Jesem Douglas Yamall Orellana

Nutrition Transition in Amazonia: Obesity and Socioeconomic Change in the Suruí Indians from Brazil

The purpose of this study was to assess the nutritional status of the adult Suruí population, an indigenous society from the Brazilian Amazon, as it relates to socioeconomic conditions. Fieldwork was carried out in February–March 2005, including 252 individuals (88.1% of the total eligible subjects older than 20 years of age in the villages surveyed). Anthropometric measurements were performed following standard procedures, and percentage of body fat (%BF) was measured by bioimpedance. To classify the Suruí according to socioeconomic status (SES), an index was constructed based on a group of variables to characterize socioeconomic differentiation. Evaluated by body mass index (BMI), the majority of Suruí 20–49.9 years of age were overweight (42.3%) or obese (18.2%). The frequency of obesity for women (24.5%) was twice that recorded for men. Subjects classified as overweight or obese also showed high %BF and waist circumference (WC). Women in the high SES category showed higher anthropometric values (including weight, BMI, arm fat area, and WC) and %BF than those of lower SES. This study shows that the Suruí are undergoing a rapid process of nutrition transition. This transition is closely associated with the emergence of intragroup differences in SES which have impacted diet and physical activity patterns. In research in indigenous peoples in Amazonia, greater attention should be paid to the human biological outcomes of socioeconomic transformations related to the growing involvement of native societies in the market economy. Am. J. Hum. Biol., 2008.

Estado nutricional e anemia em crianças Suruí, Amazônia, Brasil

OBJETIVO: Analisar o perfil nutricional de criancas indigenas Surui menores de 10 anos atraves da antropometria e da dosagem de hemoglobina. METODOS: A pesquisa foi conduzida em fevereiro-marco de 2005 na Terra Indigena Sete de Setembro, na fronteira de Rondonia com Mato Grosso. Estatura e peso foram obtidos segundo tecnicas padronizadas e comparados a referencia do National Center for Health Statistics (n = 284). A concentracao da hemoglobina foi determinada utilizando b-hemoglobinometro portatil (Hemocue) (n = 268). RESULTADOS: As porcentagens de criancas com deficit (escore z < -2) nos indices estatura para idade, peso para idade e peso para estatura foram 25,4, 8,1 e 0%, respectivamente. Nas menores de 5 anos, foram 31,4, 12,4 e 0%, respectivamente. A ampla maioria das criancas estava anemica (80,6%), alcancando 84,0% naquelas de 6 a 59 meses de idade. CONCLUSOES: Os resultados apontam para um quadro de alta prevalencia de desnutricao e anemia nas criancas Surui. A comparacao com resultados de inquerito anterior indica que houve reducao expressiva na prevalencia de baixa estatura para idade entre 1987 e 2005 (de 46,3 para 26,7% nas criancas menores de 9 anos). Por sua vez, 3,9% das criancas apresentaram sobrepeso em 2005, o que nao foi observado em 1987. As prevalencias de anemia nao se modificaram substancialmente entre os dois periodos. Apesar das melhoras observadas no perfil antropometrico, as prevalencias de deficits nutricionais ainda permanecem muito mais elevadas que as observadas na populacao brasileira em geral. Impoe-se a necessidade da implantacao de atividades sistematicas e regulares de monitoramento do crescimento e desenvolvimento das criancas indigenas, com enfase na vigilância nutricional.

Nutritional status and anemia in Suruí Indian children, Brazilian Amazon

OBJECTIVE To assess the nutritional status of Suruí Indian children aged less than 10 years by means of anthropometric measurements and determination of hemoglobin concentration levels. METHODS The study was carried out from February to March 2005 in the Sete de Setembro Indian Reservation, located on the boundary between the states of Rondônia and Mato Grosso, Amazonia, Brazil. Height and weight were measured according to standard procedures and then compared with the National Center for Health Statistics reference values (n = 284). Hemoglobin concentration was determined by a portable Beta-hemoglobinometer (Hemocue) (n = 268). RESULTS The percentages of children <or= -2 z scores for height for age, weight for age and weight for height were 25.4, 8.1 and 0%, respectively. For children aged less than 5 years, the percentages were 31.4, 12.4 and 0%. Most children had anemia (80.6%), with a rate of up to 84.0% among those aged 6 to 59 months. CONCLUSIONS There is a high prevalence of protein-energy undernutrition and anemia among Suruí children. Comparison with a previous survey indicated that the prevalence of height for age deficit significantly decreased between 1987 and 2005 (from 46.3 to 26.7% in children younger than 9 years). On the other hand, 3.9% of the children were overweight in 2005, a finding that had not been reported in 1987. The prevalence of anemia did not change remarkably between these years. Despite the improvement in anthropometric parameters, the prevalence of nutritional deficit has been persistently higher than that observed in the Brazilian population at large. It is therefore necessary that systematic and regular monitoring of indigenous childrens growth and development be implemented, focusing mainly on nutritional surveillance.

