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Brazil Infectious and Chronic Diseases
Infectious and Chronic Diseases
Perinatal conditions were responsible for 47.1 percent of total
infant mortality, ranking first among the causes of reported deaths
for those under one year old in 1988. The leading cause of mortality
among children one to four years of age, at 24.5 percent of all
deaths in 1988, was infectious and parasitic diseases, particularly
diarrheal diseases. External causes, specifically traffic accidents
and homicide, accounted for the greatest share of registered deaths
for the cohort aged five to forty-nine. Among the elderly population
sixty years and above, deaths resulting from diseases of the circulatory
system amounted to the highest percentage (50.3) of the total in
1989. Those diseases were also the leading cause of mortality for
the entire nation, with higher ratios in the wealthier Southeast
(36.2 percent) and South (37.2 percent), relative to the impoverished
North (23.2 percent) and Northeast (29.3 percent). Although the
proportion of deaths has shifted to older population groups, regional
variations continue to hold, such that over a quarter of deaths
afflicts the below-five age range in the North.
Expanded immunization coverage in recent years has favored a drop
in mortality ascribed to vaccine-preventable diseases, from 12.9
percent in 1979 to 2.4 percent in 1988. In 1993 vaccination of Brazilian
children less than one year old under the National Immunization
Program reached 68.5 percent for diphtheria, pertussis, and tetanus,
92.3 percent poliomyelitis, 77.7 percent measles, and 98 percent
tuberculosis. Although tuberculosis persists as a principal source
of morbidity and mortality, particularly with the onset of the human
immunodeficiency virus (HIV), its incidence and death rates have
been steadily on the decline.
Control measures have proven effective in reducing the prevalence
and outbreak of other infectious and endemic diseases, including
cholera, Chagas' disease (American trypanosomiasis), yellow fever,
and schistosomiasis (bilharzia). However, the number of registered
cases of malaria, which 42.9 percent of the Brazilian
population is at risk of contracting (mainly in the Amazon region),
grew from 52,000 cases per year in 1970 to about 600,000 in the
1980s, with some improvement since then. Other communicable diseases
either have been reintroduced, as in the case of dengue (breakbone
fever) since 1986. Infectious tropical diseases reflect poor sanitary
conditions as well as discrepancies in the standard of living between
Northern
and Southern
Brazil, where such diseases ranked third and last, respectively,
among the six leading causes of death in 1989.
Leprosy remains a serious problem in Brazil's high poverty areas,
where the disease is spreading most rapidly. In October 1996, an
average of 100 new cases were being reported each day. As many as
half a million Brazilians are afflicted with leprosy.
The incidence of acquired immune deficiency syndrome (AIDS) in
Brazil has also reached epidemic proportions, from 490 in 1985 to
103,262 cumulative cases by March 1, 1997, the fourth highest reported
prevalence in the world. Based on 1996 data from the Pan American
Health Organization (PAHO), homosexuals and/or bisexuals constitute
45 percent of the cumulative cases; intravenous drug users, 27 percent;
heterosexuals, 20 percent; and others, 8 percent. The incidence
was highest among young adults; 60 percent of those suffering from
AIDS in 1994 were in the twenty-five to thirty-nine age-group. What
began as a disease of homosexuals and recipients of blood transfusions
quickly spread to heterosexuals and intravenous drug users. HIV
infection attributed to needle-sharing during drug use increased
from 3.0 percent of the cases in 1986 to 24.5 percent in 1992-93
and from 5.0 percent to 23.4 percent for heterosexual transmission,
altering the male-to-female ratio from 100:1 in the 1980s to 4:1
in 1994. The surge in the proportion of women contracting the virus
has resulted in part from a rise in perinatal transmission, the
predominant mode of infection for the 12,000 infants and children
diagnosed with AIDS in 1994.
The overall reduction in the number of new cases of the above infectious
diseases, on the one hand, and the conspicuous rise in the incidence
of chronic and degenerative diseases, on the other, indicate the
occurrence of an epidemiological transition in Brazil. However,
the transition is not complete; the two types coexist as major causes
of death. Diseases of the circulatory system, including cerebrovascular
and heart diseases, currently claim first place as the leading cause
of death among the entire population (34.3 percent in 1989). The
degenerative diseases have contributed to steep rises in the cost
of health care, especially for the elderly.
Data as of April 1997
See Also Brazil Medical Tourism
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