Secular trends in maternal and child health care 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 of several child health determinants and indicators as well as to analyse t he relationships among them. The study intends to report trends in maternal and child health care. 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 three components of maternal and child health care: prenatal care, delivery and newborn care and routine health care pro vided to children lip to five years of age (including development follow-up and vaccination). Results Favourable changes seen in the period between the two surveys were the continuing universal birth coverage, significant increase in rooming-in in maternity hospitals and the number of routine visits for babies in thei r first year of life mid particularly, the universal outreach of the DPT, m easles and tuberculosis vaccinations. Unfavourable trends were seen regardi ng the slight and clearly insufficient growth of`prenatal care, the still h igh percentage (of near 50%) of cesarean sections, and the limited routine visits for children after their first year of age. Conclusions Estimates in the same period for the outreach of maternal and c hild health care in other urban areas of Brazil reinforce the unsatisfactor y trends of the prenatal care in S. Paulo. Favourable comparisons ale only seen regarding the outreach of child vaccination. The influence that change s in the maternal and child health cars provided in the city may have exert ed on several child health indicators is examined in subsequent articles.