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de Amorin Vilharba BL, Yamamura M, de Azevedo MV, Fernandes WDS, Santos-Pinto CDB, de Oliveira EF. Disease burden of congenital Zika virus syndrome in Brazil and its association with socioeconomic data. Sci Rep 2023; 13:11882. [PMID: 37482558 PMCID: PMC10363536 DOI: 10.1038/s41598-023-38553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Zika virus (ZIKV) infection became a global public health concern, causing an epidemic in Latin America from 2015 to 2016, when a sudden increase in cases of microcephaly and other congenital anomalies was observed. In 2016, the Centers for Disease Control and Prevention and the World Health Organization defined congenital Zika-associated syndrome (CZS) as a set of congenital anomalies seen in children born to mothers with a history of gestational Zika fever, who have microcephaly as the most prevalent clinical sign. In order to describe the magnitude of CZS in Brazil, this study estimated the burden of disease due to CZS in Brazil using the disability-adjusted life years (DALY) indicator and other frequency measures, such as incidence and mortality rate, during the years 2015-2020. The association of these indicators with socioeconomic variables was also evaluated using Spearman's correlation coefficient. Choropleth maps were used to evaluate the spatial distribution of the indicators evaluated and the spatial autocorrelation was verified by the Bivariate Moran Local Index. From 2015 to 2020, 3,591 cases of CZS were confirmed in Brazil, with an incidence of 44.03 cases per 1000 live births, and a specific mortality of 12.35 deaths per 1000 live births. A global loss of 30,027.44 DALYs was estimated from 2015 to 2020. The Northeast region had the highest values for all health indicators assessed. Spatial correlation and autocorrelation analyses showed significant associations between health and socioeconomic indicators, such as per capita income, Gini index, illiteracy rate and basic sanitation. The study allowed us to have access to all reported cases of CZS, showing us the possible situation of the disease in Brazil; therefore, we believe that our results can help in the understanding of future studies.
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Affiliation(s)
- Bruna Luiza de Amorin Vilharba
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - Mellina Yamamura
- Departamento de Enfermagem, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | | | - Wagner de Souza Fernandes
- Universidade Federal de Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian-HUMAP-EBSERH, Campo Grande, MS, Brasil
| | | | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
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Arrais NMR, Maia CRS, de Amorim Rodrigues NA, Moreira RS, de Almeida VA, Pereira SA, de Moraes Pinto MI. Factors Associated with Behavioral Disorders in Children with Congenital Zika Syndrome and Their Families—A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159554. [PMID: 35954904 PMCID: PMC9368289 DOI: 10.3390/ijerph19159554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
The Zika virus was responsible for an outbreak between 2015 and 2016 in Brazil: an alarming public health problem of international relevance. The Congenital Zika Syndrome (CZS) is often associated with manifestations that are responsible for cognitive and motor development delays and behavioral disorders. Thus, we aimed to characterize the clinical-epidemiological and familial context of those children and to identify factors associated with the risk of behavioral disorders using the Survey of Well-Being of Young Children questionnaire (SWYC). In total, 52 children diagnosed with CZS were evaluated. Logistic regressions were employed to assess predictive variables for behavioral alteration. Eighteen (35%) of the children presented a risk of behavioral alteration. Children born normocephalic were 36-fold more likely to present behavioral alteration (95% CI: 3.82 to 337.92, p = 0.002). Children with hearing and visual impairments showed reduced risks. In total, 35% percent of families reported food insecurity and 21% were at risk for maternal depression. Our findings suggest better social interactions and conditions to externalize reactions for children with CZS born normocephalic. The continuous assessment of these children and families may identify conditions associated with behavioral alteration and psychosocial vulnerabilities that help in decision-making, therefore optimizing patient–family interactions.
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Affiliation(s)
- Nívia Maria Rodrigues Arrais
- Pediatrics Department, Universidade Federal do Rio Grande do Norte, Natal 59077-010, Brazil;
- Pediatrics Department, Universidade Federal de São Paulo—UNIFESP, Sao Paulo 04021-001, Brazil;
- Correspondence: (N.M.R.A.); (S.A.P.)
| | | | | | - Rafaela Silva Moreira
- Department of Health Sciences, Universidade Federal de Santa Catarina, Ararangua 88905-120, Brazil;
| | - Valeria Azevedo de Almeida
- Physical Therapy Department, Universidade Federal do Rio Grande do Norte, Natal 59077-010, Brazil; (N.A.d.A.R.); (V.A.d.A.)
| | - Silvana Alves Pereira
- Pediatrics Department, Universidade Federal do Rio Grande do Norte, Natal 59077-010, Brazil;
- Correspondence: (N.M.R.A.); (S.A.P.)
