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Sansone NMS, Vitta E, Siqueira BA, Marson FAL. Overview of the Indigenous health of the Yanomami ethnic group in Brazil: A Public Health Emergency. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01978-2. [PMID: 38532175 DOI: 10.1007/s40615-024-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION The Indigenous population of the Yanomami ethnic group in Brazil is currently facing a public health emergency due to the high number of deaths, mainly of children. Taking that into consideration, this study aims to analyze this crisis impact on the health of this population in the period between 2018 and 2022. METHODS The data presented were collected from the report called Yanomami Mission ("Missão Yanomami") published by the Brazilian Ministry of Health and, from it, a descriptive analysis of the Indigenous individuals' health was carried out for (i) the geographical distribution; ii) the number of deaths; (iii) the child death rate; (iv) the deaths of Indigenous individuals from preventable causes; (v) the causes of preventable diseases related to hygiene and basic sanitation, and the distribution of diarrheal diseases according to age groups; (vi) evaluation of the nutritional classification; vii) the percentage (%) of the complete vaccination scheme, and (viii) the coverage of prenatal appointments of Indigenous pregnant women. RESULTS The report included 31,017 individuals belonging to the Yanomami ethnic group, most of the participants were up to 39 years old (N = 26,377; 85.0%) and men (N = 15,836; 51.1%). During the period described in the report, the number of deaths reached 1285/31,017 (4.1%). When analyzing the deaths, the most representative age groups were those of children under 1 year old (505/1285; 39.9%), from 1 to 4 years old (178/1285; 13.8%), and the elderly from 60 to 79 years old (150/1285; 11.6%). The Indigenous individuals from this ethnic group presented a child death rate ~ 1.5 to 3.5 higher than that of the total Indigenous population in the country. Regarding the child death rate, the neonatal component represented 57.8% of the deaths and, in 2022, 93.0% of the pregnant women had less than six prenatal appointments. This population shows a high number of deaths due to preventable causes (N = 538) and cases of illnesses associated with hygiene and sanitation, for example (N = 35,103 cases/notifications). As for vaccination, the full vaccination scheme targeting children below 5 years old has not been met since 2018. CONCLUSION In the Indigenous population of the Yanomami ethnic group, a high number of deaths was observed, which affected mainly individuals under 1 year old. Among the factors associated with the deaths, mainly in children under 5 years old, most cases have preventable causes, which could be reduced by proper action promoting their health and preventing diseases.
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Affiliation(s)
| | - Eduarda Vitta
- Molecular Biology and Genetics Laboratory, University of São Francisco, Bragança Paulista, São Paulo, Brazil
| | - Bianca Aparecida Siqueira
- Molecular Biology and Genetics Laboratory, University of São Francisco, Bragança Paulista, São Paulo, Brazil
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Queiroz BL. Challenges related to records and quality of information in the Amazon. CAD SAUDE PUBLICA 2023; 39:e00098323. [PMID: 37585905 PMCID: PMC10494665 DOI: 10.1590/0102-311xpt098323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
- Bernardo Lanza Queiroz
- Departamento de Demografia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Cardoso AM, Tavares IDN, Werneck GL. Indigenous health in Brazil: from vulnerable to protagonists. Lancet 2022; 400:2011-2014. [PMID: 36502826 DOI: 10.1016/s0140-6736(22)02419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz, Rio de Janeiro, 21041-210, Brazil.
