https://www.who.int/social_determinants/resources/articles/lancet_montenegro.pdf

Indigenous health in Latin America and the Caribbean

Introduction Optimal child growth requires adequate energy and nutrient intake, absence of disease and appropriate care Poor living conditions, including household food insecurity, low parental education, lack of access to quality health care and an unhealthy living environment are among the main determinants of stunted growth Poverty has a more detrimental effect on linear growth than on body weight (1) Child stunting is associated with higher morbidity and mortality, shorter height in adulthood, lower educational achievement, and reduced productivity in adulthood Child growth patterns are therefore strong predictors of future human capital and social progress and of the health of future generations (1-4) Estimates indicate that in 2005, one-third of all children less than 5 years of age (or approximately 178 million children) in low- and middle-income countries were stunted (5) Projections of current trends to 2015 point to declines in the prevalence of both stunting (6) and underweight (5) among children, although such declines will still fall short of the 50% reduction in undernutrition established as an indicator for fulfilling the first Millennium Development Goal (MDG- 1), (7) to eradicate hunger Of 70 low- or middle-income countries that conducted two or more surveys between 1971 and 1999, 42 showed a decline in child stunting, 17 showed no major change over the period, and 11 (9 of them in Africa) showed an increase (8) In Brazil, three national health and nutrition surveys conducted between 1974-75 and 1996 have pointed to declining trends in child stunting prevalence (9,10) An analysis of data from 47 low- and middle-income countries showed pronounced within-country socioeconomic inequalities in child stunting, particularly in Latin America and the Caribbean (11) Brazil ranked fifth among these 47 countries in terms of such inequality (11) We are unaware of studies from low- or middle-income countries on how social inequalities in child stunting are evolving over time We have taken advantage of a Demographic and Health Survey carried out in Brazil in 2006-07 to assess trends in child stunting and in related socioeconomic disparities over the past three decades The Brazilian government has prioritized the elimination of hunger and poverty (12) since 2003, and recent reports (13) suggest that redistributive policies have successfully redressed one of the most skewed income distributions in the world (14) Because child stunting is a sensitive indicator of living conditions, we believe that the effectiveness of redistributive policies can be accurately assessed by studying the social distribution of child stunting over time Methods Data sources Four national household surveys were carried out in Brazil over a period of 33 years: Estudo Nacional de Despesa Familiar [National Study on Family Expenditures] in 1974-75; Pesquisa Nacional de Saude e Nutricao [National Health and Nutrition Survey] in 1989; and two Demographic and Health Surveys, in 1996 and 2006-07, respectively Nationwide probability house hold samples were obtained in each survey using similar census-based, multistage, stratified, cluster sampling procedures The sampling schemes, variables, and data collection procedures are described elsewhere (15-17) In the four surveys, the height of all children aged 0-59 months living in the sampled households was measured Children living in the sparsely populated rural areas of the Northern region, who comprise 3% of the country's child population, were only included in the most recent survey Analyses were repeated after removing these children from the 2006-07 sample, but the results were virtually identical to those presented below, which apply to the entire sample of children studied in each survey In the four surveys, trained personnel measured the recumbent length of children aged up to 23 months and the standing height of older children …

Narrowing Socioeconomic Inequality in Child Stunting: The Brazilian Experience, 1974-2007/reduction Des Inegalites Socioeconomiques En Termes De Retard De Croissance Des Enfants : Experience Du Bresil, 1974-2007/reduccion De la Desigualdad Socioeconomica En Materia De Retraso del Crecimiento Infantil: La Experiencia del Brasil, 1974-2007

Background
Although case studies indicate that indigenous peoples in Brazil often suffer from higher morbidity and mortality rates than the national population, they were not included systematically in any previous national health survey. Reported here for the first time, the First National Survey of Indigenous People’s Health and Nutrition in Brazil was conducted in 2008–2009 to obtain baseline information based on a nationwide representative sample. This paper presents the study’s rationale, design and methods, and selected results.

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The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results

In 1994 Brazil launched what has since become the world’s largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999–2007, hospitalizations in Brazil for ambulatory care–sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil...

Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

Background
The metabolic syndrome (MS) is a complex of risk factors for cardiovascular disease. This syndrome increases the risk of diabetes, cardiovascular disease and all-cause mortality. It has been demonstrated that the prevalence of MS is increasing worldwide. Despite the importance of MS in the context of metabolic and cardiovascular disease, few studies have described the prevalence of MS and its determinants in Latin America. The present study aims to assess studies describing the prevalence of MS in Brazil in order to determine the global prevalence of the syndrome and its components.