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Kameda K, Kelly AH, Lezaun J, Löwy I. Imperfect diagnosis: The truncated legacies of Zika testing. SOCIAL STUDIES OF SCIENCE 2021; 51:683-706. [PMID: 34461777 PMCID: PMC8474320 DOI: 10.1177/03063127211035492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of 'emergency R&D' to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.
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Affiliation(s)
- Koichi Kameda
- Institute for Research and
Innovation in Society (IFRIS), Paris, France
| | - Ann H Kelly
- Department of Global Health and
Social Medicine, King’s College London, London, UK
| | - Javier Lezaun
- Institute for Science, Innovation
and Society, University of Oxford, Oxford, UK
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4
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Athni TS, Shocket MS, Couper LI, Nova N, Caldwell IR, Caldwell JM, Childress JN, Childs ML, De Leo GA, Kirk DG, MacDonald AJ, Olivarius K, Pickel DG, Roberts SO, Winokur OC, Young HS, Cheng J, Grant EA, Kurzner PM, Kyaw S, Lin BJ, López RC, Massihpour DS, Olsen EC, Roache M, Ruiz A, Schultz EA, Shafat M, Spencer RL, Bharti N, Mordecai EA. The influence of vector-borne disease on human history: socio-ecological mechanisms. Ecol Lett 2021; 24:829-846. [PMID: 33501751 PMCID: PMC7969392 DOI: 10.1111/ele.13675] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/14/2023]
Abstract
Vector-borne diseases (VBDs) are embedded within complex socio-ecological systems. While research has traditionally focused on the direct effects of VBDs on human morbidity and mortality, it is increasingly clear that their impacts are much more pervasive. VBDs are dynamically linked to feedbacks between environmental conditions, vector ecology, disease burden, and societal responses that drive transmission. As a result, VBDs have had profound influence on human history. Mechanisms include: (1) killing or debilitating large numbers of people, with demographic and population-level impacts; (2) differentially affecting populations based on prior history of disease exposure, immunity, and resistance; (3) being weaponised to promote or justify hierarchies of power, colonialism, racism, classism and sexism; (4) catalysing changes in ideas, institutions, infrastructure, technologies and social practices in efforts to control disease outbreaks; and (5) changing human relationships with the land and environment. We use historical and archaeological evidence interpreted through an ecological lens to illustrate how VBDs have shaped society and culture, focusing on case studies from four pertinent VBDs: plague, malaria, yellow fever and trypanosomiasis. By comparing across diseases, time periods and geographies, we highlight the enormous scope and variety of mechanisms by which VBDs have influenced human history.
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Affiliation(s)
- Tejas S. Athni
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Marta S. Shocket
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, CA, USA
| | - Lisa I. Couper
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Nicole Nova
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Iain R. Caldwell
- ARC Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, Queensland, Australia
| | - Jamie M. Caldwell
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Biology, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Jasmine N. Childress
- Department of Ecology, Evolution, and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Marissa L. Childs
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, CA, USA
| | - Giulio A. De Leo
- Hopkins Marine Station of Stanford University, Pacific Grove, CA, USA
- Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Devin G. Kirk
- Department of Biology, Stanford University, Stanford, CA, USA
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J. MacDonald
- Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
- Earth Research Institute, University of California, Santa Barbara, CA, USA
| | | | - David G. Pickel
- Department of Classics, Stanford University, Stanford, CA, USA
| | | | - Olivia C. Winokur
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Hillary S. Young
- Department of Ecology, Evolution, and Marine Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Julian Cheng
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | | | - Saw Kyaw
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Bradford J. Lin
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | | | - Erica C. Olsen
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Maggie Roache
- Department of Biology, Stanford University, Stanford, CA, USA
| | - Angie Ruiz
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Muskan Shafat
- Department of Biology, Stanford University, Stanford, CA, USA
| | | | - Nita Bharti
- Department of Biology, Center for Infectious Disease Dynamics, Penn State University, University Park, PA, USA
