[Inequalities in mortality, space and social strata]. / Desigualdades na mortalidade, espaço e estratos sociais.

OBJECTIVE: A description of the mortality differentials in Salvador, Bahia, Brazil, is presented. METHODS: An ecological study was carried out. The city was divided into 75 information areas and its population into six social strata. Standardized Mortality Rates, Age Specific Mortality Rates, Proportional Infant Mortality and the Proportional Mortality Ratio were calculated for each region and social strata. Data were obtained from Death Certificates and the Populational Census. RESULTS: The mortality ratio difference between the strata with best living conditions and the poorer strata ranged from 43.1% to 142.0% which corresponds to an inequality ratio ranging from 1.4 to 2.4. When that analysis was carried out in smaller areas, these differences reached 656.3%. CONCLUSIONS: These findings show the persistence of health inequalities in Salvador in more serious disproportion than that found in other studies. Despite the methodological problems related to the nature of the data and the study, project the authors it was highlight, the meaning of this kind of research concerned with new approaches to health planning and health promotion.

[Regional distribution of violence: mortality from external causes in Salvador (Bahia), Brazil]. / Distribuição espacial da violência: mortalidade por causas externas em Salvador (Bahia), Brasil.

The aim of this paper was to describe the geographic distribution of mortality resulting from external causes during 1991 within the city of Salvador, Bahia, Brazil. Mortality indicators were calculated in terms of deaths from external causes and in terms of specific types of violence. Of the deaths in that year, 15% were due to external causes, corresponding to a mortality rate of 78/100,000 inhabitants. The homicide death rate was 32.2/100,000 inhabitants, and the traffic-related death rate was 21.8/100,000 inhabitants. The elderly, young adults, and teenagers were at higher risk of death from violent causes. Among the elderly, 38% of the deaths were from car accidents and 28% from falls. Among teenagers, homicides were the main cause of death, especially in males between 15 and 29 years of age. Our results show that the geographic distribution of violent deaths in Salvador is uneven. Such deaths occur mainly in poorer neighborhoods, which have higher violent death rates than average for the city of Salvador. There is a need for prevention and control measures, including public policies and public health activities, focusing on the areas that have the greatest risk of death from external causes.

Decline and unevenness of infant mortality in Salvador, Brazil, 1980-1988.

Data relating to infant mortality in Salvador, Brazil, were analyzed in order to determine how infant mortality evolved in various parts of the city during the period 1980-1988. This analysis showed sharp drops in the numbers of infant deaths, proportional infant mortality (infant deaths as a percentage of total deaths), and the infant mortality coefficient (infant deaths per thousand live births) during the study period despite deteriorating economic conditions. It also suggested that while these declines occurred throughout the city, the overall distribution of infant mortality in different reporting zones remained uneven. Among other things, these findings call attention to a need for further investigation of the roles played by various health measures (including immunization, control of respiratory and diarrheal diseases, encouragement of breast-feeding, and monitoring of growth and development) and of reduced fertility (resulting from birth spacing, use of contraceptives, and female sterilization) in bringing about declines in infant mortality during hard economic times.

PIP: Infant mortality has declined since the 1940s in the Americas and specifically in Brazil. Infant mortality in Brazil was 65 deaths/1000 live births regardless of the recession. The aim of this study was to determine the patterns of change in infant mortality in 76 reporting zones in Salvador, Brazil, between 1980 and 1988, based on death records and decedent's place of residence. Data were analyzed in terms of changes in proportional infant mortality and the infant mortality coefficient. Quartiles were set at low (3.9 to 17.1 deaths/100 total deaths), intermediate (17.9 to 25.8), and high (37.5 to 52.5). Averages of each quartile were computed for 1980 and 1988 and compared. Live birth rates were used in computing the infant mortality coefficients; deaths/1000 live births were grouped by low, intermediate, and high, and average values calculated for 1980 and 1988. The problems of distortion in using these data are discussed. The results show declines in proportional infant mortality from 17.4% to 30.8% of total mortality and in infant mortality coefficients from 71.9 to 31.6 deaths/1000 live births. Proportional infant mortality declined by 43.5% between 1980 and 1988; the coefficient of infant mortality decreased by 56.1% for the same period. The absolute number of deaths also declined. In the quartile analysis, the rates of decline were greatest for intermediate, high, and very high proportional infant mortality and for the coefficient of infant mortality. There was also uneven distribution of deaths in different quartiles. The geographic location of reporting zones is visually displayed; it is apparent that there were few very high zones in 1988 and a sharp reduction in high zones for proportional infant mortality. The map of average infant mortality coefficients shows marked declines in very high zones; there were increases in areas with low and intermediate coefficients. Suggestions for additional research were to evaluate a longer time series and to analyze the influence of socioeconomic change on the declines.

