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Paixao ES, Ferreira AJF, Pescarini JM, Wong KLM, Goes E, Fiaccone R, Lopes de Oliveira G, Reboucas P, Cardoso AM, Smeeth L, Barreto ML, Rodrigues LC, Ichihara MY. Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil. Lancet Glob Health 2023; 11:e1734-e1742. [PMID: 37858584 DOI: 10.1016/s2214-109x(23)00405-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study estimated ethnoracial inequalities in maternal and congenital syphilis in Brazil, understanding race as a relational category product of a sociopolitical construct that functions as an essential tool of racism and its manifestations. METHODS We linked routinely collected data from Jan 1, 2012 to Dec 31, 2017 to conduct a population-based study in Brazil. We estimated the attributable fraction of race (skin colour) for the entire population and specific subgroups compared with White women using adjusted logistic regression. We also obtained the attributable fraction of the intersection between two social markers (race and education) and compared it with White women with more than 12 years of education as the baseline. FINDINGS Of 15 810 488 birth records, 144 564 women had maternal syphilis and 79 580 had congenital syphilis. If all women had the same baseline risk as White women, 35% (95% CI 34·89-36·10) of all maternal syphilis and 41% (40·49-42·09) of all congenital syphilis would have been prevented. Compared with other ethnoracial categories, these percentages were higher among Parda/Brown women (46% [45·74-47·20] of maternal syphilis and 52% [51·09-52·93] of congenital syphilis would have been prevented) and Black women (61% [60·25-61·75] of maternal syphilis and 67% [65·87-67·60] of congenital syphilis would have been prevented). If all ethnoracial groups had the same risk as White women with more than 12 years of education, 87% of all maternal syphilis and 89% of all congenital syphilis would have been prevented. INTERPRETATION Only through effective control of maternal syphilis among populations at higher risk (eg, Black and Parda/Brown women with lower educational levels) can WHO's global health initiative to eliminate mother-to-child transmission of syphilis be made feasible. Recognising that racism and other intersecting forms of oppression affect the lives of minoritised groups and advocating for actions through the lens of intersectionality is imperative for attaining and guaranteeing health equity. Achieving health equality needs to be addressed to achieve syphilis control. Given the scale and complexity of the problem (which is unlikely to be unique to Brazil), structural issues and social markers of oppression, such as race and education, must be considered to prevent maternal and congenital syphilis and improve maternal and child outcomes globally. FUNDING Wellcome Trust, CNPq-Brazil. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Enny S Paixao
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil.
| | - Andrêa J F Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; The Ubuntu Center on Racism, Global Movements & Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Julia M Pescarini
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Kerry L M Wong
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuelle Goes
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Rosemeire Fiaccone
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme Lopes de Oliveira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Centro Federal de Educação Tecnológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Poliana Reboucas
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | | | - Liam Smeeth
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
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Melo MS, Cabrera LAA, Lima SVMA, Dos Santos AD, Oliveira LMGB, de Oliveira RC, de Sousa Menezes J, de Figueiredo JA, de Moura Lane VF, de Lima Júnior FEF, da Rocha Moreira RV. Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020. Trop Med Int Health 2023. [PMID: 37060253 DOI: 10.1111/tmi.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. METHODS Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. RESULTS We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. CONCLUSION Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.
