[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.

Saúde no Brasil: Condições de saúde e inovações nas políticas de saúde no Brasil: o caminho a percorrer.

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