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

BMC Public Health

Bernardo L Horta⁴  Maj-Lis Follér⁶  Elias Rassi¹  Luiza Garnelo²  Mirian Carvalho de Souza⁵  Andrey Moreira Cardoso⁷  James R Welch⁷  Ricardo Ventura Santos³  Carlos EA Coimbra⁷ 

[1] Departamento de Saúde Coletiva, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 s/n, Goiânia, GO, 74605-050, Brazil;Centro de Pesquisa Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Terezina 476, Manaus, AM, 69057-070, Brazil;Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Quinta da Boa Vista s/n, Rio de Janeiro, RJ, 20940-040, Brazil;Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96001-970, Brazil;Divisão de Epidemiologia, Instituto Nacional de Câncer, Rua dos Inválidos 212, Rio de Janeiro, RJ, 20231-020, Brazil;School of Global Studies, University of Gothenburg, Box 700, Göteborg, SE-405 30, Sweden;Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil

关键词: Child health;    Maternal health;    Epidemiologic measurements;    Health status indicators;    Nutrition surveys;    Health surveys;    Indigenous peoples;    Brazil;   

Others  :  1162627
DOI  :  10.1186/1471-2458-13-52

 received in 2012-06-05, accepted in 2013-01-15,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Coimbra et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Cooke M, Mitrou F, Lawrence D, Guimond E, Beavon D: Indigenous well-being in four countries: an application of the UNDP’s human development index to indigenous peoples in Australia, Canada, New Zealand, and the United States. BMC Int Health Hum Rights 2007, 7:9. BioMed Central Full Text
• [2]Gracey M, King M: Indigenous health. Part 1: determinants and disease patterns. Lancet 2009, 374:65-75.
• [3]Stephens C, Nettleton C, Porter J, Willis R, Clark S: Indigenous peoples’ health - why are they behind everyone, everywhere? Lancet 2005, 366:10-13.
• [4]Torres C: La equidad en materia de salud vista con enfoque étnico. Rev Panam Salud Publica 2001, 10:188-201.
• [5]Montenegro RA, Stephens C: Indigenous health in Latin America and the Caribbean. Lancet 2006, 367:1859-1869.
• [6]Adelson N: The embodiment of inequity: health disparities in aboriginal Canada. Can J Public Health 2005, 96(Sup. 2):S45-S55.
• [7]Marmot M: Social determinants and the health of Indigenous Australians. Med J Aust 2011, 194:512-513.
• [8]Bramley D, Hebert P, Jackson R, Chassin M: Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States. N Z Med J 2004, 117:1-16.
• [9]Pan WK-Y, Erlien C, Bilsborrow RE: Morbidity and mortality disparities among colonist and indigenous populations in the Ecuadorian Amazon. Soc Sci Med 2010, 70:401-411.
• [10]Morrissey M: Poverty and Indigenous health. Health Sociol Rev 2003, 12:17-30.
• [11]UN - United Nations: State of the World’s Indigenous Peoples. New York: Secretariat of the Permanent Forum on Indigenous Issues, Department of Economic and Social Affairs, United Nations; 2009.
• [12]IBGE - Instituto Brasileiro de Geografia e Estatística: Censo Demográfico 2010: Características Gerais dos Indígenas. Resultados do Universo. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2012.
• [13]Hemming J: The Amazon Frontier: the Defeat of the Brazilian Indians. London: MacMillan Press; 1987.
• [14]Davis SH: Victims of the Miracle: Development and the Indians of Brazil. Cambridge: Cambridge University Press; 1977.
• [15]Ribeiro D: Convívio e contaminação: Efeitos dissociativos da depopulação provocada por epidemias em grupos tribais. Sociologia (São Paulo) 1956, 18:3-50.
• [16]Santos RV, Teixeira P: The “indigenous” category in the 2010 Brazilian National Census. Cad Saude Publica 2011, 27:1048-1049.
