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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
Carlos Augusto Monteiro,Maria Helena D'Aquino Benício,Wolney Lisboa Conde,Silvia Cristina Konno,Ana Lucia Lovadino,Aluísio J D Barros,Cesar G. Victora +6 more
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In this article, the authors used a Demographic and Health Survey conducted in Brazil in 2006-07 to assess trends in child stunting and in related socioeconomic disparities over the past three decades.Abstract:
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 …read more
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Chronic non-communicable diseases in Brazil: burden and current challenges.
Maria Inês Schmidt,Bruce Bartholow Duncan,Gulnar Azevedo e Silva,Ana Maria Menezes,Carlos Augusto Monteiro,Sandhi Maria Barreto,Dóra Chor,Paulo Rossi Menezes +7 more
TL;DR: Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year, however, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies.
Journal ArticleDOI
Maternal and child health in Brazil: progress and challenges
Cesar G. Victora,Estela M. L. Aquino,Maria do Carmo Leal,Carlos Augusto Monteiro,Fernando C. Barros,Célia Landmann Szwarcwald +5 more
TL;DR: Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age.
Journal ArticleDOI
Countdown to 2015 decade report (2000-10): taking stock of maternal, newborn, and child survival.
Zulfiqar A Bhutta,Mickey Chopra,Henrik Axelson,Peter Berman,Ties Boerma,Jennifer Bryce,Flavia Bustreo,Eleonora Cavagnero,Giorgio Cometto,Bernadette Daelmans,Andres de Francisco,Helga Fogstad,Neeru Gupta,Laura Laski,Joy E Lawn,Blerta Maliqi,Elizabeth Mason,Catherine Pitt,Jennifer Harris Requejo,Ann M Starrs,Cesar G. Victora,Tessa Wardlaw +21 more
TL;DR: Evidence is provided from several countries showing that rapid progress is possible and that focused and targeted interventions can reduce inequities related to socioeconomic status and sex and much more can and should be done to address maternal and newborn health and improve coverage of interventions related to family planning, care around childbirth, and case management of childhood illnesses.
Journal ArticleDOI
The World Health Organization's global target for reducing childhood stunting by 2025: rationale and proposed actions.
Mercedes de Onis,Kathryn G. Dewey,Elaine Borghi,Adelheid W. Onyango,Monika Blössner,Bernadette Daelmans,Ellen Piwoz,Francesco Branca +7 more
TL;DR: This paper presents a methodology to set individual country targets to address stunting at national scale, combining direct nutrition interventions with strategies concerning health, family planning, water and sanitation, and other factors that affect the risk of stunting.
Journal ArticleDOI
Intergenerational influences on child growth and undernutrition.
TL;DR: It is not clear whether there is an upper limit for impact on intrauterine and infant linear growth that programmes in developing countries could achieve that is set by early childhood malnutrition in the mother, and because so much can be achieved in a single generation, intergenerational influences are unlikely to be an important explanation for lack of programme impact.
References
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Robert E. Black,Lindsay H. Allen,Zulfiqar A Bhutta,Laura E. Caulfield,Mercedes de Onis,Majid Ezzati,Colin Mathers,Juan A Rivera +7 more
TL;DR: The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.
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TL;DR: It is concluded that damage suffered in early life leads to permanent impairment, and might also affect future generations, as undernutrition is associated with lower human capital and its prevention will probably bring about important health, educational, and economic benefits.
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Posted Content
Analyzing health equity using household survey data : a guide to techniques and their implementation
TL;DR: In this paper, the authors provide a step-by-step practical guide to the measurement of a variety of aspects of health equity, including gaps in health outcomes between the poor and the better-off in specific countries or in the developing world as a whole.
Journal ArticleDOI
Chronic non-communicable diseases in Brazil: burden and current challenges.
Maria Inês Schmidt,Bruce Bartholow Duncan,Gulnar Azevedo e Silva,Ana Maria Menezes,Carlos Augusto Monteiro,Sandhi Maria Barreto,Dóra Chor,Paulo Rossi Menezes +7 more
TL;DR: Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year, however, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies.