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Fernandes LT, Ayala TAA, Firmato RMDA, Matos TDS, Ferreira FDO, Silvestre CC, Paula PABD. [Consumption of non-standard medication in indigenous health: rational usage?]. CIENCIA & SAUDE COLETIVA 2023; 28:3321-3332. [PMID: 37971014 DOI: 10.1590/1413-812320232811.13412022] [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: 09/12/2022] [Accepted: 02/17/2023] [Indexed: 11/19/2023] Open
Abstract
The study analyzed the consumption of non-standard medication in the health of indigenous peoples, emphasizing the rationality of pharmacotherapy, by conducting a cross-sectional study of secondary data from 2018 and 2019 in the Minas Gerais/Espírito Santo Special Sanitary Indigenous Health Districts. These medicines were classified by Anatomical Therapeutic Chemical Classification. Non-parametric tests were applied to compare the origin of prescription and the form of acquisition, assessing access to medication. Rationality was verified through the consumption profile and the therapeutic option in the list of standardized medicines. A total of 104,928 pharmaceutical presentations were consumed, 66,967 (66%) for the alimentary tract and metabolism, 17,705 (17%) for the nervous system, and 12,961 (12%) for the cardiovascular system. With respect to medicines consumed per region, 171 (90%) out of 190 had a therapeutic option. Prescriptions were more from the SUS. Differences were found in the way the medicines were acquired. The study pointed to significant consumption of non-standard medicines, and there may be failings in therapeutic rationality. In indigenous health, ethnocultural and social issues are challenges to access to medicines with rational use.
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Affiliation(s)
- Larissa Torres Fernandes
- Departamento de Farmácia, Universidade Federal de Juiz de Fora - Campus Governador Valadares. R. Manoel Byrro 241, Vila Bretas. 35032-620 Governador Valadares MG Brasil.
| | - Tânia Alessandra Alves Ayala
- Departamento de Farmácia, Universidade Federal de Juiz de Fora - Campus Governador Valadares. R. Manoel Byrro 241, Vila Bretas. 35032-620 Governador Valadares MG Brasil.
| | | | - Tatiane da Silva Matos
- Distrito Sanitário Especial de Saúde Indígena Minas Gerais e Espírito Santo (DSEI-MG/ES). Governador Valadares MG Brasil
| | - Fernanda de Oliveira Ferreira
- Departamento de Ciências Básicas da Vida, Universidade Federal de Juiz de Fora - Campus Governador Valadares. Governador Valadares MG Brasil
| | - Carina Carvalho Silvestre
- Departamento de Farmácia, Universidade Federal de Juiz de Fora - Campus Governador Valadares. R. Manoel Byrro 241, Vila Bretas. 35032-620 Governador Valadares MG Brasil.
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Gomes OV, de Souza CDF, Nicacio JM, do Carmo RF, Pereira VC, Barral-Netto M, da Costa Armstrong A. Epidemiology of chronic kidney disease in older indigenous peoples of Brazil: findings from a cross-sectional survey. Aging Clin Exp Res 2023; 35:2201-2209. [PMID: 37517045 DOI: 10.1007/s40520-023-02510-y] [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: 04/10/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a prevalent disease worldwide, with increasing incidence particularly in low- and middle-income countries. Indigenous communities have poorer CKD outcomes due to limited access to healthcare. They are also experiencing a shift toward a sedentary lifestyle and urbanization-related dietary changes, increasing the risk of CKD-related risk factors. AIM To determine the prevalence of CKD in older Brazilian indigenous and identify the main associated risk factors. METHODS This cross-sectional study analyzed demographic and clinical data of 229 older indigenous individuals aged 60 years and above in 2022-2023. CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 or a urinary albumin-creatinine ratio > 30 mg/g. Data were presented categorically and analyzed using the Chi-square test or Fisher's exact test. RESULTS The prevalence of CKD in the population was 26.6%, with higher prevalence in women and increasing with age. The prevalence of hypertension and diabetes was 67.7% and 24.0%, respectively, and these comorbidities were associated with CKD: hypertension (OR = 5.12; 95% CI 2.2-11.9) and diabetes (OR = 5.5; 95% CI 3.7-8.2). No association was found between the prevalence of CKD and obesity, dyslipidemia, cardiovascular disease, or smoking. DISCUSSION The study found a higher prevalence of CKD among older indigenous populations in Brazil compared to non-indigenous populations, which is exacerbated by risk factors, such as aging, hypertension, diabetes, and lifestyle changes, emphasizing the importance of early detection and intervention in these communities. CONCLUSION Older persons' indigenous individuals have a high prevalence of CKD, which is correlated with factors, such as sex, age, diabetes mellitus, and hypertension.
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Affiliation(s)
- Orlando Vieira Gomes
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil.