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Affiliation(s)
- Matheus Santos Melo
- Field Epidemiology Training Program, Department of Public Health Emergencies, Ministry of Health, Brasília, Brazil
| | | | | | | | | | - Renata Carla de Oliveira
- General Coordination of Zoonoses and Vector-Transmitted Diseases Surveillance, Department of Communicable Diseases, Ministry of Health, Brasília, Brazil
| | - Janaína de Sousa Menezes
- General Coordination of Zoonoses and Vector-Transmitted Diseases Surveillance, Department of Communicable Diseases, Ministry of Health, Brasília, Brazil
| | - Josivânia Arrais de Figueiredo
- General Coordination of Zoonoses and Vector-Transmitted Diseases Surveillance, Department of Communicable Diseases, Ministry of Health, Brasília, Brazil
| | - Viviane Fragoso de Moura Lane
- General Coordination of Zoonoses and Vector-Transmitted Diseases Surveillance, Department of Communicable Diseases, Ministry of Health, Brasília, Brazil
| | | | - Rosalynd Vinicios da Rocha Moreira
- General Coordination of Zoonoses and Vector-Transmitted Diseases Surveillance, Department of Communicable Diseases, Ministry of Health, Brasília, Brazil
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Pícoli RP, Cazola LHDO. Missed opportunities in preventing mother-to-child transmission of syphilis in the indigenous population in central Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: to estimate the detection rate of syphilis in pregnant women, the occurrence of congenital syphilis, and the rate of mother-to-child transmission of syphilis, in addition to analyzing missed opportunities in the prevention of mother-to-child transmission in the indigenous population. Methods: descriptive study of cases of pregnant indigenous women with syphilis resulting or not in a case of congenital syphilis. The data were obtained from the Sistema de Informação de Agravos de Notificação (Information System of Notifable Diseases), the records of the Infecções Sexualmente Transmissíveis do Distrito Sanitário Especial Indígena (Sexually Transmitted Infections in the Special Indigenous Health District), and the medical records of pregnant indigenous women in 2015. The database and the calculation of syphilis rates in pregnant women, congenital syphilis, and mother-to-child transmission were carried out. Data on prenatal, diagnosis and treatment of syphilis during pregnancy were collected from the medical records. Results: the detection rate of syphilis in pregnant women reached 35.2/1,000 live births (LB), the occurrence of congenital syphilis encompassed 15.7/1.000 LB, and the rate of mother-to-child transmission was 44.8%. Six (24%) pregnant women started prenatal care in the first trimester and seven (28%) attended seven or more consultations. The diagnosis of syphilis was late and only nine (36%) women were properly treated. Conclusions: failures in the diagnosis and the adequate treatment of pregnant women with syphilis compromised the prevention of mother-to-child transmission of the disease.
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Venancio FA, Quilião ME, de Almeida Moura D, de Azevedo MV, de Almeida Metzker S, Mareto LK, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study. BMC Public Health 2022; 22:2069. [DOI: 10.1186/s12889-022-14490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.
Methods
This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.
Results
In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).
Conclusions
We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.
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Braga LP, Szwarcwald CL, Damacena GN, de Souza-Júnior PRB, Dourado I, de Brito AM, Grangeiro A, Crosland Guimarães MD. Health vulnerabilities in female sex workers in Brazil, 2016. Medicine (Baltimore) 2022; 101:e30185. [PMID: 36107499 PMCID: PMC9439778 DOI: 10.1097/md.0000000000030185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Female sex workers (FSW) suffer stigma and discrimination that negatively impact their physical and mental health and affect access to health care services. This paper aims to describe selected health indicators among FSW in 12 Brazilian cities in 2016. Brazilian cross-sectional Biological Behavioral Surveillance Survey was conducted in 2016 among 4328 FSW recruited by respondent-driven sampling. The sample weighing was inversely proportional to participant's network sizes and the seeds were excluded from the analysis. Health indicators were estimated with 95% confidence interval and included indicators of health status, symptoms of depression, antenatal care, pap smear coverage, signs and symptoms of sexually transmitted infection, contraception and regular condom use, number of births and children alive per women, human immunodeficiency virus and syphilis testing, usual source of care, and perception of discrimination. Most participants self-rated their health as very good/good (65.8%) and 27.7% were positively screened for major depressive disorder episode on Patient Health Questionnaire-2. Antenatal coverage was 85.8% and 62.3% of FSW had access to pap smear exam in the past 3 years. A total of 67.0% of FSW were using some contraceptive method at the time of the study. Male condom was the most common method (37.1%), followed by oral pill (28.9%). A total of 22.5% FSW had never been tested for HIV and the main reasons were "not feeling at risk" (40.4%) and "being afraid or ashamed" (34.0%). The vast majority of FSW used Brazilian National Health System as their usual source of health care (90.2%). Approximately one-fifth of the participants felt discriminated against or were treated worse for being FSW (21.4%) and only 24.3% disclose their sex work status in health services. The vulnerability of FSW is expressed in all health indicators. Indicators of health status, antenatal care, pap smear coverage, and contraception were worse than in the Brazilian population, and point out to the importance of increase FSW's access to health care services. Also, stigma and discrimination emerged as an important barrier to FSW's health care in all dimensions and need to be struggled.
