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Article ; Online: Polycystic ovary syndrome in Salvador, Brazil

Gabrielli Ligia / Aquino Estela ML

Reproductive Biology and Endocrinology, Vol 10, Iss 1, p

a prevalence study in primary healthcare

2012 Volume 96

Abstract: Abstract Background Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. It is characterized by hyperandrogenism, oligomenorrhea/amenorrhea and polycystic ovaries. It is associated with obesity, diabetes, dyslipidemia and ... ...

Abstract	Abstract Background Polycystic ovary syndrome (PCOS) is a common condition in women of reproductive age. It is characterized by hyperandrogenism, oligomenorrhea/amenorrhea and polycystic ovaries. It is associated with obesity, diabetes, dyslipidemia and cardiovascular disease. No studies have been conducted on the prevalence of PCOS in Brazilian or South American women. Few studies using the Rotterdam criteria have been published. The objective of the present study was to calculate the prevalence of PCOS at primary healthcare level in Salvador, Brazil based on these criteria. Methods This was a cross-sectional, two-phase study conducted in a probability sample of women of 18–45 years of age screened for cervical cancer in the primary healthcare network of the city of Salvador, Brazil. In the first phase, interviews were conducted, weight, height, waist circumference, blood pressure and random blood sugar levels were measured, and the presence of acne and hirsutism was investigated. Women with at least one diagnostic criterion were referred for the second phase, which consisted of specialist consultation, pelvic ultrasonography and hormone measurements for differential diagnosis and/or investigation of a second criterion. Results Of the 859 women interviewed, 88.5% were black and 58.7% had 11 years of schooling or less. A diagnosis of PCOS was excluded in 84.4%, undetermined in 7.1% and confirmed in 8.5% (95%CI: 6.80–10.56). There were no statistically significant differences between these three groups with respect to weight, body mass index, waist circumference, blood sugar levels or arterial blood pressure. Women with PCOS were younger (p = 0.00), taller (p = 0.04), had fewer children (p = 0.00), were better educated (p = 0.01), and had higher total testosterone levels (p = 0.01) and a higher LH/FSH ratio (p = 0.01). Conclusion According to the Rotterdam criteria, the prevalence of PCOS in women seeking primary healthcare in Salvador, Brazil, was 8.5%.
Keywords	Cross-sectional studies ; Hyperandrogenism ; Polycystic ovary syndrome ; Reproductive medicine ; Women’s health ; Gynecology and obstetrics ; RG1-991 ; Reproduction ; QH471-489
Subject code	610
Language	English
Publishing date	2012-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Healthy lifestyle behaviors and the periodicity of mammography screening in Brazilian women.

Patrão, Ana Luísa / de Almeida, Maria da Conceição C / Matos, Sheila M Alvim / Menezes, Greice / Gabrielli, Ligia / Goes, Emanuelle F / Aquino, Estela Ml

Women's health (London, England)

2021 Volume 17, Page(s) 17455065211063294

Abstract: Introduction: Certain behaviors have been associated with health promotion, including mammography screening, in women worldwide.: Objective: The objective of this study was to determine whether there is an association between the periodicity of ... ...

