BackgroundAnemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the country. 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 anemia and associated factors among indigenous children in Brazil.MethodsThe 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. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.ResultsEvaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.ConclusionsThe prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

RESUMO No Brasil, o direito à saúde pleiteado pelos povos indígenas dialoga com diferentes marcos regulatórios, incluindo a Declaração de Alma-Ata, a qual propõe e valoriza a atenção primária à saúde (APS) como promotora de maior acesso e forma de minimizar as desigualdades em saúde. No âmbito do Sistema Único de Saúde (SUS), o subsistema de atenção à saúde indígena (SASI) e a Política de Atenção à Saúde dos Povos Indígenas (PNASPI) foram criados como estratégia para garantir o acesso à saúde aos povos indígenas. A PNASPI prevê atenção diferenciada às populações indígenas com base na diversidade sociocultural e nas particularidades epidemiológicas e logísticas desses povos e focando no desenvolvimento da APS com garantia de integralidade da assistência. O presente artigo traz reflexões acerca da implementação da PNASPI, destacando os avanços e desafios apresentados durante esse percurso. Apesar dos crescentes recursos financeiros disponibilizados para implementar o subsistema de saúde indígena, as ações têm apresentado poucos resultados nos indicadores de saúde, que refletem desigualdades historicamente descritas entre esses povos e os demais segmentos. A participação social ainda se mantém frágil, e suas discussões refletem a insatisfação dos usuários. A descontinuidade do cuidado somada à carência e alta rotatividade de profissionais, assim como a necessidade de estabelecer diálogos interculturais que promovam a articulação com saberes tradicionais, são fatores que desafiam a efetividade da PNASPI. O cuidado ainda é centrado em práticas paliativas e emergenciais, geralmente baseado na remoção de pacientes, gerando altos custos. A superação desses desafios depende do fortalecimento da APS e de seu reconhecimento enquanto importante marco regulador do modelo organizacional da PNASPI.

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The goal of this study was to evaluate the nutritional status of indigenous children and to investigate factors associated with nutritional deficits. Weight and height measurements were obtained for 141 Kaingáng children from 0 to 5 years of age living on the Mangueirinha Indigenous Reserve in Paraná State, Brazil. Data on maternal and infant conditions and socioeconomic characteristics were also gathered through face-to-face interviews. Based on World Health Organization criteria (2006), 24.8% of the children presented low height-for-age (HA), 9.2% low weight-for-age (WA), 2.1% low weight-for-height (WH), and 2.1% low weight according to body mass index for age (BMIA). Based on NCHS criteria (1977), 19.9% of the children presented low HA, 9.2% low WA, and 1.4% low WH. 6.4% were overweight according to BMIA. Low birth weight and non-masonry housing construction were associated statistically with nutritional deficits. The Kaingáng children are subject to poor living conditions, associated with deficits in their nutritional profile.