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Affiliation(s)
- Letícia Penna Braga
- Postgraduate Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Letícia Penna Braga, Postgraduate Program in Epidemiology in Public Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil (e-mail: )
| | - Célia Landmann Szwarcwald
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Giseli Nogueira Damacena
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paulo Roberto Borges de Souza-Júnior
- Health Information Laboratory, Institute of Communication and Scientific and Technological Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation IAM/Fiocruz, Recife, Pernambuco, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Ramos AN. Persistence of syphilis as a challenge for the Brazilian public health: the solution is to strengthen SUS in defense of democracy and life. CAD SAUDE PUBLICA 2022; 38:PT069022. [PMID: 35584431 DOI: 10.1590/0102-311xpt069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alberto Novaes Ramos
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Brasil
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Castro-Arroyave DM, Martínez-Gallego JA, Montoya-Guzmán M, Silva G, Rojas Arbeláez CA. [Hepatitis B in indigenous people in Latin America: a literature reviewHepatite B em indígenas na América Latina: revisão da literatura]. Rev Panam Salud Publica 2022; 46:e22. [PMID: 35350451 PMCID: PMC8942283 DOI: 10.26633/rpsp.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Objetivo. Identificar publicaciones realizadas entre los años 2000 y 2020 sobre hepatitis B en indígenas de América Latina, con el fin de conocer avances y vacíos en el tema durante los últimos 20 años. Métodos. Revisión exploratoria y síntesis rápida de la evidencia. El proceso de organización documental se realizó con los programas Excel® y Rayyan®. Resultados. Se seleccionaron 30 de 107 artículos encontrados, 17 corresponden a estudios epidemiológicos, 10 a revisiones documentales, dos estudios clínicos y una carta al editor. Brasil fue el país con más publicaciones (50%), la mayoría con enfoque epidemiológico. La temática más abordada fue la medición de prevalencia de la infección por hepatitis B con 22 publicaciones, le siguieron 11 estudios que informan resultados de estudios moleculares del virus, siete estudios sobre vacunación, cinco estudios sobre factores de riesgo y cuatro publicaciones con temas como la transmisión vertical y estudios sociales. Conclusión. En comparación con revisiones previas realizadas por otros autores, se observa una mayor diversidad en los temas y métodos de investigación utilizados; sin embargo, aún prevalecen los enfoques epidemiológicos convencionales centrados en la medición de la prevalencia de marcadores serológicos. Esto hace necesario encarar otro tipo de investigaciones centradas en los determinantes socioculturales.
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Affiliation(s)
- Diana María Castro-Arroyave
- Grupo de Estudio en Pedagogía, Infancia y Desarrollo Humano Facultad de Educación Universidad de Antioquia Colombia Grupo de Estudio en Pedagogía, Infancia y Desarrollo Humano, Facultad de Educación, Universidad de Antioquia, Colombia
| | - Jaime Alberto Martínez-Gallego
- Grupo Epidemiología Facultad Nacional de Salud Pública Universidad de Antioquia Colombia Grupo Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Colombia
| | - Melissa Montoya-Guzmán
- Grupo Gastrohepatología Facultad de Medicina Universidad de Antioquia Colombia Grupo Gastrohepatología, Facultad de Medicina, Universidad de Antioquia, Colombia
| | - Gustavo Silva
- Empresa Social del Estado Red de Servicios de Salud de Primer Nivel Guaviare Colombia Empresa Social del Estado Red de Servicios de Salud de Primer Nivel, Guaviare, Colombia
| | - Carlos Alberto Rojas Arbeláez
- Grupo Epidemiología Facultad Nacional de Salud Pública Universidad de Antioquia Colombia Grupo Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Colombia
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Ramos Jr. AN. Persistencia de la sífilis como desafío para la salud pública en Brasil: el camino es fortalecer el SUS, en defensa de la democracia y de la vida. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xes069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ramos Jr. AN. Persistence of syphilis as a challenge for the Brazilian public health: the solution is to strengthen SUS in defense of democracy and life. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311xen069022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Reis-Muleva B, Duarte LS, Silva CM, Gouveia LMR, Borges ALV. Antenatal care in Mozambique: Number of visits and gestational age at the beginning of antenatal care. Rev Lat Am Enfermagem 2021; 29:e3481. [PMID: 34730761 PMCID: PMC8570256 DOI: 10.1590/1518-8345.4964.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE 1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique. METHOD cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously. RESULTS all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits. CONCLUSION the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.
