Andrey Moreira Cardoso

Mortalidade infantil segundo raça/cor no Brasil: o que dizem os sistemas nacionais de informação?

This study analyzes the consistency of the Brazilian national information systems on mortality (SIM) and live births (SINASC) as data sources for evaluating health inequalities according to race/color. Infant mortality rates (IMRs) were obtained according to race/color from death and live birth certificates for the country as a whole and its regions, for the years 1999-2002. The IMR was also estimated according to race/ color, based on the incorporation of deaths and live births with race/color not reported by two criteria. The study compared the IMRs obtained in the study with those estimated by indirect methods. The IMR ratios were also calculated between race/color categories. A substantial reduction was observed during the period in the number of deaths and live births with race/color not recorded. In 2002, infant mortality in black children was 30.0% to 80.0% higher than that of white children and 40.0% to 80.0% higher than that of brown or mixed-race children (pardas); infant mortality in indigenous children was 40.0% to 90.0% higher than that of white or brown children. It is hoped that improved recording in the SIM and SINASC databases will allow a more in-depth discussion of health inequalities according to race, color, and ethnicity in Brazil.

Prevalência de fatores de risco para doenças cardiovasculares na população Guaraní-Mbyá do Estado do Rio de Janeiro

Social change has been involved in the unequal distribution patterns of chronic diseases in several populations. Among Indian communities experiencing life pattern changes, international studies have reported increased prevalence of hypertension and other cardiovascular risk factors. Such increased prevalence was ascertained in a survey conducted in 1999 in selected Guaraní-Mbyá communities (Sapukai, Paraty-Mirim, and Araponga) in the State of Rio de Janeiro, Brazil. A population census was carried out and interviews and clinical and biochemical evaluations were conducted with 80 men and 71 women. Observed prevalence of selected risk factors in the overall sample, including men and women, was as follows for the three communities: hypertension (4.8%, 2.6%, 7.4%); overweight (26.7%, 19.5%, 34.8%); total cholesterol levels (2.8%, 2.7%, 2.9%), and increased triglyceride levels (12.6%, 9.5%, 15.9%). All prevalence rates were higher among women and at older ages. The results suggest that the Guaraní communities have a moderate risk of chronic diseases and that measures to reduce these risk factors should be adopted.

Povos indígenas no Brasil

SANTOS, R. V., COIMBRA JR., C. E. A., and CARDOSO, A. M. Povos indígenas no Brasil. In: BARROS, D. C., SILVA, D. O., and GUGELMIN, S. Â., orgs. Vigilância alimentar e nutricional para a saúde Indígena [online]. Vol. 1. Rio de Janeiro: Editora FIOCRUZ, 2007, pp. 20-45. ISBN: 978-85-7541-587-0. Available from: doi: 10.7476/9788575415870.003. Also available in ePUB from: http://books.scielo.org/id/fyyqb/epub/barros-9788575415870.epub.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BackgroundAnemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the Country. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil.MethodsThe survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.ResultsEvaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.ConclusionsThe prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

Hospital morbidity among Guarani indians in Southeastern and Southern Brazil

Studies on hospital morbidity among Brazilian indigenous peoples are relatively recent, show limited coverage, and lack data sources capable of generating specific indicators according to ethnic group. The current study describes hospital morbidity in the indigenous population living in 83 Guarani villages in Southern and Southeastern Brazil (N=6,483), based on primary data obtained from a hospital admissions surveillance system implemented in 2007-2008, specifically for a case-control study on acute respiratory infections (ARI) in Guarani children. During the study period there were 666 hospitalizations in a total of 497 individuals, the majority under 5 years of age (71.9%). Respiratory illnesses were the main causes of hospitalization (64.6%), especially in children (<5 years: 77.6%; <1 year: 83.4%) and exceeded the proportions of hospital admissions from these causes in other indigenous groups. The overall hospitalization rate (per 100 person-years) was 8.8, or 71.4 under 1 year and 21.0 from 1 to 4 years of age. The ARI hospitalization rate (5.3) was 6.5 and 2.0 times higher than for diarrhea and other causes, respectively, while in children under 5 years of age (ARI=23.7) these differences were 7.4 and 5.4 times, respectively. The standardized Guarani hospitalization rate exceeded the standardized rates for the South and Southeast of Brazil by 40% and 210%, respectively. Hospitalization for primary care sensitive conditions and the high ARI rates indicate the need for studies to understand the epidemiology of ARI and investments to upgrade primary health care for the Guarani.

