Morbidade hospitalar de indígenas Xavante, Mato Grosso, Brasil (2000-2002)

Cancer incidence in indigenous populations of Western Amazon, Brazil

OBJECTIVES

This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown.

DESIGN

This is a descriptive study of cancer incidence among the indigenous population (2000-2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco's public and private laboratories' reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference.

RESULTS

From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 + . Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67-1.83), liver (SIR=1.77; 95%CI:1.66-1.88), and leukemia (SIR=1.64; 95%CI:1.49-1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34-4.64) and liver (SIR=2.11; 95%CI:1.88-2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05-0.07) and female breast (SIR=0.12; 95%CI:0.11-0.14) was observed.

CONCLUSIONS

Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations.

Sanitation conditions of indigenous and nonindigenous households in Brazil according the 2000 and 2010 national censuses

This study compares the availability of basic sanitation infrastructure in indigenous and nonindigenous household located in urban and rural areas using data from the 2000 and 2010 Brazilian National Censuses. The analyses were based on descriptive statistics and modelling with multiple logistic regression. While there was an increase in the availability of basic sanitation in Brazilian households over the decade, indigenous households continued to have worse conditions in 2010. Sewage was the sanitation service with the lowest coverage in both censuses, and indigenous households had a lower rate of sewage services than nonindigenous households did. Logistic regression results confirmed the findings of the descriptive analyses, attesting to the fact that sanitation conditions are worse in indigenous households. In some areas, such as the urban North and Southeast and rural areas of the Central-West region, the gap in basic sanitation infrastructure between indigenous and nonindigenous households increased from 2000 to 2010. This study not only indicates the less-adequate sanitation conditions in indigenous households in Brazil but also attests to the persistence of major inequalities associated with race or color in the country.

[Basic sanitation and inequalities in color/race in urban households with under-five children, with a focus on the indigenous population]

This study aimed to analyze the presence of basic sanitation services in households with children under five years of age located in urban areas of Brazil, with a focus on indigenous children. This cross-sectional study was based on data from the 2010 Population Census. We calculated the rates of households with running water (public system), sewage disposal (public system or septic tanks), and garbage collection (directly or via public dumpsters). Multiple logistic regression (MLR) models were used to estimate associations between color/race and presence of sanitation services, based on odds ratios (OR). The study considered Brazil's urban metropolitan areas and stratified the results by major geographic region. Significance was set at 5%. The lowest frequencies were for sewage disposal, and all the rates were lower for indigenous people. MLR analyses included 29 comparisons (48.3%) in which households with indigenous children (compared to other color/race categories) were at a disadvantage, especially in the South of Brazil, where all comparisons were negative for indigenous households. Similar results appeared in metropolitan areas. The results thus suggest inequalities basic sanitation services based on color/race, where indigenous people are generally at a disadvantage, especially in the South of Brazil. Given the relationship between sanitation and health, as already demonstrated in the literature, these results can partly explain the low health levels in indigenous children in Brazil.

[Cancer mortality among indigenous population in Acre State, Brazil]

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.

Accidents involving Brazilian indigenous treated at urgent and emergency services of the Unified Health System

Abstract We analyzed the accidents with Brazilian indigenous treated at urgent and emergency services of the Unified Health System (SUS). Data were obtained from the 2014 Viva Survey, which included 86 services from 24 capitals and the Federal District. The demographic profile of the indigenous, the event and the attendance were characterized. Most of the attended people were male in the 20-39 years age group. Falls and traffic accidents were the main reasons for attendance. Alcohol use was informed by 5.6% of the attended people, a figure that increases to 19.1% in traffic accidents, 26.1% among drivers and 22.8% among motorcyclists. There was a statistical difference between genders in relation to age, disability, place of occurrence of the event, work-related event and victim's condition in the traffic accident. We emphasize the importance of providing visibility to accidents with indigenous and engage them in the prevention of such events. Data reliability depends on the adequate completion in indigenous health information systems.

