese:

    Foram revisados artigos sobre freqüência a serviços de cuidado infantil (não residencial) e sua associação com infecções respiratórias e diarréia. Encontrou-se grande variação entre os estudos em relação ao seu desenho e à definição das exposições e desfechos. As análises realizadas não foram sempre adequadas, levando a um conjunto de resultados de qualidade desigual, composto de diferentes medidas de associação ligando exposições e desfechos diferentes, e de difícil sumarização. Apesar das diferenças, os estudos se mostraram consistentes no sentido de associar a freqüência a creches com um maior risco de infecções respiratórias e diarréia. Por outro lado, a magnitude das associações encontradas variou bastante. Com relação a creches residenciais, no entanto, os resultados são conflitantes. Alguns estudos encontraram que crianças nestas creches são semelhantes às cuidadas em casa, outros que elas são semelhantes às que freqüentam creches e ainda outros que encontraram riscos intermediários entre os dois grupos.

    Abstract in English:

    Papers on child-care attendance as a risk factor for acute respiratory infections and diarrhea were reviewed. There was great variety among the studies with regard to the design, definition of exposure and definition of outcomes. All the traditional epidemiological study designs have been used. The studies varied in terms of how child-care attendance in general was defined, and for different settings. These definitions differed especially in relation to the minimum time of attendance required. The outcomes were also defined and measured in several different ways. The analyses performed were not always appropriate, leading to sets of results of uneven quality, and composed of different measures of association relating different exposures and outcomes, that made summarizing difficult. Despite that, the results reported were remarkably consistent. Only two of the papers reviewed failed to show some association between child-care attendance and increased acute respiratory infections, or diarrhea. On the other hand, the magnitude of the associations reported varied widely, especially for lower respiratory infections. Taken together, the studies so far published provide evidence that children attending child-care centers, especially those under three years of age, are at a higher risk of upper respiratory infections, lower respiratory infections, and diarrhea. The studies were not consistent, however, in relation to attendance at child-care homes. Children in such settings were sometimes similar to those in child-care centers, sometimes similar to those cared for at home, and sometimes presented an intermediate risk.
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br