Abstract	Introduction: Certain behaviors have been associated with health promotion, including mammography screening, in women worldwide. Objective: The objective of this study was to determine whether there is an association between the periodicity of mammography screening and healthy lifestyle behaviors in Brazilian women employed at a public university in Bahia, Brazil. Methods: A total of 635 women of 50-69 years of age at the time of the interview, from the Brazilian Longitudinal Study of Adult Health cohort who were resident in Bahia, participated in the study. Data were collected using a multidimensional questionnaire that included questions on participants' sociodemographic characteristics and health-related behaviors (smoking, alcohol consumption, leisure-time physical activity and diet) and another questionnaire that dealt with risk factors and breast cancer screening. Measures of association were calculated using simple and multivariate logistic regression. Results: The practice of physical activity, not smoking, moderate alcohol consumption and a healthy diet were the health behaviors most adopted by the women who had last had a mammogram ⩽2 years previously (which is in line with the interval recommended by the Brazilian Ministry of Health). A statistically significant association was found between a lapse of ⩾3 years since last undergoing mammography screening and excessive alcohol consumption, while a borderline association was found between the same screening interval and leisure-time physical inactivity. Conclusion: There was an association between lifestyle risk behaviors and a longer time interval between mammography screenings. The present results contribute to the debate on the use of mammography, lifestyle behaviors and health promotion among women.
MeSH term(s)	Adult ; Brazil ; Breast Neoplasms/diagnosis ; Diet, Healthy ; Female ; Humans ; Longitudinal Studies ; Mammography ; Mass Screening ; Socioeconomic Factors
Language	English
Publishing date	2021-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2274503-8
ISSN	1745-5065 ; 1745-5057
ISSN (online)	1745-5065
ISSN	1745-5057
DOI	10.1177/17455065211063294
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Article: Association between leisure-time physical activity and sedentary behavior with cardiometabolic health in the ELSA-Brasil participants.

Pitanga, Francisco José Gondim / Matos, Sheila Maria Alvim / Almeida, Maria da Conceição C / Patrão, Ana Luísa / Molina, Maria Del Carmen Bisi / Aquino, Estela Ml

SAGE open medicine

2019 Volume 7, Page(s) 2050312119827089

Abstract: Objectives: To assess associations, both individually and in combination, between leisure-time physical activity and sedentary behavior, and cardiometabolic health.: Methods: This cross-sectional study included 13,931 civil servants participating in ... ...

Abstract	Objectives: To assess associations, both individually and in combination, between leisure-time physical activity and sedentary behavior, and cardiometabolic health. Methods: This cross-sectional study included 13,931 civil servants participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Leisure-time physical activity was analyzed using the leisure-time domain of the long-form International Physical Activity Questionnaire, while questions related to cumulative sitting time and leisure-based screen time on a weekday and on one day on the weekend were used to establish sedentary behavior. Data analysis was performed using multivariate logistic regression. Results: Following adjustment for confounding variables, high levels of leisure-time physical activity and low levels of sedentary behavior were both associated with favorable cardiometabolic health markers in both genders. When these two factors were analyzed in conjunction, taking the combination of low levels of leisure-time physical activity and high levels of sedentary behavior as the reference, the inverse associations with cardiometabolic variables became even more significant. Conclusion: High levels of leisure-time physical activity and low levels of sedentary behavior were both inversely associated with the cardiometabolic variables analyzed; however, the two variables when evaluated in conjunction appear to produce more consistent associations, particularly when sedentary behavior is evaluated according to leisure-based screen time.
Language	English
Publishing date	2019-01-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2735399-0
ISSN	2050-3121
ISSN	2050-3121
DOI	10.1177/2050312119827089
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Article ; Online: Generational differences in dietary pattern among Brazilian adults born between 1934 and 1975: a latent class analysis.

Bezerra, Ilana Nogueira / Bahamonde, Nila Mara Smith Galvão / Marchioni, Dirce Maria Lobo / Chor, Dóra / de Oliveira Cardoso, Letícia / Aquino, Estela Ml / da Conceição Chagas de Almeida, Maria / Del Carmen Bisi Molina, Maria / de Jesus Mendes da Fonseca, Maria / de Matos, Sheila Maria Alvim

Public health nutrition

2018 Volume 21, Issue 16, Page(s) 2929–2940

Abstract: Objective: To identify generational differences in the dietary patterns of Brazilian adults born between 1934 and 1975.: Design: A cross-sectional study from the baseline of the multicentre Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) ... ...

