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Identifying and classifying poor and rich groups in cities depends on several factors. Using data from available nationally representative surveys from 38 sub-Saharan African countries, we aimed to identify, through different poverty classifications, the best classification in urban and large city contexts. Additionally, we characterized the poor and rich groups in terms of living standards and schooling. We relied on absolute and relative measures in the identification process. For absolute ones, we selected people living below the poverty line, socioeconomic deprivation status and the UN-Habitat slum definition. We used different cut-off points for relative measures based on wealth distribution: 30%, 40%, 50%, and 60%. We analyzed all these measures according to the absence of electricity, improved drinking water and sanitation facilities, the proportion of children out-of-school, and any household member aged 10 or more with less than 6 years of education. We used the sample size, the gap between the poorest and richest groups, and the observed agreement between absolute and relative measures to identify the best measure. The best classification was based on 40% of the wealth since it has good discriminatory power between groups and median observed agreement higher than 60% in all selected cities. Using this measure, the median prevalence of absence of improved sanitation facilities was 82% among the poorer, and this indicator presented the highest inequalities. Educational indicators presented the lower prevalence and inequalities. Luanda, Ouagadougou, and N'Djaména were considered the worst performers, while Lagos, Douala, and Nairobi were the best performers. The higher the human development index, the lower the observed inequalities. When analyzing cities using nationally representative surveys, we recommend using the relative measure of 40% of wealth to characterize the poorest group. This classification presented large gaps in the selected outcomes and good agreement with absolute measures.
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Characterizing the timing of menarche and the factors that are associated with it is important for understanding a population's reproductive health needs and long-term health trajectories. We estimated the age at the menstrual onset among adolescent girls and the association between dietary and nutritional factors and menarche in four sub-Saharan African urban sites. We used cross-sectional school-based data from 2307 female adolescents aged 10-14 years collected by the Africa Research, Implementation Science, and Education (ARISE) Network in Ouagadougou, Burkina Faso; Addis Ababa, Ethiopia; Khartoum, Sudan; and Dar es Salaam, Tanzania. Logit models were used to estimate the median age at menarche at each site. Associations between menarche and BMI-for-age, stunting, dietary quality and food insecurity across settings were assessed using Poisson regression models adjusted for country and school levels. The estimated median age at menarche was 13.1 years (95% confidence interval: 12.7, 13.5) in Ouagadougou; 12.9 (12.6, 13.2) in Addis Ababa; 13.3 (12.7, 13.6) in Khartoum; and 13.2 (12.3, 14.0) in Dar es Salaam. Between 18% and 49% of the girls in each setting had already menstruated. Based on the pooled multivariable models, underweight participants were 42% less likely (adjusted prevalence ratio [PR] 0.58 [0.44, 0.77]) to have experienced menarche in comparison to normal-weight individuals. The likelihood of experiencing menarche increased for overweight [PR 1.47 (1.30,1.66)] and obese [PR 1.57 (1.35,1.82)] in comparison to normal-weight girls. Those stunted were 47% less likely to have experienced menarche [PR 0.53 (0.41, 0.69)] than their nonstunted counterparts. A lower likelihood of menarche among those experiencing moderate/severe hunger when compared to those with no/little hunger was also observed (PR 0.78 [0.63,0.96]). No evidence of association with dietary quality was found. Further research is needed to strengthen the body of evidence and inform evidence-based initiatives in low- and middle-income settings.
