RESUMO
The objective of this study was to determine the evolution of the nutritional status of the population under five years of age during the period 1975-1990. Several conditioning factors were also assessed. The information was evaluated through time series analysis by using the AREG procedure. This procedure allows for the estimation of a regression model correcting by the autocorrelation of errors. Results indicates a significant trend to decreased undernutrition rates (p < 0.0001). A seasonal effect on undernutrition was observed, being higher the prevalences in summer. Analysis of selected conditioning factors, as well as the familiar buying capacity remained stable during the period. An exception to the lack of association among undernutrition and the conditioning factors evaluated, was seen during the period 1975-1982 when clear inverse relationship was evidenced. In conclusion, the decrease of infant undernutrition in Chile during the period 1975-1990 was not related to the changes observed in certain socioeconomic indices.
PIP: Changes in the nutritional status of the population under five years of age enrolled in Chile's National System of Health Services between 1975 and 1990 were studied, and their relationship to changes in the purchasing power of the population and to nutrition programs was assessed. A time series was constructed using quarterly data from 1975 to 1990 for the dependent and independent variables. The dependent variable was the nutritional status of children under five, assessed by weight for age from Ministry of Health records. The independent variables were income, purchasing power, cost of the basic food basket, and supplementary feeding programs. Various sources of official statistics were utilized in constructing the indicators. A multiple regression analysis was carried out for each series to determine the origin of variation. The procedure allowed for estimation of a regression model correcting by the autocorrelation of errors. A negative trend was observed in the total malnutrition rate for children under five, which was attributed to the decline between 1975 and 1982. After the first quarter of 1982 the trend stabilized at around 8 to 9%. The series also showed a pattern of seasonality, with the greatest prevalence of malnutrition in the first quarter corresponding to the summer. Purchasing power remained stable, especially in low income groups, and also presented seasonal trends, with purchasing power greatest in the summer months. Spending on nutrition programs did not present significant variation. It was concluded that a trend to decline of malnutrition occurred but was not related to the behavior of the other series studied except during 1975-82, when the socioeconomic indicators improved and malnutrition declined.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Chile/epidemiologia , Humanos , Lactente , Recém-Nascido , Prevalência , Análise de Regressão , Estações do Ano , Fatores Socioeconômicos , Fatores de TempoRESUMO
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.
Assuntos
Transtornos da Nutrição do Lactente/epidemiologia , Inquéritos Nutricionais , Estado Nutricional , Brasil/epidemiologia , Pré-Escolar , Demografia , Serviços de Alimentação , Humanos , Renda , LactenteRESUMO
PIP: The determinants of the severity of childhood malnutrition among a low income population in Cali, Colombia in 1974-76 were examined. Sections are devoted to the welfare maximization and household production model and methodology, the data set, the empirical results, the policy implications, and conclusions. The nutritional health of each preschooler is produced within the household with goods and time inputs (food, environmental sanitation, medical care, time invested in child care, and breastfeeding), and is conditioned by the state of household production technology (mother's literacy as a dummy variable -- version 1, and mother's level of schooling -- version 2) as well as by each child's sex, birth order, age, household size, and sociocultural setting. Constraints are total available income and time available (dummy variable). Reinhardt's version of the translog function is used to represent the production process. Household survey data were made available from a pilot study of a maternal and child health program (PRIMOPS) and includes 421 preschool children and 280 households, and food expenditure data for 197 children and 123 households. The main finding is that teaching Third World mothers to read holds the greatest promise of permanently improving the nutritional status of preschool children. The linear regression results show that the determinants of short-term nutritional status as reflected in weight for age (w/a) are the duration of breastfeeding, literacy, 1-3 years of schooling, and the available food in the household. The levels of significance are higher for version 2, but significance is achieved only with the lower levels of schooling. Birth order is statistically significant but weak and negative; i.e., higher birth orders are at higher risk of malnutrition. Long-term nutritional status is statistically significantly influenced by educational level, birth order, and food available, where older preschoolers are likely to experience stunting but not necessarily wasting. The last born suffers the most nutritionally. The proportion of time spent in child rearing vs. employment results needs further clarification. Breastfeeding effects are largely short term. Of the factors affecting children's nutritional status, the data show that food transfer approaches are not the most cost-effective means for solving chronic malnutrition. Implementing literacy programs would be a more successful strategy and lasts a lifetime. Breastfeeding must be for at least 4 months and preferably a year to show a significant improvement in nutrition, and does not eliminate the risk of malnutrition. Smaller families produce healthier children. A mother, who works part time or greater, increases income potential to provide for nutritional need; income and other factors such as literacy are critical determinants of preschool nutritional well being as supported by the findings of Wolfe and Behrman.^ieng
Assuntos
Ordem de Nascimento , Aleitamento Materno , Fenômenos Fisiológicos da Nutrição Infantil , Proteção da Criança , Educação , Escolaridade , Características da Família , Planejamento em Saúde , Distúrbios Nutricionais , Pobreza , Pesquisa , América , Colômbia , Países em Desenvolvimento , Doença , Economia , Relações Familiares , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Fenômenos Fisiológicos da Nutrição , Classe Social , Planejamento Social , Fatores Socioeconômicos , América do SulRESUMO
PIP: This study analyzed the relationships between breastfeeding, nutritional status, and land ownership in a sample of 225 families in an underdeveloped area in Northeast Brazil. According to weight-for-age standards, 51% of the study infants were malnourished and there was a significant inverse correlation between landholdings and malnutrition. At the time of the survey, 51 of the 225 study infants were being breastfed, 65 had never been breastfed, and 109 had been weaned. 52% of the weaned infants had been breastfed for less than 30 days and 71% had received breast milk for less than 60 days. No cases of grade II or III malnutrition were found in the breastfed infants; in contrast, 30% of the bottle-fed infants fell into these categories. There was no significant association between landholding and the duration of breastfeeding. These findings suggest a need to promote proper infant breastfeeding through both primary health care and community participation strategies. Given the correlation between land ownership and infant nutritional status, modification of the existing agricultural structure could prove essential to the success of public health interventions.^ieng