[show abstract][hide abstract] ABSTRACT: We analyzed Brazil's efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil's successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries.
American Journal of Public Health 10/2010; 100(10):1877-89. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the influence of breastfeeding support on breastfeeding rates in the city of Pelotas (RS), Brazil.
The prevalence rates of exclusive breastfeeding and of overall breastfeeding were compared in four cohorts of children, born in 1982, 1993, 1997-1998 and 2004. The children selected for this study fulfilled the inclusion criteria for the WHO Multicenter Growth Reference Study, in order to afford comparison with the 1997-1998 cohort, which was made up of children selected for that study. The 1997-1998 cohort received systematic breastfeeding support.
There was an increase in the rates of exclusive breastfeeding: from 26% at 1 month of age in 1993 to 77% at the same age in 2004, and from 16% at 3 months to 46% for the same dates, respectively. Breastfeeding rates at later ages exhibited a tendency to increase, although with less significance: from 15% in 1982 at 12 months to 34% in 2004 at the same age, and from 6% at 24 months to 14% for the same dates, respectively.
Breastfeeding support has contributed to a tendency for breastfeeding rates to increase.
Jornal de pediatria 11/2008; 84(6):560-4. · 1.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: We reviewed interventions that affect maternal and child undernutrition and nutrition-related outcomes. These interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition; and reduction of disease burden (promotion of handwashing and strategies to reduce the burden of malaria in pregnancy). We showed that although strategies for breastfeeding promotion have a large effect on survival, their effect on stunting is small. In populations with sufficient food, education about complementary feeding increased height-for-age Z score by 0.25 (95% CI 0.01-0.49), whereas provision of food supplements (with or without education) in populations with insufficient food increased the height-for-age Z score by 0.41 (0.05-0.76). Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% (risk ratio 0.45, 0.32-0.62), and recent studies suggest that newer commodities, such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. Effective micronutrient interventions for pregnant women included supplementation with iron folate (which increased haemoglobin at term by 12 g/L, 2.93-21.07) and micronutrients (which reduced the risk of low birthweight at term by 16% (relative risk 0.84, 0.74-0.95). Recommended micronutrient interventions for children included strategies for supplementation of vitamin A (in the neonatal period and late infancy), preventive zinc supplements, iron supplements for children in areas where malaria is not endemic, and universal promotion of iodised salt. We used a cohort model to assess the potential effect of these interventions on mothers and children in the 36 countries that have 90% of children with stunted linear growth. The model showed that existing interventions that were designed to improve nutrition and prevent related disease could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%. To eliminate stunting in the longer term, these interventions should be supplemented by improvements in the underlying determinants of undernutrition, such as poverty, poor education, disease burden, and lack of women's empowerment.
The Lancet 03/2008; 371(9610):417-40. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: OBJECTIVE: To investigate the prevalence of positive screening test for developmental delays in a cohort of children born in Pelotas, Brazil in 1993, and their risk factors. METHODOLOGY: A sample of 20% (1,363 children) of a cohort of children born in Pelotas, Brazil, was studied at 12 months of age regarding their development. The Denver II Test was used. The children who failed in two or more items of the test were suspected of having development delay. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, childreńs care, nutrition and morbidity). Analyses were performed using Mantel-Haenszel X2 and multivariate technique through conditional logistic regression, to control for possible confounding. RESULTS: At 12 months of age, 34% (463) of the total of 1,363 children failed in the screening test. After adjusting for possible confounding variables, failure was associated with family lower income children (OR= 1.5), very low birth weight (OR= 4.0), gestational age less than 37 weeks (OR= 1.6), more than three siblings (OR= 1.9), and duration of breastfeeding less than three months (OR=1.6), or no breastfeeding (OR= 1.9). Children who presented weight/age at six months of age less or equal to -2 z score of the reference population presented a risk 10 times greater of having failure in the Denver II Test. CONCLUSIONS: This study reinforces the multiple etiology of development delays and the concept of cumulative risk effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic and environmental) that may render to deficits in their development.
Jornal de pediatria 01/2002; 76(6):421-8. · 1.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: Resumen Objetivo: verificar la prevalencia de sospecha de atraso en el desarrollo neuropsiocomotor a los 12 meses en niños nacidos en Pelotas, RS, en 1993, y sus posibles determinantes. Método: una muestra de 20% (1.363 niños) de una cohorte de niños nacidos en los hospitales de Pelotas, RS, durante el año 1993, fue evaluada a los 12 meses de acuerdo al desarrollo neuropsicomotor, a través de la aplicación del test de Denver II. Los niños que tuvieron dos o más ítems de falla en el test fueron considerados sospechosos de presentar atraso en el desarrollo. Las variables independientes elegidas pertenecían a diferentes niveles de determinación de atraso, de acuerdo al modelo teórico jerarquizado (socioeconómico, reproductivo y ambiental, condiciones al nacer, atención al niño, nutrición y morbilidad). El análisis fue realizado utilizando el X 2 de Mantel-Haenszel y técnica multivariada a través de regresión logística, con el objetivo de controlar posibles factores de confusión. Resultados: de los 1.363 niños evaluados a los 12 meses, 464 (34%) presentaron test de Denver II con sospechas de atraso en el desarrollo. En el análisis multivariado, luego del control de variables de confusión, se verificó que los niños que tenían mayor riesgo de sospecha de atraso en su desarrollo fueron: los más pobres (OR= 1,5), los que habían nacido con bajo peso (OR= 4,0), los que presentaron edad gestacional menor a 37 semanas (OR= 1,6), los que tenían más de 3 hermanos (OR= 1,9) y los que habían recibido leche materna por menos de tres meses (OR= 1,6) o no habían sido amamantados (OR= 1,9). Los niños que presentaron un índice peso/edad, a los seis meses, igual o menor a –2 desvíos de padrón de referencia, tuvieron un riesgo diez veces mayor de sospecha de atraso en el desarrollo. Conclusiones: este estudio apoya la característica multifactorial del desarrollo y el concepto de efecto acumulativo de riesgo. En la población estudiada, la parcela más desfavorecida acumula los factores (sociales, económicos y biológicos) que determinan mayor posibilidad de atraso en el desarrollo de los niños.