title: Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition.
abstract: BACKGROUND
  Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. The First National Survey of Indigenous People's Health and Nutrition in Brazil, conducted in 2008-2009, was the first survey based on a nationwide representative sample to study the prevalence of diarrhea and associated factors among Indigenous children in the country.
  
  
  METHODS
  The survey assessed the health and nutritional status of Indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations.
  
  
  RESULTS
  Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection.
  
  
  CONCLUSIONS
  According to results of the First National Survey of Indigenous People's Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.
authors.affiliation: Departamento de Medicina, Universidade Federal de Rondônia, Rodovia BR-364 Km 9.5, Porto Velho, RO, 76801-059, Brazil. ana@unir.br.
authors.forename: Ana Lúcia
authors.initials: AL
authors.lastname: Escobar
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil. coimbra@ensp.fiocruz.br.
authors.forename: Carlos E A
authors.initials: CE
authors.lastname: Coimbra
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil. welch@ensp.fiocruz.br.
authors.forename: James R
authors.initials: JR
authors.lastname: Welch
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil. blhorta@gmail.com.
authors.forename: Bernardo L
authors.initials: BL
authors.lastname: Horta
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil. santos@ensp.fiocruz.br.|Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Quinta da Boa Vista s/n, Rio de Janeiro, RJ, 20940-040, Brazil. santos@ensp.fiocruz.br.
authors.forename: Ricardo Ventura
authors.initials: RV
authors.lastname: Santos
authors.affiliation: Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil. andrey@ensp.fiocruz.br.
authors.forename: Andrey M
authors.initials: AM
authors.lastname: Cardoso
mesh_terms: D001835:Body Weight; D001938:Brazil / Q000453:epidemiology; D015362:Child Nutrition Disorders / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005440:Fluid Therapy; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D009749:Nutrition Surveys; D044382:Population Groups; D015995:Prevalence; D012141:Respiratory Tract Infections; D064890:Social Determinants of Health