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Rapid urbanization is likely to be associated with suboptimal access to essential health services. This is especially true in cities from sub-Saharan Africa (SSA), where urbanization is outpacing improvements in infrastructure. We assessed the current situation in regard to several markers of maternal, newborn, and child health, including indicators of coverage of health interventions (demand for family planning satisfied with modern methods, at least four antenatal care visits (ANC4+), institutional birth, and three doses of DPT vaccine[diphtheria, pertussis and tetanus]) and health status (stunting in children under 5 years, neonatal and under-5 mortality rates) among the poor and non-poor in the most populous cities from 38 SSA countries. We analyzed 136 population-based surveys (year range 2000-2019), contrasting the poorest 40% of households (referred to as poor) with the richest 60% (non-poor). Coverage in the most recent survey was higher for the city non-poor compared to the poor for all interventions in virtually all cities, with the largest median gap observed for ANC4+ (13.5 percentage points higher for the non-poor). Stunting, neonatal, and under-5 mortality rates were higher among the poor (7.6 percentage points, 21.2 and 10.3 deaths per 1000 live births, respectively). The gaps in coverage between the two groups were reducing, except for ANC4, with similar median average annual rate of change in both groups. Similar rates of change were also observed for stunting and the mortality indicators. Continuation of these positive trends is needed to eliminate inequalities in essential health services and child survival in SSA cities.
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BACKGROUND: Obesity, a complex public health problem, is generally associated with other chronic diseases. The association of obesity with health service utilization has been little investigated in low- and middle-income countries. This study aimed to analyze the association between obesity and health service utilization (considering those services related to hypertension and/or diabetes). METHODS: A cross-sectional, nationally-representative, study of Brazilians aged ≥18 years was conducted. Data from the National Health Survey (2013) for 59,402 individuals were analyzed, including measured weight and height. The association between body mass index (BMI) category (under/normal weight, overweight, and obesity) and health service utilization due to hypertension and/or diabetes was investigated using Poisson regression models (crude and adjusted). To analyze the health services utilization, the following variables were considered: 1) routine visits to a general doctor or health service; 2) referrals/consultations with a specialist; 3) prescribed exams done; and 4) hospital admission due to the disease or related complication. All analyses were stratified by sex. RESULTS: Compared with under/normal-weight individuals, subjects with obesity (both male and female) made roughly double the use of all health care services assessed. Men with hypertension that had obesity had a higher risk of hospital admission (adjusted PR = 2.55; 95%CI 1.81-3.61), than those with under/normal weight. Women with diabetes that had obesity had more referrals/consultations with specialists (adjusted PR = 2.56; 95%CI 1.94-3.38), than those with under/normal weight. CONCLUSIONS: The presence of obesity was associated with increased use of health care services for hypertension and/or diabetes, indicating greater demand for human resources and materials, and a greater burden on the national health system.
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Diabetes Mellitus , Hipertensão , Adolescente , Adulto , Índice de Massa Corporal , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Obesidade/terapia , PrevalênciaRESUMO
BACKGROUND: Non-biological childhood mortality sex ratios may reflect community sex preferences and gender discrimination in health care. OBJECTIVE: We assessed the association between contextual factors and gender bias in under-five mortality rates (U5MR) in low- and middle-income countries. METHODS: Full birth histories available from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (2010-2018) in 80 countries were used to estimate U5MR male-to-female sex ratios. Expected sex ratios and their residuals (difference of observed and expected) were derived from a linear regression model, adjusted for overall mortality. Negative residuals indicate more likelihood of discrimination against girls, and we refer to this as a measure of potential gender bias. Associations between residuals and national development and gender inequality indices and with survey-derived child health care indicators were tested using Spearman's correlation. RESULTS: Mortality residuals for under-five mortality were not associated with national development, education, religion, or gender inequality indices. Negative residuals were more common in countries where boys were more likely to be taken to health services than girls (rho -0.24, 95% confidence interval -0.45, -0.01). CONCLUSIONS: Countries where girls were more likely to die than boys, accounting for overall mortality levels, were also countries where boys were more likely to receive health care than girls. Further research is needed to understand which national characteristics explain the presence of gender bias, given that the analyses of development levels and gender equality did not discriminate between countries with or without excess mortality of girls. Reporting on child mortality separately by sex is required to enable such advances.
