Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974–2007

Carlos Augusto Monteiro,a Maria Helena D’Aquino Benicio,a Wolney Lisboa Conde,a Silvia Konno,a Ana Lucia Lovadino,a Aluisio JD Barros b & Cesar Gomes Victora b

a School of Public Health, University of São Paulo, SP, Brazil.
b Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil

Bull World Health Organ 2010;88:305–311 | doi:10.2471/BLT.09.069195
Available online at: http://www.who.int/entity/bulletin/volumes/88/4/09-069195/en/index.html

“…….Optimal child growth requires adequate energy and nutrient intake, absence of disease and appropriate care. Poor living conditions, including household food insecurity, low parental education, lack of access to quality health care and an unhealthy living environment are among the main determinants of stunted growth. Poverty has a more detrimental effect on linear growth than on body weight.1 Child stunting is associated with higher morbidity and mortality, shorter height in adulthood, lower educational achievement, and reduced productivity in adulthood.
Child growth patterns are therefore strong predictors of future human capital and social progress and of the health of future generations….”

Objective
To assess trends in the prevalence and social distribution of child stunting in Brazil to evaluate the effect of income and basic service redistribution policies implemented in that country in the recent past.

Methods
The prevalence of stunting (height-for-age z score below −2 using the Child Growth Standards of the World Health Organization) among children aged less than 5 years was estimated from data collected during national household surveys carried out in Brazil in 1974–75 (n = 34 409), 1989 (n = 7374), 1996 (n = 4149) and 2006–07 (n = 4414). Absolute and relative socioeconomic inequality in stunting was measured by means of the slope index and the concentration index of inequality, respectively.
Findings Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1% to 7.1%. Prevalence dropped from 59.0% to 11.2% in the poorest quintile and from 12.1% to 3.3% among the wealthiest quintile.
The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators.

Conclusion
In Brazil, socioeconomic development coupled with equity-oriented public policies have been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles. Future studies will show whether these gains will be maintained under the current global economic crisis.