Morbidade hospitalar em crianças indígenas Suruí menores de dez anos, Rondônia, Brasil: 2000 a 2004

OBJETIVOS: analisar o perfil de morbidade hospitalar de criancas indigenas atendidas na rede de servicos do Sistema Unico de Saude. METODOS: Foram investigados 380 registros de internacao hospitalar de criancas indigenas Surui menores de 10 anos de idade atendidas na rede hospitalar do municipio de Cacoal, Rondonia, a partir de dados coletados no Hospital Materno-Infantil, instituicao publica, e no Hospital Infantil e Maternidade Menino Jesus, instituicao particular, no periodo de 2000 a 2004. Esses dois hospitais concentram o atendimento a indigenas no municipio. Utilizou-se a Classificacao Internacional de Doencas (CID), 10.a revisao, para a classificacao dos diagnosticos. RESULTADOS: as doencas do aparelho respiratorio - Cap. X (58,2%) figuraram como o principal motivo de internacao hospitalar. Doencas infecciosas e parasitarias (Cap I) apresentaram-se como a segunda maior causa (35,0%) e afeccoes originadas no periodo perinatal (Cap XVI) como a terceira (3,2%). Outras causas contribuiram individualmente com menos de 1,5% do total, que somadas nao atingiram 4%. A maioria das internacoes (65,5%) foram de criancas <2 anos de idade. O tempo medio de internacao foi significativamente superior no hospital publico em relacao ao privado. CONCLUSOES: O perfil de morbidade hospitalar observado nas criancas Surui evidencia nao somente a precariedade das suas condicoes de saude, como tambem problemas estruturais no que tange as acoes de atencao basica. Recomenda-se a realizacao de estudos que visem aprofundar aspectos epidemiologicos relacionados as internacoes hospitalares em populacoes indigenas, fundamentais para o desenvolvimento de acoes de saude mais adequadas.

Suicide mortality in São Gabriel da Cachoeira, a predominantly indigenous Brazilian municipality

OBJETIVOS: Descrever as caracteristicas e as taxas brutas de mortalidade por suicidio (TBMS), no periodo de 2000-2007, no municipio brasileiro com a maior proporcao de pessoas autodeclaradas indigenas, Sao Gabriel da Cachoeira (SGC), Estado do Amazonas, Brasil. METODO: Estudo retrospectivo e descritivo, utilizando dados do Departamento de Informatica do Sistema Unico de Saude (DATASUS). Foram considerados obitos por suicidio os registros codificados como lesoes autoprovocadas voluntariamente na Classificacao Estatistica Internacional de Doencas e Problemas Relacionados a Saude, 10a revisao. RESULTADOS: Foram registrados 44 suicidios no periodo. A TBMS media foi 16,8 por 100.000 habitantes (masc., 26,6; fem., 6,3). As taxas mais elevadas foram observadas nas faixas etarias 15-24 e 25-34 anos, com TBMS 43,1 e 30,2 por 100.000 habitantes, respectivamente. A maioria dos suicidios ocorreu entre indigenas (97,7%), do sexo masculino (81,8%) e solteiros (70,5 %). Os obitos ocorreram em sua maioria em casa (86,4%), no final de semana (59,1%) e principalmente por enforcamento (97,7%). CONCLUSAO: O suicidio e um importante problema social e de saude publica em SGC. O perfil dos suicidios observados neste municipio como um todo foi mais proximo daquele encontrado em certos contextos indigenas do que o encontrado em ambientes urbanos e nao indigenas, demonstrando as especificidades socioculturais desses eventos no Brasil.

Características sociodemográficas e indicadores operacionais de controle da tuberculose entre indígenas e não indígenas de Rondônia, Amazônia Ocidental, Brasil

With the intention of improve knowledge on the epidemiological situation of tuberculosis (TB) among vulnerable populations in Brazil, our objective was to analyze sociodemographic characteristics and operational indicators related to TB control, comparing indigenous and non-indigenous people, in Rondônia. We conducted a retrospective and descriptive epidemiological study of new TB cases reported between 1997, January 1st and 2006, December 31st. We excluded duplicate records and those for whom the results of treatment was change in diagnosis and transfer. TB cases were classified into two categories: indigenous and non-indigenous people and analysis was performed according to sex, age, origin (urban /rural), State of residence, clinical form, diagnostic tests, monitoring indicators and results of treatment. Altogether 4832 cases were reported, with 322 cases (6.7%) in indigenous people. There was a male predominance (ratios: 1.7 to 1.3 in non-indigenous and indigenous people). The majority of cases for indigenous people (82.6%) was in rural area and there was high concentration of cases (36.0%) in children < 15 years. The analysis of diagnostic tests showed a predominance of smear positive in non-indigenous (56.1%) and smear negative and smear not performed in indigenous people (31.7% and 35.4% respectively, P value=0.0001). There was difference in the monitoring in relation to smear of second month (6.1% positivity, P value = 0.0001) and exam at least one contact (69.6%, P value = 0.017) for non-indigenous. On the other hand, DOTS was more associated with indigenous people cases (23.6%, P value = 0.0001). Stands out the predominance of cure in both groups, with bigger concentration in indigenous people (90.4%, P value = 0.0001) and higher rate of noncompliance in non-indigenous (14.7%, P value = 0.0001). The approach showed useful for elucidate inequalities and has exceeded the usual analysis carried out surveillance on services that aim to delineate the epidemiological situation based only on rates or absolute values.

