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de Freitas DA, Wakimoto MD, Dias S, Souza-Santos R. High-Risk Areas for Congenital Zika Syndrome in Rio de Janeiro: Spatial Cluster Detection. Trop Med Infect Dis 2024; 9:105. [PMID: 38787038 PMCID: PMC11125739 DOI: 10.3390/tropicalmed9050105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Brazil reported 18,282 suspected congenital Zika syndrome (CZS) cases up to 2018 and accounts for 61.4% of the total reported Zika cases in the Americas in the period. To detect high-risk areas for children with CZS in the city of Rio de Janeiro, we used cluster detection and thematic maps. We analyzed data using a Poisson model in Satscan 10.1.3 software. We also analyzed the records of children with CZS from 2015 to 2016 to describe the clinical and epidemiological maternal and child profile, as well as live births in 2016 and the social development index (SDI) by neighborhood. In 2015 and 2016, the incidence rates of CZS were 8.84 and 46.96 per 100,000 live births in the city, respectively. Severe congenital findings such as microcephaly and brain damage, osteoarticular impairment, ocular abnormalities, and hearing loss were observed in 47 children. The spatial distribution of CZS was concentrated in the north and west zones in heterogeneous neighborhoods. The neighborhoods with the highest occurrence of CZS cases were found to have the worst SDIs. Stascan detected three spatial clusters in the north zone, where the SDI is lower. The clusters presented high relative risks for CZS (7.86, 1.46, and 2.08), although they were not statistically significant. Our findings highlight a higher occurrence of CZS in areas with less favorable socioeconomic conditions.
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Affiliation(s)
- Danielle Amaral de Freitas
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
| | - Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Rio de Janeiro 4365, RJ, Brazil;
| | - Sónia Dias
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), REAL, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560 Lisboa, Portugal;
| | - Reinaldo Souza-Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
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Felix JB, de Campos AC, Logan SW, Machado J, Souza Monteiro K, Longo E. Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS). Disabil Rehabil Assist Technol 2024:1-14. [PMID: 38166551 DOI: 10.1080/17483107.2023.2300052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS). MATERIALS AND METHODS A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains. RESULTS Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes. CONCLUSIONS Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.
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Affiliation(s)
- Jean Bendito Felix
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | | | - Samuel W Logan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Julianne Machado
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | - Karoline Souza Monteiro
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | - Egmar Longo
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
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de Lima Nascimento Coutinho DL, Feldner H, Coelho MLG, Monteiro KS, Longo E. The burden of global outbreaks: Photos of the daily lives of children with congenital Zika syndrome during the COVID-19 pandemic. Health Expect 2023; 26:2500-2513. [PMID: 37596733 PMCID: PMC10632653 DOI: 10.1111/hex.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION In Brazil, more than 3500 children with congenital Zika syndrome (CZS) face difficulties participating in activities of daily living, which may be aggravated by health emergencies, such as the COVID-19 pandemic. Participation could be defined as the individual's involvement in daily life situations, and participation restrictions are problems that may arise in involvement in everyday situations. AIM To explore the daily lives of children with CZS during the COVID-19 pandemic using photographic narratives captured by mothers and discuss possible strategies to improve participation results. METHODS In this participatory action research, seven young Brazilian mothers acted as co-researchers using photovoice to describe the experiences of their children with CZS (from 2 to 5 years old). Also, mothers contributed to validate the contents. The research was conducted online and included the following steps: pilot study, recruitment, individualized training, sociodemographic interview, photovoice training, photo taking, focus group for contextualization, data transcription and analysis and validation of analyses by the mothers. RESULTS Content analysis revealed five categories that influenced the participation of the children: participation preferences, family relationships, access to healthcare, access to education and social isolation. Regarding participation preferences, mothers reported their children's desire to play with peers and family members and have autonomy. Mothers described the family environment as a happy, peaceful and safe place for the children. Lack of therapy was perceived to negatively impact the health of children; thus, treatments were considered essential for child development. Access to education included accessibility of remote education and a perceived lack of infrastructure and pedagogical preparation. Last, social isolation due to COVID-19 directly affected the daily lives and behaviour of the children, interrupting therapies and medical appointments. CONCLUSION The photos and narratives captured several aspects of the daily lives of children with CZS impacted by the COVID-19 pandemic, reinforcing the importance of considering the negative effects of social isolation and offering education and social assistance to promote participation and integral health. PATIENT/PUBLIC CONTRIBUTION Consistent with a participatory action research framework, Mothers acted as co-researchers and participated in all stages of the research, especially in validating the data analysed by the researchers.
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Affiliation(s)
| | - Heather Feldner
- Department of Mechanical EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Monique L. G. Coelho
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
| | - Karolinne S. Monteiro
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
| | - Egmar Longo
- Faculty of Health Science of TrairiFederal University of Rio Grande do NorteSanta CruzBrazil
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Andrade GKSD, Marcon SS, Batiston AP, Neves ET, Vieira VCDL, Sá JSD, Benedito JCDS, Teston EF. Health care network for children with zika virus from the perspective of professionals. Rev Gaucha Enferm 2023; 44:e20230043. [PMID: 37971110 DOI: 10.1590/1983-1447.2023.20230043.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To know the perspective of health professionals working in specialized care regarding the assistance offered to children with Congenital Zika Virus Syndrome in the Health Care Network. METHOD Qualitative study carried out in Campo Grande-MS through semi-structured interviews, between September and October 2020, with 12 professionals working in a reference service for people with physical and intellectual disabilities. Minayo's thematic analysis and the theoretical subsidies of the care model for chronic conditions were used for interpretation. RESULTS Assistance in the network is weakened by aspects related to access, monitoring and integration between different professionals/services. The potential involves the implementation of the referral and counter-referral system, the communication/integration between these services and the training of professionals. FINAL CONSIDERATIONS The participants perceive that assistance is influenced by the availability of trained professionals to work in a network and the optimization of access and follow-up at different points of care.
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Affiliation(s)
- Gleice Kelli Santana de Andrade
- Universidade Federal de Mato Grosso do Sul (UFMS). Instituto Integrado de Saúde. Mestrado em Enfermagem. Campo Grande, Mato Grosso do Sul, Brasil
| | - Sonia Silva Marcon
- Universidade Estadual de Maringá (UEM). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
| | - Adriane Pires Batiston
- Universidade Federal de Mato Grosso do Sul (UFMS). Instituto Integrado de Saúde. Mestrado em Saúde da Família. Campo Grande, Mato Grosso do Sul, Brasil
| | - Eliane Tatsch Neves
- Universidade Federal de Santa Maria (UFSM). Centro de Ciências da Saúde. Programa de Pós-Graduação em enfermagem. Santa Maria, Rio Grande do Sul, Brasil
| | - Viviane Cazetta de Lima Vieira
- Universidade Estadual de Maringá (UEM). Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
| | - Jennyfer Soares de Sá
- Universidade Federal de Mato Grosso do Sul (UFMS). Instituto Integrado de Saúde. Mestrado em Enfermagem. Campo Grande, Mato Grosso do Sul, Brasil
| | - Júnior Cezar de Souza Benedito
- Universidade Federal de Mato Grosso do Sul (UFMS). Instituto Integrado de Saúde. Mestrado em Saúde da Família. Campo Grande, Mato Grosso do Sul, Brasil
| | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul (UFMS). Instituto Integrado de Saúde. Mestrado em Enfermagem. Campo Grande, Mato Grosso do Sul, Brasil
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Farias TMO, Albuquerque MDSVD, Oliveira RS, Lyra TM, Miranda GMD, Oliveira PRD. [The limited access of People with Disabilities to health services in a northeastern capital]. CIENCIA & SAUDE COLETIVA 2023; 28:1539-1548. [PMID: 37194885 DOI: 10.1590/1413-81232023285.15172022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/25/2022] [Indexed: 05/18/2023] Open
Abstract
The access of People with Disabilities (PwD) to specialized care services was analyzed on the basis of the availability-accommodation and adequacy dimensions. This is a case study with a qualitative approach and triangulation of sources based on documentary research, data from the Health Information Systems and semi-structured interviews with managers, health professionals and PwD. There was an expansion of rehabilitation services in Recife, although it was not possible to analyze the production capacity of such services. The findings point to the existence of architectural and urban barriers and insufficient resources in the services studied. Furthermore, there is a long waiting time for specialized care and difficult access to assistive technologies. It was also observed that professionals have low qualifications to meet the needs of PwD and a process of permanent education in different levels of complexity has not been instituted for workers. The conclusion drawn is that the institution of the Municipal Policy of Comprehensive Health Care for the PwD was insufficient to guarantee access to health services with continuity of care, considering the permanence of the fragmentation of the care network, thus violating the right to health of this segment.