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Prevalence of metabolic syndrome in Brazilian adults: a systematic review

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Avaliação por triangulação de métodos: abordagem de programas sociais

RESUMO Iniquidades de acesso ao Sistema Unico de Saude comprometem a garantia de cuidados primarios de saude para populacoes rurais e para outros grupos em situacao de vulnerabilidade. Estudo transversal que avaliou acesso de usuarios e cobertura assistencial de Equipes de Saude da Familia (EqSF) dos sete estados da regiao norte do Brasil e que aderiram a avaliacao externa do segundo ciclo Programa Nacional de Melhoria do Acesso e da Qualidade da Atencao Basica (PMAQ-AB). Os dados do PMAQ-AB foram relacionados a indicadores demograficos, socioeconomicos e de saude, por meio do coeficiente de correlacao de Spearman. Para o conjunto da regiao, a cobertura assistencial de equipes sediadas em area rural, urbana e urbana que declararam atender a populacoes rurais foi de 83,3%. Coberturas entre 90-100% foram encontradas para o Acre, o Amapa, Roraima e o Tocantins. Menores percentuais foram encontrados no Para (50,5%) e no Amazonas (60,5%). A extensao de cobertura encobre barreiras de acesso geografico ligadas a concentracao de equipes da Estrategia Saude da Familia nos espacos urbanos, situacao que se estende a 451 (25,3%) unidades e a 494 (22,9%) equipes encarregadas do atendimento de populacoes rurais, mas que atuam em espaco urbano, adicionando barreiras a chegada dos usuarios as unidades. Dificuldades no acolhimento a demanda espontânea, agendamento de consulta e disponibilidade de transporte para o atendimento tambem foram reportadas.

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Acesso e cobertura da Atenção Primária à Saúde para populações rurais e urbanas na região norte do Brasil

OBJETIVO: Analisar a situacao epidemiologica da hanseniase em criancas, em zona urbana. METODOS: Foram estudados 474 casos de hanseniase, em menores de 15 anos, detectados na zona urbana de Manaus (AM), de 1998 a 2005. A partir dos dados do Sistema de Informacoes de Agravos de Notificacao foram analisados o perfil da endemia e a qualidade do atendimento nos servicos de saude, utilizando os indicadores epidemiologicos e operacionais Programa Nacional de Eliminacao da Hanseniase. RESULTADOS: Os casos de hanseniase em menores de 15 anos corresponderam a 10,4% do total de casos detectados no periodo. O coeficiente de deteccao nessa faixa etaria manteve-se no nivel hiperendemico entre 1998 e 2003, reduzindo a partir do ano de 2004 mas mantendo endemicidade muito alta. A forma clinica mais frequente foi a tuberculoide, seguida da dimorfa. As formas paucibacilares corresponderam a 70,7% dos casos e no momento do diagnostico, o grau de incapacidades foi avaliado em 94,7% dos pacientes, dos quais 2,9% apresentaram incapacidades fisicas. A maioria dos casos (99,4%) foi tratada com o esquema poliquimioterapico da Organizacao Mundial da Saude. CONCLUSOES: Apesar de seu decrescimo, o coeficiente de deteccao da hanseniase nas criancas em Manaus mantem nivel de endemicidade muito alto.

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Perfil epidemiológico da hanseníase em menores de quinze anos de idade, Manaus (AM), 1998-2005

The research for this paper was conducted in Sao Gabriel da Cachoeira, in the northwestern Amazon, with the Baniwa indigenous people, in partnership with indigenous organizations, seeking to understand the relations among the group's cosmology, their system of representations of sickness and healing practices, and their transformation through inter-ethnic contact. The recording of myths showed the origin of the diseases and demonstrated the existence of several traditional categories of sickness, guiding traditional healing practices and the incorporation of biomedical knowledge. The Baniwa's cosmology operates like a reception system for biomedical information, which the people grasp according to the logic of mythical thought. Similar cognitive strategies are used to generate the demands that indigenous leaders submit to the Health Councils and Health Services.

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Luiza Garnelo

Papers

The First National Survey of Indigenous People’s Health and Nutrition in Brazil: rationale, methodology, and overview of results

Avaliação por triangulação de métodos: abordagem de programas sociais

Acesso e cobertura da Atenção Primária à Saúde para populações rurais e urbanas na região norte do Brasil

Perfil epidemiológico da hanseníase em menores de quinze anos de idade, Manaus (AM), 1998-2005

Doença, cura e serviços de saúde. Representações, práticas e demandas Baníwa