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Affiliation(s)
- Belarmina Reis-Muleva
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Bolsista da Universidade Lúrio, Nampula, Moçambique
| | - Luciane Simões Duarte
- Secretaria de Estado da Saúde de São Paulo, Coordenadoria de Controle de Doenças, Divisão de Doenças Crônicas Não Transmissíveis, São Paulo, SP, Brazil
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Kempton JW, Périssé ARS, Hofer CB, de Vasconcellos ACS, de Sousa Viana PV, de Oliveira Lima M, de Jesus IM, de Souza Hacon S, Basta PC. An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10091. [PMID: 34639393 PMCID: PMC8508331 DOI: 10.3390/ijerph181910091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.
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Affiliation(s)
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venân-cio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000, Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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Ferreira AA, Souza MCD, Cardoso AM, Horta BL, Santos RV, Welch JR, A Coimbra CE. Birth weight of indigenous children in Brazil: results of the First National Survey of Indigenous People's Health and Nutrition. CAD SAUDE PUBLICA 2021; 37:e00228120. [PMID: 33440414 DOI: 10.1590/0102-311x00228120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
Birth weight is an important predictor of perinatal, infant, and preschool-age children morbimortality. However, information about indigenous children's birth weight is still scarce. This study aimed to analyze the birth weight of indigenous children based on data from the First National Survey of Indigenous People's Health and Nutrition, Brazil (2008-2009). This is the first study to address indigenous children's birth weight based on a nationwide representative sample. Mean birth weights and the respective standard deviations were calculated according to geopolitical region, sex, type of birth, and birthplace. The chi-square test was used to analyze differences in proportions, and Kruskal-Wallis and Mann-Whitney U tests in means, considering sample design and data normality. We found no records on birth weight in the researched documents for 26.7% of the 6,128 sampled children. The mean birth weight for the 3,994 children included in the analyses was 3,201g (standard deviation - SD ± 18.6g), regardless of sex, type of birth, and birthplace. The prevalence of low birth weight was 7.6% (n = 302) and was significantly higher among girls. Boys presented significantly higher mean birth weight than girls, regardless of the geopolitical region. Low birth weight was slightly less frequent among indigenous children when compared to Brazilian children in general. Our study indicates the need to improve prenatal care and the quality of consultation records for indigenous women as a strategy to promote safe pregnancy and childbirth.