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Affiliation(s)
- Tássia Mayra Oliveira Farias
- Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901 Recife PE Brasil.
| | | | - Raquel Santos Oliveira
- Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1235, Cidade Universitária. 50670-901 Recife PE Brasil.
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Touchton M, Wampler B. Democratizing Public Health: Participatory Policymaking Institutions, Mosquito Control, and Zika in the Americas. Trop Med Infect Dis 2023; 8:tropicalmed8010038. [PMID: 36668945 PMCID: PMC9865320 DOI: 10.3390/tropicalmed8010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
The Zika virus is a mosquito-borne virus spread primarily by Aedes mosquitoes. Zika cases have been detected throughout the mosquito's range, with an epidemic occurring from 2015 to 2017 in Brazil. Many Zika cases are mild or asymptomatic, but infections in pregnant women can cause microcephaly in children, and a small percentage of cases result in Guillan-Barré syndrome. There is currently little systematic information surrounding the municipal spread of the Zika Virus in Brazil. This article uses coarsened exact matching with negative binomial estimation and ordinary least squares estimation to assess the determinants of Zika incidence across the ~280,000 cases confirmed and recorded by Brazil's Ministry of Health in 2016 and 2017. These data come from Freedom of Information Act (FOIA) requests in Brazil and have not been published. We use data on the universe of individual Zika cases in Brazil and Geographic Information Systems (GIS) software to examine the virus at the municipal level across 5570 municipalities and construct a unique, unusually rich dataset covering daily Zika transmission. Additionally, our dataset includes corresponding local data on democratic governance, mosquito control efforts, and environmental conditions to estimate their relationship to Zika transmission. The results demonstrate that the presence of subnational democratic, participatory policymaking institutions and high levels of local state capacity are associated with low rates of Zika contraction. These models control for local healthcare spending and economic conditions, among other factors, that also influence Zika contraction rates. In turn, these findings provide a better understanding of what works for local health governance and mosquito control and makes important data public so that scholars and practitioners can perform their own analyses. Stronger models of Zika transmission will then inform mosquito abatement efforts across the Global South, as well as provide a blueprint for combatting Dengue fever, which is also transmitted by Aedes mosquitoes.
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Affiliation(s)
- Michael Touchton
- Department of Political Science, University of Miami, Coral Gables, FL 33146, USA
- Faculty Lead for Global Health, Institute for Advanced Studies of the Americas, University of Miami, Coral Gables, FL 33146, USA
- Correspondence:
| | - Brian Wampler
- President’s Office of Public Engagement, Boise State University, Boise, ID 83725, USA
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Greiner R. Towards Critical Studies of Disabilities: engaging Latin American theoretical perspectives on Congenital Zika Syndrome. HORIZONTES ANTROPOLÓGICOS 2022. [DOI: 10.1590/s0104-71832022000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract Infection with the Zika virus during pregnancy can cause disability, yet disability remains under theorised in studies on Congenital Zika Syndrome (CZS). Existing studies are largely exploratory and descriptive in nature, and thus a deeper analysis is needed. Where theory has been applied, there is limited engagement with Latin American theoretical perspectives. The social construction of disability, and of caregiver identity in particular warrant further analysis. Understanding that disability is constructed through an ‘ideology of normality’ can help make sense of parents’ reactions to a diagnosis of CZS. Caregivers resistance to biomedical narratives about disability is apparent in the case of CZS and deserves further attention. Consideration has been given to the ways that social location and shared temporality in relationships of care shape caregiver identity. Here I read these together to reach a fuller understanding of how caregivers and the people they care for develop a shared embodiment. An analysis bringing together Latin American Critical Disability Studies with other critical theoretical perspectives can advance theorisations of disability and the experiences of caregivers in their social, political, economic and historical contexts.
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Laza-Vásquez C, Briones-Vozmediano E, Gea-Sánchez M. Caring for children with Congenital Zika Syndrome: The unmet needs of mothers in Southern Colombia. Glob Public Health 2022; 17:2752-2763. [PMID: 34632950 DOI: 10.1080/17441692.2021.1987500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACTIn Latin America, the Zika virus (ZIKV) epidemic of 2015-2016 resulted in children being born with a spectrum of neurological disorders called Congenital Zika Syndrome (CZS). Women are the primary caregivers of those children. The objective of the study was to identify the perceived needs of women to care for their children with CZS in Southern Colombia. In 2019, a qualitative ethnographic study was conducted in southern Colombia, including 21 women belonging to a self-managed support group and who had prenatal ZIKV between 2015 and 2016 and, as a consequence, their children were born with CZS. Three discussion groups and six semi-structured interviews were conducted and analyzed through qualitative content analysis. Three main perceived needs to care for their children were identified: knowledge and skills to provide the complex care their children require and for which they did not feel prepared, economic and social support. This study showed that women face unmet needs when caring for their children with CZS, especially regarding social support. Therefore, it is urgent to generate public policies and intervention strategies for professionals to support these women in order to meet not only the needs of their children but also their own.
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Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Nursing Program, Surcolombiana University, Neiva, Colombia
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
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Coelho MLG, Campos TNC, Magalhães AG, Felix JB, Melo A, Tavares JS, Monteiro KS, Longo E. My child is growing and now? Exploring the environmental needs of children with congenital Zika syndrome according to their caregivers' perceptions. Health Expect 2022; 25:2828-2836. [DOI: 10.1111/hex.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/07/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Monique L. G. Coelho
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | - Taynah N. C. Campos
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | | | - Jean B. Felix
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | | | | | - Karolline S. Monteiro
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
| | - Egmar Longo
- Faculty of Health Science of Trairi Federal University of Rio Grande do Norte Santa Cruz Brazil
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Clemente KAP, da Silva SV, Vieira GI, de Bortoli MC, Toma TS, Ramos VD, de Brito CMM. Barriers to the access of people with disabilities to health services: a scoping review. Rev Saude Publica 2022; 56:64. [PMID: 35792776 PMCID: PMC9239543 DOI: 10.11606/s1518-8787.2022056003893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the scientific evidence regarding barriers to the access of people with disabilities to health services. METHODS A scoping review was carried out from the main question: "What are the main barriers that people with disabilities face in accessing health services?" The articles were surveyed in July 2019 in six scientific literature databases. Of the 1,155 documents identified in the searches, after selection by title and abstract, 170 publications were read in full and, thus, 96 articles were included and categorized according to the theoretical framework. RESULTS The main barriers indicated by the users of the service were: communication failure between professionals and patient/caregiver; financial limitations; attitudinal/behavioral issues; scarce service provision; organizational and transport barriers. The main barriers presented by service providers were: lack of training to professionals; failure of the health system; physical barriers; lack of resources/technology; and language barriers. CONCLUSIONS It was evident that people with disabilities face several barriers when trying to access the health services they need and that users and health professionals have distinct and complementary views on difficulties.
