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Mosquera EMB, Tonon KM, Augusto RA, de Carvalho TM, de Morais MB. Improving the Nutritional Status of Socially Vulnerable Children in Manaus, Brazilian Amazon, through a Food Supplementation Programme. Nutrients 2024; 16:1051. [PMID: 38613084 PMCID: PMC11013924 DOI: 10.3390/nu16071051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Information on the effects of government nutrition programmes provided to socially vulnerable children to improve their nutritional status is scarce. We analysed the effectiveness of a nutritional programme, including food supplementation with infant formula, on the evolution of the weight and height of socially vulnerable children from Manaus in the Brazilian Amazon. This study included 7752 children aged 12-24 months admitted to the programme between 2017 and 2020. Weight and height measurements at admission and every three months thereafter were extracted from the programme database. Weight-for-age, weight-for-height, body mass index-for-age (BMI/A), and height-for-age z-scores were analysed using a multilevel linear regression model, which showed a statistically significant decrease in nutritional deficits toward nutritional recovery at follow-up. The programme's effectiveness was evaluated in 1617 children using a paired analysis comparing data from between 12 and 15 months of age at admission and follow-up after 6-9 months. Children admitted with wasting presented an increase in the BMI/A z-score, whereas children admitted with a risk of being overweight and obese had a statistically significant decrease in the BMI/A z-score. Children admitted with stunted growth also showed increased height-for-age z-scores. The nutrition programme was effective for children experiencing wasting and reducing excess weight.
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Affiliation(s)
- Elaine Martins Bento Mosquera
- Nutrition Postgraduate Program, Universidade Federal de São Paulo, São Paulo 04530-050, SP, Brazil;
- Medical Engagement Nestlé, São Paulo 07730-090, SP, Brazil
| | | | | | | | - Mauro Batista de Morais
- Division of Pediatric Gastroenterology, Universidade Federal de São Paulo, São Paulo 04020-040, SP, Brazil
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Benes Matos da Silva H, Ribeiro-Silva RDC, Freitas de Mello E Silva J, Chis Ster I, Rebouças P, Goes E, Ichihara MY, Ferreira A, M Pescarini J, Leovigildo Fiaccone R, S Paixão E, L Barreto M. Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children. BMC Pediatr 2024; 24:103. [PMID: 38341551 PMCID: PMC10858530 DOI: 10.1186/s12887-024-04550-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life. OBJECTIVE We aimed to investigate child growth according to maternal ethnoracial group using a nationwide Brazilian database. METHODS A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother's age, educational level, and marital status. RESULTS A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children's weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth. CONCLUSION We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.
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Affiliation(s)
- Helena Benes Matos da Silva
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil.
| | - Rita de Cássia Ribeiro-Silva
- School of Nutrition, Federal University of Bahia, Salvador, BA, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Juliana Freitas de Mello E Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Irina Chis Ster
- Infection and Immunity Research Institute, St George's University of London, London, UK
| | - Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Emanuelle Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
| | - Andrêa Ferreira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
- The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Julia M Pescarini
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Enny S Paixão
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Edf. Tecnocentro, Sl. 315. Rua Mundo, 121. Trobogy, Salvador, BA, 41745-715, Brazil
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Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol. PLoS One 2022; 17:e0268500. [PMID: 35604890 PMCID: PMC9126365 DOI: 10.1371/journal.pone.0268500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/01/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.