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Países em Desenvolvimento , Razão de Masculinidade , Criança , Escolaridade , Feminino , Humanos , Renda , Lactente , Masculino , SexismoRESUMO
OBJECTIVE: To assess whether the observed prevalence of the double burden of malnutrition (DBM) would be higher than expected on the basis of chance, through analyses at national, wealth quintile and individual child levels. DESIGN: We selected nationally representative surveys from low- and middle-income countries (LMIC) carried out since 2005 with anthropometric measures on children under 5 years of age. Household wealth was assessed through asset indices. The expected prevalence of DBM was estimated by multiplying the prevalence of stunting (low height/length for age) and overweight (high weight for height/length). The WHO recommended cut-offs (20% for stunting and 10% for overweight) that were used to define DBM at national level. DBM at individual level was defined as co-occurrence of stunting and overweight in the same child. SETTING: Nationally representative surveys from ninety-three LMIC. PARTICIPANTS: A total of 825 633 children were studied. RESULTS: DBM at national level was observed in five countries, whereas it would be expected to occur in eleven countries. Six countries did not present evidence of DBM at national level but did so in at least one wealth quintile. At individual level, thirty countries (32·3%) showed higher prevalence of DBM than would be expected, but most differences were small except for Syria, Azerbaijan, Albania and Egypt. CONCLUSIONS: The observed number of countries or socio-economic subgroups within countries with the DBM using recommended thresholds was below what would be expected by chance. However, individual-level analyses showed that one-third of countries presented higher prevalence of DBM than would be expected.
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Países em Desenvolvimento , Desnutrição , Criança , Pré-Escolar , Humanos , Desnutrição/epidemiologia , Sobrepeso/epidemiologia , Pobreza , PrevalênciaRESUMO
BACKGROUND: While assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences. METHODS: We performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology. RESULTS: From the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods - from simple averages to sophisticated modeling - to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels. CONCLUSION: Studies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.
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Mortalidade da Criança , Sexismo , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Mortalidade Infantil , Tábuas de Vida , Masculino , Mortalidade , Caracteres SexuaisRESUMO
OBJECTIVE: To analyse the association between food store type and the consumption of ultra-processed products in Brazil. DESIGN: Data from the 2008-2009 Household Budget Survey involving a probabilistic sample of 55 970 Brazilian households. Food stores were grouped into nine categories. Foods and drinks were grouped according to characteristics of food processing. The contribution of each food store type to the total energy acquired from each food processing group, and according to quintiles of consumption of ultra-processed products, was estimated. Exploratory factor analysis was conducted to identify a pattern of food store usage. Linear regression models were performed to estimate the relationship between the purchase pattern and the consumption of ultra-processed products. RESULTS: In line with their larger market share, supermarkets accounted for 59 % of total energy and participated most in acquisition for three food groups, with emphasis on ultra-processed products (60·4 % of energy). The participation of supermarkets in total purchase tended to increase in populations with higher consumption of ultra-processed products, while the participation of small markets and small producers tended to decrease. The purchase pattern characterized by use of traditional retail (street fairs and vendors, small markets, small farmers, butcheries) was associated with a smaller consumption of ultra-processed products. CONCLUSIONS: Food policies and interventions aiming to reduce the consumption of ultra-processed products should consider the influence of supermarkets on the consumption of these products. A purchase pattern based on traditional retail constitutes an important tool for promoting healthy eating in Brazil.
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Bebidas/economia , Comportamento do Consumidor/economia , Dieta/economia , Fast Foods/economia , Abastecimento de Alimentos/classificação , Brasil , Orçamentos , Características da Família , Manipulação de Alimentos , Comportamentos Relacionados com a Saúde , Humanos , Valor Nutritivo , Análise de Componente Principal , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries. METHODS: A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies. DISCUSSION: This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.
