[Secular trends in respiratory diseases of childhood in the city of São Paulo, Brazil (1984-1996)]. / Tendência secular da doença respiratória na infância na cidade de São Paulo (1984-1996).

OBJECTIVE: Data from two consecutive household surveys undertaken in mid-80s and mid-90s allow to characterize and analyse secular trends in infant and child respiratory diseases in the city of S. Paulo, Brazil. METHODS: The two surveys included random population samples aged from zero to 59 months (1,016 in the period of 1984-85 and 1,280 in 1995-96). In both surveys the instant prevalence of high respiratory diseases (above the epiglottis) and low respiratory diseases with or without wheezing were calculated. All sampled children were examined in their household at a random day by trained pediatricians using standardized procedures. The examinations included medical history, past respiratory diseases and a complete physical examination. In both surveys the examinations were distributed throughout a period of almost 12 months to assure a uniform coverage of the various areas of the city along the four seasons of the year. For each survey, the study of the social distribution of the diseases took into account tertiles of the per capita family income. For the study of the determinants of secular trends, hierarchical causal models, multivariate regression analyses and calculations analogous to the ones used to assess population attributable risks were applied. RESULTS/CONCLUSIONS: In the time span from the first to the second survey, there was a substantial increase in the prevalence of both low (from 22.2% to 38.8%) and high respiratory diseases (from 6.0% to 10.0% and from 0.8% to 2.8%, without and with wheezing, respectively). In the case of high respiratory disease and low respiratory disease without wheezing, an increase in prevalence was observed among all social strata, which did not interfere with the slightly less favourable situation of the lower income groups. In the case of low respiratory disease with wheezing, the increase was only observed among middle and low-income groups, being particularly high among the lower income group, yielding a significant inverse gradient between income and respiratory disease. Positive changes in distal (family income and maternal schooling) and in intermediate determinants related to housing characteristics would have resulted in a decline, not an increase, in the prevalence of respiratory diseases in the city. The duplication in the attendance rate to day care nurseries seen in the period could have counterbalanced the positive effect due to socioeconomic and housing variables but would not be enough to explain an increase in the disease.

Nutritional status of Brazilian children: trends from 1975 to 1989.

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.

PIP: Nutritionists used 2 surveys (1975 and 1989) to determine the trends in the nutritional status of children 5 years old in Brazil. Malnutrition rates fell by 61.4% between 1975 and 1989 (18.4% vs. 7.1%). Improvements in child nutrition occurred countrywide, but they were less in the North and the Northeast (56.7% and 52.6% respectively) than in the other regions (69.2%-78.6%). In fact, the gap between these regions and the other regions was wider in 1989 than it was in 1975 (e.g., prevalence ratio between the Northeast and the South, 2.5 in 1975 and 5 in 1989). In the Southeast and the South, nutrition improvement occurred basically equally for rural and urban children, but the percentage of rural malnourished children was still higher than it was for urban malnourished children (6.2% vs. 3.7% and 3% vs. 2.1% respectively). In the Northeast, rural children suffered more relative excess malnutrition in 1989 than they did in 1975. A sizable reduction in childhood malnutrition prevalence rates occurred in all 4 income groups, but the poorest children benefited the least (55.6% vs. 77% for the richest group). Since children most affected by malnutrition in the 1970s (i.e., children from the North and Northeast and the poor) gained the least, regional and socioeconomic differences in the prevalence of malnutrition expanded between 1975 and 1989. Modest increases in income linked to considerable expansion of sanitation, health, and education services and of preschool supplementary feeding programs were most likely responsible for nutritional improvement. In addition, fertility rates fell (5.8-3) during this period. Improvement was largely restricted to the 1970s, however. After 1980, little or no improvement occurred. Little hope for economic recovery, continued economic inequalities, and reduced spending on social programs indicated a stagnant situation for the 1990s.