Engaging local health research communities to enhance long-term capacity building in Brazil.

The '2019 Research Capacity Network (REDe) workshop series' was an initiative led by Brazil-based REDe coordinators and The Global Health Network (TGHN) in partnership with Brazilian researchers interested in arboviruses. This workshop initiative has provided crucial training to the local research community offering transferable skills to effectively respond to health emergencies, with an impact beyond arboviral diseases, as evidenced by further activities undertaken during the COVID-19 pandemic. The success of this approach resulted from several factors, especially the workshops' local leadership and the combination of in-person training with online sharing of the resources generated in the local language. Analytics data from REDe online platform evidenced the wider reach of the shared resources to a larger audience than the workshop attendees. Importantly, the impact of this approach extends beyond the workshop series per se, with workshop participants afforded access to wider training, career development and collaborative opportunities through REDe and TGHN platforms. In addition, this initiative design resulted in the development of new collaborations between the workshop leaders and other local researchers, who have been jointly writing research projects and applying for grants. As a result, REDe has become a highly dynamic community of practice for health researchers in the region, strengthening the research culture and improving connectivity. Here, we describe the design and implementation of this initiative and demonstrate the value of integrating local expertise, and a practical workshop series format with digital dissemination of research resources and training materials to generate a vibrant and robust community of practice.

Coronavirus disease-19 deaths among children and adolescents in an area of Northeast, Brazil: why so many?

OBJECTIVE: To describe COVID-19 deaths among children and adolescents in Sergipe, Brazil. METHODS: Ecological study of all COVID-19 reported cases and deaths occurring in children and adolescents < 19 years of age in Sergipe reported by the health surveillance and mortality information systems of Sergipe's Health Secretary and hospital records. RESULTS: Of 37 deaths of children < 19 years old were reported up to 30 September 2020, corresponding to 4.87 deaths for 100 000 population < 19 years old. Most deaths occurred among infants (44.1/100 000), and this age group had the highest case fatality rate (15.3 %). Most children had comorbidities such as chronic neurological diseases (n = 7; 19%) and prematurity (n = 4; 11%). Most children who died (n = 18; 49%) were not admitted to intensive care units (ICUs). CONCLUSION: COVID-19 mortality in children and adolescents in Sergipe was higher than in other Brazilian states and in high-income countries. A large proportion of the deaths occurred among children with comorbidities and a minority of children were admitted to ICU, reflecting the limited provision of such beds in the State. Newborns and infants are a high-risk group that must have priority in health public policy.

OBJECTIF: Décrire les décès par COVID-19 chez les enfants et adolescents à Sergipe, au Brésil. MÉTHODES: Etude écologique de tous les cas et décès par COVID-19 signalés chez des enfants et des adolescents <19 ans à Sergipe rapportés par les systèmes de surveillance de la santé et d'information sur la mortalité du Secrétariat de la Santé et les dossiers hospitaliers de Sergipe. RÉSULTATS: 37 décès d'enfants <19 ans ont été signalés au 30 septembre 2020, correspondant à 4,87 décès pour 100.000 habitants de <19 ans. La plupart des décès sont survenus chez des nourrissons (44,1/100.000) et ce groupe d'âge avait le taux de létalité le plus élevé (15,3%). La plupart des enfants présentaient des comorbidités telles que des maladies neurologiques chroniques (n = 7; 19%) et une prématurité (n = 4; 11%). La plupart des enfants décédés (n = 18; 49%) n'avaient pas été admis dans des unités de soins intensifs. CONCLUSION: La mortalité par COVID-19 chez les enfants et les adolescents de Sergipe était plus élevée que dans les autres Etats brésiliens et dans les pays à revenu élevé. Une grande partie des décès est survenue chez des enfants souffrant de comorbidités et une minorité d'enfants avaient été admis aux soins intensifs, ce qui reflète la disponibilité limitée de ce type de lits dans l'Etat. Les nouveau-nés et les nourrissons constituent un groupe à haut risque qui doit avoir la priorité dans les politiques de santé publiques.

Micronutrient deficiencies in normal and overweight infants in a low socio-economic population in north-east Brazil.

