BACKGROUND:
Globally,
diarrhea is the second leading
cause of death among
children under five. In
Brazil,
mortality due to
diarrhea underwent a significant reduction in recent decades principally due to expansion of the
primary healthcare network, use of
oral rehydration therapy, reduced
child undernutrition, and improved access to safe
drinking water. The First National
Survey of
Indigenous People's
Health and
Nutrition in
Brazil, conducted in 2008-2009, was the first
survey based on a nationwide representative sample to study the
prevalence of
diarrhea and associated factors among Indigenous
children in the country.
METHODS:
The
survey assessed the
health and
nutritional status of Indigenous
children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for Indigenous villages. Within villages,
children < 5 years of age in sampled households were included in the study. Interviews were based on a seven day recall period.
Prevalence rates of acute
diarrhea were calculated for independent variables and hierarchical multivariable analyses were conducted to assess
associations.
RESULTS:
Information on
diarrhea was obtained for 5,828
children (95.1% of the total sample). The overall
prevalence of
diarrhea was 23.5%. Regional differences were observed, with the highest rate being in the North (38.1%). Higher
risk of
diarrhea was observed among younger
children and those
who had less maternal schooling, lower
household socioeconomic status,
undernutrition (weight-for-age deficit), presence of another
child with
diarrhea in the
household, and occurrence of upper respiratory
infection.
CONCLUSIONS:
According to results of the First National
Survey of
Indigenous People's
Health and
Nutrition, almost a quarter of Indigenous
children throughout the country had
diarrhea during the previous week. This
prevalence is substantially higher than that documented in 2006 for Brazilian
children < 5 years generally (9.4%). Due to its exceedingly multicausal
nature, the set of associated variables that remained associated with
child diarrhea in the final multivariable model provide an excellent reflection of the diverse social and
health inequities faced by
Indigenous peoples in contemporary
Brazil.