• [17]Pagliaro H, Azevedo M, Santos RV: Demografia dos povos indígenas no Brasil: Um panorama crítico. In Demografia dos Povos Indígenas no Brasil. Edited by Pagliaro H, Azevedo M, Santos RV. Rio de Janeiro: Editora Fiocruz; 2005:11-32.
• [18]Coimbra CEA Jr, Flowers NM, Salzano FM, Santos RV: The Xavánte in Transition: Health, Ecology, and Bioanthropology in Central Brazil. Ann Arbor: University of Michigan Press; 2002.
• [19]Lourenço AEP, Santos RV, Orellana JDY, Coimbra CEA Jr: Nutrition transition in Amazonia: obesity and socioeconomic change in the Suruí Indians from Brazil. Am J Hum Biol 2008, 20:564-571.
• [20]Welch JR, Ferreira AA, Santos RV, Gugelmin SA, Werneck G, Coimbra CEA Jr: Nutrition transition, socioeconomic differentiation, and gender among adult Xavante Indians, Brazilian Amazon. Hum Ecol 2009, 37:13-26.
• [21]Ferreira AA, Welch JR, Santos RV, Gugelmin SA, Coimbra CEA Jr: Nutritional status and growth of indigenous Xavante children, Central Brazil. Nutr J 2012, 11(1):3. BioMed Central Full Text
• [22]Godoy R, Reyes-García V, Byron E, Leonard WR, Vadez V: The effect of market economies on the well-being of Indigenous peoples and on their use of renewable natural resources. Annu Rev Anthrop 2005, 34:121-138.
• [23]Coimbra CEA Jr, Basta PC: The burden of tuberculosis in indigenous peoples in Amazonia, Brazil. Trans R Soc Trop Med Hyg 2007, 101:635-636.
• [24]Souza-Santos R, Oliveira MVG, Escobar AL, Santos RV, Coimbra CEA Jr: Spatial heterogeneity of malaria in Indian reserves of southwestern Amazonia, Brazil. Int J Health Geogr 2008, 7:55. BioMed Central Full Text
• [25]Cardoso AM, Coimbra CEA Jr, Tavares FG: Hospital morbidity among the Guarani Indians in Southeastern and Southern Brazil. Rev Brasil Epidemiol 2010, 13:21-34.
• [26]Lunardi R, Santos RV, Coimbra CEA Jr: Morbidade hospitalar de indígenas Xavante, Mato Grosso, Brasil (2000–2002). Rev Brasil Epidemiol 2007, 10:441-452.
• [27]Cabral AC, Fé NF, Suárez-Mutis MC, Bóia MN, Carvalho-Costa FA: Increasing incidence of malaria in the Negro River basin, Brazilian Amazon. Trans R Soc Trop Med Hyg 2010, 104:556-562.
• [28]Tavares EF, Vieira-Filho JPB, Andriolo A, Sañudo A, Gimeno SGA, Franco LJ: Metabolic profile and cardiovascular risk patterns of an Indian tribe living in the Amazon Region of Brazil. Hum Biol 2003, 75:31-46.
• [29]Meyerfreund D, Goncalves CP, Cunha RS, Pereira AC, Krieger JE, Mill JG: Age-dependent increase in blood pressure in two different Native American communities in Brazil. J Hypertens 2009, 27:1753-1760.
• [30]Rocha AKS, Bós AJG, Huttner E, Machado DC: Prevalência da síndrome metabólica em indígenas com mais de 40 anos no Rio Grande do Sul, Brasil. Rev Panam Salud Publica 2011, 29:41-45.
• [31]Viacava F: Informações em saúde: A importância dos inquéritos populacionais. Cien Saude Colet 2002, 7:607-621.
• [32]Vasconcellos MTL, Silva PLN, Szwarcwald CL: Sampling design for the World Health Survey in Brazil. Cad Saude Publica 2005, 21(Sup):S89-S99.
