Causes for the decline in child undernutrition in Brazil, 1996-2007

OBJECTIVE: To describe the evolution of prevalence of under-nutrition among Brazilian underfives between 1996 and 2007, and to identify major factors responsible for this evolution. METHODS: Data analyzed are from two Demographic Health Surveys carried out in Brazil in 1996 and 2006/7 based on probabilistic samples of roughly 4 thousand children under five years of age. Identification of factors responsible for temporal variation in prevalence of under-nutrition (height-for-age below -2 Z-scores; WHO 2006 standard) took into account changes in the distribution of four potential determinants of nutritional status. Statistical modeling of the independent association between these determinants and risk of under-nutrition, and calculation of partial attributable fractions were used to determine the relative importance of each factor in the evolution of infant under-nutrition. RESULTS: Prevalence of under-nutrition fell by approximately 50%, from 13.5% (95% CI: 12.1%; 14.8%) in 1996 to 6.8% (5.4%; 8.3%) in 2006/7. Two-thirds of this reduction could be attributed to favorable evolution in the four factors studied: 25.7% to increased maternal schooling; 21.7% to increased purchasing power of families; 11.6% to expansion of healthcare; and 4.3% to improvements in sanitation. CONCLUSIONS: The 6.3% annual rate of decline in the proportion of children with height-for-age deficits indicates that, in another ten years, child malnutrition in Brazil may no longer be a public health issue. Achieving this will depend on the maintenance of economic and social policies that have favored an increase in purchasing power among the poor, and on public investments aimed at completing the universalization of access to essential services such as education, health, and sanitation among the Brazilian population.