How well is hypertension managed in the community? A population-based survey in a Brazilian city.

There is usually little information available on how well hypertensive individuals are managed at the community level. This survey measured the frequency of hypertension in a medium-sized Brazilian city by studying a cluster sample of 1657 adults aged 20-69 years. The 328 hypertensives (19.8%) answered a questionnaire on the knowledge and management of their condition. Two-thirds were aware of their status and more than half were on antihypertensive medication, but only one-third had their blood pressure under control. Physicians failed to advise a large proportion of their patients about the need to lose weight, take exercise, and quit smoking. Although laboratory tests were carried out in most patients, fundoscopy and chest X-rays were performed in fewer than 50%. Continued care by the same physician was the only factor significantly associated with compensated high blood pressure (relative risk for not having continued care = 1.35; 95% CI = 1.02-1.71). High levels of absenteeism, reduction of the work load, and early retirement were found among the individuals with high blood pressure.

Attendance at day care centers increases the risk of childhood pneumonia among the urban poor in Fortaleza, Brazil.

We carried out a case-control study to investigate risk factors for childhood pneumonia in two groups of 650 children aged under two years in the city of Fortaleza, Ceará, Brazil. The cases were children recruited at the main pediatric hospital with a radiological diagnosis of pneumonia, and controls were children of the same age group recruited from the neighbourhood of the cases. In this paper we focus on variables related to childcare practices. Working mothers, proportion of time the mother had worked since the child was born, and use of day care centers emerged as important risk factors with estimated relative risks of 1.58, 1.76 and 5.22, respectively. Also important were the number of children living in the house and presence of grandparents. However, the presence of siblings under two years and the birth order were not associated with pneumonia. All analysis included adjustment for confounding by income, parents' education, and other risk factors as appropriate. This is the first study from a developing country to identify attendance at day care centers as a risk factor for increased childhood morbidity, in this case pneumonia. This finding is of significant public health importance for countries such as Brazil with growing urban populations and an increasing need by mothers to find work outside the home.

[Socioeconomic situation and living conditions: comparison of two population-based cohorts from southern Brazil] / Situação sócio-econômica e condições de vida: comparação de duas coortes de base populacional no Sul do Brasil.

Socioeconomic and family characteristics of two cohorts of babies born in 1982 and 1993 in Pelotas (Southern Brazil) were compared. There were 6,011 births in 1982 and 5,304 in 1993. In relation to family income, there were fewer poor babies in 1993; 60.8 % of the families earned less than 3 times the monthly minimum wage in 1993, as compared to 69.5% in 1982. Sanitary conditions also improved over the decade, and the proportion of families with running water and flush toilets increased by 10%. On the other hand, there were no changes in the proportion of single-parent families or availability of home appliances like radios, stoves, and refrigerators. The mean number of persons per household increased from 3.0 in 1982 to 3.2 in 1993. In general, comparison of the two birth cohorts in this city suggests an improvement in quality of living over the time period for families with newborns. This finding should be taken into account when studying the evolution of health indicators over the course of the decade.

[Breastfeeding and feeding patterns in two cohorts of children in southern Brazil: trends and differences] / Amamentação e padrões alimentares em crianças de duas coortes de base populacional no Sul do Brasil: tendências e diferenciais.

Breastfeeding is fundamental for infant health. However, its median duration in Brazil is very short, and national campaigns since the mid-1980s have attempted to revert this situation. In the present paper, data on breastfeeding are compared for two population-based cohorts of children born in 1982 and 1993 in the city of Pelotas in Southern Brazil. All hospital births in both years were studied and samples of these children were visited at home around 12 months of age. Median duration of breastfeeding increased from 3.1 to 4.0 months in this period. This rise suggests an impact by the national campaigns. In both cohorts, there were interactions between family income and the percentages of children breastfed at different ages. In the early months, breastfeeding was more prevalent in high-income families, but from nine months onwards it was more common among the poor. Low birthweight babies enjoyed shorter duration of breastfeeding. Despite the progress observed during the decade, duration of breastfeeding is still far short of international recommendations, justifying further campaigns prioritizing low birthweight babies and those from low-income families.

[Infant malnutrition and obesity in two population-based birth cohort studies in southern Brazil: trends and differences] / Desnutrição e obesidade infantis em duas coortes de base populacional no Sul do Brasil: tendências e diferenciais.

Prevalence of anthropometric deficits and of obesity were studied in two population-based birth cohort studies in the city of Pelotas in Southern Brazil, in 1982 and 1993. All hospital delivered babies in each one-year period were identified, and samples of approximately 20% were visited at home at around 12 months of age, totalling 1,449 children submitted to anthropometric examination in 1982 and 1,359 in 1993. Losses and refusals accounted for 20% of the children in 1982 and 7% in 1993. In this 11-year period, prevalence of weight/age deficits (below -2 standard deviations of the NCHS reference) fell from 5.4% to 3.8%, while that of weight/height dropped from 1.3% to 0.8%. Height/age deficits increased slightly, from 5.3% to 6.1%, while the proportion of obese children increased from 4.0% to 6.7%. The increase in weight at 12 months was due to a more rapid weight gain in the first year, since birthweights remained unchanged. About 10% of the children from the lowest income group had weight/age or height/age deficits, compared to 3% or less of those with a high family income. On the other hand, obesity showed a direct association with income, except for the wealthiest group, where the prevalence dropped, possibly due to concern among these families about the consequences of infant obesity.