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Affiliation(s)
- Aline Alves Ferreira
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Bernardo Lessa Horta
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - James R Welch
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Matos CA, Osorio-de-Castro CGS, Coimbra CEA, Silva MJSD. [Profile of antineoplastic medication among indigenous people treated in the Brazilian Unified National Health System]. CAD SAUDE PUBLICA 2020; 36:e00100520. [PMID: 33331551 DOI: 10.1590/0102-311x00100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
Brazil has an estimated 900,000 indigenous people (0.4% of the country's population), belonging to more than 300 different ethnic groups. However, information is scarce on cancer epidemiology and the antineoplastic drugs used in treatment of these individuals. The study's objectives are to identify the antineoplastic drugs used and to describe the profile of use of these drugs in the indigenous population treated in Brazil, as well as to describe the patients' epidemiological profile. An ecological study was performed involving outpatient chemotherapy care from January 2014 to December 2018 throughout Brazil. The data source was the Outpatient Information System of the Brazilian Health Informatics Department, considering only Authorizations for High-Complexity Chemotherapy Procedures. We identified 2,425 authorizations for chemotherapy procedures for treatment of indigenous patients. Of these, 2,292 authorizations for a total of 210 individuals were analyzed. We found an increase in the number of authorizations and of indigenous persons receiving chemotherapy over the period, with a higher concentration of individuals living in and receiving treatment in the South of Brazil, plus a wide diversity in the types of diagnosed tumors (n = 63) and of treatment regimen used during the treatment (n = 107). The current study provided a new overview of the epidemiological profile of indigenous patients receiving chemotherapy in the Brazilian Unified National Health System. The findings help fill a current knowledge gap on indigenous people's health in Brazil.
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Affiliation(s)
- Camila Alves Matos
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Universidade Federal Fluminense, Niterói, Brasil
| | | | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Barreto CTG, Tavares FG, Theme-Filha M, Farias YN, Pantoja LDN, Cardoso AM. Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani). BMC Pregnancy Childbirth 2020; 20:748. [PMID: 33267830 PMCID: PMC7709282 DOI: 10.1186/s12884-020-03396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRATO FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.
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Affiliation(s)
- Carla Tatiana Garcia Barreto
- Universidade do Estado do Rio de Janeiro (UERJ), Av. Marechal Rondon, 381. São Francisco Xavier, Rio de Janeiro, RJ, CEP: 20950-000, Brazil.
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Felipe Guimarães Tavares
- Escola de Enfermagem Aurora de Afonso Costa. Faculdade de Enfermagem, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mariza Theme-Filha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Domingues RMSM, Dias BAS, Bittencourt SDDA, Dias MAB, Torres JA, Cunha EMD, Leal MDC. Utilização de serviços de saúde ambulatoriais no pós-parto por puérperas e recém-nascidos: dados do estudo Nascer no Brasil. CAD SAUDE PUBLICA 2020; 36:e00119519. [DOI: 10.1590/0102-311x00119519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
Este trabalho tem por objetivo estimar a utilização de serviços de saúde ambulatoriais no pós-parto e verificar os fatores demográficos, socioeconômicos e obstétricos associados a este uso. Estudo nacional de base hospitalar, realizado em 2011-2012, com entrevistas de 23.894 mulheres. Foram calculadas as estimativas pontuais e os respectivos intervalos de confiança de oito indicadores de utilização de serviços de saúde com desempenho avaliado como “satisfatório” (75%-100%); “parcial” (50%-74%) e “insatisfatório” (< 50%). Foi realizada regressão logística múltipla para verificar a associação entre as características das mulheres e cada um dos indicadores analisados. Quatro indicadores - “procura de serviço para consulta de revisão do parto” (73,9%; IC95%: 72,4-75,3); “procura de serviço para consulta do recém-nato” (91,6%; IC95%: 90,6-92,5); “vacinação com BCG” (99%; IC95%: 98,7-99,2); e “vacinação contra hepatite B” (96,8%; IC95%: 96,0-97,5) foram considerados satisfatórios. A “coleta do teste de triagem neonatal na primeira semana de vida” foi considerada parcial (60,1%; IC95%: 57,6-62,6), e “consulta da mulher nos primeiros 15 dias após o parto” (37%; IC95%: 35,0-39,0), “consulta do recém-nato nos primeiros sete dias de vida” (21,8%; IC95%: 20,2-23,5) e “recebimento do resultado da triagem neonatal no primeiro mês de vida” (29,8%; IC95%: 27,6-32,2) foram considerados insatisfatórios. Desigualdades regionais e sociais foram identificadas, com o pior desempenho de todos os indicadores nas regiões Norte e Nordeste e em mulheres mais vulneráveis, apontando para a necessidade de uma melhor organização e oferta dos serviços visando à redução de iniquidades.
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