Food profile of Yanomami indigenous children aged 6 to 59 months from the Brazilian Amazon, according to the degree of food processing: a cross-sectional study

Overview of the Indigenous health of the Yanomami ethnic group in Brazil: A Public Health Emergency

INTRODUCTION

The Indigenous population of the Yanomami ethnic group in Brazil is currently facing a public health emergency due to the high number of deaths, mainly of children. Taking that into consideration, this study aims to analyze this crisis impact on the health of this population in the period between 2018 and 2022.

METHODS

The data presented were collected from the report called Yanomami Mission ("Missão Yanomami") published by the Brazilian Ministry of Health and, from it, a descriptive analysis of the Indigenous individuals' health was carried out for (i) the geographical distribution; ii) the number of deaths; (iii) the child death rate; (iv) the deaths of Indigenous individuals from preventable causes; (v) the causes of preventable diseases related to hygiene and basic sanitation, and the distribution of diarrheal diseases according to age groups; (vi) evaluation of the nutritional classification; vii) the percentage (%) of the complete vaccination scheme, and (viii) the coverage of prenatal appointments of Indigenous pregnant women.

RESULTS

The report included 31,017 individuals belonging to the Yanomami ethnic group, most of the participants were up to 39 years old (N = 26,377; 85.0%) and men (N = 15,836; 51.1%). During the period described in the report, the number of deaths reached 1285/31,017 (4.1%). When analyzing the deaths, the most representative age groups were those of children under 1 year old (505/1285; 39.9%), from 1 to 4 years old (178/1285; 13.8%), and the elderly from 60 to 79 years old (150/1285; 11.6%). The Indigenous individuals from this ethnic group presented a child death rate ~ 1.5 to 3.5 higher than that of the total Indigenous population in the country. Regarding the child death rate, the neonatal component represented 57.8% of the deaths and, in 2022, 93.0% of the pregnant women had less than six prenatal appointments. This population shows a high number of deaths due to preventable causes (N = 538) and cases of illnesses associated with hygiene and sanitation, for example (N = 35,103 cases/notifications). As for vaccination, the full vaccination scheme targeting children below 5 years old has not been met since 2018.

CONCLUSION

In the Indigenous population of the Yanomami ethnic group, a high number of deaths was observed, which affected mainly individuals under 1 year old. Among the factors associated with the deaths, mainly in children under 5 years old, most cases have preventable causes, which could be reduced by proper action promoting their health and preventing diseases.

Estimating double burden of malnutrition among rural and urban children in Amazonia using Bayesian latent models

Background

The double burden of malnutrition (DBM) in the same individual is a neglected public health concern, especially in low- and middle-income countries (LMICs). The DBM is associated with increased risks of non-communicable diseases, childbirth complications, and healthcare costs related to obesity in adulthood. However, evaluating low prevalence outcomes in relatively small populations is challenging using conventional frequentist statistics. Our study used Bayesian latent models to estimate DBM prevalence at the individual-level in small populations located in remote towns and rural communities in the Brazilian Amazon.

Methods

We employed a cross-sectional survey of urban and rural children aged 6-59 months, considering DBM as the coexistence of stunting and overweight in the same individual. We evaluated four river-dependent municipalities, sampling children in randomly selected households in each town and a total of 60 riverine forest-proximate communities. Through Bayesian modeling we estimated the latent double burden of malnutrition (LDBM) and credible intervals (CI).

Results

The exceedance probability of LDBM was used to quantify this form of malnutrition at the population level. Rural prevalence of LDBM was significantly higher in Jutai (3.3%; CI: 1.5% to 6.7%) compared to Maues and Caapiranga. The likelihood that LDBM rural prevalence exceeded 1% was very high in Jutai (99.7%), and Ipixuna (63.2%), and very low (< 2%) in rural communities elsewhere. Exceedance probabilities (at 1%) also varied widely among urban sub-populations, from 6.7% in Maues to 41.2% in Caapiranga. The exceedance probability of LDBM prevalence being above 3.0% was high in rural Jutai (59.7%).

Discussion

Our results have important implications for assessing DBM in vulnerable and marginalized populations, where health and nutritional status are often poorest, and public health efforts remain focused on undernutrition. Our analytical approach could enable more accurate estimation of low prevalence health outcomes, and strengthen DBM monitoring of hard-to-reach populations.

Development and cultural adaptation of text messages for promoting healthy eating among Amazonian schoolchildren

OBJECTIVE

To develop text messages for a mHealth intervention promoting healthy eating among Amazonian schoolchildren.

DESIGN

Two rounds of expert panel analysis and formative research interviews.

SETTING

Western Brazilian Amazon, Cruzeiro do Sul, Acre, Brazil.

PARTICIPANTS

Included 17 healthcare professionals and 40 caregivers of school-aged children enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort study.

MAIN OUTCOME MEASURES

Evaluation focused on messages' cultural appropriateness, comprehensibility, and relevance, along with caregivers' understanding and intention to adhere to the recommendations.

ANALYSIS

Quantitative analysis employed the modified Cohen Kappa, the Scale-Content Validity Index Average (S-CVI-Ave), frequency calculations, and a ranking system.

RESULTS

Fifty-five text messages were drafted. In the initial stage, eight messages did not achieve a sufficient score and were subsequently revised and reevaluated, ultimately gaining approval. The S-CVI-Ave for each domain was as follows: cultural appropriateness = 0.97, comprehensibility = 0.96, and relevance = 0.97. Formative research indicated a 92% understanding rate and a 70% intention rate to adhere to the proposed suggestions.

CONCLUSIONS AND IMPLICATIONS

The final set of messages was successfully culturally adapted and will contribute to the translation and dissemination of Dietary Guidelines for Brazilian Population recommendations to Western Amazon families.

Temporal trend in markers of nutritional status and food consumption of non-village indigenous people in Brazil

BACKGROUND

Non-village indigenous people may face urban lifestyle influences, impacting their nutritional profile. Therefore, this study aimed to analyze the temporal trends in the nutritional status (2008-2023) and food consumption (2015-2023) of non-village indigenous people in Brazil, using data from the Food and Nutrition Surveillance System (SISVAN).

METHODS

In this time series study, secondary data available on the SISVAN online platform were used. All records of non-village indigenous people from all regions of Brazil were evaluated. Nutritional status was assessed using height-for-age (H/A) and Body Mass Index-for-age (BMI/A) for children and adolescents, and BMI for adults and the elderly. Food consumption trends were analyzed using food consumption screeners, based on specific food groups consumed the day before the assessment. An annual percentage change (APC) was calculated using Prais-Winsten regression models.

RESULTS

There was a reduction in severe stunting among children aged 2 to 4 years old (APC = -0.80%; p = 0.025) and 5 to 9 years old (APC = -4.02%; p < 0.001). Adolescents showed an increase in thinness (APC = 0.91%; p = 0.016) and obesity (APC = 4.38%; p < 0.001). In adults and the elderly, there was a decrease in underweight (APC = -5.59%; p = 0.002 and APC = -3.12%; p < 0.001, respectively) and an increase in obesity grade 1 and overweight (APC = 3.81%; p < 0.001 and APC = 1.82%; p < 0.001, respectively). There was an increase in vegetable consumption among children, adolescents and the elderly, and a rise in the consumption of hamburgers and sausages across all age groups.

CONCLUSION

There was an improvement in the nutritional status of children and adolescents, with reduced stunting, but a rise in obesity among adolescents, adults and the elderly. Food consumption trends showed increased consumption of vegetables and ultra-processed foods.