SummaryBackgroundA city-wide sanitation intervention was started in Salvador, Brazil, in 1997 to improve sewerage coverage from 26% of households to 80%. Our aim was to investigate the epidemiological effect of this city-wide sanitation programme on diarrhoea morbidity in children less than 3 years of age.MethodsThe investigation was composed of two longitudinal studies done in 1997–98 before the intervention (the sanitation programme) and in 2003–04 after the intervention had been completed. Each study consisted of a cohort of children (841 in the preintervention study and 1007 in the postintervention study; age 0–36 months at baseline) who were followed up for a maximum of 8 months. Children were sampled from 24 sentinel areas that were randomly chosen to represent the range of environmental conditions in the study site. At the start of each study an individual or household questionnaire was applied by trained fieldworkers; an environmental survey was done in each area before and after introduction of the sanitation programme to assess basic neighbourhood and household sanitation conditions. Daily diarrhoea data were obtained during home visits twice per week. The effect of the intervention was estimated by a hierarchical modelling approach fitting a sequence of multivariate regression models.FindingsDiarrhoea prevalence fell by 21% (95% CI 18–25%)—from 9·2 (9·0–9·5) days per child-year before the intervention to 7·3 (7·0–7·5) days per child-year afterwards. After adjustment for baseline sewerage coverage and potential confounding variables, we estimated an overall prevalence reduction of 22% (19–26%).InterpretationOur results show that urban sanitation is a highly effective health measure that can no longer be ignored, and they provide a timely support for the launch of 2008 as the International Year of Sanitation.

ObjectiveTo assess the association between quality of stimulation in the family environment and child's cognitive development considering the impact of mother's schooling on the quality of stimulation. Methods A cross-sectional study comprising 350 children aged 17-42 months was carried out in central and peripheral areas of Salvador, Northeastern Brazil, in 1999. A socioeconomic questionnaire was used, along with the Home Observation for Measurement of the Environment Scale (HOME Inventory), and the Bayley Scale for Infant Development. Bivariate and multivariate analyses were carried out through linear regression at 5% level of significance. ResultsThere was a positive (β=0.66) and statistically significant association between quality of stimulation in the family environment and child's cognitive development. Part of the effect was mediated by the mother's working circumstances and educational level. It was verified that a better quality of stimulation is provided for those who come early in the birth order in family, and live with only a few others under five years of age. This pattern of stimulation is better among children who live with their parents and whose mothers have better education, have a job and a partner involved in the family environment. Conclusions Quality of stimulation in the family environment is crucial for child's cognitive development, besides the significant role of the available resources and family dynamics. The study findings show the pertinence to cognitive development of interventions which improve the quality of the environment and the child-caregiver relationship.

RESUMOObjetivos: Identificar as causas e o perfil das vítimas, analisar a mortalidade nos últimos 13 anos e mapear mudanças assistenciais e socioeconômicas. Métodos: Utilizaram-se dados do SIM e Datasus. Calcularam-se as proporções das causas de suicídio segundo as categorias do CID10, X60-X84, estratificando-se por lesões (X70-X84) e autointoxicações (X60-X69). Analisaram-se as incidências por raça/cor, escolaridade e faixa etária, de 2000 a 2012. Compararam-se variações na mortalidade por suicídio com mudanças regionais nos indicadores de cobertura, características socioeconômicas e demográficas. Resultados: As maiores causas de suicídio foram enforcamento, lesão por armas de fogo e autointoxicação por pesticidas. Os mais acometidos foram os menos escolarizados, indígenas (132% superior à população geral) ou maiores de 59 anos (29% superior). As taxas entre homens são três vezes maiores em todas as regiões, embora tenha maior crescimento entre as mulheres (35%). A mortalidade mais elevada se encontra na região Sul (9,8/100.000) e o maior crescimento percentual, no Nordeste (72,4%). Conclusão: A mortalidade por suicídio continua a crescer no país, com importantes variações regionais. A assistência à saúde também apresenta inequidades regionais, com importantes lacunas nos serviços de saúde. O Brasil ainda carece de programas governamentais que trabalhem efetivamente na prevenção do suicídio. Considera-se necessário estabelecer uma estratégia nacional de prevenção focalizando as populações de maior risco identificadas: índios, pessoas com menor escolaridade, homens e maiores de 60 anos, além da necessidade de ampliar a vigilância na comercialização ilegal de pesticidas. ABSTRACTObjectives: To identify the causes, the profile of the victims, and the mortality in the last 13 years, investigating the assistance and socioeconomic changes that may have influenced this outcome. Methods: It was used data from the Mortality Information System, Ripsa, and Datasus. The proportions of causes of suicide were calculated according to the ICD10 categories X60-X84, stratifying by injuries (X70-X84) and self-intoxication (X60-X69). It was analyzed the incidence by race, color, education and age, from 2000 to 2012. It was compared variations in suicide mortality with regional changes in coverage indicators, socioeconomic and demographic characteristics. Results: The major causes of suicide were hanging, injury by firearms and self-intoxication by pesticides. The most affected were the least educated,

Background: There is evidence that poverty, health and nutrition affect children's cognitive development. This study aimed to examine the relative contributions of both proximal and distal risk factors on child cognitive development, by breaking down the possible causal pathways through which poverty affects cognition.

Studies about suicide worldwide have mainly focused on individual-level psychiatric risk factors. In Brazil, suicide is an important public health problem. Brazil has evidenced important socioeconomic changes over the last decades, leading to decreasing income inequality. However, the impact of income inequality on suicide rate has never been studied in the country.PurposeTo analyze whether income inequality and other social determinants are associated with suicide rate in Brazil.MethodThis study used panel data from all 5,507 Brazilian municipalities from 2000 to 2011. Suicide rates were calculated by sex and standardized by age for each municipality and year. The independent variables of the regression model included the Gini Index, per capita income, percentage of individuals with up to eight years of education, urbanization, average number of residents per household, percentage of divorced people, of Catholics, Pentecostals, and Evangelicals. A multivariable negative binomial regression for panel data with fixed-effects specification was performed.ResultsThe Gini index was positively associated with suicide rates; the rate ratio (RR) was 1.055 (95% CI: 1.011–1.101). Of the other social determinants, income had a significant negative association with suicide rates (RR: 0.968, 95% CI: 0.948–0.988), whereas a low-level education had a positive association (RR: 1.015, 95% CI: 1.010–1.021).ConclusionsIncome inequality represents a community-level risk factor for suicide rates in Brazil. The decrease in income inequality, increase in income per capita, and decrease in the percentage of individuals who did not complete basic studies may have counteracted the increase in suicides in the last decade. Other changes, such as the decrease in the mean residents per household, may have contributed to their increase. Therefore, the implementation of social policies that may improve the population’s socioeconomic conditions and reduce income inequality in Brazil, and in other low and middle-income countries, can help to reduce suicide rates.

PurposeTo examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally.MethodsWe used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of “caseness indicators” based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of ‘definite’ or ‘severe’ difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA’s creator, working in conjunction with experienced local professionals.ResultsAs judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8–56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators.ConclusionsThe relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.Electronic supplementary materialThe online version of this article (doi:10.1007/s00127-011-0440-2) contains supplementary material, which is available to authorized users.

Background: The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children.

BackgroundRural residence is protective against atopy and wheeze–rhinitis–eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze–rhinitis–eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures.MethodsWe performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations.ResultsAmong 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9–10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations.ConclusionsUrban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms.