Relationships Between Mental Health, Negative Feelings of COVID-19, and Parenting Among Pregnant Women in Fortaleza, Brazil.

INTRODUCTION: During the COVID-19 pandemic, the literature highlighted an increased risk of child abuse and the use of negative parenting practices. Furthermore, pregnancy during this time may have been challenging and generated different feelings regarding the pandemic and motherhood. Many pregnant women had other young children, underscoring the need to understand this scenario better. Therefore, the present study examined the predictive effect of indicators of mental health disorders, emotional discomfort with motherhood, and negative perceptions of COVID-19 on negative parenting practices. METHODS: The study used a cross-sectional design. Pregnant women (n = 303) who had other children younger than six years answered an online questionnaire during the physical distancing period due to COVID-19 in Fortaleza. A partially latent structural equation model (SEM) was used to test direct and indirect relations between the variables. RESULTS: The results revealed a direct positive relation between maternal mental health and the variables COVID-19 feelings, emotional discomfort with motherhood, and negative parenting practices. The stronger relationship was between maternal mental health and emotional discomfort with motherhood. The COVID-19 negative feelings also showed a direct positive relation to emotional discomfort with motherhood. Additionally, older mothers and those with fewer children tended to have less mental health disorders. Furthermore, being in a later trimester of pregnancy was linked to more negative feelings about motherhood. DISCUSSION: The study suggests that mothers experiencing mental health challenges are more likely to feel discomfort with motherhood and use negative parenting practices, highlighting a need for intervention.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review.

BACKGROUND: In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status. AIMS: This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures. METHODS: Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains. RESULTS: The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices. CONCLUSIONS: Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

Food insecurity among families with infants born during the COVID-19 pandemic in Fortaleza, Northeast Brazil.

PURPOSE: To assess the prevalence of food insecurity (FI) among families with infants born during the COVID-19 pandemic and its associated factors in Fortaleza, the fifth largest city in Brazil. METHODS: Data from two survey rounds of the Iracema-COVID cohort study collected at 12 (n = 325) and 18 months (n = 331) after birth. FI was measured using the Brazilian Household Food Insecurity Scale. FI levels were described according to potential predictors. Crude and adjusted logistic regressions with robust variance were used to assess factors associated with FI. RESULTS: In the 12- and 18-month follow-ups interviews, there was a 66.5% and 57.1% prevalence of FI, respectively. Over the study period, 3.5% of the families persisted in severe FI and 27.4% in mild/moderate FI. Households headed by mothers, with more children, low education and income, sustained maternal common mental disorders, and that were beneficiaries of cash transfer programs were the most affected by persistent FI. CONCLUSIONS: Although the prevalence of FI decreased in our sample, almost 60% of families in Fortaleza still have no regular access to enough and/or nutritionally appropriate food. We have identified the groups at higher FI risk, which can guide governmental policies.

Analyzing households' food insecurity during the COVID-19 pandemic and the role of public policies to mitigate it: evidence from Ceará, Brazil.

OBJECTIVE: To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil. METHODS: An analytical cross-sectional study was carried out through telephone contact during the period of May-July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity. RESULTS: The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 - 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 - 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 - 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI. CONCLUSIONS: In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

Cohort profile: maternal and child health and parenting practices during the COVID-19 pandemic in Ceará, Brazil: birth cohort study (Iracema-COVID).

PURPOSE: Maternal and child health and parenting practices during the COVID-19 pandemic in Ceará (Iracema-COVID) is a longitudinal, prospective population-based birth cohort designed to understand the effects of the pandemic and social withdrawal in maternal mental health, child development and parenting practices of mothers and families. PARTICIPANTS: A sample of mothers who gave birth in July and August 2020 (n=351) was enrolled in the study in January 2021. Interviews were conducted by telephone. Data were collected through standardised questionnaires that, in addition to sociodemographic and economic data, collected information on breast feeding, mental health status and COVID-19. FINDINGS TO DATE: Results from the first wave show that the majority of participants have 9-11 years of schooling (54.4%; 95% CI 61.0 to 70.9) and are of mixed race (71.5%; 95% CI 66.5 to 76.0). At the time of the survey, 27.9% of the participants were out of the labor force (95% CI 23.5 to 32.9) and 78.6% reported a decrease in family income after restrictions imposed due to the pandemic (95% CI 74.0 to 82.6). The prevalence of maternal common mental disorder symptoms was 32.5% (95% CI 27.8 to 37.6). FUTURE PLANS: Follow-up visits are planned to occur every 6 months for the next five years (2021-2025). Additional topics will be included in future waves (eg, food insecurity and parenting practices). Communication strategies for bonding, such as picture cards, pictures of mothers with their children and phone calls to the participants, will be used to minimise attrition. Results of this prospective cohort will generate novel knowledge on the impact of the COVID-19 pandemic on maternal and child health and parenting practices in a population of women and children living in fifth largest city of Brazil.

Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil.

BACKGROUND: Physical distancing associated with the COVID-19 pandemic may lead to suboptimal maternal mental health, social support after birth, and infant feeding practices. RESEARCH AIMS: To compare breastfeeding prevalence in participants who were pregnant at a time when strict physical distancing measures were imposed in Fortaleza, the capital of Ceará state, Brazil, with the pre-pandemic breastfeeding levels, and to assess the association of breastfeeding prevalence with maternal common mental disorders, and sociodemographic and health predictors. METHOD: A cross-sectional prospective two-group comparison design using two population-based surveys was carried out in Fortaleza before and after the pandemic. Participants (n = 351) who had a live birth in Fortaleza in July or August 2020, and participants (n = 222) who had a child younger than 12 months in 2017 were surveyed. Crude and adjusted multinomial logistic regressions with robust variance were used to estimate risk ratios and 95% confidence intervals (CI). RESULTS: Similar prevalence of exclusive breastfeeding were observed in 2021 (8.1%) and 2017 (8.5%; p = .790). An increase in predominant (2.2% vs. 13.4%; p < .001) and a decrease in complementary breastfeeding (64.0% vs. 48.4%; p = .037) was observed in 2021, compared to 2017. The prevalence of maternal common mental disorders also increased in 2021 (17.6% vs. 32.5%, p < .001). No statistically significant associations were found between breastfeeding patterns, maternal common mental disorders, and other predictors in 2017 or 2021. CONCLUSIONS: Participants who delivered during the COVID-19 pandemic delayed solid foods introduction and breastfed predominantly longer than participants during the pre-pandemic period. While common mental disorders significantly increased, they were not associated with differences in breastfeeding.

COVID-19 and mental health of pregnant women in Ceará, Brazil.

OBJECTIVE: To assess the perceptions of pregnant women about COVID-19 and the prevalence of common mental disorders during the implemented social distancing period. METHODS: This was an observational, cross-sectional study using digital media, of pregnant women exposed to social distancing due to the COVID-19 pandemic, in Fortaleza, Ceará, Northeastern Brazil. Common mental disorders were estimated using the modified Self-Report Questionnaire-20 (SRQ-20) scale, and the feelings towards COVID-19 were assessed using the Fear of COVID-19 scale through telephone calls made in May 2020. COX multivariate regression models were used to verify the associations. RESULTS: Of the 1,041 pregnant women, 45.7% (95%CI: 42.7-48.8) had common mental disorders (CMD). All items of the Fear of COVID-19 Scale showed a significant association with the prevalence of CMD (p < 0.001). A CMD risk gradient was observed, going from a prevalence ratio of 1.52 (95%CI: 1.13-2.04) in pregnant women with two positive items to 2.70 (95%CI: 2.08-3.51) for those with four positive items. Early gestational age and the lack of prenatal care were also associated with CMD. CONCLUSIONS: The prevalence of common mental disorders in pregnant women was high during the period of social distancing and was aggravated by negative feelings towards COVID-19.

Caderneta da Criança: análise situacional de sua utilização por profissionais no nordeste brasileiro / Child's Handbook: situational analysis of its use by professionals in Northeastern Brazil

Objetivo: analisar as habilidades e as práticas de profissionais de saúde da Estratégia Saúde da Família e demais áreas, educação e serviço social em municípios do nordeste brasileiro (Rio Grande do Norte, Maranhão e Piauí), precedente à formação acerca da utilização da Caderneta da Criança. Métodos: Estudo transversal que faz parte de um projeto de Formação de profissionais para o uso da Caderneta da Criança. A população do estudo foi constituída de 140 profissionais que atuam na atenção à criança, em saúde, educação e assistência social. O instrumento de coleta de dados foi formulário Google Forms, com questionário estruturado com 55 questões. A pesquisa tem Parecer Nº3554302. Resultados: observa-se que 15,71% avaliam como ruim a capacidade de conhecê-la de forma minuciosa, e apenas 45% e 3,57% como bom e excelente. Quarenta e seis por cento (46,43%) dos profissionais consideram que utilizam muito a caderneta em sua rotina, porém 24,29% dizem que não a utilizam. Apenas 0,71% sempre preenche a CC com dados relativos à aferição da pressão arterial das crianças e 6,45% sempre registram na CC as intercorrências relativas às doenças, os relatórios de internações, acidentes, as alergias e outros agravos da criança. Conclusões: o estudo aponta ser necessário que haja uma formação de profissionais das unidades de saúde, utilizando metodologias mais criativas, de forma alusiva acerca da necessidade de compreensão da CC como um documento de cidadania, com registros de todas as etapas de crescimento e desenvolvimento da criança, além do acompanhamento da vigilância das vacinas administradas.