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil.
| | - Carlos Dornels Freire de Souza
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Jandir Mendonça Nicacio
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Rodrigo Feliciano do Carmo
- College of Pharmaceutical Sciences, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
| | - Vanessa Cardoso Pereira
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
| | - Manoel Barral-Netto
- Oswaldo Cruz Foundation/Fiocruz, Institute Gonçalo Moniz, Salvador, Bahia, Brazil
| | - Anderson da Costa Armstrong
- Postgraduate Program in Human Ecology and Socio-Environmental Management, Bahia State University-UNEB, Juazeiro, Bahia, Brazil
- Faculty of Medicine, Federal University of Vale do São Francisco-UNIVASF, Petrolina, Pernambuco, Brazil
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Gomes OV, Guimarães MP, Nicacio JM, Morena L, Silva AMLD, Morais Junior JCD, Souza CDFD, Barral Netto M, Lima JAC, Armstrong ADC. Urbanization and kidney dysfunction in Brazilian indigenous people: a burden for the youth. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:240-245. [PMID: 36888763 PMCID: PMC9983479 DOI: 10.1590/1806-9282.20220934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether the degree of urbanization influences the prevalence of chronic kidney disease in Brazilian indigenous people. METHODS This is a cross-sectional study conducted between 2016 and 2017 in northeastern Brazil and includes individuals aged between 30 and 70 years from two specific indigenous groups who volunteered to participate in the study: the Fulni-ô people (lowest degree of urbanization) and the Truká group (greater degree of urbanization). Cultural and geographical parameters were used to characterize and measure the magnitude of urbanization. We excluded individuals with known cardiovascular disease or renal failure who required hemodialysis. Chronic kidney disease was defined as a single measurement of an estimated glomerular filtration rate <60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. RESULTS A total of 184 indigenous people from the Fulni-ô group and 96 from the Truká group with a median age of 46 years (interquartile range: 15.2) were included. We found a chronic kidney disease rate of 4.3% in the total indigenous population, generally affecting an older population: 41.7% over 60 years old (p<0.001). The Truká people had a chronic kidney disease prevalence of 6.2%, with no differences in kidney dysfunction across age groups. The Fulni-ô participants had a chronic kidney disease prevalence of 3.3%, with a higher proportion of kidney dysfunction in older participants (of the six Fulni-ô indigenous people with chronic kidney disease, five were older). CONCLUSION Our results suggest that a higher degree of urbanization seems to negatively influence the prevalence of chronic kidney disease in Brazilian indigenous people.
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Affiliation(s)
- Orlando Vieira Gomes
- Universidade do Estado da Bahia, Postgraduation Program in Human Ecology and Socio-Environmental Management - Juazeiro (BA), Brazil.,Universidade Federal do Vale do São Francisco, School of Medicine - Petrolina (PE), Brazil
| | | | - Jandir Mendonça Nicacio
- Universidade do Estado da Bahia, Postgraduation Program in Human Ecology and Socio-Environmental Management - Juazeiro (BA), Brazil.,Universidade Federal do Vale do São Francisco, School of Medicine - Petrolina (PE), Brazil
| | - Leela Morena
- Universidade Federal do Vale do São Francisco, School of Medicine - Petrolina (PE), Brazil
| | | | | | | | | | | | - Anderson da Costa Armstrong
- Universidade do Estado da Bahia, Postgraduation Program in Human Ecology and Socio-Environmental Management - Juazeiro (BA), Brazil.,Universidade Federal do Vale do São Francisco, School of Medicine - Petrolina (PE), Brazil
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Castelo Branco FMF, de Vargas D. Alcohol use patterns and associated variables among the Karipuna indigenous people in the extreme Northern Brazilian Amazon. J Ethn Subst Abuse 2023; 22:29-44. [PMID: 33433294 DOI: 10.1080/15332640.2021.1871695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of this study was to identify the prevalence and patterns of alcohol consumption and associated factors in the Karipuna indigenous people. A cross-sectional population-based study was conducted with 230 Karipunan respondents aged 15 or over from 12 villages in the state of Amapá, in the extreme northern Brazilian Amazon. The participants completed the Alcohol Use Disorders Identification Test (AUDIT). The prevalence of alcohol use among the Karipuna was 70%. Of these, 59.6% had low-risk use, 38.3% had hazardous or harmful alcohol use, and 2.2% met criteria for probable alcohol dependence. Overall, 40.5% of the respondents had hazardous or harmful alcohol use; 66.6% were men, and 33.4% were women. In the regression analysis, age, sex, religion, not having an occupation, being a student, low educational attainment, suicidal ideation and having sexual intercourse after alcohol consumption were associated with hazardous or harmful alcohol use. Sex and Catholic religion were risk factors for this alcohol use pattern among the Karipuna. The prevalence of problematic alcohol use among the Karipuna is higher than that observed among the general Brazilian population, and preventive screenings should be widely implemented. Efforts to address and minimize the consequences of harmful and hazardous alcohol use among Brazilian Amazonian indigenous populations could be developed.
