Coronavirus disease 2019, food security and maternal mental health in Ceará, Brazil: a repeated cross-sectional survey.

OBJECTIVE: To quantify the change in the risk of food insecurity and maternal mental disorder (MMD) before and during the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: Repeated cross-sectional survey. Between 17 July and 10 September 2020, mother-child pairs who were enrolled in a population-based survey in 2017 were re-contacted by telephone for consent and to complete a telephonic COVID-19 survey. We used the Brazilian Food Insecurity Scale to assess food security and the Self Reporting Questionnaire-20 to assess MMD. McNemar's test for paired data that also accounted for clustering was used. Logistic regression was used to assess the relationship of unemployment and receipt of government assistance with food insecurity and MMD in 2020. SETTING: Ceará, Brazil. PARTICIPANTS: Five hundred and seventy-seven mother-child pairs completed the 2017 and 2020 surveys. At the time of the 2020 interview, the child cohort was 36-108 months of age. RESULTS: The proportion of mothers reporting food insecurity was 15·5 % higher (95 % CI 5·9, 25·1, P value < 0·001) during the pandemic in July-August 2020 as compared with November 2017, while the prevalence of MMD was 40·2 % higher during the pandemic (95 % CI 32·6, 47·8, P value < 0·001). Loss of formal employment was associated with increased risk of food insecurity, but not with the risk of MMD. CONCLUSIONS: The risk of food insecurity and MMD in Ceará increased during the COVID-19 pandemic. These findings highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on maternal and child health, nutrition and well-being in Brazil.

Impact of IMCI health worker training on routinely collected child health indicators in Northeast Brazil.

The Integrated Management of Childhood Illness (IMCI) is a global strategy including improvements in case management at health facilities, strengthening health systems support and improving key family and community practices relevant to child health. In Brazil, IMCI was introduced in 1997, being largely restricted to training health workers in case management. IMCI training of doctors and nurses took place in many municipalities, but implementation of the other two components of IMCI was very limited. We analyze the impact of IMCI health worker training on infant mortality in three states in north-eastern Brazil, by comparing three groups of municipalities over the period 1999 to 2002: 23 with training coverage of 50% or greater, 216 with lower training coverage, and 204 without any IMCI training. Two sources of mortality data are used: vital registration of deaths and births, and the community health workers' (CHW) demographic surveillance system. The latter resulted in a larger number of deaths being reported and in more stable mortality rates over time than the former. Infant mortality rates (IMR) declined rapidly according to both sources of information, during the study period. After adjustment for confounding factors, there was no association between IMCI training coverage and infant mortality measured through either information system. According to the CHW data, the adjusted annual changes were of -7.2 deaths per 1,000 births in the high IMCI training coverage group, -4.6 in the low IMCI training coverage and -5.0 in the no IMCI group (p=0.46). According to vital statistics, the corresponding average annual changes were -5.0, -4.2 and -2.8 deaths per 1,000 births (p=0.16). The negative findings from the Brazil evaluation suggest that IMCI clinical training, in the absence of the other two components of IMCI, and in an area with infant mortality under 50 per 1,000, is unlikely to lead to a measurable impact on mortality.