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closeA light to rheumatic fever epidemiology
Posted by Palotufo on 11 Feb 2007 at 23:35 GMT
I read with interest this nice paper. All Brazilian physicians and epidemiologists recognize an impressive decline of rheumatic fever in the country since the 1970’s. It was very common in Rio de Janeiro and Sao Paulo from the 30´s until the 60”s. After this time, the disease was only diagnosed among children living in rural areas and who were living in small towns located in the North and the Northeast. The most recent outbreak was observed in Acre, located in the Rain Forest. Recently, we observed that incidence of nephritis due to streptococcal is also declining. End-renal failure is right now more common from “hypertension-diabetes” than from chronic nephritis. In Brazil as also elsewhere, we do not have any idea about the reason of this downward tendency of incidence and case-fatality of this “strepto-based diseases”. This paper can add some light to the search the epidemiology of rheumatic fever.
However, as a Brazilian scholar I can not agree with the notation "low income country" considering the sample from Brasilia. First of all, Brazil is not a low income, but an industrialized country (Sao Paulo is now a typical “post-industrialized place) with the tenth highest Gross National Product, and the per capita income that can be considered as "mid-high income country". Second, Brasilia is the richest city of the country due its condition of Federal Capital with abundant tax-funding resources
RE: A light to rheumatic fever epidemiology
dcampos replied to Palotufo on 21 Feb 2007 at 12:08 GMT
Classified by the GNP, Brazil is surely not a “low income country”. It is in fact situated among the ten larger economies of the world. However, considering the GNP per capita and the human development references, the classification falls to 69° position. If the adopted criterion takes into account the income distribution, as the CINI coefficient for wealth equality, Brazil occupies the 117° place (among with the eight countries with the worst income distribution in the world). According to IPEA's data (an organ of the Economy Department), 56,9 million of brazilians live in poverty situation. 24,7 million of them survive in extreme poverty conditions. The wealth concentrated by the 1% of the richest is equal to that of the 50% of the poorest. Indeed, the 10% of the richest peoples have an income 68 times greater than those of the 10% poorest.
There are, undoubtedly, two countries named Brazil. One has a high income and the other a low income. These two countries are not separated by frontiers. They cohabit narrowly in the everyday activities. The same situation is observed in Brasília. Although the income per capita of the Federal Capital is the highest, its distribution presents the same inequalities than those encountered in the whole country. The inhabitants of the peripheries are poor, unemployed, as they are in São Paulo. Moreover, migrants from the rural zone or the Federal District and from the Brazilian north and northeast regions are predominant in this population of Brasília.
So, the Brazilian children included in this research, accomplished in three medical care clinics of the Fedral District public health system, belong to poor layers of the population and have (very) low incomes.