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Mendes VA, Santos DADS, Farias EDS, Carvalho DPD, Bastos WR. Prevalence and factors associated with mercury exposure in riverside communities in the Brazilian Western Amazon. Rev Bras Enferm 2021; 73:e20200100. [PMID: 33206908 DOI: 10.1590/0034-7167-2020-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to verify mercury exposure prevalence and identify its possible associated factors in two riverside communities in the Madeira River basin of the Western Brazilian Amazon. METHOD a cross-sectional study comprising 95 children and adolescents. Age cycle, school attendance, Bolsa Família, number of siblings, meals, fish consumption, height by age were measured. Binary logistic regression was used to verify relationships between mercury exposure and its possible associated factors. RESULTS the general prevalence of mercury exposure was 46.3%; children, 35.4%; and adolescents, 57.4%. Associated factors were fish consumption (aOR=1.84; 95%CI 1.56-2.16), age cycle (aOR=2.50; 95%CI 1.09-5.7), parasites (aOR=1.22; 95%CI 1.02-2.71), and short stature (aOR=1.32; 95%CI 1.05-2.02). CONCLUSION mercury exposure prevalence in riverside children and adolescents was considered worrying, with association with fish consumption, adolescence, parasites, and short stature.
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de Souza AA, Mingoti SA, Paes-Sousa R, Heller L. Combined effects of conditional cash transfer program and environmental health interventions on diarrhea and malnutrition morbidity in children less than five years of age in Brazil, 2006-2016. PLoS One 2021; 16:e0248676. [PMID: 33784331 PMCID: PMC8009376 DOI: 10.1371/journal.pone.0248676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/03/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Governmental measures aiming at social protection, with components of disease control, have potential positive impacts in the nutritional and health outcomes of the beneficiaries. The concomitant presence of these measures with environmental sanitation interventions may increase their positive effect. The context of simultaneous improvement of social protection and environmental sanitation is found in Brazil since 2007 and an assessment of the combined effects of both programs has not been performed so far. OBJECTIVE To evaluate whether interaction effects between improvement of access to water, sanitation and solid waste collection with the Bolsa Família Program [PBF] were related to better responses in the reduction of morbidity due to diarrhea and malnutrition in children less than five years of age, acknowledging the positive results of these improved conditions and the PBF separately in coping with these diseases. METHODS Descriptive and inferential analyses were performed through Generalized Linear Models of the Negative Binomial type of fixed effects, with and without addition of zeros. Interaction models were inserted in order to evaluate the outcomes when the two public policies of interest in the current study were present simultaneously in the municipalities. RESULTS Interaction with negative effect when a concomitantly high municipal coverage of the Bolsa Família Program and adequate access to sanitation and solid waste collection were present. In contrast, regardless of municipal coverage by the PBF, the simultaneous presence of water and sanitation (0.028% / 0.019%); water and solid waste collection (0.033% / 0.014%); sanitation and solid waste collection (0.018% / 0.021%), all resulted in a positive effect, with a decrease in the average morbidity rates for both diseases. CONCLUSION Investments aimed at universalizing water, sanitation and solid waste collection services should be priorities, aiming at reducing the incidence of morbidity due to malnutrition and diarrhea and preventing deaths from these poverty-related diseases.
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Affiliation(s)
| | - Sueli Aparecida Mingoti
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rômulo Paes-Sousa
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
| | - Léo Heller
- Instituto René Rachou, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil
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Socioenvironmental Factors Influencing Distribution and Intensity of Soil-Transmitted Helminthiasis in the Brazilian Amazon: Challenges for the 2030 Agenda. J Trop Med 2021; 2021:6610181. [PMID: 33613673 PMCID: PMC7878087 DOI: 10.1155/2021/6610181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/22/2021] [Indexed: 11/29/2022] Open