[Maternal and child care in two population-based cohorts from southern Brazil: trends and differences] / Assistência médica materno-infantil em duas coortes de base populacional no Sul do Brasil: tendências e diferenciais.

Two cohort studies of mothers and children (1982 and 1993) were used to document changes in health care utilization patterns. The cohorts included all hospital deliveries in the city of Pelotas, Southern Brazil, for the two years. Some 20% of the mothers and children were visited at home at a median interval of one year later. However, there was a reduction in the percentage of mothers seeking care after the fifth month of pregnancy. The mean number of prenatal consultations increased to 7.6. Prenatal care indicators were significantly worse for low-income and high-gestational-risk women. In 1993, caesarean sections accounted for 31% of deliveries. The proportions of deliveries assisted by medical doctors increased to 88%. Low-income and high-risk mothers were less likely to have a caesarean section or to be assisted by a medical doctor. Over half of the deliveries in the highest income group were caesareans. Vaccine coverage at 12 months increased over the decade. Socioeconomic differentials were also observed. The mean number of medical consultations during the first year of life decreased to 10.5, mainly due to a drop in preventive care. Although most health care indicators improved over the course of the decade, health services are still biased towards those who least need them.

[Developmental status at 12 months of age in a cohort of children in southern Brazil: differences according birthweight and family income] / Desenvolvimento neuropsicomotor aos 12 meses de idade em uma coorte de base populacional no Sul do Brasil: diferenciais conforme peso ao nascer e renda familiar.

This study evaluated all children born in 1993 in hospitals from Pelotas, Rio Grande do Sul, Brazil. Besides a perinatal study, a sample of 20% (1400 children) was followed through home visits during the first year. During these visits the nutritional status was assessed and a screening test for development (Denver II Test) was performed. Thirty-four per cent of the children assessed at 12 months failed this screening. Failure was associated with socioeconomic status, with low-income children presenting twice the risk of those from more affluent families (p<0,001). Failure in the screening test was also associated with birthweight, and children weighing less than 2,500 g showed three times the risk of those with a birthweight equal to or greater than 2,500 g (p<0,001). In addition, children weighing less than 2000 g at birth were at three times the risk of failing the test as compared to those weighing between 2000g and 2499g. Results suggest that birthweight and family income are strongly related to the potential risk of developmental delays at the age of 12 months. It also points to the need for systematic developmental screening and early intervention programs in children at risk.

Mejores perspectivas para la supervivencia de los niños / Better prospects for child survival

Las tasas de mortalidad de lactantes y niños pequeños disminuyeron en Sao Paulo en alrededor de un 50 por ciento y un 70 por ciento respectivamente entre 1973 y 1983. Sin embargo, las encuestas realizadas en 1973-1974 y 1984-1985 no mostraron cambios en la prevalencia de malnutrición proteicoenergética y tampoco hubo cambios marcados en las características socioeconómicas de la población. Es posible que las mejoras realizadas en los sistemas de abastecimiento de agua y en la duración de la alimentación al pecho expliquen hasta un 20 por ciento de la reducción de la tasa de mortalidad de lactantes, Se sugiere que la notable mejora en la cobertura de los servicios de salud puede haber desempeñado una función importante en el resto de esta disminución. Es posible que la lucha contra la malnutrición no siempre sea indispensable para reducir la mortalidad de lactantes y niños pequeños en las sociedades en desarrollo

Better prospects for child survival

Infant and childhood mortality rates in Sao Paulo fell by about 50 per cent and 70 per cent respectively between 1973 and 1983. However, surveys in 1973-74 and 1984-85 showed no change in the prevalence of protein-energy malnutrition, nor were there marked changes in the socioeconomic characteristics of the population. Improvements in water supply and the duration of breast-feeding possibly accounted for a 20 per cent decrease in the infant mortality rate. It is proposed that the markedly improved coverage of health services may have played a large role in explaining the rest of the decrease. The control of malnutrition may not always be essential for lowering infant and child mortality in developing societies

Seminário Preparatório para a Conferência Mundial de Determinantes Sociais da Saúde, 2011 - abertura

O principal objetivo do seminário, foi debater os cinco temas: "Governança para enfrentar as causas das iniqüidades em saúde: implementação de açoes sobre os determinantes sociais da saúde"; "O papel do setor da saúde, incluindo programas de saúde pública, na redução das iniquidades em saúde"; "Promovendo a participação: liderança comunitária para as ações sobre os determinantes sociais"; "Ação global sobre os determinantes sociais: coordenando as prioridades e as partes interessadas"; "Monitorando o progresso: medição e análise para fundamentar as políticas sobre os determinantes sociais" que serão abordados na CMDSS que se realizará no Brasil, na cidade do Rio de Janeiro, de 19 a 21 de outubro de 2011. Arquivo disponível para audição e/ou download no ícone ao lado.

Health conditions and health-policy innovations in Brazil: the way forward.

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes confl ict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people. Arquivo disponível para leitura e/ou download no ícone ao lado.