Prevalência e fatores associados à anemia em mulheres indígenas Suruí com idade entre 15 e 49 anos, Amazônia, Brasil

OBJECTIVES: to investigate the prevalence of and factors associated with the occurrence of anemia in indigenous Surui women aged between 15 and 49 years. METHODS: a cross-sectional study was carried out based on the 2005 census of Sete de Setembro indigenous territory in the Brazilian State of Rondonia. Hemoglobin measurement (Hb) was carried out using a portable β-hemoglobinometer. The cut-off points for anemia were Hb <12.0 g/dL in non-pregnant women and Hb <11.0 g/dL in pregnant women. Demographic and socio-economic data were gathered using a standardized questionnaire. The first stage of statistical analysis included the: chi-square; the chi-square linear tendency test; Students t; a test for linearity and analysis of variance. In the second stage, the final logistic model was adjusted. RESULTS: the overall prevalence of anemia in non-pregnant women was 67.3% and, in pregnant women, 81.8%. Multivariate analysis showed that women with one or two anemic children aged between 6 and 35 months were three times more likely to be anemic; women from the lowest socio-economic stratum were 3.5 times more likely to be anemic. The likelihood of a Surui woman of low socio-economic status being anemic was 26% higher than that of one from the highest socio-economic stratum. CONCLUSIONS: anemia is a serious health problem among Surui women and is influenced by household factors, such as having children with anemia and socio-economic circumstances. It is suggested that measures to treat and prevent anemia among the Surui take these factors into account.

Desigualdades na mortalidade por suicídio entre indígenas e não indígenas no estado do Amazonas, Brasil

OBJECTIVE: To analyze rates and some characteristics of suicide mortality between indigenous and non-indigenous people in the State of Amazonas. METHOD: Retrospective cohort study, where in data of death were obtained from the Information System on Mortality and data of population from the Brazilian Institute of Geography and Statistics. We used all records of suicide that occurred during the period 2006-2010 and the annual geometric interpolation for the estimation of subpopulations. RESULTS: Six hundred eighty-eight suicide cases were reported in the State of Amazonas, of which 19.0% indigenous people. The standardized mortality rate for suicide (SMRS) in indigenous people, of the 18.4/100.000, was 4.4 times higher than that of non-indigenous people. The SMRS in indigenous people increased 1.6 times in 2010 compared to 2006 year. In the municipalities of Tabatinga and Sao Gabriel da Cachoeira the SMRS were much high, 75.8 and 41.9/100.000, respectively. CONCLUSIONS: Inequalities in the behavior of the suicide mortality rates between indigenous and non indigenous people were proved, exposing not only their local importance, but also a hidden public health problem issue, especially among youth age 15-24.

Cobertura do Sistema de Vigilância Alimentar e Nutricional Indígena (SISVAN-I) e prevalência de desvios nutricionais em crianças Yanomami menores de 60 meses, Amazônia, Brasil

Objectives: to investigate the coverage of the System for Nutrition Surveillance of Indigenous People (SISVAN-I) and to estimate the prevalence of nutritional disorders in children aged under 60 months, in the Yanomami Special Sanitary District (DSEI-Yanomami). Methods: a descriptive cross-sectional study was carried out between May 2008 and April 2009. Coverage was calculated by dividing the number of children evaluated by the total number of children enrolled. The health basic units (PB) with at least one record of weight and height available at each trimester, were included. The nutritional evaluation was based on the first record identified during the study period and used the World Health Organization curves as a point of reference (2006). Factors associated with low weight for age (W/A) were analyzed using logistic regression. Results: the mean coverage at the eight PB selected was 27.7%. In all, 80.5% of children presented with low H/A; 57.5% with low W/A; 8.4% were thin and 5.5% overweight. The greatest likelihood of low W/A was found in children aged 36 to 59 months and in the Sanuma subgroup (OR=2.9 IC95%: 2.1-3.9 and OR=9.8 IC95%: 5.9-16.1, respectively). There was no difference between boys and girls. Conclusions: although the coverage of the SISVAN-I has been low, the system has proved useful in revealing the severe nutritional situation among children in the DSEI-Yanomami and has signaled a need for intervention.

Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.