Risk factors for hospital admission due to acute lower respiratory tract infection in Guarani indigenous children in southern Brazil: a population-based case-control study

To assess risk factors associated with hospital admission due to acute lower respiratory tract infection (ALRTI) in indigenous Guarani children <5 years of age in southern Brazil.

Níveis tensionais de adultos indígenas Suruí, Rondônia, Brasil

This is a cross-sectional study to verify the prevalence and associated factors related to exclusive breastfeeding in adolescent mothers between 14 and 16 years of age with 6-month-old or younger babies, born in Porto Alegre in the State of Rio Grande do Sul, Brazil, in 2009. The sample was based on 50% of the newborn babies from the population surveyed. A total of 341 adolescent mothers were interviewed in their homes. The variables considered as potential determinants of exclusive breastfeeding were social and demographic, pre- and post-natal assistance, emotional aspects of the mother, birth conditions and baby characteristics. Prevalence ratios (PR) were estimated by Poisson regression by means of hierarchical analysis. The prevalence of exclusive breastfeeding ranged from 47.8% in the first month of life up to 13.8% after six months and declined, on average, 24% for each month of life (RP = 0.76; CI95%: 0.68-0.85). Besides the babys age, the factors associated with exclusive breastfeeding were maternal education (PR=1.53; CII95%: 1.18-1.98) and multiple births (PR=1.57; CI95%:1.02-2.46), the latter observed in only 4.7% of the sample. Teenage mothers with higher schooling and with live children from earlier pregnancies manifested higher prevalence of exclusive breastfeeding.Os povos indigenas no Brasil vivenciam acelerado processo de transicao nutricional e epidemiologica, verificando-se a emergencia de doencas e agravos nao transmissiveis, como hipertensao arterial (HA). Realizou-se, em 2005, um estudo transversal para descrever os niveis tensionais em adultos (> 20 anos) indigenas Surui, Rondonia, e investigar sua relacao com o estado nutricional e o nivel socioeconomico (SSE). Foram visitadas 9 aldeias e avaliados 251 individuos (87,4% dos elegiveis). As medias de pressao arterial sistolica (PAS) e pressao arterial diastolica (PAD) foram maiores no sexo masculino e superiores as verificadas em 1988, com incremento na media da PAS de 7,9 mmHg e de 1,4 mmHg, em mulheres e homens, respectivamente. A PAS correlacionou-se positivamente com a razao cintura quadril (RCQ) em ambos os sexos, e com a idade, no sexo feminino. A PAD apresentou correlacoes estatisticamente significativas com todas as variaveis antropometricas, exceto com estatura e area muscular do braco. A prevalencia de HA foi de 2,8% (M: 2,4%; F: 3,1%). Essa prevalencia foi maior nos individuos > 40 anos, com perimetro da cintura (PC) ou RCQ elevados, sobretudo no grupo feminino e tambem no grupo de mais baixo de SSE. A HA e um problema de saude emergente entre os Surui, devendo receber atencao do sistema de saude e dos pesquisadores.

Mortality among Guarani Indians in Southeastern and Southern Brazil

Worldwide, indigenous peoples display a high burden of disease, expressed by profound health inequalities in comparison to non-indigenous populations. This study describes mortality patterns among the Guarani in Southern and Southeastern Brazil, with a focus on health inequalities. The Guarani population structure is indicative of high birth and death rates, low median age and low life expectancy at birth. The crude mortality rate (crude MR = 5.0/1,000) was similar to the Brazilian national rate, but the under-five MR (44.5/1,000) and the infant mortality rate (29.6/1,000) were twice the corresponding MR in the South and Southeast of Brazil. The proportion of post-neonatal infant deaths was 83.3%, 2.4 times higher than general population. The proportions of ill-defined (15.8%) and preventable causes (51.6%) were high. The principal causes of death were respiratory (40.6%) and infectious and parasitic diseases (18.8%), suggesting precarious living conditions and deficient health services. There is a need for greater investment in primary care and interventions in social determinants of health in order to reduce the health inequalities.