Condições de saneamento e desigualdades de cor/raça no Brasil urbano: uma análise com foco na população indígena com base no Censo Demográfico de 2010

RESUMO: Objetivo: Os objetivos deste estudo foram analisar e descrever a presença da infraestrutura de saneamento básico nas áreas urbanas do Brasil, contrastando os perfis dos domicílios indígenas com os de não indígenas. Métodos: Trata-se de um estudo transversal com base nos microdados do Censo 2010. As análises foram baseadas em estatísticas descritivas (prevalências) e na construção de modelos de regressão logística múltipla (ajustados por covariáveis socioeconômicas e demográficas). Estimaram-se as razões de chance para a associação entre as variáveis explicativas (covariáveis) e de desfecho (abastecimento de água, esgotamento sanitário, coleta de lixo e saneamento adequado). O nível de significância estatística estabelecido foi de 5%. Resultados: Entre os serviços analisados, o esgotamento sanitário mostrou-se o mais precário. Em relação à cor ou raça, os domicílios com responsáveis indígenas apresentaram as menores frequências de presença de infraestrutura sanitária no Brasil Urbano. Os resultados das regressões ajustadas mostraram que, em geral, os domicílios indígenas se encontram em desvantagem quando comparados aos de outras categorias de cor ou raça, especialmente quanto à presença do serviço de coleta de lixo. Essas desigualdades foram de maior magnitude nas regiões Sul e Centro-Oeste. Conclusão: As análises deste estudo não somente confirmam o perfil de precárias condições de infraestrutura de saneamento básico dos domicílios indígenas em área urbana, como também evidenciam a persistência de iniquidades associadas à cor ou raça no país.

Anemia e níveis de hemoglobina em crianças indígenas Xavante, Brasil Central

RESUMO: Objetivo: Avaliar a prevalência de anemia, os níveis médios de hemoglobina e os principais fatores nutricionais, demográficos e socioeconômicos associados em crianças Xavante, em Mato Grosso, Brasil. Métodos: Realizou-se inquérito em duas comunidades indígenas Xavante na Terra Indígena Pimentel Barbosa visando avaliar todas as crianças com menos de dez anos. Foram coletados dados de concentração de hemoglobina, antropometria e aspectos socioeconômicos/demográficos por meio de avaliação clínica e questionário estruturado. Utilizaram-se os pontos de corte recomendados pela Organização Mundial da Saúde (OMS) para a classificação de anemia. Análises de regressão linear com hemoglobina como desfecho e regressão de Poisson com variância robusta com presença ou não de anemia como desfechos foram realizadas (intervalo de confiança de 95% -IC95%). Resultados: Os menores valores médios de hemoglobina ocorreram nas crianças com menos de dois anos, sem diferença significativa entre os sexos. A anemia atingiu 50,8% das crianças, prevalecendo aquelas com menos de dois anos 2 anos (77,8%). A idade associou-se inversamente à ocorrência de anemia (razão de prevalência - RP - ajustada = 0,60; IC95% 0,38 - 0,95) e os valores médios de hemoglobina aumentaram significativamente conforme o incremento da idade. Os maiores valores de escores z de estatura-para-idade reduziam em 1,8 vez a chance de ter anemia (RP ajustada = 0,59; IC95% 0,34 - 1,00). A presença de outra criança com anemia no domicílio aumentou em 52,9% a probabilidade de ocorrência de anemia (RP ajustada = 1,89; IC95% 1,16 - 3,09). Conclusão: Elevados níveis de anemia nas crianças Xavante sinalizam a disparidade entre esses indígenas e a população brasileira geral. Os resultados sugerem que a anemia é determinada por relações complexas e variáveis entre fatores socioeconômicos, sociodemográficos e biológicos.

