Social vulnerability and nutritional and health conditions of women and children: differences between the quilombola population and the general population of the state of Alagoas
African Continental Ancestry Group. Health Disparity, Minority and Vulnerable Populations. Social Determinants of Health. Noncommunicable Diseases.
In recent decades, significant changes in nutrition and health profiles have been observed, both in Brazil and globally. In the adult population, there was an increase in the prevalence of obesity and non-communicable chronic diseases, such as arterial hypertension. Among children, especially those living in greater social vulnerability, although the increase in overweight is a reality, other forms of malnutrition, such as chronic malnutrition and anemia, have not yet been overcome. Properly coping with these problems, whether in adults or children, requires identifying the magnitude and factors associated with these conditions in different scenarios. Therefore, special attention must be given to ethnic-racial minorities, given the intense socioeconomic inequalities they are subjected to. Among these minorities, the quilombola population stands out, which, as a result of the historical oppression suffered, lives in a particularly vulnerable situation. To contribute to this problem, the objective of this thesis was to compare the nutrition and health conditions between quilombola and non-quilombola women and children in the state of Alagoas. To meet the proposed objective, the results chapter is presented in the form of two original articles. Both were based on two independent population-based household surveys carried out in the state of Alagoas in 2015 and 2018, involving non-quilombola women and children under 5 years of age and quilombola women and children, respectively. The first article, entitled “Nutrition and health of women from the state of Alagoas (Brazil): differentials according to the condition of belonging or not to the quilombola population”, compared the prevalence and factors associated with overweight and hypertension in the two scenarios. A total of 4,627 women were evaluated, of which 1,474 were quilombolas and 3,153 were non-quilombolas. The prevalence of overweight (66.8% vs. 62.4%; p=0.005) was higher in quilombola women. There was no difference in the prevalence of hypertension between the groups (23.1% vs. 22.1%; p=447). Factors associated with excess weight in quilombola women were: age > 30 years, presence of severe food insecurity, menarche before age 12, having children, and having hypertension. Among non-quilombolas, in addition to age >30 years, menarche before age 12, having children, and presenting hypertension, schooling ≤8 years, and alcohol consumption were also conditions associated with overweight. As for hypertension, the associated factors among quilombolas were: age > 30 years, schooling ≤ 8 years, menarche before 12 years, and overweight. Among non-quilombola women, in addition to age > 30 years, schooling ≤ 8 years, and overweight, the presence of severe food insecurity and having had a health problem in the last 30 days were also associated with hypertension. The second article, entitled “Social Determinants of Health: Differences in the nutritional status of children from the state of Alagoas (Brazil), according to the condition of being or not quilombola”, aimed to compare the nutritional status and factors associated with stunting, overweight and anemia among quilombola and non-quilombola children in the state of Alagoas. For this, it involved a sample of 1,546 children under 5 years of age, 991 non-quilombolas, and 555 quilombolas. For this, it involved a sample of 1,546 children under 5 years old, 555 from quilombolas and 991 from non-quilombolas. The prevalence of stunting (6.5% vs. 3.5%, p=0.008) and anemia (38.3% vs. 27.4% p<0.001) were higher in quilombola children compared to non-quilombola children. The opposite was observed in the prevalence of overweight: 9.6% vs. 14.1% (p=0.009), respectively. Among quilombola children, the factors associated with height deficit were: wealth index below the median, low maternal height, and low birth weight. In addition to low birth weight, among non-quilombola children, factors associated with excess weight were: low maternal height, and age ≤ 24 months. The presence of moderate food insecurity, age ≤ 24 months, and high birth weight were factors associated with excess weight among quilombola children. Among non-quilombolas, being overweight was associated with an increase in quartiles of maternal BMI, and high birth weight. As for anemia, the associated factors among the quilombolas were: maternal age (<20 years), age ≤ 24 months, male gender, and health problem in the last 30 days. Among non-Quilombolas, maternal education (≤ 8 years), and age ≤ 24 months were factors associated with anemia. We concluded that, in line with the assumptions of social determination in the health and disease process, the socioeconomic disadvantages to which quilombolas women and children are historically subjected reverberate nowadays, as observed by the presence of worse nutrition and health profile. We hoped that these results will be used to guide public policies aimed at facing these conditions, which must consider that, in the state with the worst socioeconomic indicators in the country, quilombola women and children survive in an even more vulnerable scenario.