Prevalence and determinants of child undernutrition and stunting in semiarid region of Brazil.

Luciano Lima Correia,Ana Cristina Lindsay,Álvaro Jorge Madeiro Leite,Anamaria Cavalcante E Silva,Hermano Alexandre Lima Rocha,Francisca Maria De Oliveira Andrade,Jocileide Sales Campos,Márcia Maria Tavares Machado,Antonio José Ledo Alves Da Cunha

doi:10.1590/s0034-8910.2014048004828

Abstract

OBJECTIVETo analyze the evolution in the prevalence and determinants of malnutrition in children in the semiarid region of Brazil.METHODSData were collected from two cross-sectional population-based household surveys that used the same methodology. Clustering sampling was used to collect data from 8,000 families in Ceará, Northeastern Brazil, for the years 1987 and 2007. Acute undernutrition was calculated as weight/age < -2 standard deviation (SD); stunting as height/age < -2 SD; wasting as weight/height < -2 SD. Data on biological and sociodemographic determinants were analyzed using hierarchical multivariate analyses based on a theoretical model.RESULTSA sample of 4,513 and 1,533 children under three years of age, in 1987 and 2007, respectively, were included in the analyses. The prevalence of acute malnutrition was reduced by 60.0%, from 12.6% in 1987 to 4.7% in 2007, while prevalence of stunting was reduced by 50.0%, from 27.0% in 1987 to 13.0% in 2007. Prevalence of wasting changed little in the period. In 1987, socioeconomic and biological characteristics (family income, mother’s education, toilet and tap water availability, children’s medical consultation and hospitalization, age, sex and birth weight) were significantly associated with undernutrition, stunting and wasting. In 2007, the determinants of malnutrition were restricted to biological characteristics (age, sex and birth weight). Only one socioeconomic characteristic, toilet availability, remained associated with stunting.CONCLUSIONSSocioeconomic development, along with health interventions, may have contributed to improvements in children’s nutritional status. Birth weight, especially extremely low weight (< 1,500 g), appears as the most important risk factor for early childhood malnutrition.

Highlights

Changes in eating patterns and lifestyles resulting from industrialization, urbanization and economic development have contributed to declines in rates of low birth weight and early childhood undernutrition
There was a decrease in the absolute number of children under three years of age found in the 8,000 households surveyed in each study year, which fell from 4,513 (1987) to 1,533 (2007)
There was a tripling of the proportion of children with very low birth weight, which increased from 0.7% in 1987 to 2.1% in 2007

Summary

Introduction

Changes in eating patterns and lifestyles resulting from industrialization, urbanization and economic development have contributed to declines in rates of low birth weight and early childhood undernutrition. Brazil has made substantial improvements in health and nutrition indicators, especially in childhood These improvements occurred unevenly within and among major geographic regions of the country.[3] Undernutrition among preschool children declined in the whole country from 1986 to 1996, with a reduction of 51.7% in severe and moderate malnutrition assessed by height-for-age and 12.0% for age-for-weight. In Ceará, specific actions and strategies to reduce infant mortality have been implemented since 1987.2 The state launched a situation analysis including cross-sectional population-based studies to monitor major indicators of maternal and child health and nutrition in 1987 These studies, known as Pesquisa de Saúde Materno Infantil no Ceará (PESMIC) described important information in the past decades, allowing for the specific analysis of relevant indicators, such as undernutrition in childhood.a

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Conclusion