Fatores associados à pneumonia em crianças Yanomami internadas por condições sensíveis à atenção primária na região norte do Brasil

Resumo Em países em desenvolvimento, a pneumonia é a principal causa de adoecimento e morte na infância, principalmente em grupos vulneráveis. O objetivo deste estudo foi analisar os fatores associados à pneumonia em crianças Yanomami internadas por condições sensíveis à atenção primária (ICSAP). As internações foram divididas em dois grupos: i) pneumonias e ii) demais causas, de acordo com a lista brasileira de ICSAP. Foram estimadas taxas ajustadas de ICSAP e utilizou-se a regressão logística não condicional para analisar fatores associados. Mais de 90% dos registros foram considerados ICSAP. A taxa padronizada de ICSAP foi 18,6/1.000. As chances de internação por pneumonia foram 2,7 (IC: 1,3-5,4) vezes maiores em crianças de 0,1 a 5,9 meses; 1,9 (IC: 1,1-3,3) vezes maiores nas crianças que tiveram a duração da hospitalização variando de 8 a 14 dias; e 3,0 (IC: 1,2-7,5) vezes maiores nas crianças com diagnóstico secundário de desnutrição. O excesso de internações evitáveis é um forte indício da baixa qualidade das ações em terras indígenas e do limitado acesso à atenção primária, contrariando o modelo assistencial proposto pelo subsistema de saúde indígena no Brasil que, em tese, deveria privilegiar tecnologias assistenciais ancoradas na atenção primária.

Diarrhea and health inequity among Indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BACKGROUND

Globally, diarrhea is the second leading cause of death among children under five. In Brazil, mortality due to diarrhea underwent a significant reduction in recent decades principally due to expansion of the primary healthcare network, use of oral rehydration therapy, reduced child undernutrition, and improved access to safe drinking water. 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 diarrhea and associated factors among Indigenous children in the country.

METHODS

The 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. Interviews were based on a seven day recall period. Prevalence rates of acute diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess associations.

RESULTS

Information on diarrhea was obtained for 5,828 children (95.1% of the total sample). The overall prevalence of diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher risk of diarrhea was observed among younger children and those who had less maternal schooling, lower household socioeconomic status, undernutrition (weight-for-age deficit), presence of another child with diarrhea in the household, and occurrence of upper respiratory infection.

CONCLUSIONS

According to results of the First National Survey of Indigenous People's Health and Nutrition, almost a quarter of Indigenous children throughout the country had diarrhea during the previous week. This prevalence is substantially higher than that documented in 2006 for Brazilian children < 5 years generally (9.4%). Due to its exceedingly multicausal nature, the set of associated variables that remained associated with child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and health inequities faced by Indigenous peoples in contemporary Brazil.

Prevalência de sibilância e fatores associados em crianças indígenas Guarani hospitalizadas por doença respiratória aguda no Sul e Sudeste do Brasil

Realizou-se estudo de prevalência de sibilância em crianças indígenas Guarani hospitalizadas por infecção respiratória aguda baixa no Sul e Sudeste do Brasil, recrutadas a partir de um sistema de vigilância implantado nas aldeias entre maio de 2007 e junho de 2008. Os dados foram extraídos por revisão dos prontuários hospitalares. Estimaram-se razões de prevalência de sibilância brutas e ajustadas segundo categorias das variáveis exploratórias, por regressão de Poisson com ajuste para variância robusta. A prevalência de sibilância foi de 58,1% (136/234). Permaneceram significativamente associadas à sibilância no modelo final: faixa etária, inversamente associada (0-11 meses: referência; 24-35 meses: 0,63, IC95%: 0,40-0,99); internação no outono (verão: referência; outono: 1,58, IC95%: 1,05-2,40); e sinais clínicos de dispneia (1,41, IC95%: 1,09-1,83), tiragem (1,42, IC95%: 1,16-1,73) e estertor (1,43, IC95%: 1,09-1,87). Os resultados revelam elevada carga de morbidade por sibilância e sugerem o fenótipo de sibilância persistente de início precoce, relacionada à recorrência de infecções respiratórias virais.