• [33]Monteiro CA, Benício MHD, Conde WL, Konno S, Lovadino AL, Barros AJD, Victora CG: Narrowing socioeconomic inequality in child stunting: The Brazilian experience, 1974–2007. Bull World Health Organ 2010, 88:305-311.
• [34]Szwarcwald CL, Andrade CLT, Bastos FI: Income inequality, residential poverty clustering and infant mortality: a study in Rio de Janeiro, Brazil. Soc Sci Med 2002, 55:2083-2092.
• [35]Sousa A, Hill K, Poz MRD: Sub-national assessment of inequality trends in neonatal and child mortality in Brazil. Int J Equity Health 2010, 9:21. BioMed Central Full Text
• [36]Santos LMP, Paes-Sousa R, Miazagi E, Silva TF, Fonseca AMM: The Brazilian Experience with Conditional Cash Transfers: A Successful Way to Reduce Inequity and to Improve Health. Rio de Janeiro: The World Health Organization; 2011:16. [World Conference on Social Determinantes of Health]
• [37]Westphal MF, Zioni F, Almeida MF, Nascimento PR: Monitoring millennium development goals in Brazilian municipalities: Challenges to be met in facing up to inequities. Cad Saude Publica 2011, 27(Sup. 2):S155-S163.
• [38]Coimbra CEA Jr, Santos RV: Saúde, minorias e desigualdade: Algumas teias de inter-relações, com ênfase nos povos indígenas. Cien Saude Colet 2000, 5:125-132.
• [39]San Sebastián M, Hurtig A-K: Review of health research on indigenous populations in Latin America, 1995–2004. Salud Publica Mex 2007, 49:316-320.
• [40]Ministério de Salud y Medio Ambiente de la Nación: Diseño y Realización de la Encuesta de Salud Infantil de los Pueblos Originarios: Informe Final. Buenos Aires: Ministério de Salud y Medio Ambiente de la Nación; 2007.
• [41]Jokisch B, McSweeney K: Assessing the potential of indigenous-run demographic/health surveys: The 2005 Shuar Survey, Ecuador. Hum Ecol 2011, 39:683-698.
• [42]Teixeira P, Brasil M, Silva EM: Demografia de um povo indígena da Amazônia brasileira: Os Sateré-Mawé. Rev Bras Estud Popul 2011, 28:429-448.
• [43]Benavides M, Magrith y Ponce C: Estado de la Niñez Indígena en el Perú. Lima: Instituto Nacional de Estadistica e Informática - INEI/Fondo de las Naciones Unidas para la Infancia - UNICEF; 2010.
• [44]Caldas ADR, Santos RV: Vigilância alimentar e nutricional para os povos indígenas no Brasil: Análise da construção de uma política pública em saúde. Physis 2012, 22:545-565.
• [45]Garnelo L, Macedo G, Brandão LC: Os Povos Indígenas e a Construção das Políticas de Saúde no Brasil. Brasília: Organização Pan-Americana de Saúde; 2003.
• [46]Sousa MC, Scatena JHG, Santos RV: O Sistema de Informação da Atenção à Saúde Indígena (SIASI): Criação, estrutura e funcionamento. Cad Saude Publica 2007, 23:853-861.
• [47]Guimarães FMS: Divisão Regional do Brasil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 1942.
• [48]Lemeshow S, Hosmer D, Klar J, Lwanga SK: Adequacy of Sample Size in Health Studies. Chichester, England: John Wiley & Sons; 1990.
• [49]Ohlsson E: Sequential poisson sampling. J Off Stat 1998, 14:149-162.
• [50]Lohman TG, Roche AF, Martorell R: Anthropometric Standardization Reference Manual. Champaign, Illinois: Human Kinetics; 1988.
• [51]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr: The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003, 289:2560-2571.
• [52]WHO - World Health Organization: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: World Health Organization; 2006.
• [53]WHO - World Health Organization: Iron Deficiency Anaemia Assessment, Prevention and Control. A Guide for Programme Managers. Geneva: World Health Organization; 2001.
• [54]Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003, 26:3160-3167.