| | - Inara do Nascimento Tavares
- Instituto Insikiran de Formação Superior Indígena/UFRR, Boa Vista, Brazil; Programa de Pós-Graduação de Ciências Sociais em Desenvolvimento, Agricultura e Sociedade-CPDA/UFRRJ, Rio de Janeiro, Brazil
| | - Guilherme Loureiro Werneck
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Duarte MG, Valentini NC, Nobre GC, Benda RN. Contextual Factors and Motor Skills in Indigenous Amazon Forest and Urban Indigenous Children. Front Public Health 2022; 10:858394. [PMID: 35548073 PMCID: PMC9082032 DOI: 10.3389/fpubh.2022.858394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 01/22/2023] Open
Abstract
This study investigated the contextual factors, motor performance, and body mass index across indigenous land children, indigenous urban children, and non-indigenous urban children. A number of 153 children, both sexes (71 girls, 46.4%), from 8 to 10 years were assessed. The Test of Motor Gross Development-3 was utilized. Indigenous land children showed higher motor performance ( η 2 ρ = 0.37 and η 2 ρ = 0.19 locomotor and object control, respectively) than indigenous urban children (p < 0.03) and non-indigenous urban children (p < 0.01); Indigenous urban children showed higher motor performance than non-indigenous urban children (p < 0.01). Body mass index was similar across groups ( η 2 ρ = 0,02; p = 0.15). Motor performance of indigenous land children was explained by the contextual factors that lead to a more active lifestyle, unsupervised free time, and play outside. In urban areas, behavior was similar, and although indigenous urban children kept some play tradition, it was not strong enough to be a protective factor for the motor performance.
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Affiliation(s)
| | - Nadia Cristina Valentini
- School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rodolfo Novellino Benda
- School of Physical Education, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Cunha AAD, Nazima MTST, Castilho-Martins EA. Covid-19 among the Brazilian Amazon indigenous people: factors associated with death. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210368en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.
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Affiliation(s)
- Arthur Arantes da Cunha
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil
| | - Maira Tiyomi Sacata Tongu Nazima
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
| | - Emerson Augusto Castilho-Martins
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
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Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:2227-2236. [PMID: 34581998 PMCID: PMC8477716 DOI: 10.1007/s40615-021-01162-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018-1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.
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Cunha AAD, Nazima MTST, Castilho-Martins EA. Covid-19 entre indígenas na Amazônia brasileira: fatores associados ao óbito. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022210368pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo objetiva analisar fatores associados ao óbito de indígenas pela covid-19 no estado do Amapá, Brasil. Trata-se de um estudo caso-controle emparelhado por sexo e idade, que utilizou um banco de dados secundários público, produzido pela Secretaria de Estado da Saúde do Amapá. Os casos (n=29) foram óbitos de indígenas pela covid-19 e os controles foram curas da doença (n=87), registrados entre abril de 2020 e janeiro de 2021. Dados de indivíduos com doença ativa foram excluídos da análise. Foram realizadas análises univariadas seguidas por regressão logística múltipla para estudo das variáveis independentes associadas ao desfecho de óbito. A maioria dos casos de óbito era do sexo feminino (51,7%), sem comorbidades (62,1%), residentes em municípios da Região Metropolitana de Macapá (RMM) (65,5%) e em área urbana (89,7%). A mediana das idades do grupo de óbitos foi de 72 anos (intervalo interquartil= 21,5). O modelo múltiplo final demonstrou que indígenas com comorbidade cardiovascular apresentaram chance 4,01 vezes (intervalo de confiança de 95% - IC 95%= 1,05-15,36) maior de óbito pela covid-19 quando comparados a indígenas sem comorbidades. E que indígenas residentes na RMM apresentaram chance 2,90 vezes (IC 95%= 1,10-7,67) maior de óbito quando comparados aos indígenas residentes no interior do estado Amapá.
