[Decline and social inequalities of infant mortality caused by diarrhea]. / Declínio e desigualdades sociais na mortalidade infantil por diarréia.

This ecological study describes the temporal trend from 1977 to 1998, and spatial patterns of infant mortality from diarrhea in the city of Salvador, Bahia State, Brazil. The annual proportional of infant mortality and specific-cause mortality rate were estimated. Spatial units of geographical zones within the city's urban area were utilized for administrative purposes, which were aggregated according to quartile of living conditions indicators. Over the study period, the diarrhea-induced infant mortality rate decreased 91.9%. The mortality risk from diarrhea in the lowest living condition strata was 90% greater than in the highest conditions. Also, infant mortality due to diarrhea increases proportionally as living conditions worsen, which necessitates a review of the control policies concerning this important public health problem. Although the infant mortality rate declined during the study period, social inequalities related to infant mortality due to diarrhea persist, reflecting a continuing poor social development.

[Infant mortality and living conditions: the reproduction of social inequalities in health during the 1990s]. / Mortalidade infantil e condições de vida: a reprodução das desigualdades sociais em saúde na década de 90.

An ecological study was conducted to determine the infant mortality trend from 1991 to 1997 and to analyze its relationship to living conditions in Salvador, Bahia State, Brazil. Inequality patterns in infant death were analyzed by spatial distribution and a compound socioeconomic index. The data showed a decline in the infant mortality rate, with neonatal deaths and perinatal causes playing a growing role. Despite this overall trend, the infant mortality rate increased in 1992, and it was only in 1997 that it returned to the 1991 level. This fact was interpreted as related to worsening living conditions during that period. Spatial distribution highlights the persistence of health inequalities; education was the variable with the most significant correlation rate. When distributed according to the living conditions index (LCI), both the infant mortality rate and proportional infant mortality showed a linear increase from the intermediate stratum (20.4 per mil ) to the lowest (29.3 per mil ) and from the highest stratum (5.3%) to the lowest (13.3%), respectively. The authors conclude that despite the reduction in the total infant mortality rate, the persistence of social inequalities and a social process that hinders improvement of living conditions are responsible for the inequalities observed in infant mortality.

[Violence and social inequalities: mortality rates due to homicides and life conditions in Salvador, Brazil]. / Violência e desigualdade social: mortalidade por homicídios e condições de vida em Salvador, Brasil.

INTRODUCTION: Some studies have been questioning the association between poverty and violence. This study's purpose is to assess the distribution of homicide indicators associated with living conditions in Salvador, Brazil. METHODS: A cluster study for the years 1991 to 1994 was carried out including the 75 data centers of the city of Salvador, BA, Brazil. Using death certificates for the study period, yearly mortality rates and mortality ratios were estimated. The 1991 census data of monthly wages and years of education for all family providers were used to define a four-category variable related to living conditions. Mortality rates due to homicide and the relative risk regarding the lowest living condition area were calculated for each social stratum. The 95% confidence intervals were calculated using the Confidence Interval Analysis software. RESULTS: The highest mortality rates due to homicide were seen in the poorest areas. The relative risk due to homicide for the lowest and the highest living condition areas was statistically significant at 5% level and ranged from 2.9 to 5.1. CONCLUSIONS: The data show a strong association between social inequalities and homicide in this urban area, emphasizing the importance of crime reduction programs.

[Inequalities in mortality, space and social strata]. / Desigualdades na mortalidade, espaço e estratos sociais.

OBJECTIVE: A description of the mortality differentials in Salvador, Bahia, Brazil, is presented. METHODS: An ecological study was carried out. The city was divided into 75 information areas and its population into six social strata. Standardized Mortality Rates, Age Specific Mortality Rates, Proportional Infant Mortality and the Proportional Mortality Ratio were calculated for each region and social strata. Data were obtained from Death Certificates and the Populational Census. RESULTS: The mortality ratio difference between the strata with best living conditions and the poorer strata ranged from 43.1% to 142.0% which corresponds to an inequality ratio ranging from 1.4 to 2.4. When that analysis was carried out in smaller areas, these differences reached 656.3%. CONCLUSIONS: These findings show the persistence of health inequalities in Salvador in more serious disproportion than that found in other studies. Despite the methodological problems related to the nature of the data and the study, project the authors it was highlight, the meaning of this kind of research concerned with new approaches to health planning and health promotion.

[Decrease and inequalities of infant mortality in Salvador, 1980-1988]. / Decréscimo e desigualdade da mortalidade infantil: Salvador, 1980-1988.

This study sought to describe the changes in mortality among infants under one year of age in different areas of the city of Salvador, Bahia, during the period 1980-1988. This was done using estimates of variation in two indicators: proportional infant mortality and the coefficient of infant mortality. Values for the first indicator were separated into low, intermediate, high, and very high quartiles for 1980 and then calculated again using 1988 data. The second indicator was derived from the estimated number of live births using the rate of 33.4/1,000 inhabitants for 1980 and 31.4/1,000 for the years thereafter. The results showed that infant mortality in that age group had declined over the period, but that at the end of the period inequalities persisted in the distribution of infant deaths, which confirmed that conditions remained adverse for certain segments of the population.

Decline and unevenness of infant mortality in Salvador, Brazil, 1980-1988.