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Análise Custo-Benefício , Proteínas Alimentares , Suplementos Nutricionais , Estado Nutricional , Cuidado Pré-Natal , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Gravidez , Feminino , Etiópia , Adulto , Cuidado Pré-Natal/métodos , Adulto Jovem , Adolescente , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Ganho de Peso na Gestação , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Resultado do Tratamento , Fenômenos Fisiológicos da Nutrição Materna , Fatores de TempoRESUMO
Changes in the food system are associated with the increase in consumption of foods with low nutritional value in recent decades. Data on food purchasing for household consumption, collected from the Instituto Brasileiro de Geografia e Estatística (IBGE--Brazilian Institute of Geography and Statistics) Household Budget Survey (HBS) in 2002-3, were used to describe the contribution of food purchasing sites (FPS) to the diet of Brazilian families. All the 241 distinct FPS mentioned in the HBS were grouped into ten categories, according to the nature of the products available. Food acquisitions were organized into seven groups. Supermarkets and hypermarkets accounted for 49% of the acquisitions and were the main source of six out of the seven food groups. Street markets and greengroceries stood out in the acquisitions of fruits and vegetables, accounting for 39% of this market. The large contribution of supermarkets and hypermarkets to the diet shows the need for healthy eating promotion policies aiming at these locations. Street markets and greengroceries represent important allies for healthy eating.
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Comportamento Alimentar , Abastecimento de Alimentos/economia , Alimentos Orgânicos/economia , Promoção da Saúde/economia , Animais , Brasil , Orçamentos , Dieta/economia , Dieta/estatística & dados numéricos , Grão Comestível/economia , Abastecimento de Alimentos/estatística & dados numéricos , Alimentos Orgânicos/estatística & dados numéricos , Frutas/economia , Promoção da Saúde/estatística & dados numéricos , Humanos , Carne/economia , Leite/economia , Óleos/economia , Fatores Socioeconômicos , Verduras/economiaRESUMO
Background: Quantifying women's empowerment has become the focus of attention of many international organizations and scholars. We aimed to describe quantitative indicators of women's empowerment that are based on individual-level data. Methods: In this scoping review, we searched PubMed, Scopus, Web of Science, Science Direct, Google, and Google Scholar for publications describing the operationalization of measures of women's empowerment. Results: We identified 36 studies published since 2004, half of them since 2019, and most from low- and middle-income countries. Twelve studies were based on data from the Demographic and Health Surveys and used 56 different variables from the questionnaires (ranging from one to 25 per study) to measure the overall empowerment of women 15-49 years. One study focused on rural women, two included married and unmarried women, and one analyzed the couple's responses. Factor analysis and principal component analysis were the most common approaches used. Among the 24 studies based on other surveys, ten analyzed overall empowerment, while the others addressed sexual and reproductive health (4 studies), agriculture (3) and livestock (1), water and sanitation (2), nutrition (2), agency (1), and psychological empowerment (1). These measures were mainly based on data from single countries and factor analysis was the most frequently analytical method used. We observed a diversity of indicator definitions and domains and a lack of consensus in terms of what the proposed indicators measure. Conclusion: The proposed women's empowerment indicators represent an advance in the field of gender and development monitoring. However, the empowerment definitions used vary widely in concept and in the domains/dimensions considered, which, in turn influence or are influenced by the adopted methodologies. It remains a challenge to find a balance between the need for a measure suitable for comparisons across populations and over time and the incorporation of country-specific elements.