Risk factors for hospital admission due to acute lower respiratory tract infection in Guarani indigenous children in southern Brazil: a population-based case-control study

OBJECTIVE

To assess risk factors associated with hospital admission due to acute lower respiratory tract infection (ALRTI) in indigenous Guarani children <5 years of age in southern Brazil.

METHODS

Population-based matched case-control study from May 2007 to June 2008 in 81 Guarani villages. Cases were defined as hospital admissions due to confirmed ALRTI. Two controls free from acute respiratory infection, matched according to age, sex and place of residence, were selected for each case at the time of the case's hospitalisation. Both cases and controls were recruited by a surveillance routine established for the study.

RESULTS

The analysis was performed on 120 cases and 201 controls. The risk factors that remained significantly associated with hospitalisation due to ALRTI in the hierarchical multivariate conditional logistic regression were: low stable monthly per capita household income (<US$30.00 = OR: 2.77, IC95% : 1.51-5.10; no income= OR: 1.88, IC95% : 1.02-3.47); large number of persons in the household (6-9 =  OR: 2.03, IC95% : 1.06-3.88; 10-16 =  OR: 5.00, IC95% : 1.81-13.86); indoor exposure to fumes from burning firewood used for cooking (OR: 3.08, IC95% : 1.39-6.84);low maternal age (OR: 2.77, IC95% : 1.42-5.39); and low birthweight (OR: 6.12, IC95% : 1.44-26.13).

CONCLUSION

Acute respiratory infections are a major cause of morbidity and mortality among Guarani children. Our study provides the first evidence about their determinants in indigenous peoples in Brazil that can help to better understand the epidemiology of respiratory infections in indigenous children.

The First National Survey of Indigenous People's Health and Nutrition in Brazil: rationale, methodology, and overview of results

Background

Although 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.

Methods

The 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.

Results

The 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%).

Conclusions

The 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.

Demography and health of the Xavante Indians of Central Brazil

This study investigates the demographic and health behavior of the Xavante Indians of Mato Grosso State, Central Brazil. Data covering the period 1999 to 2004 was collected using information from household censuses and vital statistics. In addition to standard demographic analyses, survival analysis was carried out. Results show a young age structure, derived from a combination of high fertility rates (7.7 live births per woman) and declining mortality. Mortality rates, especially infant mortality (97 per thousand), remain very high, surpassing regional and national rates. Natural increase is the main contributing factor to population growth. The annual population growth rate is 4.4%. Results suggest that recent declines in mortality and fertility may be related to transformations in the implementation of basic health care services and internal diversity, the latter of which seems to be associated with local history and sociocultural determinants.

Nutritional status and growth of indigenous Xavante children, Central Brazil

BACKGROUND

The aim of this study was to characterize the nutritional status of Xavante Indian children less than 10 years of age in Central Brazil and to evaluate the hypothesis of an association between child nutrition and socioeconomic differentiation in this population.

METHODS

A cross-sectional study was conducted in July 2006 that included all children under the age of 10 from the Xavante village Pimentel Barbosa in Mato Grosso, Brazil. The data collected included weight, height, and sociodemographic information. Sociodemographic data were used to generate two indices ("income" and "wealth") and to determine the proportion of adults in each household. Descriptive analyses were performed for weight-for-age (W/A), height-for-age (H/A), and weight-for-height (W/H) using the NCHS and the WHO growth references. Univariate and multivariate analyses were conducted using H/A and W/A as a response variables.

