Intimate Partner Violence among women living in families with children under the poverty line and its association with common mental disorders during COVID-19 pandemics in Ceará, Brazil.

BACKGROUND: Intimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women's economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD). METHODS: The study population comprised families with children up to six years of age who participated in the cash transfer program "Mais Infância". The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used. RESULTS: Of the 479 participant women, 22% were positively screened for IPV (95% CI 18.2-26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30-4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09-4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD. CONCLUSION: We conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

Association of Sociodemographic Factors and Maternal Educational Attainment with Child Development among Families Living below the Poverty Line in the State of Ceará, Northeastern Brazil.

Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6-3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

Severe food insecurity and mental health among women living in extreme poverty in Ceara, Brazil

Introdução: a insegurança alimentar tem efeitos importantes e agravantes na saúde humana, especialmente na saúde mental das mães e crianças.Objetivo: avaliar as inter-relações do Transtorno mental comum (TMC) e Insegurança Alimentar, em famílias assistidas por programa adicional de transferência de renda no Ceará.Método: estudo transversal foi realizado no Ceará, caracterizado como um dos estados mais pobres do país, em uma amostra de 484 famílias, com crianças menores de seis anos, beneficiárias do Cartão Mais Infância Ceará (CMIC), em 24 municípios. Foram analisados o perfil social e econômico das famílias, moradia, dados sobre a saúde e educação, violência, saúde mental, insegurança alimentar, trabalho e renda. Utilizou-se modelos de Regressão de Poisson, ajustados para o efeito amostral.Resultados: das 484 famílias, 86% encontravam-se em situação de IA;36% apresentavam IA Grave. A presença do TMC materno aumentou em 73% o risco de IA Grave na família (p<0,001). A análise de regressão, mostrou que o TMC se manteve como o fator de risco associado à IA Grave, com mães com TMC mostrando um risco ajustado 64% mais elevado, em comparação às outras mães (p=0,002). Não dispor de água tratada no domicílio, apresentou uma medida ajustada de 55% maior risco de IA Grave (p=0,011).Conclusão: as mães assistidas possuem elevada prevalência de TMC e com perfil de alta vulnerabilidade, sendo necessário suporte social e nutricional, acompanhamento da saúde mental dessas mulheres, para melhor cuidar dos filhos.Palavras-chave: segurança alimentar, criança, saúde mental, nutrição, avaliação de programas.

Backgroung: the prevalence of moderate or severe food insecurity (FI) in the world will reach 2.4 billion people in 2020. Common Mental Disorders (CMDs) affect one in five people, reaching all social classes.Objective: to examine the associations between CMDs and FI in the most vulnerable population, mothers of young children.Methods: population-based cross-sectional observational study, interviewing 484 families with children under six years of age, beneficiaries of the cash transfer program Cartão Mais Infância Ceará (CMIC), in 24 municipalities of Ceara. Poisson regression models were used, adjusted for the sampling effect.Results: 86% of the families were in a situation of FI, with 36% expressing a severe FI, a condition compatible with hunger. In relation to CMDs, it was observed that the prevalence of severe FI increased significantly, affecting 53% of mothers with CMDs against 31% of those without the disorder (p<0.001). Regression analysis showed that CMDs remained the risk factor most associated with severe FI, with mothers with CMDs having a 64% higher adjusted risk compared to other mothers (p=0.002). In the final model, the condition of not having treated water at home was associated with a 55% higher adjusted risk of severe FI (p=0.011), and two factors were close to statistical significance, namely: not feeling safe at home (possibility of domestic violence) and growing edible plants at home, with adjusted measures of 48% risk and 13% protection, respectively.Conclusion: 13% of this population live with very high rates of severe FI, compatible with hunger, concomitant with CMDs. As aggravating factors of severe FI and CMDs, public social support programs are necessary to have a real positive impact on the quality of life of this population.

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.