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Affiliation(s)
- Arthur Arantes da Cunha
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil
| | - Maira Tiyomi Sacata Tongu Nazima
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
| | - Emerson Augusto Castilho-Martins
- Universidade Federal do Amapá. Faculdade de Medicina, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil; Universidade Federal do Amapá, Brasil
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Sousa BLA, Silva CA, Ferraro AA. An update on the epidemiology of pediatric COVID-19 in Brazil. REVISTA PAULISTA DE PEDIATRIA 2022; 40:e2021367. [PMID: 35442272 PMCID: PMC8983007 DOI: 10.1590/1984-0462/2022/40/2021367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/30/2022]
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Oliveira MVG, Abreu ÂMM, Welch JR, Coimbra CEA. Coping with Hypertension among Indigenous Peoples in Brazil and the Role of the Primary Care Nurse: A Critical Review from a Transcultural Perspective. NURSING REPORTS 2021; 11:942-954. [PMID: 34968280 PMCID: PMC8715468 DOI: 10.3390/nursrep11040086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Our objective is to critically review the literature addressing the strategic role of nurses in the daily primary care of arterial hypertension in Indigenous communities in Brazil. We selected studies based on an initial keyword search of major bibliographic indexing databases for the years 2000 to 2020 and manual search. Further selection was based on topical, methodological, and thematic relevance, as well as evaluation of scholarship quality and pertinence to our chosen narrative. The literature demonstrates Indigenous peoples do not receive health services that measure up to national standards in large part due to a marked lack of academic and employer preparation for nurses operating in transcultural settings. Inequities were apparent in recurrent reports of victim-blaming, deficient clinical communication with patients, clinical malpractice, devaluation of hypertension as a problem for Indigenous peoples, insufficient intercultural training for nurses, and discrimination against Indigenous students in nursing education programs. This systemic problem needs to be addressed by universities and the Indigenous Health Care Subsystem in Brazil.
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Affiliation(s)
| | - Ângela Maria Mendes Abreu
- Escola de Enfermagem Anna Nery, Universidade Federal de Rio de Janeiro, Rio de Janeiro 20211-130, Brazil;
| | - James R. Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
| | - Carlos E. A. Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
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Horta BL, Silveira MF, Barros AJD, Barros FC, Hartwig FP, Dias MS, Menezes AMB, Hallal PC, Victora CG. [Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian surveyPrevalência de anticorpos contra o SARS-CoV-2 de acordo com o status socioeconômico e étnico em uma pesquisa nacional no Brasil]. Rev Panam Salud Publica 2021; 45:e105. [PMID: 34703458 PMCID: PMC8530005 DOI: 10.26633/rpsp.2021.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate socioeconomic and ethnic group inequalities in prevalence of antibodies against SARS-CoV-2 in the 27 federative units of Brazil. METHODS In this cross-sectional study, three household surveys were carried out on May 14-21, June 4-7, and June 21-24, 2020 in 133 Brazilian urban areas. Multi-stage sampling was used to select 250 individuals in each city to undergo a rapid antibody test. Subjects answered a questionnaire on household assets, schooling and self-reported skin color/ethnicity using the standard Brazilian classification in five categories: white, black, brown, Asian or indigenous. Principal component analyses of assets was used to classify socioeconomic position into five wealth quintiles. Poisson regression was used for the analyses. RESULTS 25 025 subjects were tested in the first, 31 165 in the second, and 33 207 in the third wave of the survey, with prevalence of positive results equal to 1.4%, 2.4%, and 2.9% respectively. Individuals in the poorest quintile were 2.16 times (95% confidence interval 1.86; 2.51) more likely to test positive than those in the wealthiest quintile, and those with 12 or more years of schooling had lower prevalence than subjects with less education. Indigenous individuals had 4.71 (3.65; 6.08) times higher prevalence than whites, as did those with black or brown skin color. Adjustment for region of the country reduced the prevalence ratios according to wealth, education and ethnicity, but results remained statistically significant. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 in Brazil shows steep class and ethnic gradients, with lowest risks among white, educated and wealthy individuals.
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Affiliation(s)
- Bernardo L Horta
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Mariângela F Silveira
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Aluísio J D Barros
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Fernando C Barros
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Fernando P Hartwig
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Mariane S Dias
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Ana M B Menezes
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Pedro C Hallal
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
| | - Cesar G Victora
- Universidad Federal de PelotasPelotasBrasilUniversidad Federal de Pelotas, Pelotas, Brasil.
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Kempton JW, Périssé ARS, Hofer CB, de Vasconcellos ACS, de Sousa Viana PV, de Oliveira Lima M, de Jesus IM, de Souza Hacon S, Basta PC. An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10091. [PMID: 34639393 PMCID: PMC8508331 DOI: 10.3390/ijerph181910091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.
