PNS 2013: In two years, Caesarean sections made up more than half of all deliveries
August 21, 2015 11h36 AM | Last Updated: January 17, 2018 04h09 PM
Among women whose last delivery occurred between 01/01/2012 and 27/07/2013, 45.3% had a normal delivery and 54.7% had a Caesarean section. More than half of the surgeries (53.5%) had been scheduled in advance, as revealed in the third volume of the 2013 National Survey of Health (PNS).
The survey also informs that, from age 50 to 69, 60% of the of the women had had a mammogram in the two years preceding the interview, whereas, from age 25 to 64, 79.4% had undergone a test to prevent cervix cancer, known as Pap smear, in the last three years. Among women aged 18 and over, 7.7% had undergone surgery for uterus removal, mainly due to uterine myoma. Almost 70% of the women aged 18 to 49 had been pregnant once in life. From the total number of women in the same age bracket who had had sexual relationships in the 12 months preceding the interview and who still had menstrual periods, 38.9% did not use any kind of contraceptive method.
The third volume of PNS 2013 analyzes the population’s life cycles and presents information on physical disability and on the health of the elderly, women and children up to 2 years of age. The analysis also covers anthropometric data related to weight and abdominal fat, besides information on blood pressure.
According to the survey, obesity affected one out of five Brazilians aged 18 and over in 2013 (20.8%). The percentage was higher among women (24.4% versus 16.8% for men). Overweight affected more than half of the population (56.9%), about 82 million persons, obese ones included. In ten years, obesity among women aged 20 and over changed from 14.0% in 2003, according to the Consumer Expenditure Survey (POF), to 25.2% in 2013, according to the PNS. Among men, increase was smaller, from 9.3% to 17.5%. The accumulation of abdominal fat was also more frequent among women, reaching 52.1% of them versus and 21.8% of men. The opposite took place in relation to blood pressure, with biggest occurrence of rise among men (25.3%) than women (19.5%), reaching, at the moment of the interview, 22.3% of the population.
The PNS also reveals that 6.2% of the population had at least one of the four types of disability investigated, and that 0.8% had intellectual disability; 1.3%, physical disability; 1.1%, hearing disability and 3.6%, visual disability. Physical disability resulting from disease or accident affected one out of every one hundred Brazilians. Intellectual disability was the only type whose percentage of persons born with the problem (0.5%) surpassed that of persons who acquired it afterwards (0.3%).
The survey shows that 6.8% of the elderly were limited to perform daily activities in their own home, such as eating and putting on clothes, whereas 17.3% had difficulty in performing instrumental activities, such as shopping and taking medicines. In 2013, one out of every four children up to one year of age had not taken the three doses of the tetravalent vaccine, against tetanus, diphtheria, whooping cough and meningitis. Among children aged 9 and 12 months, 50.6% had been breastfed as a complementary source of feeding. Up to 2 years of age, 60.8% of the children used to eat cookies, crackers or cake, and 32.3%, to drink soft drinks or artificial juice.
The third volume of PNS 2013 brings data on Brazil, its Major Regions and Federation Units. Click here to see the complete publication.
Disability: one out of every hundred persons has some physical disability caused by disease or accident
Approximately 2.6 million persons (1.3% of the population) had some physical disability, such as paralysis, amputations, deformities, and dwarfism, among others. The percentage was highest among men (1.6%) than women (1.0%), increasing from age 30 on: 1.0% for the group aged 30 to 39, 1.9% for persons aged 40 to 59 and 3.3% for those aged 60 and over. Persons with no schooling of with unfinished primary education (1.9%) recorded percentages above the other levels of schooling.
In the country, about 600 thousand persons (0.3%) were born with this kind of disability, whereas 2.0 million (1.0%) had acquired it by disease or accident. The North Region had the lowest proportion of physical disability acquired by disease or accident (0.8%). Among persons with physical disability, 46.8% had a high or very high level of limitation, or could not even perform their usual activities. It was estimated that 18.4% of the population were attending some type of rehabilitation service.
Most of the persons with intellectual disability had been born with it
Intellectual disability affected about 1.6 million Brazilians (0.8%) in 2013. It is the least frequent type of disability among the four ones surveyed. Approximately 1.0 million persons (0.5% of the population) had had intellectual disabilities since birth, whereas 600 thousand (0.3%) had acquired it by disease or accident. It is the only type in which the percentage of people born with the disability was superior to those who had acquired by means of a disease or accident. The highest percentages were estimated among people with no schooling and with unfinished primary education, considering those who had been born with a disability (0.9 %), as well as those who had gotten it due to illness or accident (0.5 %).