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Affiliation(s)
- Karina Aparecida Padilha Clemente
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Simone Vieira da Silva
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Gislene Inoue Vieira
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina Legal, Ética Médica, Medicina Social e do TrabalhoSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Legal, Ética Médica, Medicina Social e do Trabalho. São Paulo, SP, Brasil.
| | - Maritsa Carla de Bortoli
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Tereza Setsuko Toma
- Secretaria de Estado da Saúde de São PauloInstituto de SaúdeDepartamento de Ciência e TecnologiaSão PauloSPBrasil Secretaria de Estado da Saúde de São Paulo. Instituto de Saúde. Departamento de Ciência e Tecnologia. São Paulo, SP, Brasil.
| | - Vinícius Delgado Ramos
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto de Medicina Física e Reabilitação. São Paulo, SP, Brasil.
| | - Christina May Moran de Brito
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Instituto do Câncer do Estado de São Paulo. São Paulo, SP, Brasil.
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Lyra TM, Veloso de Albuquerque MS, Santos de Oliveira R, Morais Duarte Miranda G, Andréa de Oliveira M, Eduarda Carvalho M, Fernandes Santos H, Penn-Kekana L, Kuper H. The National Health Policy for People with Disabilities in Brazil: An Analysis of the Content, Context and the Performance of Social Actors. Health Policy Plan 2022; 37:1086-1097. [PMID: 35771660 PMCID: PMC9557334 DOI: 10.1093/heapol/czac051] [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: 11/16/2021] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
The purpose of this article is to analyse the circumstances in which the National Health Policy for Persons with Disabilities (PNSPCD) came into place in 2002 and the factors supporting or impeding its implementation from 2002 to 2018. The analysis was based on the Comprehensive Policy Analysis Model proposed by Walt and Gilson and focussed on understanding the context, process, content and actors involved in the formulation and implementation of the Policy. Data were obtained from two sources: document analysis of the key relevant documents and seven key informant interviews. Content analysis was undertaken using the Condensation of Meanings technique. The research demonstrates that the development and implementation of PNSPCD is marked by advances and retreats, determined, above all, by national and international macro-political decisions. The policy was formulated during Fernando Henrique’s governments, under pressure from social movements and the international agenda and constituted a breakthrough for the rights of persons with disabilities. However, progress on implementation only took place under subsequent centre-left governments with the establishment of a care network for people with disabilities and a defined specific budget. These developments resulted from the mobilization of social movements, the ratification of the United Nations Convention on the rights of people with disabilities and the adherence of these governments to the human rights agenda. The coming to power of ultra-right governments triggered fiscal austerity, a setback in the implementation of the care network and a weakening in the content of various social policies related to the care of people with disabilities. During this era, the political approach changed, with the attempt to evade the role of the State, and the perspective of guaranteeing social rights. Undoubtedly, the neoliberal offensive on social policies, especially the Unified Health System, is the main obstacle to the effective implementation of the PNPCD in Brazil.
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Affiliation(s)
- Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE 50.740-465, Brazil
| | - Maria Socorro Veloso de Albuquerque
- Center for Medical Sciences, Federal University of Pernambuco, Av. da Engenharia, s/n, Bloco "D", 1º Andar - Cidade Universitária, Recife, PE 50.740-600
| | - Raquel Santos de Oliveira
- Center for Medical Sciences, Federal University of Pernambuco, Av. da Engenharia, s/n, Bloco "D", 1º Andar - Cidade Universitária, Recife, PE 50.740-600
| | - Gabriella Morais Duarte Miranda
- Center for Medical Sciences, Federal University of Pernambuco, Av. da Engenharia, s/n, Bloco "D", 1º Andar - Cidade Universitária, Recife, PE 50.740-600
| | - Márcia Andréa de Oliveira
- Medical Sciences College, University of Pernambuco, Av. Gov. Agamenon Magalhães - Santo Amaro, Recife, PE 50.100-010
| | - Maria Eduarda Carvalho
- Aggeu Magalhães Institute, FIOCRUZ/PE, Av. Professor Moraes Rego, s/n - Campus da UFPE, Cidade Universitária, Recife, PE 50.740-465, Brazil
| | - Helena Fernandes Santos
- Center for Philosophy and Human Sciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, PE 50670-901
| | - Loveday Penn-Kekana
- Epidemiology and Public Health, Maternal and Neonatal Health Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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12
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Duttine A, Smythe T, Calheiros de Sá MR, Ferrite S, Moreira ME, Kuper H. Assessment of the feasibility of Juntos: A support programme for families of children affected by Congenital Zika Syndrome. Wellcome Open Res 2022; 7:77. [PMID: 35651695 PMCID: PMC9127372 DOI: 10.12688/wellcomeopenres.17419.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The 2015-16 Zika epidemic resulted in thousands of children born with congenital Zika syndrome (CZS). In Brazil, gaps in the health system often caused parents to be left with insufficient information and support. Consequently, we developed and piloted Juntos - a participatory support programme which aims to improve knowledge, capacities and build support networks for caregivers of children with CZS. Methods: Six caregiver groups received the programme between August 2017 and June 2018: three in Rio de Janeiro and three in Bahia. We assessed the feasibility of Juntos against six of the eight areas of a feasibility framework described by Bowen
et al. to consider whether Juntos ‘could work’. These areas were: acceptability, demand, implementation, practicality, adaptation and limited efficacy. We used mixed methods including: 1) baseline and end-line questionnaires completed by all group participants; 2) in-depth interviews with 18 participants, seven facilitators and three key stakeholders; 3) participant focus group discussions after each session; 4) researchers session observation; and 5) recording programme costs. Results: 37/48 (77%) enrolled families completed both questionnaires. Acceptability and demand were noted as high, based on participant responses to interview questions, focus group feedback and satisfaction scores. Potential for implementation and practicality were also demonstrated through interviews with facilitators and key stakeholders and analysis of project documents. Two groups included caregivers of children with non-Zika related developmental disabilities, showing potential for adaptability. Self-reported quality of life scores increased in caregivers between baseline and end-line, as did the dimensions of family relationships and daily activities in the Pediatric Quality of Life Inventory (PEDS QL) Family Impact Module, showing limited efficacy. Conclusions: The programme showed feasibility according to Bowen’s framework. However, further research of scale up, particularly in the areas of integration, expansion and limited efficacy are needed to ascertain if the programme is effective.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Silvia Ferrite
- Dept of Hearing and Speech Services, Federal University of Bahia, Salvador, Bahia, 40110-902, Brazil
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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13
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Araujo MDO, Nascimento MAAD. Facilidades e dificuldades na promoção do direito à saúde de crianças com síndrome congênita do zika. AVANCES EN ENFERMERÍA 2022. [DOI: 10.15446/av.enferm.v40n2.89402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objetivo: descrever as facilidades e dificuldades na promoção do direito à saúde de crianças com síndrome congênita do vírus zika (SCZ).
