- To describe and document the political, economic and health policy changes in Pelotas, Brazil in the past decade;
- To document levels and trends in maternal and child health status and health care provision and utilisation between 1982 - 1992;
- To make policy recommendations based on the research conclusions.
- There was a reduction in the number of births in this period, 6,011 in 1982 and 5,04 in 1993, suggesting an increased utilisation of contraceptives or abortions since there was an increase in the number of women in fertile age. A breakdown by socio-economic status shows that the reduction of 707 births in 1993 was not evenly distributed as there were around 1,000 births less in the poorest groups and 300 more in the high-income strata.
- There were also important variations in the nutritional status of the mother, in the decade the mean height increased from 156.4 cm m 1982 to 159.9 cm in 1993, and weight in the beginning of pregnancy was also substantially higher in 1993, 62,1 Kg compared to 58 Kg in 1982. Antenatal care attendances also increased in 1993, with a mean of 7.6 attendances compared to 6.6 cm 1982 and medical assistance during delivery increased from 61 per cent in 1982 to 88.3 per cent in 1993. Despite these improvements the proportion of low birthweight (<2,500 g) showed a slight increase in the proportion of pre-term births (5,6 and 7,5 per cent, respectively) and intra-uterine growth retardation (15,0 per cent in 1982 and 17,5 per cent in 1993) The reason for these unexpected findings are still being analysed.
- There was an important reduction in the perinatal mortality, from 32.2/1000 births in 1982 to 22.1/1000 births in 1993, and the reduction of perinatal deaths was equally observed both in the fetal and in the early neonatal period. Regarding breastfeeding, there was an increase in the proportion of babies being breastfed in the first months of life. At three months of age, for example, the prevalence of full breastfeeding was 53 per cent in 1993 in relation to around 33 per cent in the previous decade. As far as the nutritional status at 12 months of age is concerned, there were changes according to the indicator. Thus, there was a slight increase in the proportion of children with low height for age, 6.1 per cent compared to 5.3 per cent in 1982. On the other hand, a reduction was observed in the prevalence of low weight for age, 5.4 per cent in 1982 and 3.8 per cent in 1993, and weight for height. Finally, an important progress was detected in the infant mortality rates, with a drop from 36,4/1,000 liver births in 1982 to 21,1/1,000 in 1993. The results of this study will certainly contribute to the understanding of the evolution of the health status of mothers and children during the last decade and in planning new preventive actions.
Phase 1 included three studies :
- A study of changes in health policies and health care provision with emphasis on maternal and child care. This study provided data on recent trends in these areas to document historical changes in the city;
- Anthropological studies based on interviews with members of different groups involved in health care. The aim here was to investigate the perception of the population and of the health providers regarding changes in health services;
- A study on socio-economic trends intended to document political and economical changes that took place during the decade and how these have affected the quality of life.
This Phase 1 studies will result in a detailed description of changes in health sector and the perception of the population and providers relative to these changes.
Phase 2 of the study involved six separate studies focusing on maternal and child health indicators. The studies in this phase included :
- A perinatal study in three maternity hospitals during twelve months;
- A descriptive infant mortality and nested infant mortality case-control study to identify all deaths among cohort children and ascertain cause and compare their characteristics with those of control children from the same birth cohort;
- A hospital morbidity study to provide data on the causes of all hospital admissions;
- A follow-up study to trace a 20 per-cent sub-sample of approximately 2000 children at 6-12 months of age and 400 pre-term and/or low birth-weight children;
- Finally, a maternal study on health, fertility and family planning utilisation to provide data on past reproductive history.
The data from these studies are compared to data collected to assess changes during the decade that will be analysed in the light of the overall scenario of economic and health sector changes.
Funding SchemeCSC - Cost-sharing contracts
WC1E 7HT London