Academic journal article Bulletin of the World Health Organization

Nutritional Status of Brazilian Children: Trends from 1975 to 1989

Academic journal article Bulletin of the World Health Organization

Nutritional Status of Brazilian Children: Trends from 1975 to 1989

Article excerpt

The prevalence of malnutrition among under-5-year-olds in Brazil fell by more than 60% between 1975 and 1989. The benefits were smaller for population strata that were more affected by malnutrition in the 1970s, i.e., children from the North and North-east regions and those from poor families in general. Regional and socioeconomic differentials in the prevalence of malnutrition therefore increased between 1975 and 1989. Trends in family income indicate extraordinary economic gains in the 1970s, some losses in the 1980s, and a modest net gain over the period 1975-89.

The availability of sanitation, health, and education services, and the provision of preschool supplementary feeding programmes increased markedly in the 1970s and 1980s. Demographic trends were also positive, reducing the demand for services and programmes, increasing the economic efficiency of families, and concentrating the population in urban areas, where incomes, job opportunities, and social and material infrastructures are better. The observed nutritional improvement was therefore probably due to a moderate increase in family income associated with a substantial expansion in the provision of services and programmes, both of which were facilitated by favourable demographic trends. Also, the nutritional improvement was probably concentrated during the 1970s, while little, if any, occurred after 1980; prospects for the 1990s point to a stagnant situation. This is a reason for great concern particularly in the North and North-east regions of the country, where high rates of child malnutrition are still found.

Introduction

Monitoring trends in child nutritional status constitutes an essential step for establishing trends in child health and provides also an opportunity to obtain accurate and objective information on the living conditions that prevail in a given society[1]. The importance of nutritional evaluation is in keeping with the considerable influence that nutrition exerts on child health, while the inference on general living conditions arises because of the close relationship between child nutrition and the fulfilment of basic needs, such as food, housing, sanitation, health care, education, etc.

In the period covered by this study, the determinants of access to basic needs have changed in Brazil. Economic growth was high during the 1970s, while during most of the 1980s recession occurred. Concentration of income remained very high during the whole period.(a) Trends in the provision of public services were generally positive, although not always targeted to those in most need[2]. Important demographic changes occurred in Brazil between the mid-1970s and the end of the 1980s, including an increase in the urban population and a substantial reduction in fertility rates and population growth[3].

The net effect of these changes on children's health or general living conditions has not yet been fully clarified. The present study represents a contribution to this aim by establishing the trends in the nutritional status of under-5-year-olds in Brazil from 1975 to 1989.

Methods

The results of two national surveys are analysed in this article: the Estudo Nacional da Despesa Familiar (ENDEF) and the Pesquisa Nacional sobre Saude e Nutricao (PNSN). Both surveys were carried out by the Brazilian Institute for Geography and Statistics (IBGE); the ENDEF survey from August 1974 to August 1975; and the PNSN survey from June to September 1989 (subsequently, these surveys will be referred to simply as the national surveys of 1975 and of 1989).

Details of the methodologies used in the two surveys have been described previously[4-7]. In general the procedures are similar to those used in the yearly household surveys carried out by IBGE in Brazil. Multiple-stage, cluster, stratified sampling was used in both surveys. Use of weighting factors facilitates estimates to be made for the country as a whole, as well as for the five Brazilian macroregions (and for other regional or socioeconomic strata, provided the sample size is adequate). …

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