Calidad de vida y estado nutricional: sus manifestaciones en escolares de ámbitos urbanos y rurales de Tucumán

Abstract

Esta tesis estudia el estado nutricional y la calidad de vida relacionada a la salud de niños en edad escolar residentes en Yerba Buena y Simoca (Tucumán). Su abordaje incluyó el análisis de indicadores de salud según escalas macrosociales o contextuales (calidad de vida departamental, lugar de residencia urbano-rural, nivel socioeconómico familiar) e individuales o composicionales (edad y sexo), así como también su distribución en el espacio. La tesis está compuesta por seis capítulos, la bibliografía y un anexo. En el capítulo I se formula el problema de la investigación, la justificación del estudio y los objetivos. El capítulo II, dedicado al marco teórico que sustentó la investigación, se organiza en tres apartados. El primero refiere al análisis del contexto socio-histórico en el que se desarrollan los estudios de calidad de vida y estado nutricional, se describen los modelos clásicos de transición demográfica, epidemiológica y nutricional, analizados luego en el contexto nacional y local. El segundo apartado versa sobre el surgimiento, evolución y alcance del concepto de la calidad de vida objetiva y subjetiva y, dentro de ésta última, la importancia de los estudios de calidad de vida relacionada a la salud en poblaciones infantiles. El tercer apartado focaliza en el análisis conceptual y teórico de los procesos de crecimiento, desarrollo y estado nutricional y su valoración durante en la infancia. El capítulo III describe en detalle los aspectos metodológicos: tipo y diseño de investigación, población y muestra, variables, técnicas y herramientas para su obtención y procesamiento y análisis estadísticos de los datos. Cierra este capítulo un apartado referido especialmente a las consideraciones éticas de la investigación. El capítulo IV, presenta y describe los resultados obtenidos. Teniendo en cuenta los objetivos específicos de este trabajo, está organizado en cuatro apartados. En los dos primero se describen en profundidad las características geográficas, ecológicas y socio-históricas de los departamentos seleccionados como ámbito de estudio y de la muestra obtenida. Los apartados tres y cuatro exponen los resultados obtenidos del análisis antropométrico y de calidad de vida relacionada a la salud, en relación a las variables macrosociales (índice de calidad de vida departamental, residencia urbana o rural y nivel socioeconómico) e individuales (edad y sexo) y se presenta la cartografía elaborada en base a los indicadores de salud para cada departamento. El capítulo V resulta medular en la obra, por cuanto allí se discuten e interpretan los resultados obtenidos en relación a antecedentes teóricos y empíricos, del ámbito internacional, nacional y local. El perfil nutricional (Apartado 5.1) y la salud percibida (Apartado 5.2) de los niños tucumanos son analizados en relación a los aspectos macrosociales e individuales. Por último, se interpretan los mapas temáticos de malnutrición y baja percepción de la salud (Apartado 5.3) en relación a la presencia o ausencia, agrupamiento o dispersión de las problemáticas de salud estudiadas.Finalmente, en el capítulo VI se exponen las conclusiones del trabajo y efectúan consideraciones finales acerca de los aportes, limitaciones y fortalezas de esta tesis.

The general objective of the present study was to advance on the knowledge of the quality of life and the nutritional status of school-aged children living in urban and rural areas of the province of Tucumán. To achieve this goal: a) It was studied in depth the geographical, historical, social and economic characteristics of Yerba Buena and Simoca, departments of the province of Tucumán with different quality of life, b) It was determined the anthropometric nutritional status and health related quality of life or perceived health of children living in these departments, c) it was analyzed and compared the anthropometric nutritional status and perceived health in relation to macrosocial (departmental quality of life, urban or rural place of residence, family socioeconomic level) and individual factors (age and sex), d) it was explored and described the spatial distribution of malnutrition and the low health related quality of life in the studied departments. For it, two departments of the province of Tucumán were selected as study areas, characterized by presenting, according to previous studies, opposite indicators of quality of life: Yerba Buena (high quality of life) and Simoca (low quality of life). The study was a quantitative and transverse type and included school children between the ages of 8.0 and 11.9 years, attending to public schools during the 2014-2015 school years. For the determination of the nutritional status, the variables surveyed were: age (E), body weight (P) and height (T) and the Body Mass Index (BMI) was calculated. The data and cut-off points proposed by the World Health Organization were used to define the cases of: normonutrition, undernutrition (low T / E or low BMI / E) and excess weight (overweight (S) or obesity (O)). For the study of the health related quality of life, the international, validated and adapted for the Argentine child population Kidscreen 52 questionnaire was applied. It describes the perception of health from ten dimensions (physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, relationship with parents and family life, relationship with friends and social support, school environment, social acceptance and economic resources). The urban or rural place of residence was determined following the National Institute of Statistics and Census criteria. Finally, the socioeconomic level (NSE) was determined from the percentage of households with unsatisfied basic needs in census radio. For the handling of the anthropometric data and perceived health, the SPSS program version 19.0 was used. The analysis of the anthropometric data included the calculation of descriptive parameters (central tendency, dispersion, prevalence) and bivariate analysis (Chi square test) to analyze associations between the macrosocial and individual variables and the child nutritional status. For the study of the health-related quality of life, scores were assigned to each response offered by the child. The scores by dimension were obtained as average of the answers according to the likert scale and later they were transformed to Rasch values, corresponding to a mean (M) of 50 and a standard deviation (SD) of 10. Scores greater than 60 (M + 1DE) indicate a better perceived health, while values lower than 40 (M-1DE) indicate low health related quality of life or commitment of the same one. To identify associations between perceived health and the rest of the variables, bivariate (T-test and ANOVA) and multivariate analyzes (Odd ratios) were performed. Finally, the information collected was mapped using indicators with scale in the minimum spatial unit of aggregation in Argentina: the census radius, using the shape files (.shp) corresponding to the province of Tucumán (year 2010). For the management of the cartography, the program QGIS version 2.18.14 was used. The anthropometric analysis allowed to warn that approximately half of the schoolchildren had nutritional alterations. 5% showed undernourishment, with the predominant manifestation of emaciation. Contrary, excess weight was very high reaching 42% of children, with obesity predominating. While the undernutrition was higher in Yerba Buena, the excess weight was in Simoca. On the other hand, for every child with undernourishment found in rural areas, four were found in urban areas, while overweight was 1.5 times more frequent in rural areas and obesity was 2.2 times higher. Only malnutrition for excess was associated with socioeconomic status. In relation to perceived health, the children of Tucumán described better perceptions regarding to the school environment and psychological well-being. On the other hand, the worst assessments involved moods and emotions, social acceptance (bullying) and economic resources. Also, it was found that the children of Yerba Buena had the worse appreciations of economic resources and family financial capacity, while, while in the children from Simoca the worst appreciations corresponded to physical condition, depressive moods and feeling of stress, self-perception and family atmosphere. Rural children had worse perceptions in most dimensions, with significant differences in self-perception and mood, while the NSE was not associated with self-perception of health. Finally, younger school children and boys perceived, in general, better its health. The spatial distribution of malnutrition and the low health related quality of life made possible to warn the recurrent localization of these problems in both departments. In Yerba Buena, the most unfavorable indicators had a predominantly urban distribution, especially in the area of urban-rural transition; while in Simoca, cases with worse health reports were located distant of the urban area, towards the departmental southeast. In this way, the cartography allowed to focus on the analyzed health problems in each geographical unit, evidencing the potential richness of applying geographic information systems to guide and promote specific local policies.