Escobar Ana Lúcia, Coimbra Carlos E A, Welch James R, Horta Bernardo L, Santos Ricardo Ventura, Cardoso Andrey M
Departamento de Medicina, Universidade Federal de Rondônia, Rodovia BR-364 Km 9.5, Porto Velho, RO, 76801-059, Brazil.
Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil.
BMC Public Health. 2015 Feb 27;15:191. doi: 10.1186/s12889-015-1534-7.
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.
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.
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.
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.
在全球范围内，腹泻是五岁以下儿童的第二大死因。在巴西，近几十年来，腹泻死亡率显著下降，这主要归功于基层医疗保健网络的扩展、口服补液疗法的使用、儿童营养不良情况的改善以及安全饮用水获取的改善。2008 - 2009年开展的巴西首次全国原住民健康与营养调查，是基于全国代表性样本进行的首次调查，旨在研究该国原住民儿童腹泻的患病率及相关因素。
该调查基于巴西主要地缘政治区域的代表性样本，评估了五岁以下原住民儿童的健康和营养状况。对原住民村庄进行了分层概率抽样。在村庄内，抽样家庭中五岁以下的儿童被纳入研究。访谈基于七天回忆期。计算了急性腹泻的患病率，并进行了分层多变量分析以评估相关性。
共获得了5828名儿童（占总样本的95.1%）的腹泻信息。腹泻的总体患病率为23.5%。观察到存在区域差异，北部地区患病率最高（38.1%）。年龄较小的儿童、母亲受教育程度较低、家庭社会经济地位较低、营养不良（年龄别体重不足）、家中有另一名腹泻儿童以及发生上呼吸道感染的儿童，腹泻风险更高。
根据首次全国原住民健康与营养调查的结果，全国近四分之一的原住民儿童在上一周患有腹泻。这一患病率显著高于2006年巴西五岁以下儿童的总体记录患病率（9.4%）。由于其多因素性质，最终多变量模型中仍与儿童腹泻相关的一系列相关变量，很好地反映了当代巴西原住民面临的各种社会和健康不平等问题。
