Diarrhea is a leading cause of death in tropical countries. One of the highest childhood mortalities is in northeastern Brazil, where little is known about the morbidity, etiology, and risk factors of diarrhea. Prospective village surveillance over 30 months revealed diarrhea attack rates of more than seven episodes per child-year at six to 11 months of age among the children of the poorest families. Other risk factors included early weaning and the lack of toilets. Diarrhea led to weight loss and stunted growth. Enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens, accounting for 21% and 19% of cases, respectively, followed by Shigella species (8.0%), Campylobacter jejuni (7.5%), Giardia species (6.7%), Strongyloides species (5.3%), and enteropathogenic E coli serotypes (4.6%). Most (84%) enterotoxigenic E coli were isolated during the rainy season of October to March (P less than 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P less than 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.

Current theories of fatalism and neglect and current descriptions of childhood illness in impoverished Northeastern Brazil are evaluated. Findings of an ongoing multidisciplinary project indicate that neglect and fatalism theories are incomplete as applied to the Brazilian Northeast. Intensive interviews and observations with bereaved mothers and traditional healers show that mothers' failure to obtain medical care for severely ill children is due more to real-life bureaucratic and geographic barriers to access than to fatalistic or neglectful attitudes on the part of the poor, that mothers' flat affect in response to infant deaths is due more to folk Catholic beliefs than to lack of emotional attachment to infants, that fatalistic statements are often post hoc and do not indicate fatalistic behavior, and that decisions about whether to treat severely ill infants are made by mothers and families in consultation with traditional healers in accord with a folk system of classification of high risk infants. What have been described as "death accepting," "pathogenic," and "ethnoeugenic" attitudes are part of a folk ethical system developed to guide reactions to terminal childhood illness. We argue that human behavior, especially in the realm of health, cannot be understood without reference to both biomedical and psychosocial realities.

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In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called "United-States-of-Sobral", in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A "contextualized semantic interpretation" revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. "Skin Spot Day" discriminates more than educates. Patients' "non-compliance" with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. "Social leprosy" in Northeast Brazil deforms patients' moral reputations and personal dignity.

This anthropological study critically evaluates Brazilian caregivers' symbolic production and significance of their malnourished offspring's primary teeth, as well as their own, and describes popular dental practices. From January to June 2004, ethnographic interviews of 27 poor, low-literacy mothers were conducted at a public Malnutrition Treatment Center in Fortaleza, Ceará State. Participant observation of clinical pathways and home environments supplemented the data. Content analysis was performed. Results confirm that primary teeth are imbued with cultural significance in Northeast Brazil. Mothers examine mouths, perceive signs of decay, associate primary with permanent tooth healthiness, identify ethnodental illnesses, seek assistance, and perform rituals with exfoliated teeth. The mother's motivation to care for primary teeth is sparked by her memories of past toothache and attempts to avoid stigma and discrimination. Social determinants, not mothers' beliefs or behaviors, are the most critical obstacles to effective dental care. Legitimizing lay knowledge and empowering caregivers and children can improve oral health in Northeast Brazil.

Este estudo antropológico investiga a experiência vivida das doenças bucais no contexto da pobreza no Nordeste brasileiro. Durante seis meses em 2004, foram conduzidas entrevistas etnográficas, narrativas e observação participante com 31 moradores do Dendê, comunidade de baixa renda em Fortaleza, Ceará, analisadas pelo método hermenêutico-dialético. Revelou-se que as precárias condições de vida dificultam priorizar o cuidado em saúde. Embora sofram da dor dentária, ir ao dentista é percebido com um luxo, não um direto do cidadão. O difícil acesso ao serviço e restauração de má qualidade, favorecem a extração dentária como mais resolutiva. A deterioração da saúde bucal é lamentada pelos moradores que buscam ajuda de clínicas populares, políticos e curandeiros. A experiência da doença dentária diferencia de acordo com a classe, deixa marcas bucais da iniqüidade e prejudica a auto-estima e inclusão social. "Tratar" os dentes da desigualdade nesse contexto exige aprofundar a compreensão dos determinantes sociais da saúde, reduzir injustiças no acesso aos serviços de qualidade, remover estigmas que desmoralizam e fortalecer a viva voz da comunidade frente às forças estruturais que afetam sua vida.