Implementação da política de saúde indígena no Pólo-base Angra dos Reis, Rio de Janeiro, Brasil: entraves e perspectivas

This article discusses the Brazilian National Policy for Indigenous Peoples Health, formulated in the 1990s as part of the national Health Reform Movement and based on the creation (in 1999) of the Indigenous Healthcare Sub-System. Coordinated at the central government level under the administration of the National Health Foundation/Ministry of Health, the implementation of this sub-system required adaptations in the organization of health services systems at the local level, with the creation of Special Indigenous Health Districts. This configuration showed the need for dialogue and negotiation among the various institutions involved with indigenous affairs, from the perspective of overcoming various conflicts and operational difficulties. The current analysis identifies the difficulties in the implementation of a differentiated indigenous health policy under federal responsibility and within the decentralized Brazilian Unified Health System (SUS), since the absence of specific mechanisms and instruments regulating the operationalization of these services at the local level and the lack of more effective supervision and on-going evaluation of this policy mean that differentiated care for the indigenous population is subject to both the vices and virtues of local policy.

A persistência das infecções respiratórias agudas como problema de Saúde Pública

Cad. Saúde Pública, Rio de Janeiro, 26(7):1270-1271, jul, 2010 Acute respiratory infections (ARIs) constitute a clinical syndrome whose most common infectious agents are respiratory viruses like the respiratory syncytial virus and bacteria such as Streptococcus pneumoniae and Haemophilus influenzae. Children, older persons, socially underprivileged populations in developing countries, and ethnic minorities are particularly susceptible. ARI incidence is similar in children under 5 worldwide, while the incidence rates for severe forms, such as clinical pneumonia (bronchiolitis and pneumonia), hospitalizations, and deaths are heterogeneous. In developing countries, there are an estimated 0.29 episodes of clinical pneumonia/child-year or 151.8 million new cases per year (95% of the world incidence in children under 5 years); 7 to 13% of the cases result in hospitalization; and more than 2 million evolve to death, making pneumonia the main single cause of death in children. The proportions of death from pneumonia vary from 12% (Americas and Europe) to 21% (Africa and Eastern Mediterranean), with relatively greater importance in regions with more precarious health systems. Brazil is one of the 15 countries with the highest number of annual cases of clinical pneumonia in children under 5 (1.8 million), with an estimated incidence of 0.11 episodes/ child-year. In this group, 30 to 50% of outpatient consultations, more than 50% of hospitalizations, and 10 to 15% of deaths are attributed to ARIs, 80% of which due to pneumonia. From 2000 to 2007, there was an 18% decrease in hospitalizations due to clinical pneumonia in children under 1 year of age and a 27% decrease from 1 to 4 years of age, although the hospitalization rate due to this cause remained stable during the same period (27%). However, the hospitalization costs increased, reaching 189 million reais (more than 100 million US dollars) and 20.5% of hospitalization expenditures in children under 5. The number of deaths decreased, but the proportion of deaths from clinical pneumonia remained stable, representing the second cause of death in a major portion of the States of Brazil. Among indigenous peoples in South and Southeast Brazil, the annual mortality rates in children under 5 years (54.8/1,000) and under 1 year of age (35.6/1,000) exceeded the corresponding rates for Brazil as a whole by 2.8 times and 84.4%, respectively, with 85.7% of infant deaths concentrated in the post-neonatal period. ARI mortality accounts for more than half of allcause mortality in under-5 indigenous children. Brazil is making strides towards reaching the Millennium Development Goal of reducing the under-5 mortality rate by two-thirds by the year 2015. However, the mean childhood mortality indicators disguise inequalities between the groups comprising Brazilian national society, in regional, ethnic or racial, and socioeconomic terms. Another relevant issue is that the reduction in mortality means a probable increase in the impacts of ARI morbidity on children’s growth and physical and cognitive development, with repercussions throughout life. Although the Brazilian Ministry of Health promotes comprehensive maternal and child health care through the expansion of the Family Health Strategy, Integrated Management of Childhood Illnesses (IMCI, Neonatal IMCI), and the Pact for the Reduction of Infant Mortality in the Northeast and Legal Amazonia, among others, the persistence of ARIs among the main causes of morbidity and mortality in the Brazilian population, inequalities in access to health, lack of vaccines to prevent the spectrum of infectious agents in ARIs, and the complexity and long-term effects of interventions on social and environmental health determinants, make ARIs a contemporary public health problem, calling for prioritization by health services, policy-makers, and researchers in the areas of communicable diseases and technological innovations in health. The persistence of acute respiratory infections as a Public Health problem EDITORIAL