Health care in Brazil.

Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor.

Birth order effects and time allocation.

"In this paper, a model is developed in which the explanation for birth-order effects does not rely on absence of capital markets, but follows from optimal allocation of parental time and goods among children over the childrearing years. The model yields two key results, which are then tested using 1967-1968 household survey data from urban Colombia.... It is shown that first and last-born children of mothers who do not work have an advantage over middle-borns.... At the same time, as predicted, there are no differences by birth order among children of working mothers. The persistence of birth-order effects even in high-income families indicates that such effects are at least in part due to the time constraint modelled; this is a strong result given the possibility of better substitutes for mother's time than allowed for in the model, and the likelihood that high-income families are able to purchase better substitutes."

[Models of feeding in the genesis of obesity in the 1st year of life]. / Pautas de alimentación en la génesis del sobrepeso durante el primer año de vida.

PIP: This work analyzes the prevalence of obesity and overweight in infants of the upper socioeconomic strata in Mexico and assesses the role of feeding practices in overweight. The study subjects were 317 healthy boys and 289 healthy girls under 1 year old seen by a group of 6 pediatricians. Obesity was defined as 120% of the standard weight for height and overweight as 110-119% of the standard. Infants were considered underweight if they weighed 80-90% of the standard weight for height. 2.8% of the children were obese, 15.7% were overweight, 75.1% were the optimal weight, and 6.4% were underweight. There were no differences by sex. The frequency of obesity and overweight were higher in the 1st half of the 1st year. There was no statistically significant difference in birth weight although the average birth weight of the currently underweight was lower. Firstborn children were significantly more likely to have a low birth weight or optimal weight. The obese and overweight children were significantly more likely to have been born between January-June. By 6 months of age, only 3.3% of the infants were exclusively breast fed and 4.9% were breast fed and given supplementary milk feedings. Over 90% of the children were bottle fed by 6 months. The obese and overweight children were weaned at earlier ages on average and were more likely to be fed cereals in the 2nd 6 months. They also were fed a more varied diet. Weight problems in infants thus appear to result in large part from exogenous factors related to feeding practices.^ieng

Food antibodies in milk from Guatemalan women.

PIP: This study investigates the presence of antibodies against food products in milk samples from 30 Guatemalan women of 3 different socioeconomic status: 10 rural poor, 10 urban poor, and 10 urban privileged. The 3 groups had varied dietary habits. Both the rural and urban poor mothers do not consume cow's milk. Black beans are consumed more often by the urban groups while soy bean products are consumed by both rural and urban poor regularly. Milk samples were collected from the mothers. The volume of milk produced in a 24-hour period was estimated by weighing the children before and after every meal. The enzyme-linked immunosorbent assay (ELISA) described by Sohe-Akerlund et.al. was used in quantitating milk secretory immunoglobulin A (SIgA). A modification of the ELISA method was used to determine levels of specific IgA antibodies directed against cow's milk, black beans and soybeans. The Wilcoxon rank sum test was used in statistical analysis. Comparable amounts of SIgA were produced by the 3 groups of mothers in a 24-hour period (p0.1). The urban privileged mothers exhibited significantly higher antibody levels against cow's milk (p0.01) and black beans (p0.05) compared to the other 2 groups. There were no differences in the level of anti-soybean antibodies among the 3 groups. The notion that antibodies found in the breast milk reflect the mother's intestinal antigenic experience is supported by this study. It has been suggested that anti-food protein antibodies contribute in the prevention of allergies. If so, cow's milk fed among the rural and urban poor children may be expected to produce negative reactions. This negative reaction can be prevented by feeding the mother, before delivery, cow's milk products to induce them to produce milk antibodies against cow's milk.^ieng

[Breast feeding in different income classes in the Municipality of São Paulo]. / Aleitamento natural em diferentes classes de renda no Município de São Paulo.

PIP: The relationship between breast feeding and socioeconomic factors in children below 2 from different social classes in Sao Paulo, Brazil is analyzed. Of a total 200 children, 46 were malnourished and 31 belonged to the lower socioeconomic classes. 39% of mothers from the lower income families breastfed for 6 months, as compared to 13% of mothers from families with higher incomes 18% and 36% of mothers from the 2 classes did not breastfeed; mothers from the middle class breastfed for an average 28 days. The problem of protein-calorie malnutrition in young children is a growing one in Brazil, even in a relatively rich city such as Sao Paulo; one of the factors responsible for this problem is undoubtedly early weaning. Reasons given for early weaning in a group of 351 mothers were deficient amount of milk (49.6%), medical advice (11.1%), "bad" milk (14.3%), and only 1.4% because of occupation outside of the home. When interviewed about their opinion on the best type of milk for infants, 45% out of a group of 500 mothers indicated artificial milk, 37% maternal milk, and 16.2% cow's milk. Out of 492 mothers, 77% had 4 prenatal visits at a public health center, 11% had no prenatal visits, and 12% had 1-3 visits. Prenatal care does not influence attitude in favor of breast feeding; 45.5% of mothers who had not had any prenatal care breastfed for 6 months or more, as compared to 20% of those with 1-3 visits, and 17.5% of those with 4 visits. Those who delivered in a hospital tended to breastfeed more than those who delivered at home. It is obvious that not only mothers but health workers as well must be educated on the importance of breast feeding to fight infant malnutrition in Brazil.^ieng

WHO collaborative study on breast feeding.

WHO, concerned with the declining breast feeding rate in developing countries, has organized investigations in nine different countries of different aspects of breast feeding and breast milk with the ultimate aim of formulating programmes of intervention. The basic epidemiological study on 24000 mother/child pairs is just completed and some preliminary data are reported on the pattern of breast feeding in the three studied socio-economic groups--urban elite, urban poor and traditional rural--which differ significantly in their breast feeding rate as well as in the pattern of return of menstruation in breast-feeding and non-breast-feeding mothers.

PIP: Concerned with the declining breast-feeding rate in developing countries, WHO has organized investigations in 9 different countries of different aspects of breast-feeding and breast milk with the ultimate aim of formulating programs of intervention. The basic study was begun in 1975 and concentrated on the epidemiology of breast-feeding among 3 different socioeconomic groups, the urban elite, urban poor, and traditional rural. 9 countries, Chile, Guatemala, the Philippines, India, Ethiopia, Nigeria, Zaire, Sweden, and Hungary, participated in the study, and altogether almost 24,000 mother/child pairs were involved. Data from all 9 countries have now been compiled, and are being centrally analyzed. Results of a few of the important preliminary findings are reported here. As far as duration of breast-feeding is concerned, significant differences are appearing between the 3 different socioeconomic groups in each country. In most settings, it is apparent that breast-feeding declines most rapidly among the urban elite group and is most prolonged in the rural traditional populations. The preliminary data corroborate the long-held position that postpartum amenorrhea is more prolonged in breast-feeding than in non-breast-feeding mothers. The breast-feeding development in Sweden is contrasted with that in Guatemala, and marked differences are noted in breast-feeding patterns. It was felt that once the various factors influencing breast-feeding patterns are better understood, the specific action and intervention program suitable to each country and setting could be initiated to improve infant nutrition. The action program thus developed would be more effective and efficient since it would be addressed specifically to the factors influencing breast-feeding and infant feeding in a given area.