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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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Carvalho-Sauer RDCOD, Costa MDCN, Paixão ES, de Jesus Silva N, Barreto FR, Teixeira MG. Cross-sectional study of the anthropometric characteristics of children with congenital Zika syndrome up to 12 months of life. BMC Pediatr 2020; 20:479. [PMID: 33054749 PMCID: PMC7557056 DOI: 10.1186/s12887-020-02365-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about physical development of children with Congenital Zika Syndrome (CZS). This study aims to evaluate the anthropometric characteristics of children with CZS up to 12 months. Methods This is a cross-sectional study developed with 46 children with CZS living in Bahia. We used the Public Health Events Register, Live Births Information System and Childcare Records of Primary Health Care Services. Descriptive analysis was performed by distributing absolute and relative frequencies and median and interquartile range. The Weight/Age (W/A), Length/Age (L/A), Weight/Length (W/L) and Head Circumference/Age (HC/A) indexes were calculated for each month and expressed in z-score values, and the results were evaluated individually and by group average. Values between ≥ − 2 and ≤ 2 standard deviations were used as reference. T-Student and Spearman’s Correlation Tests were applied to verify the existence of any relationship between maternal and children’s variables with the anthropometric indexes weight/age and height/age at birth and at 3, 6 and 12 months of age. Results The studied children had high proportions of low birth weight (23.9%), dysphagia (56.8%) and seizures (53.5%). The mean z-score for the HC/A index at birth was − 3.20 and remained below − 3 z-scores throughout the assessed period. The analysis of the indices equivalent to every single child’s anthropometric measurement showed a deficit in 20.4% of the W/A, 39.1% of the L/A, 9.2% of the W/L and 85.7% of the HC/A measurements. Distribution of the mean values of these anthropometric indices revealed a risk of delayed stature growth (L/A < -1 z-score). There was a statistically significant association between L/A at 12 months and dysphagia (p = 0.0148) and a positive correlation between breastfeeding time and W/A. No statistically significant correlation was found between any other tested variables. Conclusions We observed a deficit in the HC/A index, which is a common feature in CZS, but also a high proportion of W/A and L/A deficit. The average group z-score highlighted the risk of delay in stature growth for age, which calls attention to the need for health interventions, as this condition exposes them to a higher risk of morbidity and mortality.
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Affiliation(s)
- Rita de Cássia Oliveira de Carvalho-Sauer
- Bahia State Health Secretariat, Epidemiological Surveillance Service of the East Regional Health Center, Avenida Esperança, 406, Santo Antônio de Jesus, Bahia, ZC 44435-500, Brazil
| | | | - Enny S Paixão
- London School of Hygiene and Tropical Medicine, London Keppel St, Bloomsbury, London, WC1E 7HT, UK.
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Parque Tecnológico da Bahia. Rua Mundo, 121 - Trobogy, Salvador, Bahia, ZC 41745-715, Brazil
| | - Florisneide Rodrigues Barreto
- Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s / n. Canela, Salvador, Bahia, ZC-40.110.040, Brazil
| | - Maria Gloria Teixeira
- Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s / n. Canela, Salvador, Bahia, ZC-40.110.040, Brazil
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"Too Much to Ask, Too Much to Handle": Women's Coping in Times of Zika. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124613. [PMID: 32604943 PMCID: PMC7344537 DOI: 10.3390/ijerph17124613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022]
Abstract
Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences for pregnancies have made governments and both national and international agencies issue advice and recommendations to women. This study was designed to understand the impacts of Zika on women who were less directly affected and less vulnerable to Zika. Women were recruited from various locations in Brazil, Puerto Rico, and the United States. Data were collected through semi-structured interviews and analyzed using thematic analysis. Women perceived that public health systems placed an unfair responsibility for preventing health complications from Zika onto women who had limited ability to do so. They also stated that the measures recommended to them were invasive, while creating the perception that women were the sole determinant of whether they contracted Zika. The results indicate that women with higher levels of education understood the limitations of the information, government actions, and medical care they received, which ended up producing higher levels of anguish and worry. Gender inequality and discrimination must be recognized and rendered visible in the public health emergency response. The social effects of the epidemic affected women more than had been thought before and at deeper emotional levels.
