Windows of opportunity offered by the national immunization days: The development of health and nutrition days in Brazil

To monitor progress towards the first MDG it is essential to have baseline data about child nutrition. National household surveys are costly, time consuming and do not furnish information about specific poverty stricken areas or deprived populations. To overcome this difficulty, the Brazilian government used the windows of opportunity offered by National Immunization Days (NID), which are held regularly since the 1980s. This study describes large-scale Health and Nutrition Days (HND) simultaneous with Immunizations Days. HNDs were carried out among high-risk under five children during 2005-2007; samples of children in the semi-arid region (n=16,239), agrarian reform settlements (n=1,305), isolated rural black communities, or Quilombolas (n=2,723) and the Amazon region (n=15,249) were studied. It was possible to obtain estimates for more than 4.3 million children from different subgroups of underprivileged populations who had never before been studied in such detail. The methodology involved data collection to estimate coverage of health and social welfare services and nutrition assessment employing the WHO 2006 standard. The highest prevalence of stunting (height for age below -2SD) was found among children from Amazon region: 23.1%, followed closely by children from the rural settlements. Around 95% of children had a Child Health Card, but it was used for growth monitoring in about 65% of cases. More than five prenatal clinic visits varied from 60% to 80% of mothers. The education data confirmed very poor social conditions, as indicated by 30.3% to 81.4% heads of household with less than four years of schooling in the Amazon and rural settlements, respectively. The implementation of HNDs nested with NIDs proved feasible in Brazil and resulted in essential data for health policy-makers, obtained quickly and at a much lower cost than household based surveys. The NIDs windows of opportunity may be useful and are valid whenever immunization coverage is very high.