Abstract	Objective: To identify generational differences in the dietary patterns of Brazilian adults born between 1934 and 1975. Design: A cross-sectional study from the baseline of the multicentre Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Year of birth was categorized into three birth generations: Traditionalists (born between 1934 and 1945); Baby Boomers (born between 1946 and 1964); and Generation X (born between 1965 and 1975). Food consumption was investigated using an FFQ. Latent class analysis (LCA) was used to identify data-driven dietary patterns. Setting: Brazil. Subjects: Individuals (n 15 069) aged 35-74 years. Results: A three-class model was generated from the LCA for each birth generation. Generation X presented higher energy intakes (kJ/kcal) from soft drinks (377·4/90·2) and sweets (1262·3/301·7) and lower energy intakes from fruit (1502·5/359·1) and vegetables (311·3/74·4) than Baby Boomers (283·7/67·8, 1047·7/250·4, 1756·0/419·7 and 365·3/87·3, respectively) and Traditionalists (186·2/44·5, 518·8/124·0, 1947·7/465·5 and 404·6/96·7, respectively). For Baby Boomers and Generation X, we found food patterns with similar structures: mixed pattern (22·7 and 29·7 %, respectively), prudent pattern (43·5 and 34·9 %, respectively) and processed pattern (33·8 and 35·4 %, respectively). Among Traditionalists, we could also identify mixed (30·9 %) and prudent (21·8 %) patterns, and a third pattern, named restricted dietary pattern (47·3 %). Conclusions: The younger generation presented higher frequencies of consuming a pattern characterized by a low nutritional diet, compared with other generations, indicating that they may age with a greater burden of chronic diseases. It is important to develop public health interventions promoting healthy foods, focusing on the youngest generations.
MeSH term(s)	Adult ; Age Factors ; Aged ; Brazil ; Cross-Sectional Studies ; Diet/trends ; Female ; Humans ; Latent Class Analysis ; Longitudinal Studies ; Male ; Middle Aged
Language	English
Publishing date	2018-08-08
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	1436024-x
ISSN	1475-2727 ; 1368-9800
ISSN (online)	1475-2727
ISSN	1368-9800
DOI	10.1017/S136898001800191X
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Article ; Online: Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social.

Ximenes, Ricardo Arraes de Alencar / Albuquerque, Maria de Fatima Pessoa Militão de / Martelli, Celina Maria Turchi / Araújo, Thália Velho Barreto de / Miranda Filho, Demócrito de Barros / Souza, Wayner Vieira de / Ichihara, Maria Yury Travassos / Lira, Pedro Israel Cabral de / Kerr, Ligia Regina Franco Sansigolo / Aquino, Estela Ml / Silva, Antônio Augusto Moura da / Almeida, Rosa Lívia Freitas de / Kendall, Carl / Pescarini, Julia M / Brandão Filho, Sinval Pinto / Almeida-Filho, Naomar / Oliveira, Juliane Fonseca de / Teles, Carlos / Jorge, Daniel Cardoso Pereira /

Santana, Guilherme / Gabrielli, Ligia / Rodrigues, Moreno Ms / Silva, Natanael Jesus da / Souza, Rafael Felipe da Silva / Silva, Vivian Alessandra Ferreira da / Barreto, Maurício Lima

Ciencia & saude coletiva

2021 Volume 26, Issue 4, Page(s) 1441–1456

Abstract: Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the ... ...

Title translation	Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures.
Abstract	Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.
MeSH term(s)	Bed Occupancy/statistics & numerical data ; Brazil/epidemiology ; COVID-19/epidemiology ; COVID-19/prevention & control ; Communicable Disease Control ; Humans ; Pandemics ; Physical Distancing ; World Health Organization
Language	Portuguese
Publishing date	2021-01-09
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2078799-6
ISSN	1678-4561 ; 1678-4561
ISSN (online)	1678-4561
ISSN	1678-4561
DOI	10.1590/1413-81232021264.39422020
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Article: Generational differences in dietary pattern among Brazilian adults born between 1934 and 1975: a latent class analysis

Bezerra, Ilana Nogueira / Aquino, Estela ML / Bahamonde, Nila Mara Smith Galvão / Chor, Dóra / da Conceição Chagas de Almeida, Maria / de Jesus Mendes da Fonseca, Maria / de Matos, Sheila Maria Alvim / de Oliveira Cardoso, Letícia / del Carmen Bisi Molina, Maria / Marchioni, Dirce Maria Lobo

Public health nutrition. 2018 Nov., v. 21, no. 16

2018

Abstract: To identify generational differences in the dietary patterns of Brazilian adults born between 1934 and 1975. A cross-sectional study from the baseline of the multicentre Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Year of birth was ...