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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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9
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Freitas PSS, Soares GB, Mocelin HJS, Lamonato LCXL, Sales CMM, Linde-Arias AR, Bussinger ECA, Maciel ELN. How do mothers feel? Life with children with congenital Zika syndrome. Int J Gynaecol Obstet 2020; 148 Suppl 2:20-28. [PMID: 31975400 PMCID: PMC7065199 DOI: 10.1002/ijgo.13044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe the repercussions, from the perspectives of caregiver mothers, of confirmed congenital Zika syndrome (CZS) in their offspring. METHODS A descriptive-exploratory study with a qualitative approach was carried out in the state of Espírito Santo in southeastern Brazil, with 25 women who had a child diagnosed with CZS. RESULTS Emerging themes from the content analysis were grouped into two categories: (1) inequalities experienced by mothers, including social inequality, poverty, and gender inequality; (2) the impact of a child with CZS on mothering, including feelings at the time of diagnosis, maternal isolation and mental health, experiences of stigma and prejudice, and exhausting itineraries searching for therapeutic care. CONCLUSION The repercussions of CZS were a huge burden on already vulnerable women, and social inequalities and poverty were important markers in the mothers' reports. Many of the families affected by CZS already lived in precarious social conditions and these conditions were exacerbated further. Robust public and social policies to support these mothers need effective implementation given that babies born with CZS need long-term care and support.
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Affiliation(s)
- Paula S S Freitas
- Laboratory of Epidemiology, Federal University of Espírito Santo, Vitória, ES, Brazil.,Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Gabriella B Soares
- Department of Health Promotion, Medical Sciences Center, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Helaine J S Mocelin
- Laboratory of Epidemiology, Federal University of Espírito Santo, Vitória, ES, Brazil.,Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Larissa C X L Lamonato
- Health Sciences Department, Federal University of Espírito Santo, São Mateus, ES, Brazil
| | - Carolina M M Sales
- Laboratory of Epidemiology, Federal University of Espírito Santo, Vitória, ES, Brazil.,Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Ana R Linde-Arias
- Maurício Gastón Institute, University of Massachusetts, Boston, MA, USA
| | | | - Ethel L N Maciel
- Laboratory of Epidemiology, Federal University of Espírito Santo, Vitória, ES, Brazil.,Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
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de Souza HP, de Oliveira WTGH, Dos Santos JPC, Toledo JP, Ferreira IPS, de Sousa Esashika SNG, de Lima TFP, de Sousa Delácio A. [Infectious and parasitic diseases in Brazil, 2010 to 2017: considerations for surveillanceEnfermedades infecciosas y parasitarias en Brasil de 2010 a 2017: aspectos para la vigilancia sanitaria]. Rev Panam Salud Publica 2020; 44:e10. [PMID: 32051684 PMCID: PMC7008608 DOI: 10.26633/rpsp.2020.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/31/2019] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Apresentar um método para identificar áreas críticas relativas a doenças infecciosas e parasitárias selecionadas para fins de vigilância em saúde, analisando a sua associação a indicadores de pobreza no Brasil. Métodos. Foram mapeadas as taxas de incidência de dengue, doença de Chagas aguda, esquistossomose, hanseníase, hepatite A, leishmaniose tegumentar, leishmaniose visceral, leptospirose, malária e tuberculose. Foram realizadas análises para os anos de 2010 a 2017 a partir de um indicador síntese, calculado como a média dos coeficientes médios de incidência para cada agravo normalizada pela média e desvio padrão durante o período analisado. A estimativa da base populacional foi de 2014. Os coeficientes calculados foram estratificados para classificação dos municípios em criticidade muito alta, alta, média, baixa ou muito baixa conforme cada doença. Também foram selecionados indicadores de diferentes dimensões que expressassem desigualdades socioeconômicas e segregação espacial nos municípios brasileiros, sendo testada a sua associação às doenças em estudo. Resultados. O indicador mostrou que 40,5% dos municípios brasileiros apresentam alta criticidade, sobretudo nas regiões Norte, parte do Nordeste e Centro-Oeste. Os indicadores “proporção de pobreza”, “lixo no entorno”, “esgoto no entorno” e “famílias chefiadas por mulheres” podem aumentar a chance de a localidade apresentar maior criticidade para as doenças. O indicador “esgoto adequado” pode ser considerado potencial fator de proteção. Conclusões. A técnica utilizada foi adequada para orientar ações de vigilância no país e permite a articulação entre vigilâncias locais e demais setores para contornar os problemas de saúde causados por doenças infecciosas e parasitárias e fatores relacionados.