Materiais e métodos: estudo qualitativo realizado nos serviços onde as crianças com SCZ são acompanhadas, no município de Feira de Santana, Bahia, Brasil. Para a coleta de dados, foram utilizadas a entrevista semiestruturada e a observação sistemática. Os participantes foram constituídos de três grupos: grupo I (sete responsáveis das crianças com SCZ); grupo II (seis profissionais de saúde e dos serviços sociais) e grupo III (oito gestores dos serviços de saúde). Utilizou-se a análise de conteúdo temática.
Resultados: emergiram duas categorias empíricas: Facilidades na promoção do direito à saúde, que diz respeito ao direito à saúde ser uma garantia legal, à existência de profissionais comprometidos, ao acesso à informação, à priorização do acesso, à disponibilização de transporte e à existência de uma rede de apoio familiar; Dificuldades na promoção do direito à saúde, que foram a demanda/procura por serviços/consultas/exames ser maior que a oferta, o tempo destinado para as atividades de estimulação precoce e a sua frequência de realização ser menor que a necessária, a inexistência de um espaço de referência para o atendimento interprofissional, a inclusão escolar, o transporte insuficiente, a aquisição de cadeira de rodas, órteses e próteses.
Conclusões: a descrição das facilidades e dificuldades na promoção do direito à saúde de crianças com SCZ poderá contribuir para o acesso aos serviços e às práticas de saúde, mediante uma política de saúde efetiva e adequada à realidade apresentada, colaborando para uma maior qualidade de vida.
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14
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Santos DN, de Araújo TM, dos Santos LM, Kuper H, Aquino R, Da Silveira IH, Miranda SS, Pereira M, Werneck GL. The Salvador Primary Care Longitudinal Study of Child Development (CohortDICa) Following the Zika Epidemic: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052514. [PMID: 35270212 PMCID: PMC8909628 DOI: 10.3390/ijerph19052514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022]
Abstract
This article describes the Salvador Primary Care Longitudinal Study of Child Development (CohortDICa). The exposed group was defined by confirmation of Congenital Zika Syndrome (CZS) diagnosed through computed tomography, magnetic resonance or transfontanellar ultrasound. A random selection of the 169 exposed children led to a subgroup of 120 children who were paired with children from the Live Birth Information System, according to birthdate, residence in the same street or neighborhood, and gestational age, resulting in 115 subjects in the non-exposed group. Following recruitment and before the participants completed 42 months, three measures were applied to assess cognitive, motor, and language performance, corresponding to three home visits. Social characteristics of the families and children, and the neurocognitive development of the children will be compared across the CZS exposed group (n = 147), the typical children with no exposure to CZS (n = 115) and the STORCH exposed group (Syphilis, Toxoplasma gondii, Rubella, Cytomegalovirus, and Herpes simplex) (n = 20). Primary Health Care (PHC) should include long-term care strategies for the care of children and family members, and might benefit from the research, teaching, and extension activities provided in this study. In the face of the consequences of the Zika virus epidemic, an opportunity arose to intervene in the integrated care of child development within PHC, including, on an equal basis, typical children and those with delays or disabilities in the first six years of life.
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Affiliation(s)
- Darci Neves Santos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
- Correspondence: (D.N.S.); (M.P.)
| | - Tânia Maria de Araújo
- Núcleo de Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana 44036-900, Brazil;
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK;
| | - Rosana Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Ismael Henrique Da Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Samilly Silva Miranda
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador 40110-040, Brazil; (R.A.); (I.H.D.S.); (S.S.M.)
- Correspondence: (D.N.S.); (M.P.)
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20559-900, Brazil;
- Fiocruz Piauí, Teresina 64000-128, Brazil
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15
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Bancroft D, Power GM, Jones RT, Massad E, Iriat JB, Preet R, Kinsman J, Logan JG. Vector control strategies in Brazil: a qualitative investigation into community knowledge, attitudes and perceptions following the 2015-2016 Zika virus epidemic. BMJ Open 2022; 12:e050991. [PMID: 35105618 PMCID: PMC8808399 DOI: 10.1136/bmjopen-2021-050991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups. DESIGN In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies. PARTICIPANTS 120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews. SETTING Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital). RESULTS Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging. CONCLUSIONS Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement.
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Affiliation(s)
- Dani Bancroft
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace M Power
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert T Jones
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Eduardo Massad
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- School of Applied Mathematics, Fundação Getulio Vargas, Rio de Janeiro, RJ, Brazil
| | | | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - James G Logan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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16
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Moreira MCN, Mendes CHF, Nascimento MAFD, Melo APLD, Albuquerque MDSVD, Kuper H, Pinto M, Penn-Kenkana L, Moreira MEL. Stigmas of congenital Zika syndrome: family perspectives. CAD SAUDE PUBLICA 2022; 38:e00104221. [DOI: 10.1590/0102-311x00104221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.
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Affiliation(s)
| | | | | | | | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, U.K
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17
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Dias FM, Berger SMD, Lovisi GM. O cuidado em saúde às crianças com a Síndrome Congênita do Zika. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-11042022e608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
RESUMO Este artigo teve como objetivo analisar o cuidado ofertado às crianças com a Síndrome Congênita do Zika, a partir das experiências dos profissionais participantes de um projeto de pesquisa clínica de um hospital público e universitário no estado do Rio de Janeiro. Foi realizado um estudo de caso exploratório, qualitativo, por meio de observação participante e entrevistas semiestruturadas com 11 profissionais de saúde. Os dados foram conduzidos por análise de conteúdo, modalidade temática. Sob a perspectiva do cuidado como uma das dimensões da integralidade em saúde, percebeu-se que os profissionais, em sua maioria mulheres e médicas, são sensíveis às questões das famílias, consideradas também como unidade de cuidado, e reconhecem a diferença no atendimento que prestam ante o modelo biomédico ainda hegemônico na área da saúde. No entanto, apontam seus limites perante uma rede fragmentada e ineficiente. Tais limites parecem inviabilizar uma assistência que acolha as dimensões afetivas e sociais dessas famílias, em especial, das mulheres, legitimadas na centralidade do cuidado de seus filhos. Foi constatada a importância de pensar em uma formação em saúde interdisciplinar, crítica e reflexiva que possibilite um olhar ampliado às vulnerabilidades e necessidades dessas famílias, incluindo uma perspectiva de gênero interseccional que compreenda o complexo processo de determinação social em saúde.
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18
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Pinto M, Moreira MEL, Barros LBDP, Costa ACCD, Fernandes S, Kuper H. [Catastrophic expenditure on congenital Zika syndrome: results of a cross-sectional study of caregivers of children in Rio de Janeiro, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00007021. [PMID: 34816948 DOI: 10.1590/0102-311x00007021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/01/2021] [Indexed: 01/07/2023] Open
Abstract
In 2015, there was an increase in cases of congenital malformations in newborns in Brazil, associated with maternal Zika virus infection, having serious social and economic repercussions for the families. The study aimed to estimate the prevalence of catastrophic expenditure by families of children with severe or mild/moderate congenital Zika syndrome (CZS) in comparison to families of children without a diagnosis of CZS in the state of Rio de Janeiro. Catastrophic expenditure occurs when spending exceeds a given proportion of the family income due to a disease. Family caregivers of children with severe CZS were younger and had less schooling and lower income. Prevalence of catastrophic expenditure was higher in families of children with CZS. Among caregivers of children with severe CZS, the prevalence of catastrophic expenditure was higher in those with severe or very severe depression, anxiety, and stress. Low social support among caregivers was also a determinant factor for increased prevalence of catastrophic expenditure. The burden on caregivers of children with severe CZS exacerbates a situation of vulnerability that requires the expansion of mechanisms for financial and social protection, through linkage of various policies capable of effectively reaching this group.