BACKGROUND: Micronutrient deficiencies are the most prevalent form of malnutrition worldwide. Although commonly related to underweight, micronutrient deficiencies can occur in both normal and overweight children in medium- and low-income populations undergoing nutritional transition. OBJECTIVE: To describe haemoglobin and micronutrient levels in infants from a low-income area in Brazil in relation to their weight-for-length Z-score. METHODS: A cross-sectional survey was undertaken of 2-11-month-old infants in Laranjeiras, a small urban community in North-east-Brazil between April 2009 and February 2010. Anthropometry and assays for haemoglobin, ferritin, plasma zinc, copper and selenium and erythrocyte zinc and copper concentrations were investigated. RESULTS: The total number of full-term infants born in the study period was 222, of whom 153 were available for the study. Three (2%) children were wasted, 98 (66%) were of normal weight, 37 (25%) were at risk of overweight and 11 (7%) were overweight or obese. Nearly all (97%) children had at least one micronutrient deficiency, 102 (67%) had anaemia, 86 (58%) and 100 (67%) had plasma and erythrocyte zinc deficiency, respectively, and 7 (5%) and 113 (76%) had plasma and erythrocyte copper deficiency, respectively. 138 (91%) children had selenium deficiency. Except for plasma zinc, the proportion of infants with micronutrient deficiencies did not differ by weight-for-length status. CONCLUSIONS: The increased risk of overweight and micronutrient deficiencies in this population highlights the need to address the double burden of excess weight with micronutrient deficiencies in medium- and low-income settings.

Neonatal care in Brazil: hospital structure and adequacy according to newborn obstetric risk.

BACKGROUND: In Brazil, hospital birth care is available to all, but there are important differences between hospitals in the public and private sectors, geographical regions and capitals/inland cities, resulting in inequalities of infant health. AIMS: To assess the hospital structure for birth care in Brazil and analyze hospital adequacy to care for newborns according to levels of risk. METHODS: Data were collected as part of a nationwide hospital-based cohort study, 'Birth in Brazil'. The hospitals were classified according to whether they had a neonatal intensive care unit and divided into two models of governance: public and private financing. Three structure domains were assessed: human resources, medications and equipment for post-natal women and newborn emergency care. Newborns were classified according to the obstetric risk. RESULTS: There are more NICUs in private hospitals and they cater mostly for low obstetric risk newborns; the public sector serves 50% of at-risk patients in hospitals without an NICU. The differences between hospital service structures according to geographic region and capital/inland cities were evident. Hospitals in less developed regions and inland cities had poorer adequacy in the three domains. CONCLUSION: The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector.

Vocal function and vocal discomfort in sheltered and non-sheltered 7- to 10-year-old school children in Aracaju, Brazil.

OBJECTIVE: To compare vocal function, school performance, and vocal discomfort between sheltered and nonsheltered school children in Aracaju, Brazil. METHODS: A controlled cross-sectional study was carried out on 7- to 10-year-old children who attended school regularly. Two groups of children were studied: the study group (SG), with children who lived in a shelter, and the control group (CG) containing children who lived with their families. We interviewed 44 children for the SG and 15 (34%) revealed vocal discomfort (SG = 15). Concomitantly, we interviewed 400 regular school children from the same geographical area and 45 (11.25%) were selected for the control group (CG). They were paired by sex and age with the sheltered children using a 3:1 ratio. Both groups were interviewed about school performance and vocal discomfort and were evaluated using perceptual and acoustic measurements for the voice and larynx. RESULTS: Children from both groups had started public school late. There were more individuals with vocal discomfort in the SG and individuals in this group also had a slower speech rate and inadequate pneumophonic coordination compared with the CG. The Dysphonia Severity Index (DSI) revealed mild-moderate deviation for both groups. Upper harmonics and palatal tonsil hypertrophy were higher in the CG, whereas laryngeal constriction was more common in the SG. CONCLUSION: All the SG children revealed mild-moderate deviance on the DSI, a higher level of vocal discomfort, a slow speech rate, inadequate pneumophonic coordination, and laryngeal constriction. The results here presented suggest that social conditions are important for voice behavior in children.

Voice performance evaluation of street children from Aracaju, Brazil using perceptual-auditory and acoustic analyses.

OBJECTIVE: To compare the voice performance of children involved in street labor with regular children using perceptual-auditory and acoustic analyses. METHODS: A controlled cross-sectional study was carried out on 7- to 10-year-old children of both genders. Children from both groups lived with their families and attended school regularly; however, child labor was evident in one group and not the other. A total of 200 potentially eligible street children, assisted by the Child Labor Elimination Programme (PETI), and 400 regular children were interviewed. Those with any vocal discomfort (106, 53% and 90, 22.5%) had their voices assessed for resonance, pitch, loudness, speech rate, maximum phonation time, and other acoustic measurements. RESULTS: A total of 106 street children (study group [SG]) and 90 regular children (control group [CG]) were evaluated. The SG group demonstrated higher oral and nasal resonance, reduced loudness, a lower pitch, and a slower speech rate than the CG. The maximum phonation time, fundamental frequency, and upper harmonics were higher in the SG than the CG. Jitter and shimmer were higher in the CG than the SG. CONCLUSION: Using perceptual-auditory and acoustic analyses, we determined that there were differences in voice performance between the two groups, with street children having better quality perceptual and acoustic vocal parameters than regular children. We believe that this is due to the procedures and activities performed by the Child Labor Elimination Program (PETI), which helps children to cope with their living conditions.