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Objectives: To assess social determinants of stunting and the shifts in contributions of socio-demographic factors to national prevalence trends in India between 2005 and 2021. Methods: We leveraged data from three rounds of the National Family Health Survey (NFHS-3: 2005-2006, NFHS-4: 2015-2016, NFHS-5: 2019-2021) for 443 038 children under 5 years. Adjusted logistic regression models and a Kitigawa-Oaxaca-Blinder decomposition were deployed to examine how wealth, residence, belonging to a marginalised social group, maternal education and child sex contributed to changes in stunting prevalence. Results: The decrease in stunting prevalence was notably slower between NFHS-4 and NFHS-5 (annual average rate of reduction (AARR): 1.33%) than between NFHS-3 and NFHS-4 (AARR: 2.20%). The protective effect of high wealth diminished from 2015 onwards but persisted for high maternal education. However, an intersection of higher household wealth and maternal education mitigated stunting to a greater extent than either factor in isolation. Residence only predicted stunting in 2005-2006 with an urban disadvantage (adjusted OR: 1.18; 95% CI: 1.07 to 1.29). Children from marginalised social groups displayed increased likelihoods of stunting, from 6-16% in 2005-2006 to 11-21% in 2015-2016 and 2020-2021. Being male was associated with 6% and 7% increased odds of stunting in 2015-2016 and 2019-2021, respectively. Increased household wealth (45%) and maternal education (14%) contributed to decreased stunting prevalence between 2005 and 2021. Conclusions: Stunting prevalence in India has decreased across social groups. However, social disparities in stunting persist and are exacerbated by intersections of low household wealth, maternal education and being from a marginalised social group. Increased survival must be accompanied by needs-based interventions to support children and mitigate mutually reinforcing sources of inequality.
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BACKGROUND: Latin America and the Caribbean present the second highest adolescent fertility rate in the world, only after sub-Saharan Africa, and have reached the third position globally in the incidence of motherhood in adolescence. We aimed to explore trends and inequities in adolescent childbearing in the region. METHODS: We used nationally representative household surveys from Latin American and Caribbean countries to address trends in early childbearing (proportion of women having their first livebirth before age 18 years) over generations and in adolescent fertility rates (AFRs; livebirths per 1000 women aged 15-19 years) over time. For early childbearing, we analysed the most recent survey conducted since 2010 from 21 countries (2010-20); for AFR, we analysed nine countries with two or more surveys, with the most recent being conducted from 2010 onwards. For both indicators, variance-weighted least-square regression was used to estimate the average absolute changes (AACs) at the national level and by wealth (bottom 40% vs top 60%), urban versus rural residence, and ethnicity. FINDINGS: Among 21 countries studied, we noted a decrease in early childbearing along generations in 13 of them, with declines varying from -0·6 percentage points (95% CI -1·1 to -0·1) in Haiti to -2·7 percentage points (-4·0 to -1·4) in Saint Lucia. We observed increases over generations in Colombia (1·2 percentage points [0·8 to 1·5]) and Mexico (1·3 percentage points [0·5 to 2·0]) and no changes in Bolivia and Honduras. The fastest early childbearing decline occurred among rural women, whereas no clear pattern was observed for wealth groups. Decreasing estimates from oldest to youngest generations were found among Afro-descendants and non-Afro-descendant and non-indigenous groups, but results were mixed for indigenous people. All nine countries with data for AFR presented reductions over time (-0·7 to -6·5 births per 1000 women per year), with the steepest declines observed in Ecuador, Guyana, Guatemala, and the Dominican Republic. In general, adolescents in rural areas and the poorest adolescents had the largest reductions in AFR. If current trends persist, by 2030 most countries will present AFR values ranging between 45 and 89 births per 1000 women, with notable wealth-related inequalities. INTERPRETATION: Our results indicate a reduction in AFR in Latin American and Caribbean countries that was not necessarily accompanied by a decrease in early childbearing overall. Large inequalities both between countries and within countries were observed, with no clear reduction over time. Understanding trends in adolescent childbearing and its determinants is essential for planning and designing programmes to ensure the desired reductions in rates and gaps across population subgroups. FUNDING: PAHO, Bill & Melinda Gates Foundation, and Wellcome Trust. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