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Affiliation(s)
- Márcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Letícia Baptista de Paula Barros
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Silke Fernandes
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, U.K
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, U.K
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19
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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20
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Andrade GKSD, Teston EF, Marcon SS, Giacon-Arruda BCC, Amorim MD, Sato DM, Werle JE, Silva JLD. Congenital Zika Virus Syndrome: care in light of the Brazilian Unified Health System principles. Rev Bras Enferm 2021; 75:e20210146. [PMID: 34614105 DOI: 10.1590/0034-7167-2021-0146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/09/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE to know health professionals' perceptions about care actions provided to children with Congenital Zika Virus Syndrome and their families. METHODS this is a qualitative study, carried out in a capital of center-western Brazil, based on the Unified Health System theoretical precepts. Data were collected in September and October 2020, through audio-recorded interviews with 12 health professionals from a specialized service and submitted to analysis of content, thematic modality. RESULTS the implementation of care actions with these children occurs through multidimensional assessment of children and their families, use of the Unique Therapeutic Project, therapeutic interventions for the development of children and the communication and exchange of interprofessional and family experiences, in addition to considering professionals' prior knowledge and their search for it. FINAL CONSIDERATIONS children with CZS and their families need individualized, frequent, integrated and continuous care.
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Affiliation(s)
| | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
| | | | | | | | - Daniela Miyuki Sato
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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21
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Aguiar LR, Frias PGD, Quinino LRDM, Miranda-Filho DDB. [Evaluation of implementation of the response to the public health emergency of microcephaly in Pernambuco State, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00271020. [PMID: 34495097 DOI: 10.1590/0102-311x00271020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/17/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess the degree of implementation of the response to the emergency of microcephaly associated with Zika virus in Pernambuco State, Brazil. This was a normative evaluative study conducted in the initial epicenter of the public health emergency of international concern, from October 2015 to July 2017. A logical model was produced for the intervention under analysis, with the components of Management, Surveillance, and Care in the dimensions of structure, process, and result, based on technical publications and institutional guidelines, in addition to a corresponding log frame of indicators for assessment. Data were collected through a questionnaire, direct observation, and consultation of official documents. The results showed partial implementation (74.9%) of the response to the microcephaly emergency by the Pernambuco State Health Department, with the process dimension reaching 75% of the expected level and the structure dimension, 74.5%. Surveillance was the only component that was assessed as implemented (81%), although with a shortage of regional and laboratory investments, while Management (74.2%) and Care (68.8%) were partially implemented, with insufficiencies in items related to human resources and physical structure, planning, and evaluation. In conclusion, the response to the public health emergency of international concern involving microcephaly associated with the Zika virus was assessed as partially implemented, with different levels between the intervention´s components, especially surveillance when compared to management and care. The shortcomings signal the need for investments to deal with future public health emergencies, with a view towards more timely and adequate interventions.
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Affiliation(s)
- Lucilene Rafael Aguiar
- Programa de Pós-graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brasil
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22
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Anser MK, Usman B, Hyder S, Nassani AA, Askar SE, Zaman K, Abro MMQ. Does improvement in the environmental sustainability rating help to reduce the COVID-19 cases? Controlling financial development, price level and carbon damages. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:49820-49832. [PMID: 33939085 PMCID: PMC8089134 DOI: 10.1007/s11356-021-13873-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 04/15/2023]
Abstract
The study's objective is to evaluate the impact of environmental sustainability rating, financial development, changes in the price level and carbon damages on the new COVID-19 cases in a cross-sectional panel of 17 countries. The study developed two broad models to analyse the relationship between the stated factors at the current level and forecast level. The results show that improvement in the environmental sustainability rating and financial efficiency reduces the COVID-19 cases, while continued economic growth and changes in price level likely to exacerbate the COVID-19 cases across countries. The forecast results suggest the U-shaped relationship between COVID-19 cases and carbon damages controlling financial development, price level and environmental sustainability rating. The variance decomposition analysis shows that carbon damages, environmental sustainability rating and price level changes will largely influence COVID-19 cases over the next year. The soundness of economic and ecological regulated policies would be helpful to contain coronavirus cases globally.
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Affiliation(s)
- Muhammad Khalid Anser
- School of Public Administration, Xi’an University of Architecture and Technology, Xi’an, 710000 China
| | - Bushra Usman
- School of Management, Forman Christian College (A Chartered University), Lahore, Pakistan
| | - Shabir Hyder
- Department of Management Sciences, COMSATS University Islamabad Attock Campus, Attock, Pakistan
| | - Abdelmohsen A. Nassani
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587 Saudi Arabia
| | - Sameh E. Askar
- Department of Statistics and Operations Research, College of Science, King Saud University, P.O. Box 11451, Riyadh, 11587 Saudi Arabia
| | - Khalid Zaman
- Department of Economics, University of Haripur, Haripur Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Moinuddin Qazi Abro
- Department of Management, College of Business Administration, King Saud University, P.O. Box 71115, Riyadh, 11587 Saudi Arabia
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Teixeira GA, Silva AND, Miranda LSMVD, Silva MPMD, Cavalcante EFDO, Enders BC. Theoretical care model for children with congenital Zika virus syndrome in the family context. Rev Lat Am Enfermagem 2021; 29:e3458. [PMID: 34190948 PMCID: PMC8253351 DOI: 10.1590/1518-8345.4057.3458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: to develop a theoretical model about the care of children with Congenital
Zika Virus Syndrome in the family context. Method: the Straussian Grounded Theory and the theoretical/philosophical framework of
Callista Roy and Leonardo Boff were used. It was carried out in northeastern
Brazil, with 19 participants, in four sample groups. The data were collected
and analyzed simultaneously, using the constant comparison method. Results: the theoretical model comprising the mother’s care for the child with
Congenital Zika Virus Syndrome in the family context is formed by five
categories: revealing family care, centered on the mother, to the child with
the syndrome; identifying the maternal bond that determines the care for
children with the syndrome in the family context; identifying the factors
that hinder the mother’s care for the child with the syndrome; recognizing
the evolution of the child with the syndrome in the face of early
stimulation care; and recognizing harms due to the absence of early stimulus
to children with the syndrome. Conclusion: the phenomenon runs through the care of the child with Congenital Zika Virus
Syndrome, in the family context and centered on the mother, and is faced
with the need for shared responsibility among the family members.
