Secular trends in environmental determinants of child health in S. Paulo city, Brazil (1984-1996)

Abstract

OBJECTIVE: Two consecutive household surveys undertaken in mid-80s and mid-90s in the city of S. Paulo Brazil, made possible to establish time trends of several child health determinants and indicators as well as to analyse the relationships among them. The study intends to report trends in environmental determinants of child health. METHODS: Random samples of the population aged from zero to 59 months were studied: 1,016 children in the period of 1984-85 and 1,280 children in 1995-96. Both surveys investigated several housing characteristics -- materials used in the building, size, occupation density, existence of shower, toilet, running water in the kitchen, and the presence of smoker dwellers -- as well as access to water supply, sewage, garbage disposal and pavement of public areas. RESULTS: Improvements from mid-80s to mid-90s are observed regarding both housing characteristics and the implementation of basic services public services. The only indicator showing no improvement was the proportion of children living in slums, near 12% in both surveys. However, housing characteristics in slums showed an impressive improvement in the period between the surveys as well as the access of this population to water supply and garbage disposal services. CONCLUSIONS: Improvements in housing characteristics are consistent with increases in the purchasing power reported in the same period. The expansion of public basic services resulted from both public investments and a significant reduction in population growth. The noticeable increase in the coverage of water supply and garbage disposal in the slums indicates a more equitable delivery of the basic services. The same trend was not seen regarding sewage and street paving, which are not widespread in slum areas. The influence that changes in the physical environment may have exerted on several child health indicators is examined in subsequent articles.