RESULTS

Of a total of 246 children under the age of ten residing in the village, 232 (94.3%) were evaluated. Following the NCHS reference, 5.6% of children under the age of ten presented low W/A and 14.7% presented low H/A. Among children under the age of five, deficit percentages for weight and height were 4.5% and 29.9%, respectively, following the WHO curves. Among children < 2 years of age, H/A index variability was found to be directly related to child's age and inversely related to the proportion of adults in the household. Maternal BMI was positively associated with growth for children from 2 to 4 years of age, explaining 11.5% of the z-score variability for the H/A index. For children 5 years of age and older, the wealth index and maternal height were positively associated with H/A. No significant associations were found using W/A as the dependent variable.

CONCLUSION

This study demonstrated that undernutrition, in particular linear growth deficit, is a notable health issue for Xavante children. These findings contrast with the nutritional profile observed among Brazilian children nationally, which is characterized by a sharp decline in child undernutrition in recent decades, even in the poorest regions of the country. This discrepancy calls attention to the persistent health disparities that exist between indigenous and non-indigenous people in Brazil.

CE, Tavares FG. Morbidade hospitalar indígena Guarani no Sul e Sudeste do Brasil

Estudos sobre morbidade hospitalar em povos indígenas no Brasil são relativamente recentes, restritos quanto à cobertura e carecem de fontes de dados capazes de gerar indicadores por etnia. Esse estudo descreve a morbidade hospitalar indígena na população residente em 83 aldeias Guarani no Sul e Sudeste do Brasil (N = 6.483), a partir de dados primários obtidos em um sistema de vigilância de hospitalizações implantado em 2007/2008, especificamente para um estudo caso-controle sobre infecção respiratória aguda (IRA) em crianças Guarani. No período, ocorreram 666 hospitalizações concentradas em 497 indivíduos, sendo a maioria em < 5 anos (71,9%). As doenças respiratórias foram as principais causas de hospitalização (64,6%), sobretudo em crianças (< 5 anos: 77,6%; < 1 ano: 83,4%), superando as magnitudes das proporções de hospitalização por essas causas em outros grupos indígenas. A taxa de hospitalização (por 100 pessoas-ano) global foi de 8,8, correspondendo a 71,4 em < 1 ano e a 21,0 entre 1 e 4 anos. A taxa de hospitalização por IRA (5,3) superou em 6,5 e 2,0 vezes àquelas por diarréia e por demais causas, enquanto em < 5 anos (IRA = 23,7), essas razões de taxas foram de 7,4 e 5,4, respectivamente. A taxa padronizada de hospitalização Guarani superou as taxas padronizadas das regiões Sul e Sudeste em 40% e 210%, respectivamente. As hospitalizações marcadas por condições sensíveis à atenção primária e a magnitude das IRA indicam que, além de estudos para compreender a epidemiologia das IRA, são necessários investimentos na qualificação da atenção primária à saúde Guarani.

Cytokine genes are associated with tuberculin skin test response in a native Brazilian population

Tuberculosis was a major cause of population decline among Brazilian indigenous peoples and remains a leading cause of morbidity and mortality among them. Despite high BCG coverage, results of Tuberculin Skin Test (TST) reactivity have shown high rates of anergy in Amazonian Indians. Given the high prevalence of anergy in these populations and the fact that genetic host factors play an important role in susceptibility to Mycobacterium tuberculosis (MTB), the aim of this study was to evaluate the association of nineteen polymorphisms in fifteen genes related to immune response and anergy in the Xavante, an indigenous group from Brazil. A total of 481 individuals were investigated. TST anergy was observed in 69% of them. Polymorphisms in four genes showed absence or very low variability: SP110, PTPN22, IL12RB1 and IL6. IFNG +874 A/T heterozygotes and IL4-590 C/C homozygotes were more frequent in those individuals who presented a positive TST (prevalence ratios of 1.9 and 2.0 respectively). The risk of anergy was 1.5 in IL10-1082 G/G homozygotes when compared to carriers for the A allele. In indigenous groups such as the Xavante exposure to a variety of infections, associated with specific genetic factors, may disturb the T-helper 1 and T-helper 2 balance leading to increased immunological susceptibility.