RESUMO
Infant and childhood mortality rates in São Paulo fell by about 50% and 70% 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% 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.
PIP: Between 1973-83 infant and child mortality rates in Sao Paulo, Brazil fell about 50% and 70% 2 health surveys were done: one in 1973-74 and a second one in 1984-85. Results from both surveys showed that moderate and severe cases of malnutrition were rare; the prevalence of severe cases was below 1%. The most important finding regarding causes of declines in mortality rates for children under 5 was that this was not accompanied by any significant changes in the prevalence of malnutrition. Therefore, reductions in the prevalence of malnutrition may not be an essential ingredient in lessening the death rates in developing countries. The authors used data on the relative risks for infant mortality (IM) from 2 studies in similar urban areas to assess the possible impact of other factors on mortality. The 1st study was a cohort study of risk factors for IM and the 2nd was a case-control study of IM due to infectious diseases. The indicators used were socioeconomic status, demographic, environmental, health care, and breastfeeding. The outcomes of the study demonstrated that changes in socioeconomic variables and in the prevalence of malnutrition do not explain reductions in infant and child mortality in Sao Paulo. However, expansion of the water supply and increase in breastfeeding could account for 20% of the IMR. One can also state that the expansion and quality of health care were instrumental in lowering the mortality rates.