In 2013, 54.8% of the population with intellectual disabilities had a high or very high level of limitation, or were unable to perform their usual activities, such as going to school, playing and working. This was the highest proportion of limitation between the disabilities investigated. Among persons with intellectual disability, the proportion of people who attended health rehabilitation services, composed of multiprofessional teams and interdisciplinary assistance, was 30.4 %, the highest among the four disabilities surveyed.
2,2 million persons had hearing impairment in 2013
In Brazil, about 2.2 million persons (1.1% of the population) had hearing impairment, with the smallest ratio observed in the Northern Region (0.8%). The survey considered persons with hearing impairment those with deafness in both ears, or deafness in one ear and reduced hearing in another, or reduced hearing in both ears.
This type of disability was more frequent among persons with no schooling with unfinished primary education (1.8%) and in the group aged 60 and over (5.2%). It was the only one with statistically different results by color or race, in which white persons made up a bigger proportion (1.4%) than black and brown ones (both with 0.9%).
In the population, 09% had hearing impairment caused by disease or accident, whereas 0.2% had had it since birth. The proportion of persons who acquired hearing disability was lowest in the North Region (0.6%) and biggest in the South (1.3%), being biggest in the group aged 60 and over (5.0%), the white population (1.2%) persons with no schooling or with incomplete primary education (1.6%). In 2013, 20.6% of the population with this disability had a high or very high level of limitation or were unable to perform usual activities. In Brazil, 8.4% of them attended rehabilitation services. In Brazil, 8.4% of them attended rehabilitation services.
Visual impairment is the most common type affecting the population
Visual impairment is the most frequent type among the population (3.6%), reaching approximately 7.2 million persons. It was highest in the South Region (5.9%) and among persons aged 60 and over (11.5%). Visual impairment encompassed cases of blindness in both eyes, blindness in one eye and reduced sight in the other, blindness in one eye and normal sight in the other and low sight in both eyes. This disability included the biggest proportion of persons who had gotten it due to a disease or accident (3.3%), while 0.4% had had it since birth. In the country, 6.6% of people with visual impairment made use of some resource to assist locomotion, such as a folding cane guide dog.
Regarding the high or very high level of limitation or failure to perform activities of daily living, visual impairment had the lowest proportion (16.0%). The Northeast region was the only one with a proportion above the national level (20.8%). Rehabilitation services were attended by 4.8% of the persons with this type of disability, the lowest percentage among the four types surveyed.
Health of the elderly: 17.3% of the elderly have difficulty to perform daily instrumental activities
In 2013, about 26.5 million persons were 60 and over, representing 13.2% of the population and 17.3% of them (4.6 million) had functional limitation to perform, alone, their instrumental activities of daily living (IADL). That represents limitations to go shopping, take care of their own money, take medicines and use public transportation such as buses, taxi or cars. The Northeast Region presented the biggest proportion of this indicator (22.0%).
The functional limitation for IADL was biggest among women (20.4%) than men (13.4%). The older the age group, the biggest the proportion estimated, ranging from 6.4% to persons aged 60 to 64 and 39.2% among persons aged 75 and over. The higher the level of schooling, the smaller the estimated proportion: 27.6% for those with no schooling and 7.9% for those with at least complete primary education.
Functional limitation to perform activities of daily living (ADL) reached 6.8% of the elderly in 2013 (1.8 million persons). These activities include eating, taking a shower, getting dressed and lying down. The older the age group, the biggest the proportion of elderly persons facing these difficulties, ranging from 2.8% among persons aged 60 to 64 to 15.6% among persons aged 75 and over. On the other hand, the highest the level of schooling, the smaller the indicator, with 10.2% for persons with no schooling and 3.7% for those with complete primary school or more.
The survey also showed that 84.0% of the elderly with these difficulties (1.5 million) needed help to perform these activities, but 10.9% did not receive any help, 17.8% had care provided by a paid professional (either a family member or not, living in the same housing unit or not) and 78.8% had care provided by a family members (living in the same housing unit or not).
