Epidemiology, health, and inequality among indigenous peoples in Brazil

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1 Epidemiology, health, and inequality among indigenous peoples in Brazil 20 th IEA World Congress of Epidemiology Anchorage, AK, August 2014 Suruí, Rondônia 1989 (photo: Denise Zmekhol)

2 The global indigenous population in Latin America is estimated at 50 million, comprising more than 400 different ethnic groups. By percentage, Brazil has one of the smallest indigenous populations in L. A. only 0.4 % of the total population according to the latest national demographic census (896,917 individuals). Despite the small relative size of the indigenous population in Brazil, it has enormous ethnic and linguistic diversity. 300 indigenous ethnic groups, speakers of over 200 distinct languages, are present in Brazil, constituting one of the national indigenous populations with the greatest ethnic diversity in the world.

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4 The majority of Indigenous population in Brazil is distributed among thousands of villages located within approximately 600 reservations (this represents ± 13% of the Brazilian territory). The Amazon Region concentrates ± 60% of the total Indigenous population and 98% of Indigenous lands. Zoró, Mato Grosso, 1987 (photo: Denise Zmekhol) at

5 Ministério da Saúde Fundação Nacional de Saúde Total population: 896,917 Indian reserves: ± 600 (± 13% Brazil s territory) Ethnic groups: 300 Languages: ± 200 Source: 2010 National Population Census

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7 Sources of Information about population health in Brazil. Brazil in the context of Latin America, Brazil conducts population censuses of its population on a regular basis since It was not until 1991 that Indigenous peoples in Brazil were counted in the national decennial census, when for the first time it was included the response option indigenous for the question about race or skin color. Also, the census only began collecting data on ethnicity and languages spoken for those who classified themselves as indigenous in 2010.

8 Periodic nationwide population-based surveys conducted since the 1970s monitored not only the principal trends of morbidity and mortality, but also those related to access and use of health services by diverse socioeconomic strata of the general population.

9 Health Information Systems in Brazil Sistema de Informações sobre Mortalidade Mortality Information System Sistema de Informações de Nascidos Vivos Live Births Information System Sistema de Informação de Agravos de Notificação Notifiable Diseases Information System (mainly covers the national list of notifiable diseases) Sistema de Informação do Programa Nacional de Imunizações National Immunization Program Information System Sistema de Informações Hospitalares do SUS Unified Health System Hospital Information System

10 Brasil ,6% entre 0-15 anos Indígenas ,7% entre 0-15 anos Mulheres Fonte: FUNASA (2003) Homens Mulheres Homens

11 Nearly 50% of the Indigenous population in Brazil is < 15 years

12 Population pyramid of indigenous population living Inside and outside federally demarcated reservations, Brazil, Males Females 25% 15% 5% 5% 15% 25% Inside indigenous lands Outside indigenous lands Source: 2010 National Census, IBGE.

13 Total fertility rates of indigenous and non-indigenous women, according to geographical regions, Brazil, Source: 2000 National Census, IBGE.

14 Total Fertility Rates for Selected Indigenous Societies in Brazil Ethnic Group TFT Xavante, Sangradouro 8.6 ( ) Xavante, Pimentel Barbosa 8.5 ( ) Bakairi, Mato Grosso Kaigang,Terena,Guarani, São Paulo Mucajai Yanomama Guarani Mbya, Rio de Janeiro

15 Infant mortality rates (per 1,000) according to color/race, Brazil, Yellow White Brown Black Indigenous All Source: 2000 National Census, IBGE.

16 Infant mortality rates (per 1,000) by Indigenous special sanitary districts (DSEI), Brazil. CMI (por 1,000 nasc. vivos) Indians 60,3 per 1,000 Brazil-General 27,8 per 1, ,0 140,0 130,0 120,0 110,0 100,0 90,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 DSEIs Source: L. Garnelo et al. (2003)

17 The First National Survey of Indigenous People s Health and Nutrition, conducted in , sought to characterize nutritional status and other health measures in indigenous children < 5 years of age and women 14 to 49 years of age employing a representative probabilistic sample of the indigenous population residing in villages in Brazil, according to four major regions: North, Northeast, Central-West, and South/Southeast. Interviews, clinical measurements, and secondary data collection in the field addressed the major topics: nutritional status, prevalence of hypertension and diabetes mellitus in women, child hospitalization, prevalence of tuberculosis and malaria in women, access to health services and programs, and characteristics of the domestic economy and diet to obtain baseline information based on a nationwide representative sample.