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Affiliation(s)
- Helen Paredes de Souza
- Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) Rio de Janeiro (RJ) Brasil Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), Rio de Janeiro (RJ), Brasil
| | - Wanessa Tenório Gonçalves Holanda de Oliveira
- Ministério da Saúde Departamento de Imunização e Doenças Transmissíveis Brasília (DF) Brasil Ministério da Saúde, Departamento de Imunização e Doenças Transmissíveis, Brasília (DF), Brasil
| | - Jefferson Pereira Caldas Dos Santos
- Fundação Oswaldo Cruz (FIOCRUZ) Centro de Inovação em Biodiversidade e Saúde Rio de Janeiro (RJ) Brasil Fundação Oswaldo Cruz (FIOCRUZ), Centro de Inovação em Biodiversidade e Saúde, Rio de Janeiro (RJ), Brasil
| | - João Paulo Toledo
- Organização Pan-Americana da Saúde (OPAS) Consultor em Doenças Infecciosas Brasília (DF) Brasil Organização Pan-Americana da Saúde (OPAS), Consultor em Doenças Infecciosas, Brasília (DF), Brasil
| | - Isis Polianna Silva Ferreira
- Ministério da Saúde Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde Brasília (DF) Brasil Ministério da Saúde, Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde, Brasília (DF), Brasil
| | - Suely Nilsa Guedes de Sousa Esashika
- Ministério da Saúde Departamento de Promoção da Saúde Brasília (DF) Brasil Ministério da Saúde, Departamento de Promoção da Saúde, Brasília (DF), Brasil
| | - Tatiane Fernandes Portal de Lima
- Ministério da Saúde Departamento de Imunização e Doenças Transmissíveis Brasília (DF) Brasil Ministério da Saúde, Departamento de Imunização e Doenças Transmissíveis, Brasília (DF), Brasil
| | - Amanda de Sousa Delácio
- Ministério da Saúde Departamento de Imunização e Doenças Transmissíveis Brasília (DF) Brasil Ministério da Saúde, Departamento de Imunização e Doenças Transmissíveis, Brasília (DF), Brasil
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11
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Mocelin HJ, Catão RC, Freitas PS, Prado TN, Bertolde AI, Castro MC, Maciel EL. Analysis of the spatial distribution of cases of Zika virus infection and congenital Zika virus syndrome in a state in the southeastern region of Brazil: Sociodemographic factors and implications for public health. Int J Gynaecol Obstet 2020; 148 Suppl 2:61-69. [PMID: 31975398 PMCID: PMC7065179 DOI: 10.1002/ijgo.13049] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To perform spatial distribution analysis of reported cases of Zika virus and congenital Zika syndrome (CZS) in the state of Espírito Santo, Brazil, by neighborhood, and relate the results to sociodemographic indicators and implications for the health process. METHODS An ecological study using data from the 2016 National Notifiable Diseases Surveillance System, epidemiological records, and information on neighborhoods of families confirmed with CZS from qualitative field research. RESULTS Sociodemographic indicators were analyzed in three distinct groups: general population with Zika virus, pregnant women with Zika virus, and cases of CZS visited. For the three groups, average literacy rates were 71.1%, 71.0%, and 68.3%; the average income per minimum wage was 1.4, 1.1, and 1.4; sanitary sewage coverage was 75.6%, 76.1%, and 71.4%; garbage coverage was 90.8%, 91.2%, and 89.2%; and water supply was 93.8%, 94.1% and 93.8%, respectively. Socioeconomic indicators showed no significant differences between groups, although they were above the national average. A nonsignificant variation of 68.3%-71.1% was seen in the average literacy level above 15 years of age. CONCLUSION Socioeconomic and demographic indicators of cases of Zika virus infection and CZS may indicate that the outbreak had different impacts according to class, social group, or gender, reflecting the persistence and social geography of inequality in Brazil.