7.6 million elderly persons have been diagnosed with cataract
The proportion of elderly persons diagnosed with cataract in one or both eyes was 28.7% (7.6 million). The highest rates were those of the Northeast (31.9%) and Central West (33.7%) and the lowest, in the South Region (21.8%). The rate was less frequent among men (24.6%) than among women (31.9%) and rose with the age, reaching 47.5% in the group aged 75 and over. With reference to color or race, white persons made up the biggest proportion (30.5%).
Among persons diagnosed with cataract, 72.2% had indication of surgery and had it done. The Northeast Region (66.5%) recorded a result below the national average. Among persons who did not undergo surgery, the most often mentioned reasons were: they found it unnecessary (18.4%); the surgery was already scheduled (17.8%); there were no vacancies; they had financial difficulties (9.1%).
Women's health: 60% of the women aged 50 to 69 had had a mammogram in the two years preceding the date of the survey
Three out of every five Brazilian women aged 50 to 69 (60.0%) had taken a mammogram in the two years preceding the survey. This concern for health was more common among white women (66.2%) with complete higher education (80.9%). Considering black (54.2%), brown (52.9%) and less schooled women (50.9% among women with no schooling and those with incomplete primary education), frequencies were smaller. The smallest proportion of women who had taken this test was found in the North Region (38.7%), followed by the Northeast (47.9%), Central West (55.6%), South (64.5%) and Southeast (67.9%).
In Brazil, 79.4% of the women aged 25 to 64 underwent the test to prevent cervix cancer (Pap test) in the three years preceding the survey. The Southeast (81.1%), South (83.0%) and Central West (80.9%) accounted for the biggest proportions, and the North (75.5%) and Northeast (75.1%) were lower in 2013. Among women aged 25 to 64 who had never taken the test, 45.6% reported not finding it necessary; 20.7% had never been advised to take it and 9.7% reported being embarrassed to do it.
In Brazil, 7.7% of the women aged 18 and over underwent surgery for uterus removal. The main reason was the removal of a uterine myoma (65.7%). In 2013, 69.8% of the women aged 45 and over who had not had their uterus removed had already started menopause.
First pregnancy occurs at earlier age among less educated women
In Brazil, 21 was the average age of women at their first pregnancy. Those with a lower level of schooling had their first pregnancy even earlier 919 for those without instruction or with unfinished elementary school), whereas among those with complete higher education that occurred, on the average, at 25.
Considering women aged 18 to 49, sexually-active in the last 12 months, and who still had menstrual periods, 61.1% had made use of contraceptive methods. White women (65.8%), those with complete higher education (69.7%) and complete or unfinished higher education presented bigger percentages of contraceptive method use.
In the same age bracket, 69.2% of the women had been pregnant at least once in life. In the North (73.6%) and Northeast (72.9%), the percentages surpassed the national average. The Southeast recorded the lowest percentage (66.1%). Bigger percentages of women who had once been pregnant were found among those without instruction of with unfinished primary school (87.0%) and this percentage was reduced with the level of schooling (56.4% among those who had complete higher education).
Among women aged 18 to 49, 2.1% had induced abortion at least once in life. This percentage changed from 1.0% in the South, to 3.0% in the Northeast. Women without instruction or with incomplete primary school (2.8%), and also those with complete primary school of unfinished high school (2.1%) recorded the biggest percentages, if compared with women with a higher education degree. The proportion of black women (3.5%) who reported having induced abortion was bigger than that of white women (1.7%).
On the other hand, 15.2% of the women in the same age group had had a miscarriage. The biggest percentages were registered in the North Region (18.1%) and Northeast Region (17.8%); the lowest one was registered in the South Region (12.7%). That occurred to 21.1% of women without instruction and 11.7% of those with complete higher education. Black (18.9%) and white women (17.7%) had higher percentages than white women (12.3%).
In two years, Caesarean sections accounted for more than half of all deliveries
In Brazil, 97.4% of the women whose latest delivery had take place between 01/01/2012 and 27/07/2013 had had prenatal care. Among those, 83.7% had started treatment with less than 13 weeks of pregnancy, 75.2% received guidance on the risk of pregnancy and 82.4% had guidance on breastfeeding. Among women who had pre-natal care, 74.9% were informed about the health service they should search for at the time of delivery.
As for the tests conducted throughout pre-natal care, 97.3% of the expecting women had a blood test, 64.8%, a test for syphilis, 98.1%, urine test and 88.8% of them were asked to undergo an HIV test. During pre-natal treatment, 97.7% of the women had at least one ultrasound test.