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Etnicidade , População Rural , Humanos , Adolescente , Feminino , América Latina/epidemiologia , Região do Caribe/epidemiologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate food consumption in Brazil by race/skin color of the population. METHODS: Food consumption data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Survey) 2017-2018 were analyzed. Food and culinary preparations were grouped into 31 items, composing three main groups, defined by industrial processing characteristics: 1 - in natura/minimally processed, 2 - processed, and 3 - ultra-processed. The percentage of calories from each group was estimated by categories of race/skin color - White, Black, Mixed-race, Indigenous, and Yellow- using crude and adjusted linear regression for gender, age, schooling, income, macro-region, and area. RESULTS: In the crude analyses, the consumption of in natura/minimally processed foods was lower for Yellow [66.0% (95% Confidence Interval 62.4-69.6)] and White [66.6% (95%CI 66.1-67.1)] groups than for Blacks [69.8% (95%CI 68.9-70.8)] and Mixed-race people [70.2% (95%CI 69.7-70.7)]. Yellow individuals consumed fewer processed foods, with 9.2% of energy (95%CI 7.2-11.1) whereas the other groups consumed approximately 13%. Ultra-processed foods were less consumed by Blacks [16.6% (95%CI 15.6-17.6)] and Mixed-race [16.6% (95%CI 16.2-17.1)], with the highest consumption among White [20.1% (95%CI 19.6-20.6)] and Yellow [24.5% (95%CI 20.0-29.1)] groups. The adjustment of the models reduced the magnitude of the differences between the categories of race/skin color. The difference between Black and Mixed-race individuals from the White ones decreased from 3 percentage points (pp) to 1.2 pp in the consumption of in natura/minimally processed foods and the largest differences remained in the consumption of rice and beans, with a higher percentage in the diet of Black and Mixed-race people. The contribution of processed foods remained approximately 4 pp lower for Yellow individuals. The consumption of ultra-processed products decreased by approximately 2 pp for White and Yellow groups; on the other hand, it increased by 1 pp in the consumption of Black, Mixed-race, and Indigenous peoples. CONCLUSION: Differences in food consumption according to race/skin color were found and are influenced by socioeconomic and demographic conditions.
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Fast Foods , Pigmentação da Pele , Humanos , Brasil , Ingestão de Energia , Dieta , Inquéritos sobre Dietas , Manipulação de AlimentosRESUMO
Objective: To evaluate changes in socioeconomic inequalities in food consumption in Brazil over a 10-year period. Methods: Data on 24-h recalls of adults (aged 20 years or more) from the 2008/9 (n = 26,327) and 2017/8 (n = 37,689). Brazilian Dietary Survey were analyzed. We used the Nova classification system to group food items and estimate the percentage of total energy from ultra-processed foods and plant-based natural or minimally processed foods. For sex and area of residence, we calculated the percentage points (p.p.) difference between the estimates for women and men, and rural and urban populations. Negative values indicate higher consumption among men or urban residents, positive values indicate higher consumption among women or rural residents, and zero indicates equality. For education and wealth levels we calculated the slope index of inequality (SII). The SII varies from -100 to 100, with positive values indicating higher consumption among more educated or wealthiest groups, negative values indicating higher consumption among less educated or poorest groups, and zero equality. Results: Over the period, we observed a reduction in the percentage of total energy from plant-based natural/minimally processed foods from 13.0 to 12.2% and an increase in that of ultra-processed foods from 17.0 to 18.3%. The urban population and those in the wealthier and more educated groups presented higher consumption of ultra-processed foods and lower consumption of plant-based natural/minimally processed foods in both survey years. Over the 10-year period, there was an overall reduction of the socioeconomic inequalities, mainly explained by the greater increase in ultra-processed food consumption by the rural population and those from the poorest and less educated groups (difference for area -7.2 p.p. in 2008/9 and -5.9 p.p. in 2017/8; SII for education 17.7 p.p. in 2008/9 and 13.8 p.p. in 2017/8; SII for wealth 17.0 p.p. in 2008/9 and 11.2 p.p. in 2017/8). Conclusion: Socioeconomic inequalities in food consumption decreased in Brazil, but it may lead to the overall deterioration of the dietary quality of the more vulnerable groups.