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Affiliation(s)
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venân-cio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000, Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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Sousa BLA, Brentani A, Costa Ribeiro CC, Dolhnikoff M, Grisi SJFE, Ferrer APS, Ferraro AA. Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study. BMJ Open 2021; 11:e050724. [PMID: 34489291 PMCID: PMC8423513 DOI: 10.1136/bmjopen-2021-050724] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents. DESIGN Cross-sectional observational study using publicly available data from the Brazilian Ministry of Health. SETTING Nationwide. PARTICIPANTS 5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020. MAIN OUTCOME MEASURE We used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development. RESULTS Individually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North-OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities-OR 0.26, 95% CI 0.17 to 0.38) CONCLUSIONS: Besides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.
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Affiliation(s)
| | - Alexandra Brentani
- Department of Pediatrics, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Marisa Dolhnikoff
- Department of Pathology, University of São Paulo School of Medicine, São Paulo, Brazil
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Alves FTA, Prates EJS, Carneiro LHP, Sá ACMGND, Pena ÉD, Malta DC. Mortalidade proporcional nos povos indígenas no Brasil nos anos 2000, 2010 e 2018. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi analisar a mortalidade indígena no Brasil em 2000, 2010 e 2018. Estudo descritivo com dados do Sistema de Informação sobre Mortalidade. Calculou-se a mortalidade proporcional entre indígenas e restante da população brasileira, segundo idade, sexo, causa e regiões do Brasil. A proporção de óbitos em indígenas menores de 1 ano em 2000, 2010 e 2018 foi de 15,3%, 17,7% e 16,2%; e no restante do Brasil, foi de 7,2%, 3,5% e 2,7% respectivamente. A proporção de óbitos a partir de 50 anos nos indígenas nos mesmos anos foi de 47,0%, 48,1% e 52,0%; e no restante do Brasil, foi de 66,8%, 74,4% e 79,4%. Em 2018, indígenas menores de 1 ano morreram mais de afecções perinatais (39,4%), doenças infecciosas e parasitárias (10,1%) e causas externas (9,8%). Em menores de 1 ano do restante da população brasileira, essas causas corresponderam a 57,8%, 3,8% e 2,8%. Indígenas acima de 50 anos morreram mais por doenças circulatórias (28,6%), respiratórias (15,4%) e neoplasias (14,6%); e no restante da população brasileira, essas causas representaram 31,5%, 13,6% e 19,0%. Evidenciaram-se desigualdades em saúde e piores indicadores nos povos indígenas no Brasil.
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de M Pontes AL, Santos RV. Health reform and Indigenous health policy in Brazil: contexts, actors and discourses. Health Policy Plan 2021; 35:i107-i114. [PMID: 33165584 PMCID: PMC7649663 DOI: 10.1093/heapol/czaa098] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Given the challenges related to reducing socio-economic and health inequalities, building specific health system approaches for Indigenous peoples is critical. In Brazil, following constitutional reforms that led to the universalization of health care in the late 1980s, a specific health subsystem was created for Indigenous peoples in 1999. In this paper, we use a historical perspective to contextualize the creation of the Indigenous Health Subsystem in Brazil. This study is based on data from interviews with Indigenous and non-Indigenous subjects and document-based analysis. In the 1980s, during the post-dictatorship period in Brazil, the emergence of Indigenous movements in the country and the support for pro-Indigenous organizations helped establish a political agenda that emphasized a broad range of issues, including the right to a specific health policy. Indigenous leaders established alliances with participants of the Brazilian health reform movement, which resulted in broad debates about the specificities of Indigenous peoples, and the need for a specific health subsystem. We highlight three main points in our analysis: (1) the centrality of a holistic health perspective; (2) the emphasis on social participation; (3) the need for the reorganization of health care. These points proved to be convergent with the development of the Brazilian health reform and were expressed in documents of the Indigenist Missionary Council (CIMI) and the Union of Indigenous Nations (UNI). They were also consolidated in the final report of the First National Conference on the Protection of Indigenous Health in 1986, becoming the cornerstone of the national Indigenous health policy declared in 1999. Our analysis reveals that Indigenous people and pro-Indigenous groups were key players in the development of the Indigenous Health Subsystem in Brazil.