Data relating to infant mortality in Salvador, Brazil, were analyzed in order to determine how infant mortality evolved in various parts of the city during the period 1980-1988. This analysis showed sharp drops in the numbers of infant deaths, proportional infant mortality (infant deaths as a percentage of total deaths), and the infant mortality coefficient (infant deaths per thousand live births) during the study period despite deteriorating economic conditions. It also suggested that while these declines occurred throughout the city, the overall distribution of infant mortality in different reporting zones remained uneven. Among other things, these findings call attention to a need for further investigation of the roles played by various health measures (including immunization, control of respiratory and diarrheal diseases, encouragement of breast-feeding, and monitoring of growth and development) and of reduced fertility (resulting from birth spacing, use of contraceptives, and female sterilization) in bringing about declines in infant mortality during hard economic times.

PIP: Infant mortality has declined since the 1940s in the Americas and specifically in Brazil. Infant mortality in Brazil was 65 deaths/1000 live births regardless of the recession. The aim of this study was to determine the patterns of change in infant mortality in 76 reporting zones in Salvador, Brazil, between 1980 and 1988, based on death records and decedent's place of residence. Data were analyzed in terms of changes in proportional infant mortality and the infant mortality coefficient. Quartiles were set at low (3.9 to 17.1 deaths/100 total deaths), intermediate (17.9 to 25.8), and high (37.5 to 52.5). Averages of each quartile were computed for 1980 and 1988 and compared. Live birth rates were used in computing the infant mortality coefficients; deaths/1000 live births were grouped by low, intermediate, and high, and average values calculated for 1980 and 1988. The problems of distortion in using these data are discussed. The results show declines in proportional infant mortality from 17.4% to 30.8% of total mortality and in infant mortality coefficients from 71.9 to 31.6 deaths/1000 live births. Proportional infant mortality declined by 43.5% between 1980 and 1988; the coefficient of infant mortality decreased by 56.1% for the same period. The absolute number of deaths also declined. In the quartile analysis, the rates of decline were greatest for intermediate, high, and very high proportional infant mortality and for the coefficient of infant mortality. There was also uneven distribution of deaths in different quartiles. The geographic location of reporting zones is visually displayed; it is apparent that there were few very high zones in 1988 and a sharp reduction in high zones for proportional infant mortality. The map of average infant mortality coefficients shows marked declines in very high zones; there were increases in areas with low and intermediate coefficients. Suggestions for additional research were to evaluate a longer time series and to analyze the influence of socioeconomic change on the declines.

Spatial distribution of proportional infant mortality and certain socioeconomic variables in Salvador, Bahia, Brazil.

PIP: The spatial distribution of infant deaths in each zone of the city of Salvador, Brazil, in 1980 was examined and related to selected socioeconomic and health care variables. The spatial distribution of infant mortality (defined as the ratio of infant deaths to total deaths in Salvador) was uneven, ranging from 3.9% in a zone in the center of the old city near the water to 52.5% in an outlying area. There was a direct correlation between proportional infant mortality and low income. The proportion of low-income families was 23.1% in the quartile containing the lowest rates of infant mortality compared with 97.7% in the quartile containing the highest such rates. Also noted was an inverse relationship between proportional infant mortality and water consumption. Similarly, the percentage of substandard housing (shacks) was directly associated with infant mortality, rising from 2% in the 1st quartile (low infant mortality) to 43% in the 4th quartile. There was additionally an inverse correlation between the average number of physicians per inhabitant and proportional infant mortality, with a rate of 5.7/10,000 inhabitants in the 1st quartile compared with 1.8 in the 4th. Overall, analysis of the spatial distribution of infant deaths in Salvador reveals that an especially high proportion of those dying were infants residing in certain zones of the city, most notably outlying neighborhoods and slums. The results further point to an important association between certain socioeconomic and sanitation variables and infant mortality. The fact that the highest correlation coefficient found in the present study was between proportional infant mortality and the percentage of low-income families underscores the significant role that economic structure plays in infant mortality. There is a need both to redefine the urban development model prevailing in Latin America and to reorient the aims of the health sector.^ieng

O movimento pelo planejamento de saúde na América Latina / The movement for health planning in Latin America

Descreve-se o desenvolvimento de concepções e técnicas do planejamento de saúde na América Latina, procurando discutir alguns determinantes sociais da sua emergência nesses países e da sua incorporação pelo Estado através de politicas sociais planificadas do planejamento.. descreve quatro momentos para o planejamento de saúde na América Latina. O primeiro caracteriza-se pela elaboração de técnicas como é o caso da CENDES/OPS. No segundo, ocorre uma difusão do processo de planejamento e uma autocrítica quando os planos nacionais de saúde foram considerados documentos que nunca se implementaram. O terceiro momento envolve a revisão das deficiências metodológicas e a ênfase sobre sobre os aspectos organizacionais (sistêmicos) e políticos do objeto do planejamento. Finalmente, o quarto momento corresponde à segunda metade da década de 70, quando foram elaborados guias para formulação de politicas de saúde. Conclui-se que na atual conjuntura o planejamento de saúde tem encontrado seu espaço de viabilidade no âmbito das chamadas "politicas racionalizadoras". O seu desenvolvimento dependera da redefinição das relações sociais de produção e das forma históricas de resolução dos conflitos de classe.