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Affiliation(s)
| | - Aylla Nauana da Silva
- Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil
| | | | | | | | - Bertha Cruz Enders
- Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil
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Guedes ATA, Soares AR, França DBLD, Vaz EMC, Collet N, Reichert APDS. Continuity of neuro-psychomotor stimulation of children with congenital Zika syndrome. Rev Bras Enferm 2021; 74:e20200694. [PMID: 34133669 DOI: 10.1590/0034-7167-2020-0694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Understand the continuity of stimulation of neuro-psychomotor development in children with congenital Zika syndrome. METHOD Descriptive-exploratory study with theoretical support in symbolic interactionism. Between August and November 2019, 12 health professionals were interviewed in depth; and to the focus group, seven caregivers of children with the syndrome. The analysis was thematic inductive. RESULTS The continuation of neuro-psychomotor stimulation of children with Zika syndrome goes through: organizational difficulties (lack of doctors, professional unpreparedness, dissatisfaction and search for other services); socioenvironmental aspects (low maternal education, low socioeconomic level, difficulty in moving and lack of support); and conditions inherent to children (hospitalizations for respiratory crises, seizures, hypoactivity and social stigma). FINAL CONSIDERATIONS A strengthened support network with qualified human resources is necessary in order to provide comprehensive care and avoid the discontinuity of neuro-psychomotor stimulation of children with congenital Zika syndrome.
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Affiliation(s)
| | | | | | | | - Neusa Collet
- Universidade Federal da Paraíba. João Pessoa, Paraíba, Brazil
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Pinto M, Fernandes S, Barros L, Valongueiro S, Moreira MEL, Barreto de Araújo TV, Jofre-Bonet M, Entringer A, Lyra TM, Kuper H. Estimating the cost of congenital Zika syndrome to families and healthcare providers in Rio de Janeiro and Pernambuco, Brazil: results of a case-control study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16623.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Children with congenital Zika syndrome (CZS) have a wide range of additional healthcare needs. This study aimed to estimate the direct costs of CZS from the health provider and family perspectives, and the indirect costs for families, in two Brazilian states: Rio de Janeiro and Pernambuco. Methods: A case-control study was undertaken between May 2017-January 2018 recruiting 174 cases with severe CZS, 41 with mild/moderate CZS and 269 children with no CZS, across the two sites, from existing studies. The primary caregiver was interviewed using a structured questionnaire to collect information on healthcare use and costs incurred during the previous 12 months. In Rio de Janeiro, health care utilization data was also extracted from electronic medical records. We estimated direct and indirect costs incurred as a result of CZS from the perspective of the health system and families. Results: Children with CZS accessed more healthcare facilities and reported longer travel and waiting times than children unaffected by CZS. Total costs from the health provider perspective of outpatient visits, were highest for children with severe CZS (U$1,411) followed by children with mild/moderate CZS (U$264) and children without CZS (U$107). This pattern was apparent for direct costs incurred by families, while median indirect costs were low. Families of children with CZS reported high levels of catastrophic expenditures; Expenses incurred by families to meet their child’s needs as a proportion of household income was 30% (IQR=14%-67%, p<0.01) for children with severe CZS, 11% (IQR=4%-33%, p<0.01) for mild/moderate CZS, and 1% (IQR=0%-8%) for controls. Costs incurred by families were generally higher in Rio de Janeiro than Pernambuco. Conclusions: Families of children affected by CZS in Brazil may need additional public health resources and social benefits to protect them from incurring catastrophic expenses while meeting the needs of their children.
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Laza-Vásquez C, Castaño-Paya PA, Sinisterra-Castro JP, Gea-Sánchez M, Briones-Vozmediano E. [Caring for children with Zika congenital syndrome in Colombia: Consequences for women's lives]. Aten Primaria 2021; 53:101972. [PMID: 33588269 PMCID: PMC7890145 DOI: 10.1016/j.aprim.2021.101972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Celmira Laza-Vásquez
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Lleida, Lleida, España; Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, España; Programa de Enfermería, Universidad Surcolombiana, Neiva-Departamento del Huila, Colombia.
| | | | | | - Montserrat Gea-Sánchez
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Lleida, Lleida, España; Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, España
| | - Erica Briones-Vozmediano
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Lleida, Lleida, España; Grup de Recerca en Cures de la Salut (GRECS), Institut de Recerca Biomèdica de Lleida, Lleida, España
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27
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"Life Is Taking Me Where I Need to Go": Biographical Disruption and New Arrangements in the Lives of Female Family Carers of Children with Congenital Zika Syndrome in Pernambuco, Brazil. Viruses 2020; 12:v12121410. [PMID: 33302536 PMCID: PMC7763975 DOI: 10.3390/v12121410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/23/2023] Open
Abstract
The congenital Zika syndrome (CZS) epidemic in Brazil turned the spotlight on many other factors beyond illness, such as poverty, gender, and inequalities in health care. Women were the emblematic subjects in this study, not only because Zika virus is a vertical transmission disease, but also because women—in Brazil and elsewhere—typically represent the primary carers of children. This is a qualitative analytic study using semi-structured interviews with 23 female family carers of children with CZS in Brazil. Through the concept of biographical disruption, we analysed some of the social impacts experienced by women involved in caring for affected children. We identified that the arrival of a child with disabilities resulted in biographical disruption similar to that experienced by people with chronic illnesses. Social support networks were configured through an alliance between women from different generations, revealing solidarity networks, but also highlighting the absence of the state in tackling these social vulnerabilities. Tracing the pathways of these biographical narratives enables us to understand how women have acted to defend the value of their disabled children in a society structured on the model of body normativity and inequality. These results may provide clues to a more inclusive society, which confronts systems of gender oppression and the sexual division of labour focused on women.
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Campos TNC, Schiariti V, Gladstone M, Melo A, Tavares JS, Magalhães AG, Longo E. How congenital Zika virus impacted my child's functioning and disability: a Brazilian qualitative study guided by the ICF. BMJ Open 2020; 10:e038228. [PMID: 33268403 PMCID: PMC7713226 DOI: 10.1136/bmjopen-2020-038228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The Zika virus outbreak in Brazil has had devasting social, medical and financial consequences for families. Both researchers and clinicians are measuring longer-term outcomes to understand the impact of the Zika on child development, functioning and disability. Outcomes and tools used to measure them are very varied and we are unclear how meaningful they are to families and children. This study aimed to identify the parents' perspectives on relevant areas of functioning and disability that should be included as outcome measures for children with congenital Zika syndrome (CZS), as guided by the International Classification of Functioning, Disability and Health (ICF). METHODS This qualitative study included parents or caregivers of children aged 0-5 years with confirmed CZS from two states in northeastern Brazil. Interviews were conducted using focus groups. Content mapping followed the WHO's ICF linking rules. Three raters analysed the content using NVivo V.11. RESULTS Thirty-two caregivers participated in six focus groups, 88% were mothers with an average age of 30 years. Most children were male (59%) and all were level V (severe) to on the Gross Motor Function Classification System (GMFCS). Overall, 825 themes were mapped to 36 ICF categories. Although parents mentioned areas across all ICF domains, they reported that areas of mobility, eating and recreation were most relevant for them. In addition, environmental factors were highly identified as barriers, specifically services, policies and access to assistive devices. The most predominant facilitators within the environment were; immediate family support, kind relationships with therapists and support from the extended family. CONCLUSIONS Although parents emphasised issues related to mobility, their greatest concerns involved environmental factors, such as access and quality of health and social services, systems and policies. These results reinforce the importance of including parents' perspectives when selecting or developing outcome measures for CZS.