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dos Santos M, Oliveira Penteado J, de Lima Brum R, da Silva Bonifácio A, Florêncio Ramires P, de Franceschi Gariboti D, Santos Cardoso RM, da Silva Júnior FMR. Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil. SPATIAL DEMOGRAPHY 2023; 11:1-17. [PMID: 36685786 PMCID: PMC9841953 DOI: 10.1007/s40980-022-00112-2] [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] [Accepted: 11/30/2022] [Indexed: 01/18/2023]
Abstract
The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.
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Affiliation(s)
- Marina dos Santos
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Júlia Oliveira Penteado
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Rodrigo de Lima Brum
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Alicia da Silva Bonifácio
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Paula Florêncio Ramires
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Diuster de Franceschi Gariboti
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
| | - Ruana Michela Santos Cardoso
- grid.411252.10000 0001 2285 6801Universidade Federal de Sergipe – UFS, Av. Marechal Rondon, S/N - Jardim Rosa Elze, São Cristóvão, SE 49100-000 Brazil
| | - Flavio Manoel Rodrigues da Silva Júnior
- grid.411598.00000 0000 8540 6536Universidade Federal do Rio Grande - FURG, Avenida Itália, Km 8, Campus Carreiros, Rio Grande, Rio Grande do Sul 96203-900 Brazil
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Kramer CK, Leitão CB, Viana LV. The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry. Lancet 2022; 400:2074-2083. [PMID: 36502845 DOI: 10.1016/s0140-6736(22)00625-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes. METHODS In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480. FINDINGS 46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions. INTERPRETATION The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. FUNDING None.
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Affiliation(s)
- Caroline K Kramer
- Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, ON, Canada; Leadership Sinai Centre for Diabetes and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Cristiane B Leitão
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana V Viana
- Serviço de Nutrologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Sombra NM, Gomes HLM, Sousa AM, Almeida GSD, Souza Filho ZAD, Toledo NDN. High blood pressure levels and cardiovascular risk among Munduruku indigenous people. Rev Lat Am Enfermagem 2021; 29:e3477. [PMID: 34495189 PMCID: PMC8432582 DOI: 10.1590/1518-8345.4970.3477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: to identify the risk factors associated with prehypertension and arterial
hypertension among Munduruku indigenous people in the Brazilian Amazon. Method: a cross-sectional study carried out with 459 Munduruku indigenous people
selected by means of stratified random sampling. Sociodemographic variables,
habits and lifestyles, anthropometric data, fasting glucose and lipid
profiles were evaluated. An automatic device calibrated and validated to
measure blood pressure was used. The analyses of the data collected were
carried out in the R software, version 3.5.1. For continuous variables, the
Kruskall-Wallis test was used; for the categorical ones, Fischer’s Exact.
The significance level was set at 5% and p-value≤0.05. Results: the prevalence of altered blood pressure levels was 10.2% for values
suggestive of hypertension and 4.1% for pre-hypertension. The risk of
prehypertension among indigenous people was associated with being male
(OR=1.65; 95% CI=0.65-4.21) and having a substantially increased waist
circumference (OR=7.82; 95% CI=1.80-34.04). Regarding the risk for arterial
hypertension, it was associated with age (OR=1.09; 95% CI=1.06-1.12), with
increased waist circumference (OR=3.89; 95% CI=1.43-10, 54) and with
substantially increased waist circumference (OR=5.46; 95%
CI=1.78-16.75). Conclusion: among Munduruku indigenous people, men were more vulnerable to developing
hypertension; age and increased waist circumference proved to be strong
cardiovascular risk factors.
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Affiliation(s)
- Neuliane Melo Sombra
- Universidade Federal do Amazonas, Escola de Enfermagem de Manaus, Manaus, AM, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Hanna Lorena Moraes Gomes
- Universidade Federal do Amazonas, Escola de Enfermagem de Manaus, Manaus, AM, Brazil.,Scholarship holder at the Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM), Brazil
| | - António Manuel Sousa
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brazil
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Cupertino GA, Cupertino MDC, Gomes AP, Braga LM, Siqueira-Batista R. COVID-19 and Brazilian Indigenous Populations. Am J Trop Med Hyg 2020; 103:609-612. [PMID: 32524964 PMCID: PMC7410482 DOI: 10.4269/ajtmh.20-0563] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/24/2022] Open
Abstract
The newly discovered SARS-CoV-2 is the cause of COVID-19, including severe respiratory symptoms with an important lethality rate and high dissemination capacity. Considering the indigenous people of Brazil, it is feared that COVID-19 will spread to these communities, causing another stage of decimation. Despite advances in indigenous health care in the country, there are still many challenges due to the social vulnerability of this population, whose lands continue to be illegally exploited. Based on these considerations, this article discusses challenges in caring for the indigenous population in the context of the COVID-19 pandemic in Brazil.
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Affiliation(s)
| | - Marli do Carmo Cupertino
- School of Medicine, Faculdade Dinâmica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Andréia Patrícia Gomes
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Luciene Muniz Braga
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Rodrigo Siqueira-Batista
- School of Medicine, Faculdade Dinâmica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil
- Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
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