The epidemiological transition in maternal and child health in a Brazilian city, 1982-93: a comparison of two population-based cohorts

Two studies carried out in 1982 and 1993 in the city of Pelotas, Southern Brazil, provide a unique opportunity for assessing the impact on maternal and child health of the economic and health care changes, which took place in Brazil in this period. The cohorts of mothers and infants of 1982 and 1993 were studied from the time of delivery. In both years, all mothers identified in the city's maternity hospitals answered a standardised questionnaire and their infants were examined. Over 99% of all children born in the city in each of the 2 years were included in the cohorts. Deaths occurring among these children were monitored prospectively, as well as all hospital admissions in the 1993 cohort. In the 1982 study, attempts were made to locate a 25% sample of the children at the mean age of 12 months using the addresses collected at the hospital (82% of the children were located), and all of the cohort children at the mean age of 20 months and 42 months, through a city census (87% were located in both follow-ups). In the 1993 study, 20% of all children plus all low birthweight infants were sought at 12 months of age, using the addresses collected at the hospital, and 95% were successfully traced. There was a 12% fall in the number of births occurring in 1993 (5,304 births), in comparison with 1982 (6,011 births), in spite of the increase in the population of reproductive age in the city during the decade. There was a marked difference in maternal height and weight at the beginning of pregnancy, with women giving birth in 1993 being, on average, 3.4 cm taller and 2.5 kg heavier than those who gave birth in 1982. The proportion of preterm babies (<37 weeks), measured by the date of last menstrual period, increased from 5.6% in 1982 to 7.5% in 1993. The median duration of breast feeding increased from 3.1 months in 1982 to 4.0 months in 1993. At 12 months of age, the prevalence of deficit of weight for age decreased from 5.4% in 1982 to 3.7% in 1993. The prevalence of deficit of height for age, however, increased from 5.3% to 6.1%. The perinatal mortality rate dropped 31%, from 32.2 per 1,000 births in 1982 to 22.1 deaths per 1,000 births in 1993. There was also a marked reduction in the infant mortality rate, from 36.4 per 1,000 livebirths in 1982 to 21.1 per 1,000 livebirths in 1993. The findings of the study indicate that there were improvements in the decade for most of the indicators evaluated, with the exception of birthweight and gestational age. It appears that improvements in perinatal and infant mortality rates are largely due to improvements in the health care sector.

[The Children's Pastoral in Criciúma, Southern Brazil: coverage and socio-demographic characteristics of participating families]

This study describes the main social, economic, biological, and demographic characteristics of children and families who participate or have participated in the Children's Pastoral as compared to the overall urban population of Criciúma (Southern Brazil). A population-based cross-sectional study with a probabilistic sample of 2208 children under three years of age was conducted; 16.7% of the mothers confirmed having participated in the Pastoral at any given time, of whom 4.8% were currently participating, while the rest had dropped out. Black children and those over 12 months old or with two or more older siblings participated more frequently in the Pastoral. The main family factors associated with participation were mother's age (over 25), mother not working outside the home, low per capita income, low parental schooling, living in the neighborhood for more than 4 years, and death of sibling before age five. Reasons most often given by mothers for dropping out were migration, lack of time, and interruption of the Pastoral's activities in the neighborhood. The conclusion was that the Pastoral should prioritize the poorest of the poor and adopt measures to reduce drop-out rates.

[Assessment of the performance of Pastoral de Criança, a health support group, in promoting child survival and health education in Criciúma,a city in southern Brazil]

Thousands of children younger than 5 years of age still die all over the world as a result of preventable diseases. Community intervention measures emphasizing primary health and nutritional care have been identified as one of the solutions to this problem. This article describes a population-based cross-sectional study of the Pastoral da Criança, a Roman Catholic health support group in Brazil. The study assesses whether mothers and children assisted by the Pastoral present better health indicators and have a better knowledge of basic child survival actions than non-assisted mothers and children. The study was carried out in 1996 in an urban area of the municipality of Criciúma, in the state of Santa Catarina, in southern Brazil. The sample was composed of 2,208 children under 3 years of age. The adjusted analysis taking into consideration possible confounding factors showed that the presence of the Pastoral was significantly associated with maternal knowledge of appropriate feeding measures during diarrheal episodes, optimal duration of exclusive breast-feeding, implications of feeding powdered milk to infants, correct interpretation of the infant growth curve, and knowledge of the proper vaccination schedule for infants. Participation in the Pastoral was positively associated with longer total breast-feeding duration, later introduction of bottle-feeding, higher frequency of growth monitoring visits in the quarter before the study, and availability in the home of measuring spoons for oral rehydration. No significant association was found between participation in the Pastoral and duration of predominant or exclusive breast-feeding, or correct diarrhea management. The results showed Pastoral actions have a positive effect and also revealed areas in which greater investments are needed. It is recommended that the Pastoral, as well as other similar institutions, give priority to educating mothers on child care and to recruiting mothers early in pregnancy, when the impact of these actions is potentially greater.

[Longitudinal study of the mother and child population in an urban region of southern Brazil, 1993: methodological aspects and preliminary results]

All babies born in the hospitals of the city of Pelotas, Brazil, in 1982 were studied soon after delivery and followed up prospectively during the first years of their lives. In 1993, this study was repeated with a similar methodology, with the aim of assessing eventual changes in the level of maternal and child health. All five maternity hospitals in the city were visited daily and the 5,304 babies born included in the study. They were weighed and measured, and their gestational age was assessed using the Dubowitz method. Their mothers were examined and interviewed regarding a large number of risk factors. The mortality of these children was studied through the surveillance of all hospitals, cemeteries and death registries, and all hospital admissions were also recorded. Two nested case-control studies were carried out to assess risk factors for mortality and hospital morbidity. A systematic sample of 655 children were examined at home at one and three months of age, and these infants, as well as another sample of 805 children including all low-birthweight babies were also examined at the ages of six and twelve months. Their psychomotor development was also assessed. Losses to follow-up were only 6.6% at twelve months. Relative to the 1982 indicators, perinatal mortality fell by about 30% and infant mortality by almost 50%. The median duration of breastfeeding increased from 3.1 to 4.0 months. On the other hand, there was little change in the prevalences of low birthweight or of length for age at twelve months. The article that refers this abstract describes the methodology of the study and forthcoming publications will present detailed results.