18 The National Survey obtained data for 113 villages (91.9% of the planned sample), 5,305 households (93.5%), 6,692 women (101.3%), and 6,128 children (93.1%).

19 Sanitation The most typical waste management infrastructure observed was that of a simple pit latrine (63.3%), with sewage rarely being collected or receiving any kind of treatment. Only 5.9% of the households reported possessing any kind of sewage system. 19.4% of households reported defecating in facilities inside their homes (in the North just 1.0% of households had indoor installations);30.6% in the open. 79.0% of households reported disposing of domestic trash in the village (buried, burned, or discarded near the house).

20 Characteristics Studied Low height-for-age Anemia Hospitalized during prior year With at least one hospitalization due to diarrhea during prior year With at least one hospitalization due to acute respiratory infection during prior year With diarrhea during the prior week Region All regions North Central- West Northeast South/ Southeast n=6011 n=2539 n=1277 n=1331 n= % 40.8% 27.6% 13.9% 22.3% CI: CI: CI: CI: CI: n=5397 n=2280 n=1141 n=1211 n= % 66.4% 51.5% 41.1% 48.0% CI: CI: CI: CI: CI: n=6087 n=2555 n=1298 n=1352 n= % 16.9% 27.3% 14.0% 19.2% CI: CI: CI: CI: CI: n=1117 n=426 n=347 n=181 n= % 48.4% 43.5% 24.8% 29.8% CI: CI: CI: CI: CI: n=1115 n=425 n=348 n=180 n= % 54.4% 40.4% 35.6% 58.4% CI: CI: CI: CI: CI: n=6068 n=2546 n=1298 n=1347 n= % 38.1% 21.4% 19.4% 17.8% CI: CI: CI: CI: CI:

21 Major findings for Indigenous women, First National Survey of Indigenous People s Health and Nutrition, Brazil, Region Characteristic All regions North Central-West Northeast South/Southeast Overweight n=5714 n=2064 n=1112 n=1585 n= % 24.7% 35.3% 27.7% 32.0% CI: CI: CI: CI: CI: Obesity n=5714 n=2064 n=1112 n=1585 n= % 6.1% 17.2% 13.5% 22.6% CI: CI: CI: CI: CI: Anemia n=5720 n=2068 n=1116 n=1586 n= % 46.8% 34.9% 22.6% 30.6% CI: CI: CI: CI: CI: Hypertension n=4753 n=1679 n=942 n=1347 n= % 3.6% 17.5% 11.2% 17.4% CI: CI: CI: CI: CI: Diabetes mellitus n=5722 n=2070 n=1115 n=1587 n= % 0.5% 1.4% 1.1% 2.1% At least 1 prenatal consultation during first trimester At least six prenatal consultations CI: CI: CI: CI: CI: n=2427 n=792 n=642 n=578 n= % 33.4% 43.3% 58.6% 47.2% CI: CI: CI: CI: CI: n=2549 n=848 n=654 n=586 n= % 10.9% 33.3% 48.3% 45.0% CI: CI: CI: CI:

22 The impact of infectious and parasitic diseases in the determination of morbidity and mortality among indigenous children in Brazil is known through numerous community-based studies realized since the 1980s. Diarrhea stands out among the principal causes of illness and death among indigenous children, followed by pneumonia (both can account for 60-80% of causes of hospitalization, according to some analyses). This contrasts with the national Brazilian population, for which diarrhea is no longer considered a leading cause of child hospital admission in pediatric wards, even in the poorer regions of the country. For example, in the Brazilian Northeast, where in the 1990s diarrhea represented 57% of the total causes of hospitalization for children in the general population, this rate is now less than 15%. In endemic regions, malaria can represent over 50% of outpatient visits and hospitalizations of indigenous children. Tuberculosis presents elevated incidence in children and adolescents, as documented by recent studies. A study conducted in Southwestern Amazonia show that up to 60% of reported TB cases are in children < 5 years.

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