Abstract	To identify generational differences in the dietary patterns of Brazilian adults born between 1934 and 1975. A cross-sectional study from the baseline of the multicentre Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Year of birth was categorized into three birth generations: Traditionalists (born between 1934 and 1945); Baby Boomers (born between 1946 and 1964); and Generation X (born between 1965 and 1975). Food consumption was investigated using an FFQ. Latent class analysis (LCA) was used to identify data-driven dietary patterns. Brazil. Individuals (n 15 069) aged 35–74 years. A three-class model was generated from the LCA for each birth generation. Generation X presented higher energy intakes (kJ/kcal) from soft drinks (377·4/90·2) and sweets (1262·3/301·7) and lower energy intakes from fruit (1502·5/359·1) and vegetables (311·3/74·4) than Baby Boomers (283·7/67·8, 1047·7/250·4, 1756·0/419·7 and 365·3/87·3, respectively) and Traditionalists (186·2/44·5, 518·8/124·0, 1947·7/465·5 and 404·6/96·7, respectively). For Baby Boomers and Generation X, we found food patterns with similar structures: mixed pattern (22·7 and 29·7 %, respectively), prudent pattern (43·5 and 34·9 %, respectively) and processed pattern (33·8 and 35·4 %, respectively). Among Traditionalists, we could also identify mixed (30·9 %) and prudent (21·8 %) patterns, and a third pattern, named restricted dietary pattern (47·3 %). The younger generation presented higher frequencies of consuming a pattern characterized by a low nutritional diet, compared with other generations, indicating that they may age with a greater burden of chronic diseases. It is important to develop public health interventions promoting healthy foods, focusing on the youngest generations.
Keywords	adults ; chronic diseases ; cross-sectional studies ; eating habits ; energy intake ; food intake ; fruits ; healthy diet ; longitudinal studies ; soft drinks ; sweets ; vegetables ; Brazil
Language	English
Dates of publication	2018-11
Size	p. 2929-2940.
Publishing place	Cambridge University Press
Document type	Article
ZDB-ID	1436024-x
ISSN	1475-2727 ; 1368-9800
ISSN (online)	1475-2727
ISSN	1368-9800
DOI	10.1017/S136898001800191X
Database	NAL-Catalogue (AGRICOLA)

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Article: Maternal and child health in Brazil: progress and challenges

Victora, Cesar G / Aquino, Estela ML / do Carmo Leal, Maria / Monteiro, Carlos Augusto / Barros, Fernando C / Szwarcwald, Celia L

lancet. 2011 May 28, v. 377, no. 9780

2011

Abstract: In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and ... ...

Abstract	In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974–75 to 7% in 2006–07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006–07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.
Keywords	breast feeding ; cesarean section ; child nutrition ; childbirth ; children ; death ; demographic statistics ; education ; growth retardation ; health services ; income ; infant mortality ; infants ; oral rehydration ; sanitation ; socioeconomic status ; statistics ; surveys ; urbanization ; women ; women's health ; Brazil
Language	English
Dates of publication	2011-0528
Size	p. 1863-1876.
Publishing place	Elsevier Ltd.
Document type	Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(11)60138-4
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Social distancing measures to control the COVID-19 pandemic

Aquino, Estela ML / Silveira, Ismael Henrique / Pescarini, Julia Moreira / Aquino, Rosana / Souza-Filho, Jaime Almeida de / Rocha, Aline dos Santos / Ferreira, Andrea / Victor, Audêncio / Teixeira, Camila / Machado, Daiane Borges / Paixão, Enny / Alves, Flávia Jôse Oliveira / Pilecco, Flávia / Menezes, Greice / Gabrielli, Ligia / Leite, Luciana / Almeida, Maria da Conceição Chagas de / Ortelan, Naiá / Fernandes, Qeren Hapuk R Ferreira /

