Fatores associados ao risco de doenças de transmissão hídrica e alimentar em unidades de alimentação e nutrição escolar: primeira avaliação nacional

Abstract

The National School Feeding Program stands out nationally and internationally for covering food as the Human Right to Adequate Food and Food and Nutritional Safety, aiming to contribute to biopsychosocial development, school performance, and the formation of healthy eating habits. One of the main milestones of the program was the enactment of Law No. 11,947/2009, as through it a healthy and diversified diet was guaranteed, the appreciation of family farming, and the use of Good Manipulation Practices promoting adequate hygienicsanitary conditions. The risk assessment determines the risk and estimates the potential for adverse health effects when an individual or population is exposed to a hazard. The present study intends to evaluate the School Food and Nutrition Units of Brazilian public schools regarding the degree of risk of Waterborne and Foodborne Diseases and their associated factors. This is a cross-sectional study, which used data obtained from two questionnaires (identified as QA - Characterization of the sampled unit (school) and QF - Evaluation of the school feeding unit) of the National Survey of Food Consumption and Nutritional Profile of School Children, Management and Social Control Models of the National School Feeding Program, conducted by the Associação Brasileira de Nutrição in 2007. The sample was representative of public elementary schools in Brazil. The evaluation of the schools took place through the calculation and categorization of risk (dependent variable), according to the methodology developed and validated by Viera et al. (2022), dichotomized into Medium/High Risk (yes/no). Risk predictor factors (independent variables), such as evolution to good handling practices, school location, presence of basic sanitation services, and administrative linkage, were analyzed using Multiple Logistic Regression. The analyzes were carried out using the statistical software SPSS version 28 and Stata version 9 considering a significance level of 5%. Descriptive analysis, Pearson's Chi-square test, and Multiple Logistic Regression are applied. The baseline research was tested and approved by the Research Ethics Committee of União Social Camiliana - Centro Universitário São Camilo, with Opinion number 022/07. Of the 937 School Food and Nutrition Units (SFNU) in Brazil, 31.1% were concentrated in the Northeast region and 24.5% in the North, with the majority located in the urban area (85.3%) and managed by themselves ( 92.8%). It is observed that for good practices 42.8% of SFNU were between 51 and 75% of compliance (Group 2). In assessing the degree of risk, 44.8% (n=420) of the SFNU showed a Medium/High Risk of developing an outbreak of Waterborne and Foodborne Diseases (WFD), with a statistically significant relationship (p<0.05) with the good practices, Brazilian region, type of management, sewage system, waste destination and location (rural and urban). It is concluded, therefore, that the probability of SFNU in Brazilian public schools having Medium/High Risk of WFD is related to presenting 51 to 75% of compliance with Good Practices, not having garbage collection, and being from the North or Northeast, while being connected to the sewer network reduces the likelihood of Medium/High Risk of WFD.