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BackgroundAlthough case studies indicate that indigenous peoples in Brazil often suffer from higher morbidity and mortality rates than the national population, they were not included systematically in any previous national health survey. Reported here for the first time, the First National Survey of Indigenous People’s Health and Nutrition in Brazil was conducted in 2008–2009 to obtain baseline information based on a nationwide representative sample. This paper presents the study’s rationale, design and methods, and selected results.MethodsThe survey sought to characterize nutritional status and other health measures in indigenous children less than 5 years of age and indigenous women from 14 to 49 years of age on the basis of a survey employing a representative probabilistic sample of the indigenous population residing in villages in Brazil, according to four major regions (North, Northeast, Central-West, and South/Southeast). Interviews, clinical measurements, and secondary data collection in the field addressed the major topics: nutritional status, prevalence of hypertension and diabetes mellitus in women, child hospitalization, prevalence of tuberculosis and malaria in women, access to health services and programs, and characteristics of the domestic economy and diet.ResultsThe study obtained data for 113 villages (91.9% of the planned sample), 5,305 households (93.5%), 6,692 women (101.3%), and 6,128 children (93.1%). Multiple household variables followed a pattern of greater economic autonomy and lower socioeconomic status in the North as compared to other regions. For non-pregnant women, elevated prevalence rates were encountered for overweight (30.3%), obesity (15.8%), anemia (32.7%), and hypertension (13.2%). Among children, elevated prevalence rates were observed for height-for-age deficit (25.7%), anemia (51.2%), hospitalizations during the prior 12 months (19.3%), and diarrhea during the prior week (23.6%).ConclusionsThe clinical-epidemiological parameters evaluated for indigenous women point to the accentuated occurrence of nutrition transition in all regions of Brazil. Many outcomes also reflected a pattern whereby indigenous women’s and children’s health indicators were worse than those documented for the national Brazilian population, with important regional variations. Observed disparities in health indicators underscore that basic healthcare and sanitation services are not yet as widely available in Brazil’s indigenous communities as they are in the rest of the country.

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.

IntroductionThe prevalence of undernutrition, which is closely associated with socioeconomic and sanitation conditions, is often higher among indigenous than non-indigenous children in many countries. In Brazil, in spite of overall reductions in the prevalence of undernutrition in recent decades, the nutritional situation of indigenous children remains worrying. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first study to evaluate a nationwide representative sample of indigenous peoples. This paper presents findings from this study on the nutritional status of indigenous children < 5 years of age in Brazil.MethodsA multi-stage sampling was employed to obtain a representative sample of the indigenous population residing in villages in four Brazilian regions (North, Northeast, Central-West, and Southeast/South). Initially, a stratified probabilistic sampling was carried out for indigenous villages located in these regions. Households in sampled villages were selected by census or systematic sampling depending on the village population. The survey evaluated the health and nutritional status of children < 5 years, in addition to interviewing mothers or caretakers.ResultsHeight and weight measurements were taken of 6,050 and 6,075 children, respectively. Prevalence rates of stunting, underweight, and wasting were 25.7%, 5.9%, and 1.3%, respectively. Even after controlling for confounding, the prevalence rates of underweight and stunting were higher among children in the North region, in low socioeconomic status households, in households with poorer sanitary conditions, with anemic mothers, with low birthweight, and who were hospitalized during the prior 6 months. A protective effect of breastfeeding for underweight was observed for children under 12 months.ConclusionsThe elevated rate of stunting observed in indigenous children approximates that of non-indigenous Brazilians four decades ago, before major health reforms greatly reduced its occurrence nationwide. Prevalence rates of undernutrition were associated with socioeconomic variables including income, household goods, schooling, and access to sanitation services, among other variables. Providing important baseline data for future comparison, these findings further suggest the relevance of social, economic, and environmental factors at different scales (local, regional, and national) for the nutritional status of indigenous peoples.

A cor da dor: iniquidades raciais na atenção pré-natal e ao parto no Brasil El color del dolor: inequidades raciales en la atención pre-natal y partos en Brasil

The purpose of this study was to assess the nutritional status of the adult Suruí population, an indigenous society from the Brazilian Amazon, as it relates to socioeconomic conditions. Fieldwork was carried out in February-March 2005, including 252 individuals (88.1% of the total eligible subjects older than 20 years of age in the villages surveyed). Anthropometric measurements were performed following standard procedures, and percentage of body fat (%BF) was measured by bioimpedance. To classify the Suruí according to socioeconomic status (SES), an index was constructed based on a group of variables to characterize socioeconomic differentiation. Evaluated by body mass index (BMI), the majority of Suruí 20-49.9 years of age were overweight (42.3%) or obese (18.2%). The frequency of obesity for women (24.5%) was twice that recorded for men. Subjects classified as overweight or obese also showed high %BF and waist circumference (WC). Women in the high SES category showed higher anthropometric values (including weight, BMI, arm fat area, and WC) and %BF than those of lower SES. This study shows that the Suruí are undergoing a rapid process of nutrition transition. This transition is closely associated with the emergence of intragroup differences in SES which have impacted diet and physical activity patterns. In research in indigenous peoples in Amazonia, greater attention should be paid to the human biological outcomes of socioeconomic transformations related to the growing involvement of native societies in the market economy.

This study compares anthropometric and ecological profiles of two Xavánte indigenous communities in Mato Grosso, Central Brazil. The research describes time allocation patterns and involves an anthropometric survey (including body mass, stature, and BMI) in adults over 20 years of age. Data from Etéñitépa (also known as Pimentel Barbosa) were collected in 1994. Field work at São José was conducted in 1998 and 1999. Compared with the São José group, Xavánte in Etéñitépa do more subsistence activities like farming, fishing, hunting, and gathering. The São José Xavánte do more paid work and generally engage in less physical activity. Average stature in the two communities is similar, but there are major differences in mean body mass and BMI. The São José group has average BMI values well over those of the Etéñitépa group in practically all age brackets. Obesity prevalence rates were high in both men (24.6%) and women (41.3%) in São José, while in Etéñitépa the rates were only 2.5% and 4.8%, respectively. The authors conclude that the different nutritional profiles in the two communities result from specific patterns of social, political, and economic interactions with Brazilian society.

High prevalence rates of overweight and obesity are increasingly common among indigenous Amazonian societies experiencing greater involvement in market economies. An important factor in such nutritional transition is internal socioeconomic differentiation, which partially accounts for fatness frequencies. We report the results of a diachronic anthropometric comparison and crosssectional anthropometric and socioeconomic survey of Xavante adults from a single, large community. Our data show an accelerated nutrition transition, with significant weight and BMI increases for males and females between 1962 and 2006. We also found income and wealth to be significantly associated with fatness measures for both sexes combined and for females separately. We interpret the observed gender differences as reflecting differences between male and female social dietary practices. Comparison with other studies in the Amazon region suggests that the relationships between internal socioeconomic differentiation and dietary health vary between cultural and economic settings. We also argue that parallels between Xavante health perspectives and epidemiological interpretations demonstrate the potential for proactive interchange between native and scientific health discourses.