Abstract
Soil-transmitted helminthiasis (STHs) are poverty-related diseases with high prevalence rates in developing countries. The present study aims to describe the epidemiological scenario of STHs in an urban population in the Brazilian Amazon. A cross-sectional survey (n = 349 children aged 1–15 years) was carried out to obtain faecal samples and sociodemographic and sanitation data. Among the children, 143 (41%) were positive for at least one STH. Prevalence rates of infections by A. lumbricoides, T. trichiura, and hookworms were 24.4%, 42.6%, and 9%, respectively. A logistic regression multivariate model showed that infection with A. lumbricoides is significantly more frequent in children aged 11–15 years (odds ratio [OR] = 2.38; 95% confidence interval [CI] = 1.15–4.94; p=0.018) and the presence of latrines inside houses is a protection factor against ascariasis (OR = 0.38; 95% CI = 0.17–0.85; p=0.019). Positivity for T. trichiura is higher in the 5–10 (OR = 3.31; 95% IC = 1.85–5.89; p=0.001) and 11–15 age groups (OR = 3.16; 95% IC = 1.66–6.00; p=0.001), in children living in poor families (OR = 1.78; 95% IC = 1.01–3.14; p=0.045) and practicing open evacuation (OR = 2.07; 95% IC = 1.07–3.99; p=0.029). Hookworm infection is more frequent in children aged 11–15 years (OR = 6.70; 95% IC = 1.91–23.43; p=0.002), males (OR = 6.35; 95% IC = 2.00–20.14; p=0.002), and those living in stilt houses (OR = 3.52; 95% IC = 1.22–10.12; p=0.019). The use of albendazole in the last six months was a protection factor against hookworm infection (OR = 0.31; 95% IC = 0.10–0.96; p=0.042). The proportion of mild, moderate, and severe infections was 55.2%, 37.8%, and 7%, respectively, for A. lumbricoides, 72.4%, 24.3%, and 3.3% for T. trichiura, and 93.8%, 3.1%, and 3.1% for hookworms. Significantly higher worm burdens in T. trichiura and hookworm infections were associated with practicing open defecation and living in stilt houses. The data points to the need to improve sanitation infrastructure in Amazonian cities with similar sociodemographic and environmental characteristics.
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Silveira VNDC, Padilha LL, Frota MTBA. Malnutrition and associated factors among quilombola children under 60 months of age in two cities of the state of Maranhão, Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:2583-2594. [PMID: 32667542 DOI: 10.1590/1413-81232020257.21482018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 09/25/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of malnutrition in children under 60 months of age living in quilombo remnant communities of two municipalities in the state of Maranhão and their associated factors. METHODS This is a cross-sectional study conducted with a sample of 372 children in August 2015. Socioeconomic, demographic, maternal and child information were collected. The anthropometry followed the one proposed by the World Health Organization. Height-for-age and weight-for-height rates were calculated using Anthro software version 3.2.2. Poisson regression was performed with a robust variance for the association of malnutrition with the studied variables, using Stata software version 14.0. RESULTS Child malnutrition was high for height-for-age (15.1%) and weight-for-height (7%). Children whose mothers had a short height (< 1.497 m) were more likely to have height-for-age deficits (p < 0.05). No variables were statistically associated with low weight-for-height. CONCLUSION Child malnutrition persists as a public health problem in vulnerable regions, and maternal factors such as low maternal height may explain the short stature of the children. The need for actions to address this nutritional deviation is pointed out.
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Affiliation(s)
- Victor Nogueira da Cruz Silveira
- Departamento de Ciências Fisiológicas, Universidade Federal do Maranhão (UFMA). Av. Portugueses, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | - Luana Lopes Padilha
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, UFMA. São Luís MA Brasil
| | - Maria Tereza Borges Araújo Frota
- Departamento de Ciências Fisiológicas, Universidade Federal do Maranhão (UFMA). Av. Portugueses, Vila Bacanga. 65080-805 São Luís MA Brasil.