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Affiliation(s)
- Ana Lucia de M Pontes
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brazil
| | - Ricardo Ventura Santos
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brazil.,Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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15
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Ferreira AA, Souza MCD, Cardoso AM, Horta BL, Santos RV, Welch JR, A Coimbra CE. Birth weight of indigenous children in Brazil: results of the First National Survey of Indigenous People's Health and Nutrition. CAD SAUDE PUBLICA 2021; 37:e00228120. [PMID: 33440414 DOI: 10.1590/0102-311x00228120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
Birth weight is an important predictor of perinatal, infant, and preschool-age children morbimortality. However, information about indigenous children's birth weight is still scarce. This study aimed to analyze the birth weight of indigenous children based on data from the First National Survey of Indigenous People's Health and Nutrition, Brazil (2008-2009). This is the first study to address indigenous children's birth weight based on a nationwide representative sample. Mean birth weights and the respective standard deviations were calculated according to geopolitical region, sex, type of birth, and birthplace. The chi-square test was used to analyze differences in proportions, and Kruskal-Wallis and Mann-Whitney U tests in means, considering sample design and data normality. We found no records on birth weight in the researched documents for 26.7% of the 6,128 sampled children. The mean birth weight for the 3,994 children included in the analyses was 3,201g (standard deviation - SD ± 18.6g), regardless of sex, type of birth, and birthplace. The prevalence of low birth weight was 7.6% (n = 302) and was significantly higher among girls. Boys presented significantly higher mean birth weight than girls, regardless of the geopolitical region. Low birth weight was slightly less frequent among indigenous children when compared to Brazilian children in general. Our study indicates the need to improve prenatal care and the quality of consultation records for indigenous women as a strategy to promote safe pregnancy and childbirth.
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Affiliation(s)
- Aline Alves Ferreira
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Bernardo Lessa Horta
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - James R Welch
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Hallal PC, Hartwig FP, Horta BL, Silveira MF, Struchiner CJ, Vidaletti LP, Neumann NA, Pellanda LC, Dellagostin OA, Burattini MN, Victora GD, Menezes AMB, Barros FC, Barros AJD, Victora CG. SARS-CoV-2 antibody prevalence in Brazil: results from two successive nationwide serological household surveys. Lancet Glob Health 2020; 8:e1390-e1398. [PMID: 32979314 PMCID: PMC7511212 DOI: 10.1016/s2214-109x(20)30387-9] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Population-based data on COVID-19 are essential for guiding policies. There are few such studies, particularly from low or middle-income countries. Brazil is currently a hotspot for COVID-19 globally. We aimed to investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody prevalence by city and according to sex, age, ethnicity group, and socioeconomic status, and compare seroprevalence estimates with official statistics on deaths and cases. METHODS In this repeated cross-sectional study, we did two seroprevalence surveys in 133 sentinel cities in all Brazilian states. We randomly selected households and randomly selected one individual from all household members. We excluded children younger than 1 year. Presence of antibodies against SARS-CoV-2 was assessed using a lateral flow point-of-care test, the WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech, Guangzhou, China), using two drops of blood from finger prick samples. This lateral-flow assay detects IgG and IgM isotypes that are specific to the SARS-CoV-2 receptor binding domain of the spike protein. Participants also answered short questionnaires on sociodemographic information (sex, age, education, ethnicity, household size, and household assets) and compliance with physical distancing measures. FINDINGS We included 25 025 participants in the first survey (May 14-21) and 31 165 in the second (June 4-7). For the 83 (62%) cities with sample sizes of more than 200 participants in both surveys, the pooled seroprevalence increased from 1·9% (95% CI 1·7-2·1) to 3·1% (2·8-3·4). City-level prevalence ranged from 0% to 25·4% in both surveys. 11 (69%) of 16 cities with prevalence above 2·0% in the first survey were located in a stretch along a 2000 km of the Amazon river in the northern region. In the second survey, we found 34 cities with prevalence above 2·0%, which included the same 11 Amazon cities plus 14 from the northeast region, where prevalence was increasing rapidly. Prevalence levels were lower in the south and centre-west, and intermediate in the southeast, where the highest level was found in Rio de Janeiro (7·5% [4·2-12·2]). In the second survey, prevalence was similar in men and women, but an increased prevalence was observed in participants aged 20-59 years and those living in crowded conditions (4·4% [3·5-5·6] for those living with households with six or more people). Prevalence among Indigenous people was 6·4% (4·1-9·4) compared with 1·4% (1·2-1·7) among White people. Prevalence in the poorest socioeconomic quintile was 3·7% (3·2-4·3) compared with 1·7% (1·4-2·2) in the wealthiest quintile. INTERPRETATION Antibody prevalence was highly heterogeneous by country region, with rapid initial escalation in Brazil's north and northeast. Prevalence is strongly associated with Indigenous ancestry and low socioeconomic status. These population subgroups are unlikely to be protected if the policy response to the pandemic by the national government continues to downplay scientific evidence. FUNDING Brazilian Ministry of Health, Instituto Serrapilheira, Brazilian Collective Health Association, and the JBS Fazer o Bem Faz Bem.