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Affiliation(s)
- Taynah Neri Correia Campos
- Graduate Program in Collective, HealthFederal University of Rio Grande do Norte - UFRN-FACISA, Natal, Brazil
| | - Veronica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Adriana Melo
- Instituto de Pesquisa Joaquim Amorim Neto, Campina Grande, Brazil
| | | | - Adriana Gomes Magalhães
- Health of Women, Graduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte - UFRN-FACISA, Santa Cruz, Brazil
| | - Egmar Longo
- Health of Children, Graduate Program in Collective Health - Federal University of Rio Grande do Norte -UFRN-FACISA, Natal, Brazil
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Reichenberger V, Alburquerque MDSVD, David RB, Ramos VD, Lyra TM, Brito CMMD, Köptcke LS, Kuper H. The challenge of including people with disabilities in the strategy to address the COVID-19 pandemic in Brazil. ACTA ACUST UNITED AC 2020; 29:e2020770. [PMID: 33263616 DOI: 10.1590/s1679-49742020000500023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | | | - Tereza Maciel Lyra
- Fundação Instituto Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, PE, Brasil
| | | | | | - Hannah Kuper
- London School of Hygiene and Tropical Medicine, Londres, Reino Unido
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30
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Simas C, Penn-Kekana L, Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, de Melo APL, Figueira Mendes CH, Nunes Moreira MC, Ferreira do Nascimento MA, Pimentel C, Pinto M, Valongueiro S, Larson H. Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil. Health Policy Plan 2020; 35:953-961. [PMID: 32681164 PMCID: PMC7553755 DOI: 10.1093/heapol/czaa042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/16/2022] Open
Abstract
This article investigates how hope and trust played out for two groups at the forefront of the Zika epidemic: caregivers of children with congenital Zika syndrome and healthcare workers. We conducted 76 in-depth interviews with members of both groups to examine hope and trust in clinical settings, as well as trust in public institutions, in the health system and in the government of Brazil. During and after the Zika epidemic, hope and trust were important to manage uncertainty and risk, given the lack of scientific evidence about the neurological consequences of Zika virus infection. The capacity of healthcare workers and caregivers to trust and to co-create hope seems to have allowed relationships to develop that cushioned social impacts, reinforced adherence to therapeutics and enabled information flow. Hope facilitated parents to trust healthcare workers and interventions. Hope and trust appeared to be central in the establishment of support networks for caregivers. At the same time, mistrust in the government and state institutions may have allowed rumours and alternative explanations about Zika to spread. It may also have strengthened activism in mother's associations, which seemed to have both positive and negative implications for healthcare service delivery. The findings also point to distrust in international health actors and global health agenda, which can impact community engagement in future outbreak responses in Brazil and other countries in Latin America.
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Affiliation(s)
- Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Tereza Maciel Lyra
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Department of Social Medicine, Faculty of Medicine, Federal University of Pernambuco, Avenida da Engenharia, S/N, Bloco D, 1º Andar, Cidade Universitária. CEP: 50.740-600 Recife, PE, Brazil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Maria do Socorro Veloso de Albuquerque
- Postgraduate Programme in public Health, Center of Medical Sciences, Federal University of Pernambuco. Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E, 4o.andar. Cidade Unitersitária, CEP 50.670-901, Recife -PE, Brazil
| | - Thália Velho Barreto de Araújo
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Ana Paula Lopes de Melo
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
- Núcleo de Saúde Coletiva da Universidade Federal de Pernambuco R. Alto do Reservatório - Alto José Leal, Vitória de Santo Antã - PE-Brasil, 55608-250l
| | - Corina Helena Figueira Mendes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Marcos Antonio Ferreira do Nascimento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Camila Pimentel
- Fundação Oswaldo Cruz, Instituto Aggeu Magalhães/Fiocruz, Avenida Professor Moraes Rêgo, S/N Cidade Universitária. CEP 50740-465, Recife, PE, Brasil
| | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fiocruz, Avenida Rui Barbosa, 716 - Flamengo, Rio de Janeiro, RJ 20021-140, Brazil
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Center of Medical Sciences, Federal University of Pernambuco, Avenida Professor Moraes Rêgo, S/N Hospital das Clínicas, Bloco E - 4º Andar, Cidade Universitária, CEP: 50.670-901, Recife, PE, Brazil
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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AlHeresh R, Cahn PS. Expanding Global Rehabilitation Services through International Academic-Community Partnerships. Ann Glob Health 2020; 86:71. [PMID: 32676300 PMCID: PMC7333551 DOI: 10.5334/aogh.2876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background More than one billion people worldwide live with a disability, yet rehabilitation professionals are scarce in low- and middle-income countries. Attempts to expand access to rehabilitation services have encountered barriers on multiple levels: limited resources on the systemic level, hierarchies on the professional level, and cultural stigma on the community level. Objectives We sought to determine if an academic-community partnership could overcome multiple levels of barriers to expand services for people with disabilities. Methods Toward an All-Inclusive Jordan incorporates community-based rehabilitation with prelicensure health professions education to address the three primary levels of barriers to rehabilitation services in low- and middle-income countries. The yearlong curriculum includes formal training, research, and advocacy with graduate students from the United States and health professions students and community members in Palestinian refugee camps near Amman, Jordan. Findings After two cycles of the program, 14 Jordanian volunteers have partnered with 20 graduate students from the United States. They have delivered over 300 direct rehabilitation sessions, conducted ten workshops with mothers of children with disabilities, and trained 12 community-based rehabilitation workers in the refugee camps. Conclusions The academic-community partnership model builds on the evidence base for the success of community-based rehabilitation services in low- and middle-income countries. Its components address barriers on multiple levels to create a sustainable expansion of services to people with disabilities.
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Affiliation(s)
- Rawan AlHeresh
- “Toward an All-Inclusive Jordan”, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, US
| | - Peter S. Cahn
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA, US
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Santos-Pinto CDB, de Almeida Soares-Marangoni D, Ferrari FP, Ajalla MEA, Venancio FA, da Rosa TS, de Oliveira EF. Health demands and care of children with congenital Zika syndrome and their mothers in a Brazilian state. BMC Public Health 2020; 20:762. [PMID: 32448272 PMCID: PMC7245942 DOI: 10.1186/s12889-020-08880-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/10/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND A Zika virus (ZIKV) infection outbreak occurred in Brazil in 2015, accompanied by a marked increase in the number of newborns presenting with microcephaly and other neurological disorders. This characteristic set of birth defects was later termed congenital Zika syndrome (CZS). The therapeutic itinerary of mothers and children infected by ZIKV can be determined by several factors, including the relationship established with existing healthcare services. Here, we aimed to describe and analyze the extent to which children with CZS, born from 2015 to 2018 in the state of Mato Grosso do Sul, Brazil, and their mothers were treated according to the guidelines established by the Brazilian Ministry of Health. METHODS This was a descriptive cross-sectional study that considered all children (and respective mothers) with confirmed or suspected CZS born in Mato Grosso do Sul. Children and their mothers were identified based on all suspected or confirmed cases of congenital anomalies in Mato Grosso do Sul that were reported to the Registry of Public Health Events. We analyzed data on the epidemiological profile of mother-child pairs and the care received by them. Data were summarized using statistical descriptive analysis. RESULTS We showed that most mothers were white women (57%) with low income. Among pregnant women, 73% had a diagnosis of fever caused by ZIKV infection at a primary health care institution (PHCI), but only 36% received the necessary information regarding the risk of CZS. Over a third (36%) of the mothers did not receive guidance about childcare follow-up and 73% did not receive guidance regarding the availability of social support after childbirth. Gaps in medical care were observed mainly in pregnant women treated at a PHCI. Specialized assistance for children was adequate in most cases. Psychosocial support was not made available to women throughout their therapeutic itineraries. CONCLUSIONS Here, we identified gaps in the care of families and children with disabilities, which can have an important impact on their quality of life. Beyond protocols, practical interventions must cover all the needs that arise throughout the therapeutic itineraries not only of children but also of pregnant women and mothers.
