Revista de Saúde Pública (Feb 2010)
Causas do declínio acelerado da desnutrição infantil no Nordeste do Brasil (1986-1996-2006) Causas de la disminución acelerada de la desnutrición infantil en Noreste de Brasil (1986-1996-2006) Causes of the accelerated decline in child undernutrition in Northeastern Brazil (1986-1996-2006)
Abstract
OBJETIVO: Descrever a variação temporal na prevalência de desnutrição infantil na região Nordeste do Brasil, em dois períodos sucessivos, identificando os principais fatores responsáveis pela evolução observada em cada período. MÉTODOS: Os dados analisados provêm de amostras probabilísticas da população de crianças menores de cinco anos estudadas por inquéritos domiciliares do programa Demographic Health Surveys realizados em 1986 (n=1.302), 1996 (n=1.108) e 2006 (n=950). A identificação dos fatores responsáveis pela variação na prevalência da desnutrição (altura para idade OBJETIVO: Describir la variación temporal en la prevalencia de desnutrición infantil en la región Noreste de Brasil, en dos períodos sucesivos, identificando los principales factores responsables por la evolución observada en cada período. MÉTODOS: Los datos analizados provienen de muestras probabilísticas de la población de niños menores de cinco años estudiados por pesquisas domiciliares del programa Demographic Health Surveys realizados en 1986 (n=1.302), 1996 (n=1.108) y 2006 (n=950). La identificación de los factores responsables por la variación en la prevalencia de la desnutrición (altura para edad OBJECTIVE: To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes. METHODS: Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions. RESULTS: Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period. CONCLUSIONS: The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.
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