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Background: Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. Methods: Using national household surveys (2011-2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. Findings: Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. Interpretation: Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. Funding: Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.
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INTRODUCTION: Although boys tend to be more affected by linear growth faltering than girls, little is known about sex differences across distinct age groups. We aimed to compare sex differences in linear growth throughout the first 5 years of life among children from low-income and middle-income countries. METHODS: We analysed 87 cross-sectional Demographic and Health Surveys and Multiple Cluster Indicator Surveys (2010-2019). Growth was expressed as height-for-age z-scores (HAZ) based on the 2006 WHO Growth Standards. Sex-specific means were estimated for each country and results were pooled through random-effects meta-analysis for all children and by 12-month age groups. Using linear regression, we assessed the association between sex differences in HAZ and gross domestic product as a proxy for national economic development. RESULTS: Boys presented lower mean HAZ than girls in the first 30 months. Sex differences were mostly absent between 30 and 45 months, and in several countries, girls had lower HAZ at ages over 45 months. The pooled sex difference (boys minus girls) for the whole sample was -0.10 (95% CI -0.12 to -0.08). The difference was -0.17 (95% CI -0.20 to -0.14) at 0-11 months and -0.22 (95% CI -0.25 to -0.19) at 12-23 months. This was followed by a narrowing of the sex gap to -0.10 (95% CI -0.13 to -0.07) and -0.04 (95% CI -0.07 to -0.01) among children aged 24-35 and 36-47 months, respectively. At 48-59 months, there was evidence of female disadvantage; the mean height-for-age of boys was 0.02 (95% CI 0.00 to 0.05) SDs higher than for girls. Ecological analyses showed that in all age groups, male disadvantage decreased with increasing national income, and this was no longer present for the 4-year-old children, particularly in wealthier countries. CONCLUSION: Male disadvantage in linear growth is most evident in the first years, but by the age of 4 years, the sex gap has mostly disappeared, and in some countries, the gap has been reversed.
Assuntos
Países em Desenvolvimento , Renda , Estatura , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , PobrezaRESUMO
The scope of this study was to describe the consumption of fruit in Brazil and its association with the intake of ultra-processed (UP) foods in a representative sample of 32,900 individuals from the 2008-2009 Household Budget Survey. The association between calory contribution of fruit to the diet and quintiles of UP food intake was analyzed using linear regression. Fruit accounted for just over 5% of the calories, about half of which (2.4%) was in the form of juice. Men revealed lower consumption than women, and consumption increased with increasing age, income, and schooling. An inverse association between consumption of whole fruits and UP food was observed. Among the individuals who reported consuming fruit (68%), there was little diversity (mean: 1.16 types/day). The fruit most consumed included orange, banana, and apple. Whole fruit was consumed mainly at lunchtime and as snacks. The consumption was inversely associated with UP food intake at lunch, afternoon snack, and dinner. Juices were consumed mainly at lunchtime and did not vary with UP food intake. Higher fruit consumption outside the home occurred in all quintiles of UP food intake. Low fruit intake in Brazil and the association with UP consumption highlight the need for initiatives to promote healthy eating.
O objetivo deste estudo foi descrever o consumo de frutas no Brasil e a associação com a ingestão de alimentos ultraprocessados (UP) em amostra representativa de 32.900 brasileiros da Pesquisa de Orçamentos Familiares 2008-2009. A associação entre a participação calórica (% energia) das frutas na dieta e quintos de consumo de UP foi analisada por meio de regressão linear. Frutas representaram 5% das calorias, sendo cerca de metade (2,4%) como suco. Homens apresentaram consumo inferior ao das mulheres e houve maior consumo com aumento da idade, renda e escolaridade. Foi observada associação inversa entre consumo de frutas inteiras e UP. Dentre os indivíduos que consumiram frutas (68%) houve pouca diversidade (média: 1,16 tipos/dia). As frutas mais consumidas foram laranja, banana e maçã. Consumiu-se frutas inteiras principalmente nos horários de almoço e lanches e o consumo foi inversamente associado com a ingestão de UP no almoço, lanche da tarde e jantar. Os sucos foram mais consumidos no almoço e não variaram com o consumo de UP. Maior consumo de frutas fora do domicílio se repetiu em todos os quintos de UP. A baixa ingestão de frutas no Brasil e a associação com UP reforçam a necessidade de iniciativas de promoção da alimentação saudável.