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Affiliation(s)
| | | | | | | | - Fabio Antonio Venancio
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Thais Silveira da Rosa
- Programa de Residência Multiprofissional em Reabilitação Física, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Everton Falcão de Oliveira
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
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Duttine A, Smythe T, Ribiero Calheiro de Sá M, Ferrite S, Zuurmond M, Moreira ME, Collins A, Milner K, Kuper H. Congenital Zika Syndrome-Assessing the Need for a Family Support Programme in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103559. [PMID: 32438700 PMCID: PMC7277658 DOI: 10.3390/ijerph17103559] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
The Zika outbreak in Brazil caused congenital impairments and developmental delays, or Congenital Zika Syndrome (CZS). We sought to ascertain whether a family support programme was needed and, if so, could be adapted from the Getting to Know Cerebral Palsy programme (GTKCP) designed for children with cerebral palsy (CP). We conducted a systematic review of the needs of families of children with CZS or CP in low- and middle-income countries and reviewed the findings of the Social and Economic Impact of Zika study. We undertook a scoping visit to three facilities offering services to children with CZS in Brazil to understand potential utility and adaptability of GTKCP. The literature review showed that caregivers of children with CZS experience challenges in mental health, healthcare access, and quality of life, consistent with the CP literature. The scoping visits demonstrated that most support provided to families was medically orientated and while informal support networks were established, these lacked structure. Caregivers and practitioners expressed an eagerness for more structure community-based family support programmes. A support programme for families of children with CZS in Brazil appeared relevant and needed, and may fill an important gap in the Zika response.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
- Correspondence:
| | - Tracey Smythe
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Míriam Ribiero Calheiro de Sá
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador 40110-902, Brazil;
| | - Maria Zuurmond
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Anna Collins
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Kate Milner
- Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Hannah Kuper
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
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Passos MJ, Matta G, Lyra TM, Moreira MEL, Kuper H, Penn-Kekana L, Mendonça M. The promise and pitfalls of social science research in an emergency: lessons from studying the Zika epidemic in Brazil, 2015-2016. BMJ Glob Health 2020; 5:e002307. [PMID: 32345582 PMCID: PMC7213811 DOI: 10.1136/bmjgh-2020-002307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/08/2022] Open
Abstract
Social science generates evidence necessary to control epidemics. It can help to craft appropriate public health responses, develop solutions to the epidemic impacts and improve understanding of why the epidemic occurred. Yet, there are practical constraints in undertaking this international research in a way that produces quality, ethical and appropriate data, and that values all voices and experiences, especially those of local researchers and research participants. In this paper, we reflected on the experience of undertaking social science research during the 2015/2016 Zika epidemic in Brazil. This experience was considered from the perspective of this paper's authors: three Brazilian academics, two UK academics and two mothers of children affected by congenital Zika syndrome. This group came together through the conduct of the Social and Economic Impact of Zika study, a mixed-methods social science study. The key findings highlight practical issues in the achievement of three goals: the conduct of high-quality social science in emergencies and efforts towards the decolonisation of global health in terms of levelling the power between Brazilian and UK researchers and optimising the role of patients within research. From our perspective, the information collected through social science was valuable, providing detailed insight into the programmatic needs of mothers and their affected children (eg, economic and social support and mental health services). Social science was considered a low priority within the Zika epidemic despite its potential importance. There were logistical challenges in conducting social science research, foremost of which are the difficulties in developing a trusting and balanced power relationship between the UK and Brazilian researchers in a short time frame. When these issues were overcome, each partner brought unique qualities, making the research stronger. The mothers of affected children expressed dissatisfaction with research, as they were involved in many studies which were not coordinated, and from which they did not see a benefit. In conclusion, the importance of social science in epidemics must continue to be promoted by funders. Funders can also set in place mechanisms to help equalise the power dynamics between foreign and local researchers, researchers and participants, both to promote justice and to create best quality data.
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Affiliation(s)
| | - Gustavo Matta
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil
- Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Wilder-Smith A, Preet R, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Araújo TVBD, Montarroyos UR, Moreira ME, Turchi MD, Solomon T, Jacobs BC, Villamizar CP, Osorio L, de Filipps AMB, Neyts J, Kaptein S, Huits R, Ariën KK, Willison HJ, Edgar JM, Barnett SC, Peeling R, Boeras D, Guzman MG, de Silva AM, Falconar AK, Romero-Vivas C, Gaunt MW, Sette A, Weiskopf D, Lambrechts L, Dolk H, Morris JK, Orioli IM, O'Reilly KM, Yakob L, Rocklöv J, Soares C, Ferreira MLB, Franca RFDO, Precioso AR, Logan J, Lang T, Jamieson N, Massad E. ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas. Glob Health Action 2020; 12:1666566. [PMID: 31640505 PMCID: PMC6818126 DOI: 10.1080/16549716.2019.1666566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.
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Affiliation(s)
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | | | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco , Recife , Brasil.,Departamento de Medicina Interna, Universidade de Pernambuco , Recife , Brasil
| | | | | | | | | | | | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás , Goiânia , Brasil
| | - Tom Solomon
- Institute of Infection and Global Health, The University of Liverpool , Liverpool , UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam , The Netherlands
| | | | | | | | - Johan Neyts
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Suzanne Kaptein
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium
| | - Ralph Huits
- Institute of Tropical Medicine , Antwerp , Belgium
| | | | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Julia M Edgar
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | - Susan C Barnett
- Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK
| | | | - Debi Boeras
- London School of Hygiene & Tropical Medicine , London , UK
| | | | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill , NC , USA
| | - Andrew K Falconar
- London School of Hygiene & Tropical Medicine , London , UK.,Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | - Claudia Romero-Vivas
- Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia
| | | | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA.,Department of Medicine, University of California San Diego , La Jolla , CA , USA
| | - Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA
| | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS , Paris , France
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University , Newtownabbey , UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London , London , UK
| | - Ieda M Orioli
- Associação Técnico-Científica Estudo Colaborativo Latino Americano de Malformações Congênitas (ECLAMC) no Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | | | - Laith Yakob
- London School of Hygiene & Tropical Medicine , London , UK
| | - Joacim Rocklöv
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Cristiane Soares
- Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil
| | | | | | - Alexander R Precioso
- Instituto Butantan , Brazil.,Pediatrics Department, Medical School of University of Sao Paulo , Sao Paulo , Brazil
| | - James Logan
- London School of Hygiene & Tropical Medicine , London , UK
| | - Trudie Lang
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Nina Jamieson
- The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK
| | - Eduardo Massad
- Fundacao de Apoio a Universidade de Sao Paulo , Sao Paulo , Brazil.,School of Applied Mathematics, Fundacao Getulio Vargas , Rio de Janeiro , Brazil
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Kelly AH, Lezaun J, Löwy I, Matta GC, de Oliveira Nogueira C, Rabello ET. Uncertainty in times of medical emergency: Knowledge gaps and structural ignorance during the Brazilian Zika crisis. Soc Sci Med 2020; 246:112787. [DOI: 10.1016/j.socscimed.2020.112787] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 01/22/2023]
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