Ethnicity and infant health in Southern Brazil. A birth cohort study

BACKGROUND: Black children present more health problems than white children, but little information is available from less developed countries. Ethnic inequalities may vary according to country, and studies from developing countries are needed to evaluate possible differentials and their magnitude, and identify social and health interventions. METHODS: Birth cohort study in Pelotas, Southern Brazil. Information collected during the perinatal period in hospitals, and at home at 1, 3, 6 and 12 months of age. In all, 5305 children were studied at birth, 96.8% of the sample of 1461 at 6 months, and 93.4% of this sample at 12 months of age. RESULTS: Of the children, 28% were African Brazilian. Socioeconomic position was lower among families of black children, and mothers presented a number of unfavourable characteristics. Black children presented higher prevalences of low birthweight (LBW), preterm and small-for-gestational age (SGA), were less often immunized, had more deficits of weight-for-age and height-for-age, and higher early neonatal and infant mortality. When a number of covariates, including antenatal care, were added to a multiple regression analysis the odds ratios were markedly reduced, but there was still a clear trend towards worse results for black children. Black mothers had some aspects of antenatal care of lower quality and were submitted less frequently to caesarean sections and episiotomies. CONCLUSIONS: Black infants experienced a much worse health status than white infants. Socioeconomic and other variables played a major role in determining inequalities between these ethnic groups. Antenatal care was especially important in explaining differentials in risk between black and white children.