title: Reducing child mortality: the contribution of Ceará state, northeast of Brazil, on achieving the Millennium Development Goal 4 in Brazil.
abstract: To describe the experience of Ceará, Northeast of Brazil, state on improving child survival, over a 20 year period, and discuss its contribution to Brazil's progress toward the achievement of MDG 4. Five population-based, statewide household surveys, with children <3 years of age, known as PESMIC (Mother and Child Health Survey of Ceará), were conducted in 1987, 1990, 1994, 2001 and 2007. They aimed to investigate levels and causes of mortality and access to child health services. The cluster sampling of 8,000 households identified 2,000 children on average. They used the same methodological approach and indicators. Important changes occurred in demographic and health indicators in the 20 year period, including 81 % reduction in the infant mortality rate, 43 % increase in breastfeeding rate and the achievement of a 95 % immunization rate. The prevalence of chronic malnutrition declined from 28 to 13 % and acute malnutrition from 13 to 5 %. Diarrheal diseases contributed with 36.6 % to the infant mortality in 1986 and 3.9 % in 2007. The major improvements in child health contributed substantially to the progress on MDG 4 in Brazil. Results of the 5 surveys produced reliable information for planning and evaluation that contributed to the remarkable progress made by the state.
authors.affiliation: Centro Universitário Christus - Unichristus, Rua Rua João Adolfo Gurgel, 133, Fortaleza, CE, Brazil, anamariacasil@yahoo.com.br.
authors.forename: Anamaria
authors.initials: A
authors.lastname: Cavalcante e Silva
authors.forename: Luciano Lima
authors.initials: LL
authors.lastname: Correia
authors.forename: Jocileide Sales
authors.initials: JS
authors.lastname: Campos
authors.forename: Francisca Maria de Oliveira
authors.initials: FM
authors.lastname: Andrade
authors.forename: Dirlene Mafalda Ildefonso da
authors.initials: DM
authors.lastname: Silveira
authors.forename: Álvaro Jorge Madeiro
authors.initials: ÁJ
authors.lastname: Leite
authors.forename: Hermano A L
authors.initials: HA
authors.lastname: Rocha
authors.forename: Márcia Maria Tavares
authors.initials: MM
authors.lastname: Machado
authors.forename: Antonio Jose Ledo Alves da
authors.initials: AJ
authors.lastname: Cunha
mesh_terms: D001938:Brazil / Q000453:epidemiology; D001942:Breast Feeding; D002662:Child Health Services; D046688:Child Mortality; D015362:Child Nutrition Disorders / Q000517:prevention & control; D002675:Child, Preschool; D003967:Diarrhea / Q000517:prevention & control; D006285:Health Planning; D006297:Health Services Accessibility; D040361:Healthy People Programs; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn
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