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Affiliation(s)
- Helaine J.S. Mocelin
- Laboratory of EpidemiologyFederal University of Espírito SantoVitóriaESBrazil
- Graduate Program in Collective HealthFederal University of Espírito SantoVitóriaESBrazil
| | - Rafael C. Catão
- Departament of GeographyFederal University of Espírito SantoVitóriaESBrazil
| | - Paula S.S. Freitas
- Laboratory of EpidemiologyFederal University of Espírito SantoVitóriaESBrazil
- Graduate Program in Collective HealthFederal University of Espírito SantoVitóriaESBrazil
| | - Thiago N. Prado
- Laboratory of EpidemiologyFederal University of Espírito SantoVitóriaESBrazil
- Graduate Program in Collective HealthFederal University of Espírito SantoVitóriaESBrazil
| | - Adelmo I. Bertolde
- Laboratory of EpidemiologyFederal University of Espírito SantoVitóriaESBrazil
- Department of StatisticsFederal University of Espírito SantoVitóriaESBrazil
| | - Marcia C. Castro
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ethel L.N. Maciel
- Laboratory of EpidemiologyFederal University of Espírito SantoVitóriaESBrazil
- Graduate Program in Collective HealthFederal University of Espírito SantoVitóriaESBrazil
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Mocelin HJS, do Prado TN, Freitas PDSS, Bertolde AI, Perez F, Riley LW, Maciel ELN. [Variations in the detection of congenital Zika syndrome associated with changes in protocolsVariación de la detección del síndrome congénito por el virus del Zika en función de los cambios de los protocolos]. Rev Panam Salud Publica 2019; 43:e79. [PMID: 31579398 PMCID: PMC6752177 DOI: 10.26633/rpsp.2019.79] [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: 04/01/2019] [Accepted: 07/01/2019] [Indexed: 11/24/2022] Open
Abstract
Em 2015, o Brasil enfrentou uma epidemia de infecção pelo vírus Zika que se propagou por países do mundo. Posteriormente, recomendações acerca dos critérios de notificação de casos de síndrome congênita do Zika (SCZ) foram divulgadas através de protocolos. As mudanças frequentes nessas recomendações podem ter afetado o gerenciamento clínico e o acesso a suporte pós-diagnóstico por crianças afetadas mas não identificadas. No presente estudo, 39 casos de SCZ notificados no estado do Espírito Santo no período de 2015 a 2016 foram reclassificados quanto ao seu diagnóstico de acordo com o protocolo atualmente vigente, diferente daquele que vigorava em 2015. Pela reclassificação, apenas oito dos 36 casos seriam confirmados, respeitando o critério de dois ou mais sinais ou sintomas da SCZ com ou sem microcefalia e confirmação sorológica. Ainda, pela diminuição no perímetro cefálico que define microcefalia, 17 casos passaram a não se enquadrar nessa condição. Apesar de o protocolo vigente não utilizar somente o perímetro cefálico como critério para notificação e confirmação da SCZ, cabe ressaltar que este achado ainda é o maior sinalizador para as equipes de saúde, indicando um risco da não detecção precoce da SCZ. Seria prudente uma revisão dos casos “descartados” no momento de transição entre protocolos, a fim de avaliar se foram corretamente classificados.
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Affiliation(s)
- Helaine Jacinta Salvador Mocelin
- Universidade Federal do Espírito Santo (UFES) Laboratório de Epidemiologia (Lab-Epi) Vitória (ES) Brasil Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória (ES), Brasil
| | - Thiago Nascimento do Prado
- Universidade Federal do Espírito Santo (UFES) Laboratório de Epidemiologia (Lab-Epi) Vitória (ES) Brasil Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória (ES), Brasil
| | - Paula de Souza Silva Freitas
- Universidade Federal do Espírito Santo (UFES) Laboratório de Epidemiologia (Lab-Epi) Vitória (ES) Brasil Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória (ES), Brasil
| | - Adelmo Inácio Bertolde
- Universidade Federal do Espírito Santo (UFES) Departamento de Estatística Vitória (ES) Brasil Universidade Federal do Espírito Santo (UFES), Departamento de Estatística, Vitória (ES), Brasil
| | - Freddy Perez
- Organização Pan-Americana da Saúde (OPAS) Departamentos de Doenças Transmissíveis e Determinantes Ambientais da Saúde Washington (DC) Estados Unidos Organização Pan-Americana da Saúde (OPAS), Departamentos de Doenças Transmissíveis e Determinantes Ambientais da Saúde, Washington (DC), Estados Unidos
| | - Lee W Riley
- Universidade da Califórnia, Escola de Saúde Pública Divisão de Doenças Infecciosas e Vacinologia Berkeley (CA) Estados Unidos Universidade da Califórnia, Escola de Saúde Pública, Divisão de Doenças Infecciosas e Vacinologia, Berkeley (CA), Estados Unidos
| | - Ethel Leonor Noia Maciel
- Universidade Federal do Espírito Santo (UFES) Laboratório de Epidemiologia (Lab-Epi) Vitória (ES) Brasil Universidade Federal do Espírito Santo (UFES), Laboratório de Epidemiologia (Lab-Epi), Vitória (ES), Brasil
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