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Epidemiology

Fast change

Income transfer and access to education are pillars in the reduction of child malnutrition in the Northeast

Miguel BoyayanMalnutrition among children has dropped from 22.2% to 5.9% in the NortheastMiguel Boyayan

Malnutrition among children in the Northeast may vanish from the map of Brazilian troubles in less than 10 years, if the problem continues to shrink at the same pace as in the last 10 years. This is the conclusion of a study coordinated by Carlos Augusto Monteiro, a professor from the School of Public Health at the University of São Paulo, and Ana Lucia Lovadino de Lima, a researcher from Nupens, the Center for Nutrition- and Health-Related Epidemiological Research of USP, who holds a postdoctoral grant from FAPESP. The study, to be published in the January edition of Revista de Saúde Pública [the Public Health Journal], shows that the prevalence of malnutrition was cut by one third from 1986 to 1996, falling from 33.9% to 22.2% of the northeastern children and by almost three quarters, from 1996 to 2006, when it plummeted to 5.9%. “This speed is unprecedented. No other study in the world has shown such a great drop in malnutrition within this time frame”, says Carlos Augusto Monteiro.

The reduction of malnutrition in Brazil, in particular in the Northeast, had already been identified in earlier studies. The novelty in the work of the USP researchers was the comparison of the factors that led to the improvement in children’s growth rate over the last two decades, as the height deficits are an even more reliable source of measurements of chronic malnutrition than weight deficits. This analysis was only feasible in the Northeast because the region, which has systematically concentrated the country’s problem of children’s malnutrition, had a rich source of data enabling comparisons, in this case the home surveys of an international survey, the Demography and Health Study, conducted in 1986, 1996 and 2006.

The study of the USP group went beyond this and sought to find out the reasons underlying such progress. It concluded that different factors slashed malnutrition in the Northeast in the two periods. Whereas the improvement in mothers’ level of schooling and the availability of sanitation services were the core factors from 1986 to 1996, in the second period the phenomenon was tied to an improvement in families’ purchasing power, driven by income transfer programs, such as bolsa-familia [family benefit] or the higher minimum wage, besides, yet again, the improvement in mothers’ level of schooling. “To control the problem within 10 years, we will have to maintain the increased purchasing power of the poorer people and ensure public investment in making access to essential healthcare, education and sanitation services widespread”, says Ana Lucia Lovadino.

The research results show that measures such as the direct transfer of income had a prompt and significant impact on the reduction of malnutrition rates. According to Carlos Augusto Monteiro, the focusing of resources yielded real results in regard to the malnutrition issue. “It might seem to be little, but R$100 per family that is the victim of extreme poverty changes the malnutrition outlook radically”, he states. This decade’s economic growth was also an encouragement, but, says Monteiro, periods in Brazil’s history when there was substantially greater economic development, such as the “Brazilian miracle” of the 1970’s, failed to yield the reduction of malnutrition in the Northeast that we are now witnessing. According to him, the improvement in the malnutrition rate has become unhitched from the progress of the Gross Domestic Product (GDP). “The country’s GDP suggests a greater prevalence of malnutrition than has been observed. Mexico, for instance, whose GDP is close to ours, has a malnutrition rate of 13 to 14%”, he states.

If such evidence vouches for the efficiency of minimum income programs, there is another piece of data that reveals the importance of long-term measures for the quality of life improvement in the Northeast. The research suggests that a major reason for the drop in malnutrition was the mothers’ improved level of schooling and the change in the women’s “reproductive antecedents”, a concept that takes into account factors such as the fertility rate, the mother’s age and the gap between the births of her children. “The larger the number of children a woman has, the less the time she will have to dedicate to each one of them; the tendency is to prioritize the youngest, to the detriment of the others”, says Monteiro. The behavioral changes in this area have been extraordinary. The fertility rate in the Northeast, which stood at 5.2 children per woman in 1986, dropped to 3.1 in 1996 and to 1.75 in 2006, slightly lower, even, than the national average of 1.77 children per woman. “This change coincides with fundamental schooling having become widespread in the 1990’s. It was during this decade that the mothers evaluated in the 2006 study got their fundamental schooling. Contrary to prior generations, they had fewer children and achieved autonomy to look after themselves and their kids”, states Monteiro.

Cultural value
The researcher notes that this trend is an indicator of Brazilian society’s modernization. “It means that most Brazilians have adopted having two kids at most as the standard. It’s a cultural value that has become disseminated in a vast but interconnected country. If you go to Africa, to India and even to certain Latin-American countries, you will find that they haven’t advanced much in this regard and that they continue to have, in some social stratas, four or five children per woman. That is why it is so amazing that the Northeast, within a mere 10 years, has reached the Brazilian average”, he says.

Improved healthcare services are also considered a decisive factor, both because they provide women with access to fundamental information and monitor health. According to Monteiro, the Family Health Program, which takes healthcare agents and physicians to regions that lack healthcare is the key for one to understand such progress. “It is clearly a compensation policy that aims to speed up access to healthcare among populations that would otherwise take a long time to get this”, he states. As for other indicators, they have been improving at a less virtuous pace. This is the case, for example, of sanitation conditions. From 2001 to 2007, the proportion of homes in the Northeast that were connected to a sewage system rose from 22% to 29.7%. During this time, the coverage of the water system increased from 69.2% to 75.7%. “In spite of the improvement in sanitation conditions, in 2006, only one quarter of the children in the Northeast live in homes served by public water and sewage systems”, stated Ana Lucia Lovadino. “Those who study Brazil’s social policies have been drawing attention to the lower visibility and lower political attraction of investing in basic sanitation and to the need to prioritize this in the Brazilian agenda of public policies”, she states.

The project
Determinants of the secular trend of child malnutrition in the Northeast Region of Brazil from 1986 to 2006 (nº 06/55316-9); Modality: Post-doctoral grant; Coordinator: Carlos Augusto Monteiro; Grant holder: Ana Lucia Lovadino de Lima – USP; Investment: R$161,206.30

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