• [55]MS - Ministério da Saúde: Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher – PNDS 2006: Dimensões do Processo Reprodutivo e da Saúde da Criança. Brasília: Ministério da Saúde; 2009. [Série G Estatística e Informação em Saúde. Brasília]
• [56]Ricardo CA: A sociodiversidade nativa contemporânea no Brasil. In Povos Indígenas no Brasil 1991/1995. Edited by Ricardo CA. São Paulo: Instituto Socioambiental; 1996:i-xii.
• [57]Abreu MA: European conquest, Indian subjection and the conflicts of colonization: Brazil in the early modern era. GeoJournal 2004, 60:365-373.
• [58]Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JJM: Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis. Lancet Infect Dis 2005, 5:42-52.
• [59]Esrey SA, Habicht J: Epidemiologic evidence for health benefits from improved water and sanitation in developing countries. Epidemiol Rev 1986, 8:117-128.
• [60]Victora CG, Smith PG, Vaughan JP, Nobre LC, Lombardi C, Teixeira AM, Fuchs SC, Moreira LB, Gigante LP, Barros FC: Water supply, sanitation and housing in relation to the risk of infant mortality from diarrhoea. Int J Epidemiol 1988, 17:651-654.
• [61]IBGE - Instituto Brasileiro de Geografia e Estatística: Pesquisa Nacional de Saneamento Básico - 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010.
• [62]Oliveira GF, Oliveira TR, Rodrigues FF, Correa LF, de Arruda TB, Casulari LA: Prevalence of metabolic syndrome in the indigenous population, aged 19 to 69 years, from Jaguapiru Village, Dourados (MS), Brazil. Ethn Dis 2011, 21:301-306.
• [63]IBGE - Instituto Brasileiro de Geografia e Estatística: Pesquisa Nacional por Amostra de Domicílios. Um Panorama da Saúde no Brasil: Acesso e Utilização dos Serviços, Condições de Saúde e Fatores de Risco e Proteção à Saúde - 2008. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2010.
• [64]Orellana JDY, Coimbra CEA Jr, Lourenço AEP, Santos RV: Estado nutricional e anemia em crianças Suruí, Amazônia, Brasil. J Pediatr (Rio J) 2006, 82:383-388.
• [65]Santos RV, Coimbra CEA Jr: Socioeconomic transition and physical growth of Tupí-Mondê Amerindian children of the Aripuanã Park, Brazilian Amazon. Hum Biol 1991, 63:795-819.
• [66]Mondini L, Rodrigues D, Gimeno SGA, Baruzzi RG: Estado nutricional e níveis de hemoglobina em crianças Aruak e Karibe: Povos indígenas do Alto Xingu, Brasil Central, 2001–2002. Rev Brasil Epidemiol 2009, 12:469-477.
• [67]Kühl AM, Corso ACT, Leite MS, Bastos JL: Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil. Cad Saude Publica 2009, 25:409-420.
• [68]Leite MS, Santos RV, Coimbra CEA Jr: Sazonalidade e estado nutricional de populações indígenas: O caso Wari’, Rondônia, Brasil. Cad Saude Publica 2007, 23:2631-2642.
• [69]Monteiro CA, Benício MHA, Konno SC, Silva ACF, Conde WL: Causes for the decline in child under-nutrition in Brazil, 1996–2007. Rev Saude Publica 2009, 43:35-43.
• [70]Victora CG, Bryce J, Fontaine O, Monasch R: Reducing deaths from diarrhoea through oral rehydration therapy. Bull World Health Organ 2000, 78:1246-1255.
• [71]Victora CG: Diarrhea mortality: what can the world learn from Brazil? J Pediatr (Rio J) 2009, 85:3-5.
• [72]Orellana JDY, Basta PC, Santos RV, Coimbra CEA Jr: Morbidade hospitalar em crianças indígenas Suruí menores de dez anos, Rondônia, Brasil: 2000 a 2004. Revista Brasileira de Saúde Materno Infantil 2007, 7:281-287.