Ortiz, Renzo Joel Flores / Palmeira, Raquel Nunes / Junior, Elzo Pereira Pinto / Aragão, Erika / Souza, Luis Eugenio Portela Fernandes de / Netto, Manoel Barral / Teixeira, Maria Glória / Barreto, Mauricio Lima / Ichihara, Maria Yury / Lima, Raíza Tourinho dos Reis Silva

potential impacts and challenges in Brazil.

2020

Abstract: The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social ... ...

Abstract	The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.
Keywords	covid19
Subject code	300
Language	English
Publishing date	2020-06-05
Publisher	FapUNIFESP (SciELO)
Publishing country	uk
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Gênero e saúde no Brasil

Aquino Estela M.L. / Menezes Greice M.S. / Amoedo Marúcia B.

Revista de Saúde Pública, Vol 26, Iss 3, Pp 195-

considerações a partir da Pesquisa Nacional por Amostra de Domicílios

1992 Volume 202

Abstract: A mulher brasileira tem vivido mais que o homem, como ocorre em países industrializados centrais. Nesses países, paradoxalmente, as mulheres apresentam indicadores de morbidade mais altos que os homens. O conhecimento sobre o padrão nacional pode ajudar ... ...

Abstract	A mulher brasileira tem vivido mais que o homem, como ocorre em países industrializados centrais. Nesses países, paradoxalmente, as mulheres apresentam indicadores de morbidade mais altos que os homens. O conhecimento sobre o padrão nacional pode ajudar a compreender os determinantes de sua própria realidade, permitindo antecipar tendências futuras e adequar os serviços de saúde. Com esta perspectiva foi feito um estudo de morbidade, a partir de dados da Pesquisa Nacional por Amostra de Domicílios (PNAD/IBGE) de 1986, em dez Estados brasileiros, construindo-se coeficientes de prevalência de morbidade, de demanda e de utilização de serviços segundo sexo, e padronizados por idade pelo método direto. Como medida dos diferenciais, usou-se razões entre os sexos. A sobremorbidade feminina foi constante em todas as regiões. Os diferenciais de uso de serviços apresentaram variação regional, sugerindo relação com a oferta de serviços de saúde. Os diferenciais foram nulos na infância; assumiram seus mais altos valores na idade reprodutiva das mulheres, diminuindo depois dos 60 anos. O padrão foi quase constante em todo o país. Parte do fenômeno pode ser explicada por fatores de ordem metodológica. Contudo, os resultados foram semelhantes aos de outros países. As transformações profundas no padrão reprodutivo e na inserção social da mulher brasileira têm seu impacto sobre a saúde e o consumo de serviços ainda não avaliado. Recomenda-se a realização de estudos mais específicos que contribuam para a reorganização do sistema de saúde de modo equânime e universal.
Keywords	Saúde da mulher ; Morbidade ; Necessidades e demanda de serviços de saúde/tendências ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	1992-01-01T00:00:00Z
Publisher	Universidade de São Paulo
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Maternal and child health in Brazil: progress and challenges

Victora, Cesar G / Aquino, Estela ML / do Carmo Leal, Maria / Monteiro, Carlos Augusto / Barros, Fernando C / Szwarcwald, Celia L

lancet

Volume v. 377,, Issue no. 9

Abstract	In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974–75 to 7% in 2006–07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006–07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.
Keywords	sanitation ; breast feeding ; childbirth ; infant mortality ; death ; children ; demographic statistics ; education ; women ; urbanization ; growth retardation ; statistics ; child nutrition ; women's health ; socioeconomic status ; health services ; income ; oral rehydration ; surveys ; infants ; cesarean section
Language	English
Document type	Article
ISSN	0140-6736
Database	AGRIS - International Information System for the Agricultural Sciences and Technology

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