OBJECTIVE:To describe the evolution of prevalence of under-nutrition among Brazilian underfi ves between 1996 and 2007, and to identify major factors responsible for this evolution. METHODS:Data analyzed are from two Demographic Health Surveys carried out in Brazil in 1996 and 2006/7 based on probabilistic samples of roughly 4 thousand children under fi ve years of age. Identifi cation of factors responsible for temporal variation in prevalence of under-nutrition (height-for-age below -2 Z-scores; WHO 2006 standard) took into account changes in the distribution of four potential determinants of nutritional status. Statistical modeling of the independent association between these determinants and risk of under-nutrition, and calculation of "partial attributable fractions" were used to determine the relative importance of each factor in the evolution of infant under-nutrition. RESULTS:Prevalence of under-nutrition fell by approximately 50%, from 13.5% (95%CI: 12.1%; 14.8%) in 1996 to 6.8% (5.4%; 8.3%) in 2006/7. Twothirds of this reduction could be attributed to favorable evolution in the four factors studied: 25.7% to increased maternal schooling; 21.7% to increased purchasing power of families; 11.6% to expansion of healthcare; and 4.3%to improvements in sanitation. CONCLUSIONS:The 6.3% annual rate of decline in the proportion of children with height-for-age defi cits indicates that, in another ten years, child malnutrition in Brazil may no longer be a public health issue. Achieving this will depend on the maintenance of economic and social policies that have favored an increase in purchasing power among the poor, and on public investments aimed at completing the universalization of access to essential services such as education, health, and sanitation among the Brazilian population.
OBJECTIVE:To describe changes in prevalence of child undernutrition in Northeastern Brazil in two successive time periods, identifying, in each period, the major factors responsible for these changes. METHODS:Data analyzed are from probabilistic samples of underfives from three Demographic Health Surveys carried out in 1986 (n=1,302), 1996 (n=1,108), and 2006 (n=950). Identification of factors responsible for temporal changes in child undernutrition (height-for-age below < -2 z) took into account time changes in five potential determinants of child nutritional status, statistical modeling of the independent association between determinants and risk of undernutrition, and calculation of attributable fractions. RESULTS:Prevalence of child undernutrition fell by one-third between 1986 and 1996 (from 33.9% to 22.2%) and by almost three-quarters between 1996 and 2006 (from 22.2% to 5.9%). Improvements in maternal schooling and in the coverage of water and sewage services were particularly important for the decline in child undernutrition in the first period, while increasing purchasing power of the poorest families and, again, maternal schooling were more relevant in the second period. CONCLUSIONS:The acceleration of the decline in child undernutrition between the two periods was consistent with accelerated improvement of maternal schooling, water supply and sewage, health care, and maternal reproductive antecedents, as well as with the outstanding increase in purchasing power among the poor during the second period. If the rate of decline in growth deficits is kept at around the rate of the most recent period, child undernutrition will be controlled in the Brazilian Northeast in less than ten years. Achieving this will depend on sustaining the increase in purchasing power among the poor and on ensuring public investment in completing the universalization of access to essential services such as education, health, and sanitation.
OBJECTIVE:To assess the infl uence of socioeconomic, reproductive, and behavioral factors on the evolution of weight during pregnancy. METHODS:Body weight was measured prospectively in a cohort of 215 healthy pregnant women attended to by a public prenatal service in the city of São Paulo, between 1997 and 1998. The criteria for inclusion were the following: aged 18 or older and with the beginning of prenatal care at a gestational age ≤ 16 weeks. The relation between the independent variables and the evolution of weight during pregnancy was assessed by means of the multilevel hierarchical linear analysis, and subsequently analyzed by the maximum likelihood test. RESULTS:In the multilevel analysis, the factors that were signifi cantly associated to gestational weight gain were the following: initial BMI, level of education, marital status and parity. The equations thus obtained enabled to identify the individual effect of each of these characteristics: eutrophic initial BMI, level of education ≥ 4 years, lack of partner, and primiparity cause increases of 3.0 kg, 1.9 kg, 2.3 kg and 2.4 kg in the total weight gain during pregnancy, respectively. CONCLUSIONS:Initial BMI, level of education and parity are the maternal characteristics that, along with the marital status, must be taken into consideration in the development of strategies to promote adequate weight gain during pregnancy.
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