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

Objective Two consecutive household surveys undertaken in mid-80s and mid-9 0s in the city of S. Paulo Brazil, made possible to establish time trends o f several child health determinants and indicators as well as to analyse th e relationships among them. The study intends to report trends irt environm ental determinants of child health. Methods Random samples of the population aged from zero to 59 months were s tudied: 1,016 children in the period of 1984-85 and 1,280 children in 1995- 96 Both surveys investigated several housing characteristics - materials us ed in the building, size, occupation density, existence of shower; toilet, running water irt the kitchen, and the presence of smoker dwellers - as wel l as access to water supply, sewage, garbage disposal and pavement of publi c areas. Results Improvements from mid-80s to mid-90s are observed regarding both ho using characteristics and the implementation of basic services public servi ces. The only indicator showing no improvement was the proportion of childr en living in slums, near 12% in both surveys. However housing characteristi cs irt slums showed an impressive improvement in the period between the sur veys as well as the access of this population to water supply and garbage d isposal services. Conclusions Improvements in housing characteristics are consistent with inc reases in the purchasing power reported in the same period The expansion of public basic services resulted from both public investments and a signific ant reduction in population growth. The noticeable increase in the cover as e of water supply and garbage disposal in the slums indicates a more equita ble delivery of the basic services. The same trend was not seen regarding s ewage and street paving, which are,lot widespread in slum areas. The influe nce that changes in the physical environment may have exerted on several ch ild health indicators is examined in subsequent articles.