Objective: to analyze the skills and practices of health professionals of the Family Health Strategy and other areas, education, and social service in municipalities of northeastern Brazil (Rio Grande do Norte, Maranhão, and Piauí), preceding the training on the use of the Child's Handbook. Methods: cross-sectional study that is part of a project for training professionals to use the Child's Handbook. The study population consisted of 140 professionals working in child care, health, education, and social. The data collection instrument was Google Forms form, with a structured questionnaire with 55 questions. Results: it is observed that 15.71% evaluate as bad the ability to know it thoroughly, and only 45% and 3.57% as good and excellent. Forty-six percent (46.43%) of professionals consider that they use the handbook a lot in their routine, but 24.29% say they do not use it. Only 0.71% always fill out the handbook with data related to the measurement of children's blood pressure and 6.45% always record in the handbook the complications related to diseases, reports of hospitalizations, accidents, allergies, and other injuries of the child. Conclusions: the study points to the need for training of professionals in health units, using more creative methodologies, alluding to the need to understand the child handbook as a citizenship document, with records of all stages of growth and development of the child, in addition to monitoring the surveillance of administered vaccines.

Implicações da covid-19 no cotidiano das famílias nordestinas e no cuidado infantil / Implications of covid-19 in the daily lives of northeastern families and childcare

Resumo Este estudo explora o cotidiano das famílias com filhos de 0 a 6 anos, residentes em Fortaleza, no Ceará, durante o período de distanciamento físico, estipulado pelo Governo do Estado do Ceará. Esta pesquisa qualitativa se utilizou do referencial da teoria de formação de vínculos na adversidade. Foram entrevistadas 30 mães, entre os meses de julho e agosto de 2020, utilizando videochamadas ou telefonemas. Para análise do material empírico, recorreu-se à análise de conteúdo de Bardin, possibilitando a criação de duas categorias temáticas: (1) o exercício do cuidado parental em tempos de covid-19; (2) o cotidiano das crianças diante da pandemia. A interpretação das narrativas revelou que alguns cuidadores buscaram realizar brincadeiras e atividades manuais com os filhos, e explicavam o que estava acontecendo no cenário mundial, exercendo a parentalidade positiva. Ademais, o distanciamento físico favoreceu o aumento da tolerância dos pais no tempo em que os filhos ficaram expostos às telas. Percebeu-se que os pais influenciaram a prática de hábitos alimentares não saudáveis entre as crianças e a manifestação de mudanças no comportamento dos filhos. Como conclusão, destaca-se a necessidade de um acompanhamento contínuo dos aspectos referentes ao desenvolvimento dessas crianças e do retorno delas às atividades presenciais.

Abstract This study sought to explore the daily life of families with children aged 0 - 6 years old, living in Fortaleza, Ceará - Brazil, during the period of social distancing stipulated by the State Government. This qualitative research was conducted with data collected by means of video or phone interviews with thirty mothers, between July and August 2020. The empirical material was analyzed in the light of Bardin's content analysis, generating two thematic categories: (1) the exercise of parental care in Covid-19 times; and (2) the daily life of children in the face of the pandemic. The narratives revealed that some caregivers tried to play games and practice arts and crafts with their children, besides explaining what was happening in the world scenario - thus exercising positive parenting. Moreover, the social distancing measures promoted parental tolerance during the time children were exposed to screens, and parents showed to influence the practice of unhealthy eating habits and the manifestation of behavior changes in their children. These findings highlight the need for a continuous monitoring of aspects related to these children's development, as well as for their return to face-to-face activities.

COVID-19 and mental health of pregnant women in Ceará, Brazil

ABSTRACT OBJECTIVE To assess the perceptions of pregnant women about COVID-19 and the prevalence of common mental disorders during the implemented social distancing period. METHODS This was an observational, cross-sectional study using digital media, of pregnant women exposed to social distancing due to the COVID-19 pandemic, in Fortaleza, Ceará, Northeastern Brazil. Common mental disorders were estimated using the modified Self-Report Questionnaire-20 (SRQ-20) scale, and the feelings towards COVID-19 were assessed using the Fear of COVID-19 scale through telephone calls made in May 2020. COX multivariate regression models were used to verify the associations. RESULTS Of the 1,041 pregnant women, 45.7% (95%CI: 42.7-48.8) had common mental disorders (CMD). All items of the Fear of COVID-19 Scale showed a significant association with the prevalence of CMD (p < 0.001). A CMD risk gradient was observed, going from a prevalence ratio of 1.52 (95%CI: 1.13-2.04) in pregnant women with two positive items to 2.70 (95%CI: 2.08-3.51) for those with four positive items. Early gestational age and the lack of prenatal care were also associated with CMD. CONCLUSIONS The prevalence of common mental disorders in pregnant women was high during the period of social distancing and was aggravated by negative feelings towards COVID-19.