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

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.

Health in Brazil 2 Maternal and child health in Brazil: progress and challenges

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5.5% a year in the 1980s and 1990s, and by 4.4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2.5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil`s progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women`s health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.

The impact of maternal cortisol concentrations on child arterial elasticity

Epidemiological studies suggest that glucocorticoid excess in the fetus may contribute to the pathophysiology of cardiovascular diseases in adulthood. However, the impact of maternal glucocorticoid on the cardiovascular system of the offspring has not been much explored in studies involving humans, especially in childhood. The objective of this study was to assess the influence of maternal cortisol concentrations on child arterial elasticity. One hundred and thirty pregnant women followed from 1997 to 2000, and respective children 5-7 years of age followed from 2004 to 2006 were included in the study. Maternal cortisol was determined in saliva by an enzyme immunoassay utilizing the mean concentration of nine samples of saliva. Arterial elasticity was assessed by the large artery elasticity index (LAEI; the capacitive elasticity of large arteries) by recording radial artery pulse wave, utilizing the equipment HDI/PulseWave CR-2000 Cardiovascular Profiling System (R). The nutritional status of the children was determined by the body mass index (BMI). Insulin concentration was assessed by chemiluminescence, and insulin resistance by the homeostasis model assessment. Blood glucose, total cholesterol and fractions (LDL-c and HDL-c) and triglyceride concentrations were determined by automated enzymatic methods. The association between maternal cortisol and child arterial elasticity was assessed by multivariate linear regression analysis. There was a statistically significant association between maternal cortisol and LAEI (P=0.02), controlling for birth weight, age, BMI and HDL-c of the children. This study suggests that exposure to higher glucocorticoid concentrations in the prenatal period is associated to lower arterial elasticity in childhood, an earlier cardiovascular risk marker.

Septic Shock, Necrotizing Pneumonitis, and Meningoencephalitis Caused by Mycoplasma pneumoniae in a Child: A Case Report

Mycoplasma pneumoniae is an important causative agent of respiratory infection in childhood. Although the infection caused by M. pneumoniae is classically described as benign, severe and life-threatening pulmonary and extrapulmonary complications can occur. This study describes the first case of septic shock related to M. pneumoniae in a child with necrotizing pneumonitis, severe encephalitis, and multiple organs involvement, with a favorable outcome after lobectomy and systemic corticosteroids

ACUTE LIVER FAILURE ASSOCIATED WITH RUBELLA VIRUS IN A CHILD

Acute liver failure is a syndrome with a wide range of etiologic possibilities in children, but in up to 50% of the cases in the literature no diagnosis is established. This case report adds rubella virus to the list of possible causes of acute liver failure. This association was made by serologic, cell culture, molecular, histopathologic, and immunohistochemical methods.

Too Many Bad Cooks Spoiling the Broth? Effectiveness of NGOs in Addressing Child Labour in El Salvador

The reaction of the first world to the persevering plight of a large part of the third world varies. In response to the sometimes glaring disparities, many international organizations and multinational corporations have recently adopted a pro-development rhetoric with relation to the problem of global poverty. However, the rhetoric rarely translates into action. As David Bacon discusses, leaders of corporations and organizations now tend to conclude their speeches by expressing a desire to reduce the suffering of the third world. However, when it comes to agreeing on specific concessions that could indeed improve the world-wide economic situation, first world countries are reluctant to act. A good example of this type of behavior is the current negotiation of the WTO, the “development round of Doha,” in which the United States along with the European Union pressure countries of the developing South to open up their markets, while at the same time refusing to remove or even decrease their own agricultural subsidies. The first world civil society observes the behavior of international organizations and western based multinational corporations as ineffectual. Taking the matter in its own hands, especially in the past couple of decades, this civil society has created a countless number of development-oriented nongovernmental organizations. These are supposed to compensate for the lack of action by international organizations. Development NGOs are believed to be more locally responsive as well as free of business or political considerations in choosing their strategies, and thus generally more efficient than IOs. However, if they really were how they are alleged to be, the problems of the third world would already be ameliorated by a significant amount, if not completely eradicated. Do development-NGOs indeed possess the characteristics that they claim to possess? What is their real affect on human rights? And how effective are they in their work?

A Catalyst for Culture: Early Child Development and Education in Japan

A popular Western perception of Japan is that it is an eminently homogeneous and conformist society. However, both conformity and homogeneity, recognized even by the Japanese themselves, coexist with the concept of individuality, which is valued in a manner unique to its culture. In order to come to a deeper understanding of that dynamic, it is important to comprehend the specifics of child rearing and education within Japanese society. Based in part on the author's observational fieldwork conducted while in Japan in 1994, the thesis explicates the manner in which various core relationships exhibit the socialization of an individual that occurs within the home during a child's first few years. Furthermore, the text incorporates research in both primary and secondary historical materials. The author displays the manner in which educational issues such as the development of the Japanese education system and the dynamics of the elementary years serve to demonstrate the importance of functioning within a group. This is further clarified through an examination of elementary school texts, which also reveal underlying moral messages of profound importance in Japanese society. The seemingly contradictory issues of becoming an individual yet performing as a member of a group are pulled together by the idea that culture provides the guidance by which an individual becomes an active member of society. In Japan, individuality and group conformity are not mutually exclusive. Within the context of Japanese society, individuality is inextricably linked to group orientation.