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Affiliation(s)
- Pedro C Hallal
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando P Hartwig
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Mariângela F Silveira
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Luís P Vidaletti
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Lucia C Pellanda
- Fundação Universidade Federal de Ciências de Saúde de Porto Alegre, Brazil
| | - Odir A Dellagostin
- Postgraduate Programme in Biotechnology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Marcelo N Burattini
- Universidade Federal de São Paulo, São Paulo, Brazil; Universidade de São Paulo, São Paulo, Brazil
| | - Gabriel D Victora
- Laboratory of Lymphocyte Dynamics, Rockefeller University, New York, NY, USA
| | - Ana M B Menezes
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil; Universidade Católica de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil.
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Horta BL, Silveira MF, Barros AJD, Barros FC, Hartwig FP, Dias MS, Menezes AMB, Hallal PC, Victora CG. Prevalence of antibodies against SARS-CoV-2 according to socioeconomic and ethnic status in a nationwide Brazilian survey. Rev Panam Salud Publica 2020; 44:e135. [PMID: 33165337 PMCID: PMC7595003 DOI: 10.26633/rpsp.2020.135] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate socioeconomic and ethnic group inequalities in prevalence of antibodies against SARS-CoV-2 in the 27 federative units of Brazil. METHODS In this cross-sectional study, three household surveys were carried out on May 14-21, June 4-7, and June 21-24, 2020 in 133 Brazilian urban areas. Multi-stage sampling was used to select 250 individuals in each city to undergo a rapid antibody test. Subjects answered a questionnaire on household assets, schooling and self-reported skin color/ethnicity using the standard Brazilian classification in five categories: white, black, brown, Asian or indigenous. Principal component analyses of assets was used to classify socioeconomic position into five wealth quintiles. Poisson regression was used for the analyses. RESULTS 25 025 subjects were tested in the first, 31 165 in the second, and 33 207 in the third wave of the survey, with prevalence of positive results equal to 1.4%, 2.4%, and 2.9% respectively. Individuals in the poorest quintile were 2.16 times (95% confidence interval 1.86; 2.51) more likely to test positive than those in the wealthiest quintile, and those with 12 or more years of schooling had lower prevalence than subjects with less education. Indigenous individuals had 4.71 (3.65; 6.08) times higher prevalence than whites, as did those with black or brown skin color. Adjustment for region of the country reduced the prevalence ratios according to wealth, education and ethnicity, but results remained statistically significant. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 in Brazil shows steep class and ethnic gradients, with lowest risks among white, educated and wealthy individuals.
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Affiliation(s)
- Bernardo L Horta
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Mariângela F Silveira
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Fernando P Hartwig
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Mariane S Dias
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Ana M B Menezes
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Pedro C Hallal
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Universidade Federal de PelotasPelotasBrazilUniversidade Federal de Pelotas, Pelotas, Brazil
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