Gastroenteritis epidemic in the area of the Itaparica Dam, Bahia, Brazil.

Dam construction and associated flooding along rivers can alter ecosystems and pose serious threats to the welfare and health of local populations. This article describes a severe gastroenteritis epidemic in the Paulo Afonso region of Brazil's Bahia State related to flooding of the newly constructed Itaparica Dam's reservoir in 1988. Some 2,000 gastroenteritis cases, 88 of which resulted in death, were reported over a 42-day period. Responding to the outbreak, clinical data and water sample test results were reviewed; blood and fecal specimens from gastroenteritis patients were subjected to bacteriologic, virologic, and toxicologic testing; and drinking water samples were examined for microorganisms and heavy metals. The results revealed that the source of the outbreak was water impounded by the dam and pointed to toxin produced by cyanobacteria as the responsible agent. Proliferation of these microbes, present at concentrations of 1,104 to 9,755 standard cyanobacterial units per milliliter in untreated water, appears to have been encouraged by the decomposing biomass and other conditions prevailing in the newly flooded reservoir area.

[Protective effect of intradermal BCG on tuberculous meningitis]. / Efeito protetor do BCG intradérmico na meningite tuberculosa.

The incidence of tuberculosis in Bahia, though declining, remains very high, and one of the severe forms of the disease is tubercular meningitis. This case-control study sought to compare confirmed cases of tubercular meningitis in children 0 to 14 years of age with members of a control group, matched as closely as possible for age (not more than about six months apart), who had shown no sign of meningitis or neurological disease. The comparison considered such factors as schooling of the parents, their occupations, exposure to the bacillus at home, and others. The study showed that failure to vaccinate heightens the risk of contracting the disease--a risk estimated at 11.7 with a confidence interval of 4.5 to 30.5, and an etiological component of 9.14%--and also that the risk is lower the earlier the child is vaccinated. With this study the authors wish to underscore the need to expand the coverage of intradermal BCG vaccination.

Spatial distribution of proportional infant mortality and certain socioeconomic variables in Salvador, Bahia, Brazil.

PIP: The spatial distribution of infant deaths in each zone of the city of Salvador, Brazil, in 1980 was examined and related to selected socioeconomic and health care variables. The spatial distribution of infant mortality (defined as the ratio of infant deaths to total deaths in Salvador) was uneven, ranging from 3.9% in a zone in the center of the old city near the water to 52.5% in an outlying area. There was a direct correlation between proportional infant mortality and low income. The proportion of low-income families was 23.1% in the quartile containing the lowest rates of infant mortality compared with 97.7% in the quartile containing the highest such rates. Also noted was an inverse relationship between proportional infant mortality and water consumption. Similarly, the percentage of substandard housing (shacks) was directly associated with infant mortality, rising from 2% in the 1st quartile (low infant mortality) to 43% in the 4th quartile. There was additionally an inverse correlation between the average number of physicians per inhabitant and proportional infant mortality, with a rate of 5.7/10,000 inhabitants in the 1st quartile compared with 1.8 in the 4th. Overall, analysis of the spatial distribution of infant deaths in Salvador reveals that an especially high proportion of those dying were infants residing in certain zones of the city, most notably outlying neighborhoods and slums. The results further point to an important association between certain socioeconomic and sanitation variables and infant mortality. The fact that the highest correlation coefficient found in the present study was between proportional infant mortality and the percentage of low-income families underscores the significant role that economic structure plays in infant mortality. There is a need both to redefine the urban development model prevailing in Latin America and to reorient the aims of the health sector.^ieng