The causal effect of family size on child labor and education

This paper investigates the causal relationship between family size and child labor and education among brazilian children. More especifically, it analyzes the impact of family size on child labor, school attendance, literacy and school progression. It explores the exogenous variation in family size driven by the presence of twins in the family. The results are consistent under the reasonable assumption that the instrument is a random event. Using the nationally representative brazilian household survey (Pnad), detrimental effects are found on child labor for boys. Moreover, significant effects are obtained for school progression for girls caused by the exogenous presence of the young siblings in the household.

Microeconomic instability and children's human capital accumulation: the effects of idiosyncratic shocks to father's income on child labor, school drop-outs and repetition rates in Brazil

This paper evaluates the long-run effects of economic instability. In particular, we study the impact of idiosyncratic shocks to father’s income on children’s human capital accumulation variables such as school drop-outs, repetition rates and domestic and non-domestic labor. Although, the problem of child labor in Brazil has declined greatly during the last decade, the number of children working is still substantial. The low levels of educational attainment in Brazil are also a main cause for concern. The large rotating panel data set used allows for the estimation of the impacts of changes in occupational and income status of fathers on changes in his child���s time allocation circumstances. The empirical analysis is restricted to families with fathers, mothers and at least one child between 10 and 15 years of age in the main Brazilian metropolitan areas during the 1982-1999 period. We perform logistic regressions controlling for child characteristics (gender, age, if he/she is behind in school for age), parents characteristics (grade attainment and income) and time and location variables. The main variables analyzed are dynamic proxies of impulses and responses, namely: shocks to household head’s income and unemployment status, on the one hand and child���s probability of dropping out of school, of repeating a grade and of start working, on the other. The findings suggest that father’s income has a significant positive correlation with child���s dropping out of school and of repeating a grade. The findings do not suggest a significant relationship between a father’s becoming unemployed and a child entering the non-domestic labor market. However, the results demonstrate a significant positive relationship between a father becoming unemployed and a child beginning to work in domestic labor. There was also a positive correlation between father becoming unemployed and a child dropping out and repeating a grade. Both gender and age were highly significant with boys and older children being more likely to work, drop-out and repeat grades.

New evidence of the causal effect of family size on child quality in a developing country

This paper presents new evidence of the causal effect of family size on child quality in a developing-country context. We estimate the impact of family size on child labor and educational outcomes among Brazilian children and young adults by exploring the exogenous variation of family size driven by the presence of twins in the family. Using the Brazilian Census data for 1991, we nd that the exogenous increase in family size is positively related to labor force participation for boys and girls and to household chores for young women. We also and negative e ects on educational outcomes for boys and girls and negative impacts on human capital formation for young female adults. Moreover, we obtain suggestive evidence that credit and time constraints faced by poor families may explain the findings.

Child labor and learning

This paper investigates the impact of working while in school on learning outcomes through the use of a unique micro panel dataset of Brazilian students. The potential endogeneity is addressed through the use of di erence-in-di erence and instrumental variable estimators. A negative e ect of working on learning outcomes in both math and Portuguese is found. The e ects of child work range from 3% to 8% of a standard deviation decline in test score which represents a loss of about a quarter to a half of a year of learning on average. We also explore the minimum legal age to entry in the labor market to induce an exogenous variation in child labor status. The results reinforce the detrimental e ects of child labor on learning. Additionally, it is found that this e ect is likely due to the interference of work with the time kids can devote to school and school work.

Conditional cash transfers, schooling and child labor : micro-simulating bolsa escola

Cash transfers targeted to poor people, but conditional on some behavior on their part, such as school attendance or regular visits to health care facilities, are being adopted in a growing number of developing countries. Even where ex-post impact evaluations have been conducted, a number of policy-relevant counterfactual questions have remained unanswered. These are questions about the potential impact of changes in program design, such as benefit levels or the choice of the means-test, on both the current welfare and the behavioral response of household members. This paper proposes a method to simulate the effects of those alternative program designs on welfare and behavior, based on microeconometrically estimated models of household behavior. In an application to Brazil’s recently introduced federal Bolsa Escola program, we find a surprisingly strong effect of the conditionality on school attendance, but a muted impact of the transfers on the reduction of current poverty and inequality levels.