The proportion of women seen by a doctor in the last pregnancy occurred in the period from 01/01/2012 to 27/07/2013 was 87.4%, ranging from 76.1% in the North Region to 94.6% in the Central West. On the average, 97.9% of the pregnant women had had their latest delivery in a hospital or maternity ward.
In Brazil, 45.3% of the women had a natural birth, with highest percentages in the North (59.8%) and Northeast (55.0%) and among women without instruction or with unfinished primary school (65.3%). Among women who had a Caesarean section, 53.5% had their surgery pre-scheduled during the pre-natal period.
Health of children under two years of age: almost 76% of the children aged one were up-to-date with the tetravalent vaccine
In Brazil, 75.9% of the children aged one had at least three doses of the tetravalent vaccine, which provided immunization against diphtheria, tetanus, whooping cough and meningitis. The South Region was the only one to present a distinct proportion from the national average (85.3%). The urban area (83.3%) had proportions above those in the urban area (74.3%).
Considering children aged 9 to 12 months, 50.6% had been breastfed as a complementary form of feeding. It was estimated that 60.8% of the children aged less than two years of age used to eat cookies, crackers or cake, and 32.3% use to drink milk or artificial juice.
In 2013, 28.7% of the children below two years of age had had their first medical appointment in the period of up to seven days after release from the maternity hospital. The South Region (44.0%) reached a proportion above the national average, whereas in the Northeast Region and North Region, figures were below the average. This percentage was bigger in the urban area (30.4%) than in the urban one (20.0%).
In Brazil, 70.8% of the children aged less than two year of age had undergone the neonatal heel prick in their first week of life. Their objective is to precociously detect metabolic, genetic or infectious diseases. The biggest proportions were those in the South (83.5%) and Southeast (84.7%), whereas the Central West (69.1%), Northeast (53.8%) and North (56.4%) recorded proportions below the national average. The urban area (73.2%) had a proportion above the rural area (58.4%).
More than half (56.0%) of the children below two years of age conducted, in the first month of life, the newborn hearing screening, which is used for the early diagnosis of hearing impairment. The biggest proportions were found in the Southeast Region (70.3%) and South Region (77.6%), whereas the smallest ones occurred in the North (35.3%) and Northeast (37.5%). The urban area (60.6%) had a proportion above the rural area (32.2%).
In the same age bracket, 51.1% of the children had, in the first month, the red reflex test, which can detect and prevent eye changes and their serious consequences. The North (22.7%) and Northeast (23.6%) recorded the biggest results, and the Southeast (13.5%) and Central West (14.3%), the lowest. The rural area had its estimated proportion below the rural are: 31.3% and 54.9%. In the same age bracket, 51.1% of the children had, in the first month, the red reflex test, which can detect and prevent eye changes and their serious consequences. The North (22.7%) and Northeast (23.6%) recorded the biggest results, and the Southeast (13.5%) and Central West (14.3%), the lowest. The rural area had its estimated proportion below the rural are: 31.3% and 54.9%.
Anthropometry: Obesity affects one out of every four women
One out of every four women aged 18 and over (24.4%) was obese in 2013, whereas, among men, the percentage was 16.8%. That means these persons had a body mass index (BMI) greater than or equal to 30, resulting from the division of people's weight in kilograms divided by the square of height in meters. Obesity affected 32.2% of the women aged 55 to 64, versus 23.0% of men.
More than half of the population was overweight (56.9%), that is, about 82 million persons had a BMI equal to or greater than 25, including all the obese ones. That points to a prevalence of excess weight women (58.2%), whereas men made up 55.6%. These percentages include obese persons. Excess weight increases with the age, at a higher pace among men, reaching 50.4% in the group aged 25 to 29. However, among women from the age group 35 to 44 on, the prevalence of excess weight (63.6%) surpasses the percentage of men (62.3%), and reaches ore than 70% in the group aged 55 to 64. From age 65 on, there is a decline of excess weight prevalence, among both men and moment, but more significant among men, who corresponds to 45.4% in the group aged 75 and over, versus women (58.3%).
The weight deficit in adults aged 18 and over was 2.5% (2.1% for men and 2.8% for women), being below the limit of 5.0% expected for constitutionally thin individuals in any population. The stratification of the adult population by age groups indicated the prevalence of excess weight surpasses 5.0% only among women aged 18 to 24 (6.8%), and that for men in this age group the prevalence of weight deficit (4.6%) is bigger in the two age groups, but does not reach 5.0%. That signals the non exposition to malnutrition by the adult population, as a whole.