Assuntos
Ingestão de Energia , Frutas , Brasil , Estudos Transversais , Dieta , Ingestão de Alimentos , Comportamento Alimentar , Feminino , Humanos , MasculinoRESUMO
We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.
Revisamos a produção sobre saúde materna e de crianças menores de dez anos disseminada pela Revista Ciência & Saúde Coletiva, através de revisão sistemática de publicações dos últimos 25 anos, com foco em estudos quantitativos. Características de autores e populações sob estudo, eixos temáticos e metodologia são descritos. Foram selecionadas 170 publicações classificadas em 12 temas. Gestação, parto ou puerpério foram objeto de 47 estudos, seguidos de avaliação antropométrica (29 artigos), amamentação (24) e mortalidade (13). Os trabalhos selecionados representaram 3,5% do total de artigos originais publicados pela Revista desde 1996, com tendência crescente, constituindo cerca de 5% das publicações em 2015-2020. As principais fontes de dados foram registros de serviços de saúde, sistemas de informação e inquéritos populacionais. O delineamento transversal foi utilizado em 113 dos 170 artigos e 70% destes abrangeram apenas um município. As Regiões Sudeste e Nordeste foram alvo da maioria dos estudos, sendo a Região Norte a menos representada. As publicações refletem a complexidade de temas que perpassam a saúde materna e da criança, com especial foco na importância do Sistema Único de Saúde e demonstrando como dados em acesso aberto podem contribuir para a pesquisa em Saúde Coletiva.
Assuntos
Saúde da Criança , Saúde Pública , Adulto , Brasil , Criança , Estudos Transversais , Coleta de Dados , Feminino , Humanos , GravidezRESUMO
BACKGROUND: Although religious affiliation has been identified as a potential barrier to immunization in some African countries, there are no systematic multi-country analyses, including within-country variability, on this issue. We investigated whether immunization varied according to religious affiliation and sex of the child in sub-Saharan African (SSA) countries. METHODS: We used data from 15 nationally representative surveys from 2010 to 2016. The major religious groups were described by country in terms of wealth, residence, and education. Proportions of fully immunized and unvaccinated children were stratified by country, maternal religion, and sex of the child. Poisson regression with robust variance was used to assess whether the outcomes varied according to religion, with and without adjustment for the above cited sociodemographic confounders. Interactions between child sex and religion were investigated. RESULTS: Fifteen countries had >10% of families affiliated with Christianity and >10% affiliated with Islam, and four also had >10% practicing folk religions. In general, Christians were wealthier, more educated and more urban. Nine countries had significantly lower full immunization coverage among Muslims than Christians (pooled prevalence ratio = 0.81; 95%CI: 0.79-0.83), of which seven remained significant after adjustment for confounders (pooled ratio = 0.90; 0.87-0.92). Four countries had higher coverage among Muslims, of which two remained significant after adjustment. Regarding unvaccinated children, six countries showed higher proportions among Muslims, all of which remained significant after adjustment [crude pooled ratio = 1.83 (1.59-2.07); adjusted = 1.31 (1.14-1.48)]. Children from families practicing folk religions did not show any consistent patterns in immunization. Child sex was not consistently associated with vaccination. CONCLUSION: Muslim religion was associated with lower vaccine coverage in several SSA countries, both for boys and girls. The involvement of religious leaders is essential for increasing immunization coverage and supporting the leave no one behind agenda of the Sustainable Development Goals.