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Appiah CA, Mensah FO, Hayford FEA, Awuuh VA, Kpewou DE. Predictors of undernutrition and anemia among children aged 6–24 months in a low-resourced setting of Ghana: a baseline survey. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-05-2019-0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe purpose of this study was to identify the predictors of child undernutrition and anemia among children 6–24 months old in the East Mamprusi district, Northern region, Ghana.Design/methodology/approachThis cross-sectional study recruited 153 children and their mothers. Weight, height and hemoglobin levels of the children were measured. A structured questionnaire based on the World Health Organization's indicators for assessing infant and young child feeding practices was used to collect data on parents' socioeconomic status, household characteristics, hygiene and sanitation practices, mothers' knowledge on feeding practices such as child's meal frequency and dietary diversity and child morbidity within the past two weeks. Predictors of child nutritional status were determined using multinomial logistic regression analysis.FindingsUnderweight in the children was significantly predicted by maternal knowledge on protein foods (AOR = 0.045, p = 0.008), time of initiation of complementary feeding (AOR = 0.222, p = 0.032) and maternal age (AOR = 9.455, p = 0.017). Feeding child from separate bowls (AOR = 0.239, p = 0.005), minimum meal frequency per child's age (AOR = 0.189, p = 0.007) and time of initiation of complementary feeding (AOR = 0.144, p = 0.009) were significant determinants of stunting among the children. Exclusive breast feeding (AOR = 7.975, p = 0.012) and child's past morbidity (AOR = 0.014, p = 0.001) significantly contributed to anemia among the children.Research limitations/implicationsThis is a cross-sectional study and cannot establish causality. The small sample size also limits the generalizability of study findings. However, findings of the study highlight factors which could potentially influence the high rate of child undernutrition in the study setting.Practical implicationsThis study identifies determinants of undernutrition in the East Mamprusi district, an underresourced area in Ghana. This information could inform the development/reformulation of locally sensitive key messages and targeted intervention strategies to curb the high levels of child undernutrition in the East Mamprusi district of Ghana.Originality/valueThis study identifies maternal care practices as key potential drivers of undernutrition in a low-resource setting known for high prevalence of child undernutrition. It suggests insight for large-scale studies on the predictors of child undernutrition in Northern Ghana and other resource-poor settings.
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Borges MFDSO, Koifman S, Koifman RJ, Silva IFD. [Cancer mortality among indigenous population in Acre State, Brazil]. CAD SAUDE PUBLICA 2019; 35:e00143818. [PMID: 31141029 DOI: 10.1590/0102-311x00143818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/24/2019] [Indexed: 12/22/2022] Open
Abstract
The study aimed to estimate cancer mortality among indigenous peoples in Acre State, Brazil. This was a descriptive observational study based on the nominal bank of the Brazilian Mortality Information System for the period from January 1st, 2000, to December 31st, 2012. The study analyzed the distribution death frequencies by sex and age. Standardized mortality ratio (SMR) was calculated taking Goiânia (Goiás State), Acre State, and the North Region of Brazil as the references. A total of 81 deaths were identified, the majority in men (59.3%) and in individuals over 70 years of age. The five main sites in men were stomach, liver, colon and rectum, leukemia, and prostate. The five main sites in women were uterine cervix, stomach, liver, leukemia, and uterus. In indigenous men there was an excess of deaths from stomach cancer compared to the populations of Goiânia (SMR = 2.72; 2.58-2.87), Acre State (SMR = 2.05; 1.94-2.16) and North region (SMR = 3.10; 2.93-3.27). The same was observed for deaths from hepatic cell carcinomas referenced against Goiânia (SMR = 3.89; 3.66-4.14), Acre State (SMR = 1.79; 1.68-1.91), and the North of Brazil (SMR = 4.04; 3.77-4.30). Among indigenous women, there was an excess of cervical cancer in comparison to Goiânia (SMR = 4.67; 4.41-4.93), Acre State (SMR = 2.12; 2.00-2.24), and the North (SMR = 2.60; 2.45-2.75). The estimates show that preventable neoplasms such as cervical cancer and those linked to underdevelopment, such as stomach and liver cancer, account for 49.4% of deaths among indigenous peoples. Compared to the reference population, mortality from liver, stomach, and colorectal cancer and leukemias was more than twice as high in indigenous men; among indigenous women, cervical, stomach, and liver cancer and leukemias were 30% higher.
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Affiliation(s)
| | | | - Rosalina Jorge Koifman
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ilce Ferreira da Silva
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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