More than half of the women had an increased waist circumference
Whereas 52.1% of the women had wais circumference greater than or equal to 88 cm, which characterizes abdominal obesity, 21.8% of the men had a circumference of 102 cm or more in this part of their bodies. The excess of abdominal weight is associated to the risk of cardio-metabolic diseases, such as obesity, diabetes and high blood pressure. In relation to the increased waist circumference by age group, it is observed that, as this measurement increases with the age, both among men and women, surpassing 70.0% in women over 55 years of age and 35.0% in the case of men.
In ten years, female obesity rose from 14% to 25.2%
Between 2003 and 2013, obesity among women aged 20 and over changed from 14.05 (according to POF 2002-2003) to 25.2% (according to the PNS), an increase of 11.2 percentage points. Among men, there was smaller increase, from 9.3% to 17.5%, with a difference of 8.2 percentage points. In relation to excess weight, there was also continuous increase both for men (from 42.4% to 57.3%) and women (from 42.1% to 59.8%). On the other hand, there was continuous decline of the weight deficit, among both men (from 2.8% to 1.9%) and women crease (from 4.9% to 2.5%).
High blood pressure: one out of every four men was suffering from high blood pressure at the moment of the interview
In 2013, 22.3% of the persons were suffering from high blood pressure at the moment of the interview. That was more frequent among men (25.3%) than women (19.5%0, and became more common with the increase of age: whereas 5.7% of the persons aged 19 and 24 had high blood pressure, this problem affected 46.5% of the persons aged 75 and over. On the other hand, 5.9% of the population had blood pressure below normal limits. The occurrence among women (8.7%) was significantly higher than among men (2.8%). This is the first national survey on the topic measuring the blood pressure of persons aged 18 and over.
Table 3
Prevalence and total number of persons aged 18 and over with low blood pressure and high blood pressure, by sex, by age group - Brazil – 2013
Age Groups | Prevalênce and total number of persons aged 18 and over with low blood pressure and high blood pressure (%) | |||||
---|---|---|---|---|---|---|
Total | Men | Women | ||||
% |
Estimated |
% |
Estimated |
% |
Estimated |
|
Low Blood Pressure |
||||||
Total |
5.9 |
8 552 |
2.8 |
1 918 |
8.7 |
6 634 |
18 to 24 |
11.1 |
2 536 |
6.3 |
719 |
16.1 |
1 817 |
25 to 29 |
9.0 |
1 306 |
3.4 |
249 |
15.0 |
1 056 |
30 to 34 |
6.4 |
1 054 |
1.8 |
142 |
10.8 |
912 |
35 to 44 |
5.1 |
1 419 |
1.6 |
208 |
8.2 |
1 212 |
45 to 54 |
3.2 |
817 |
1.2 |
139 |
5.0 |
678 |
55 to 64 |
2.5 |
490 |
1.4 |
130 |
3.4 |
360 |
65 to 74 |
3.4 |
384 |
2.4 |
121 |
4.2 |
263 |
75 and over |
8.2 |
545 |
7.4 |
210 |
8.7 |
335 |
High Blood Pressure |
||||||
Total |
22.3 |
32 254 |
25.3 |
17 452 |
19.5 |
14 802 |
18 to 24 |
5.7 |
1 308 |
8.7 |
997 |
2.7 |
310 |
25 to 29 |
9.9 |
1 431 |
14.0 |
1 036 |
5.6 |
394 |
30 to 34 |
13.5 |
2 224 |
17.0 |
1 355 |
10.3 |
869 |
35 to 44 |
18.2 |
5 071 |
22.8 |
2 967 |
14.2 |
2 104 |
45 to 54 |
28.5 |
7 302 |
33.5 |
4 048 |
24.1 |
3 254 |
55 to 64 |
35.8 |
7 043 |
39.1 |
3 527 |
33.0 |
3 516 |
65 to 74 |
42.2 |
4 769 |
43.8 |
2 210 |
40.9 |
2 559 |
75 and over |
46.5 |
3 108 |
46.2 |
1 313 |
46.6 |
1 795 |
Source: IBGE, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento, Pesquisa Nacional de Saúde 2013.
Note: Low Blood Pressure: Systolic Blood Pressure < 100 mmHg or Diastolic Blood Pressure < 60 mmHg. High Blood Pressure: Systolic Blood Pressure >= 140 mmHg or Diastolic Blood Pressure >= 90 mmHg