Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007.
OBJECTIVE
To assess trends in the prevalence and social distribution of child stunting in Brazil to evaluate the effect of income and basic service redistribution policies implemented in that country in the recent past.


METHODS
The prevalence of stunting (height-for-age z score below -2 using the Child Growth Standards of the World Health Organization) among children aged less than 5 years was estimated from data collected during national household surveys carried out in Brazil in 1974-75 (n = 34,409), 1989 (n = 7374), 1996 (n = 4149) and 2006-07 (n = 4414). Absolute and relative socioeconomic inequality in stunting was measured by means of the slope index and the concentration index of inequality, respectively.


RESULTS
Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1% to 7.1%. Prevalence dropped from 59.0% to 11.2% in the poorest quintile and from 12.1% to 3.3% among the wealthiest quintile. The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators.


CONCLUSIONS
In Brazil, socioeconomic development coupled with equity-oriented public policies have been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles. Future studies will show whether these gains will be maintained under the current global economic crisis.
Monteiro
Carlos Augusto
CA
School of Public Health, University of Sao Paulo, Av. Dr Arnaldo 715, Sao Paulo, 01246-904, SP, Brazil. carlosam@usp.br
Benicio
Maria Helena D'Aquino
MH
Conde
Wolney Lisboa
WL
Konno
Silvia
S
Lovadino
Ana Lucia
AL
Barros
Aluisio J D
AJ
Victora
Cesar Gomes
CG
D001827:Body Height / Q000502:physiology; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D003625:Data Collection; D006130:Growth Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D012923:Social Class