Causes for the decline in child under-nutrition in Brazil, 1996-2007.
OBJECTIVE
To describe the evolution of prevalence of under-nutrition among Brazilian underfives between 1996 and 2007, and to identify major factors responsible for this evolution.


METHODS
Data analyzed are from two Demographic Health Surveys carried out in Brazil in 1996 and 2006/7 based on probabilistic samples of roughly 4 thousand children under five years of age. Identification of factors responsible for temporal variation in prevalence of under-nutrition (height-for-age below -2 Z-scores; WHO 2006 standard) took into account changes in the distribution of four potential determinants of nutritional status. Statistical modeling of the independent association between these determinants and risk of under-nutrition, and calculation of 'partial attributable fractions' were used to determine the relative importance of each factor in the evolution of infant under-nutrition.


RESULTS
Prevalence of under-nutrition fell by approximately 50%, from 13.5% (95%CI: 12.1%; 14.8%) in 1996 to 6.8% (5.4%; 8.3%) in 2006/7. Two-thirds of this reduction could be attributed to favorable evolution in the four factors studied: 25.7% to increased maternal schooling; 21.7% to increased purchasing power of families; 11.6% to expansion of healthcare; and 4.3%to improvements in sanitation.


CONCLUSIONS
The 6.3% annual rate of decline in the proportion of children with height-for-age deficits indicates that, in another ten years, child malnutrition in Brazil may no longer be a public health issue. Achieving this will depend on the maintenance of economic and social policies that have favored an increase in purchasing power among the poor, and on public investments aimed at completing the universalization of access to essential services such as education, health, and sanitation among the Brazilian population.
Monteiro
Carlos Augusto
CA
Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil. carlosam@usp.br
Benicio
Maria Helena D'Aquino
MH
Konno
Silvia Cristina
SC
Silva
Ana Carolina Feldenheimer da
AC
Lima
Ana Lucia Lovadino de
AL
Conde
Wolney Lisboa
WL
D000293:Adolescent; D000328:Adult; D001827:Body Height / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D016012:Poisson Distribution; D015995:Prevalence; D012016:Reference Values; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult