OBJECTIVE: To expand the "Countdown to 2015" analyses of health inequalities beyond the 75 countries being monitored worldwide to include all countries in Latin America and the Caribbean (LAC) that have adequate data available. METHODS: Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to monitor progress in health intervention coverage and inequalities in 13 LAC countries, five of which are included in the Countdown (Bolivia, Brazil, Guatemala, Haiti, and Peru) and eight that are not (Belize, Colombia, Costa Rica, Dominican Republic, Guyana, Honduras, Nicaragua, and Suriname). The outcomes included neonatal and under-5 year mortality rates, child stunting prevalence, and the composite coverage index-a weighted average of eight indicators of coverage in reproductive, maternal, newborn, and child health. The slope index of inequality and concentration index were used to assess absolute and relative inequalities. RESULTS: The composite coverage index showed monotonic patterns over wealth quintiles, with lowest levels in the poorest quintile. Under-5 and neonatal mortality as well as stunting prevalence were highest among the poor. In most countries, intervention coverage increased, while under-5 mortality and stunting prevalence fell most rapidly among the poor, so that inequalities were reduced over time. However, Bolivia, Guatemala, Haiti, Nicaragua, and Peru still show marked inequalities. Brazil has practically eliminated inequalities in stunting. CONCLUSIONS: LAC countries presented substantial progress in terms of reducing inequalities in reproductive, maternal, newborn, and child health interventions, child mortality, and nutrition. However, the poorest 20% of the population in most countries is still lagging behind, and renewed actions are needed to improve equity.

OBJETIVO: Extender los análisis de la "Cuenta Regresiva para 2015" de las desigualdades en materia de salud más allá de los 75 países sometidos a vigilancia en todo el mundo para incluir a todos los países de América Latina y el Caribe (ALC) que disponen de datos adecuados. MÉTODOS: Se utilizaron encuestas de demografía y salud y encuestas agrupadas de indicadores múltiples para vigilar el progreso de la cobertura de las intervenciones de salud y de las desigualdades en 13 países de ALC, 5 de ellos incluidos en la Cuenta Regresiva (Bolivia, Brasil, Guatemala, Haití y Perú) y 8 no incluidos (Belice, Colombia, Costa Rica, Guyana, Honduras, Nicaragua, República Dominicana y Suriname). Los resultados incluyeron las tasas de mortalidad neonatal y en menores de 5 años, la prevalencia del retraso del crecimiento en niños y el índice compuesto de cobertura (un promedio ponderado de 8 indicadores de cobertura en materia de salud reproductiva, materna, neonatal e infantil. Para evaluar las desigualdades absolutas y relativas, se emplearon el índice de desigualdad de la pendiente y el índice de concentración. RESULTADOS: El índice compuesto de cobertura mostró patrones monotónicos en función de los quintiles de riqueza, con los niveles más bajos en el quintil más pobre. La mortalidad neonatal y en menores de 5 años, así como la prevalencia del retraso del crecimiento, fueron más elevadas entre los pobres. En la mayor parte de los países aumentó la cobertura de las intervenciones, mientras que la mortalidad en menores de 5 años y la prevalencia del retraso del crecimiento disminuyeron más rápidamente entre los pobres, de manera que las desigualdades se redujeron con el transcurso del tiempo. Sin embargo, en Bolivia, Guatemala, Haití, Nicaragua y Perú aún se observan marcadas desigualdades. Brasil prácticamente ha eliminado las desigualdades en cuanto a retraso del crecimiento. CONCLUSIONES: Los países de ALC mostraron avances considerables en la reducción de las desigualdades con respecto a las intervenciones de salud reproductiva, materna, neonatal e infantil, y en materia de mortalidad y nutrición infantil. Sin embargo, el 20% más pobre de la población en la mayor parte de los países sigue quedándose a la zaga, y son necesarias iniciativas renovadas para mejorar la equidad.

OBJETIVO: Identificar fatores associados à interrupção precoce (antes dos 4 meses) do aleitamento materno exclusivo e à introdução tardia (após os 8 meses) de alimentos complementares. MÉTODOS: Realizou-se estudo transversal, por meio de inquérito, no primeiro dia da Campanha Nacional de Vacinação de 2004 em Cuiabá (MT). A amostra consistiu de 921 crianças menores de 1 ano, cujos acompanhantes foram entrevistados utilizando questionário semi-estruturado. Aplicou-se técnica de probitos para avaliação da oferta de líquidos e sólidos, e análise de regressão logística para análise de fatores associados à introdução precoce de líquidos ou introdução tardia de sólidos. RESULTADOS: Observou-se elevado consumo de água e chás, seguido pelo de leite de vaca, nos menores de 120 dias. A chance de estar ofertando líquido no momento do inquérito foi maior para as crianças que receberam tais alimentos no dia da alta da maternidade. A partir dos 8 meses, aproximadamente 60% das crianças estavam recebendo sopa ou comida da família. CONCLUSÕES: A oferta de líquidos no primeiro dia em casa mostrou-se um bom preditor desse hábito nos primeiros 4 meses, reforçando a necessidade de ações no acompanhamento pré-natal e na maternidade sobre os malefícios dessa prática. Após os 8 meses, no entanto, há que se reforçar a importância da participação da criança na comida da família, especialmente para as mães adultas, com menos do que o 3º grau de escolaridade e primíparas.

OBJECTIVE: To identify factors associated with early interruption (before 4 months) of exclusive breastfeeding and late introduction (after 8 months) of complementary foods. METHODS: This is a cross-sectional study, based on a survey conducted on the first day of the National Vaccination Campaign in 2004, in Cuiabá, MT, Brazil. The sample comprised 921 children less than 1 year old, and the adult accompanying each child was interviewed and a semi-structured questionnaire filled out. Probit analysis was employed to assess consumption of liquids and solids, and logistic regression analysis was applied to identify factors associated with early introduction of liquids and with late introduction of solids. RESULTS: There was elevated consumption of water and teas, followed by cow's milk among those less than 120 days old. Children were more likely to be being given liquids on the day of the survey if they had been consuming them on the day they were discharged from the maternity unit. Approximately 60% of the children were being given soup or the family meal by 8 months. CONCLUSIONS: Liquids being given on the first day at home was a good predictor that they would be given for the first 4 months, emphasizing the need for intervention during prenatal care and at maternity units to counter the harm caused by this practice. After 8 months, however, it is necessary to emphasize the importance of the child participating in family meals, especially for adult mothers without higher education and primaparous mothers.