Causes of the accelerated decline in child undernutrition in Northeastern Brazil (1986-1996-2006).
OBJECTIVE
To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes.


METHODS
Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions.


RESULTS
Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period.


CONCLUSIONS
The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.
Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, SP, Brasil.
Ana Lucia Lovadino de
AL
Lima
Ana Carolina Feldenheimer da
AC
Silva
Silvia Cristina
SC
Konno
Wolney Lisboa
WL
Conde
Maria Helena D'Aquino
MH
Benicio
Carlos Augusto
CA
Monteiro
D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors