Low Physical Performance Could Be Associated with Adverse Health Outcomes over Time: Results from a Cohort of Older Adults.

A few studies on physical performance (PP) decline among community-dwelling older adults have simultaneously evaluated various outcomes in Brazil. This longitudinal cohort study aimed to verify the association between PP and health outcomes (negative health self-perception-NHSP; consultations with health professionals; disability; falls; and hospitalization) in older Brazilians (N = 476, 68 ± 6.7 years). PP assessments included Gait Speed (GS) and Timed Up and Go (TUG) tests, and changes were evaluated over time (2014 to 2019-2020). The association between the PP and the outcomes was estimated using Poisson's regression with robust variance. The physical tests were not associated with NSPH or with the number of consultations with health professionals. However, after adjustment (economic level, diet quality, physical activity, multimorbidity, depression, polypharmacy, and BMI), low PP at baseline (TUG and GS) was associated with disability at follow-up. A low TUG performance at baseline was also associated with subsequent falls (PR = 1.57, p = 0.007). A decline in GS was associated with hospitalization (PR = 1.86, p = 0.033). PP was associated with disability, falls, and hospitalization over a five- to six-year period in older Brazilians. Regular PP assessments should be conducted and low PP should be used as an indicator of the need for preventative measures to avoid poor health outcomes.

Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis.

Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort.

OBJECTIVE: To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS: The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS: The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION: In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Contraindicated use of modern contraceptives among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To describe the prevalence of contraindicated use of combined hormonal contraceptives, progesterone-only contraceptives, and intrauterine devices in mothers participating in the 2015 Pelotas Birth Cohort according to the WHO medical eligibility criteria. METHODS The biological mothers of children belonging to the 2015 Pelotas birth cohort who attended the 48-month follow-up were studied. The 48-month follow-up data were collected from January 1, 2019, to December 31, 2019. Contraindicated use of modern contraceptives was considered to occur when these women presented at least one of the contraindications for the use of modern contraceptives and were using these methods. The prevalence of contraindicated use was calculated according to each independent variable and their respective 95% confidence intervals (95%CI). RESULTS The analyzed sample consisted of 3,053 women who used any modern contraceptive method. The prevalence of contraindicated use of modern contraceptives totaled 25.9% (95%CI: 24.4-27.5). Combined hormonal contraceptives showed the highest prevalence of contraindicated use (52.1%; 95%CI: 49.3-54.8). The prevalence of contraindicated use of modern contraceptives methods was greater in women with family income between one and three minimum wages, a 25-30 kg/m2 body mass index, indication by a gynecologist for the used method, and purchasing the contraceptive method at a pharmacy. The higher the women's education, the lower the prevalence of inappropriate use of modern contraceptives. CONCLUSION In total, one in four women used modern contraceptives despite showing at least one contraindication. Policies regarding women's reproductive health should be strengthened.

Coverage and determinants of childhood vaccination during the COVID-19 pandemic in Fortaleza, Northeastern Brazil: a longitudinal analysis / Cobertura e determinantes da vacinação infantil durante a pandemia de COVID-19 em Fortaleza, Nordeste do Brasil: uma análise longitudinal / Cobertura y determinantes de la vacunación infantil durante la pandemia de COVID-19 en Fortaleza, Nordeste de Brasil: un análisis longitudinal

Abstract: Brazil has seen a decrease in vaccination coverage since 2016. This study analyzes the immunization status of children born during the COVID-19 pandemic in Fortaleza, Northeastern Brazil. This is a longitudinal analysis that included vaccination data of 313 children aged 12 and 18 months. Vaccination cards were checked for dose application considering the schedule of immunization recommended by the Brazilian Ministry of Health. Factors associated with no retention of vaccination cards and incomplete immunization by 18 months were identified by Tobit regression analysis. About 73% of mothers presented their child's vaccination card. Non-availability of vaccination cards was associated with maternal age < 25 years and mothers with paid jobs. Only 33% and 45% of the children aged 12 and 18 months had all vaccines up to date, respectively. For 3-dose vaccines, the delay rate was around 10% for the first dose application, but 40% for the third dose. Despite delays, most children with available vaccine cards had coverage above 90% by 18 months of age. Adjusted factors associated with incomplete vaccination included living in a household with more than one child (p = 0.010) and monthly income of less than one minimum wage (p = 0.006). Therefore, delays in child vaccine application were high during the COVID-19 pandemic but a considerable uptake by 18 months of age was found. Poorer families with more than one child were particularly at risk of not fully immunizing their children and should be the target of public policies.

Resumo: O Brasil registra uma diminuição na cobertura vacinal desde 2016. Este estudo analisa a situação vacinal de crianças nascidas durante a pandemia de COVID-19 em Fortaleza, Nordeste do Brasil. Uma análise longitudinal incluiu 313 crianças com informações aos 12 e 18 meses de idade. A aplicação das doses foram conferidas com base nos cartões de vacinação, considerando o calendário de imunização recomendado pelo Ministério da Saúde. Fatores associados à não retenção do cartão de vacinação e imunização incompleta aos 18 meses foram identificados por meio da regressão de Tobit. Cerca de 73% das mães apresentaram o cartão de vacinação do filho. A não apresentação do cartão de vacinação associou-se à idade materna < 25 anos e à participação materna em emprego remunerado. Apenas 33% e 45% das crianças tinham todas as vacinas em dia aos 12 meses e 18 meses, respectivamente. Para as vacinas com 3 doses, a taxa de atraso foi de cerca de 10% para a aplicação da 1ª dose, mas de 40% para a 3ª dose. Apesar dos atrasos, a maioria das crianças com cartão de vacinação disponível tinha cobertura acima de 90% até os 18 meses de idade. Os fatores ajustados associados à vacinação incompleta foram residir em domicílio com mais de um filho (p = 0,010) e renda mensal inferior a 1 salário mínimo (p = 0,006). Em conclusão, os atrasos na aplicação da vacina infantil foram altos durante a pandemia de COVID-19, mas houve uma adesão considerável até os 18 meses de idade. As famílias mais pobres, com mais de um filho, correm o risco de não imunizar totalmente seus filhos e devem ser alvo de políticas públicas.

Resumen: Brasil ha experimentado una disminución en la cobertura vacunal desde el 2016. Este estudio analiza la situación vacunal de los niños nacidos durante la pandemia de COVID-19 en Fortaleza, Nordeste de Brasil. Un análisis longitudinal incluyó a 313 niños con información a los 12 y 18 meses de edad. Se revisaron los carnés de vacunación para aplicar la dosis considerando el calendario de inmunización recomendado por el Ministerio de Salud. Los factores asociados con la no retención del carné de vacunación y la inmunización incompleta a los 18 meses se identificaron mediante la regresión de Tobit. Alrededor del 73% de las madres presentaron el carné de vacunación de sus hijos. La no disponibilidad del carné de vacunación se asoció con la edad materna < 25 años y la participación materna en actividad remunerada. Solo el 33% y el 45% de los niños estaban al día con todas sus vacunas a los 12 meses y 18 meses, respectivamente. Para las vacunas de 3 dosis, la tasa de retraso fue de alrededor del 10% para la 1ª dosis, pero del 40% para la 3ª dosis. A pesar de los retrasos, la mayoría de los niños con el carné de vacunación disponible tenía una cobertura superior al 90% hasta los 18 meses de edad. Los factores ajustados asociados con la vacunación incompleta fueron vivir en un hogar con más de un hijo (p = 0,010) e ingreso mensual inferior a 1 salario mínimo (p = 0,006). En definitiva, los retrasos en la administración de la vacuna infantil fueron altos durante la pandemia de COVID-19, pero hubo una adhesión considerable hasta los 18 meses de edad. Las familias más pobres, con más de un hijo, corren el riesgo de no inmunizar completamente a sus hijos y deberían ser objeto de políticas públicas.

Women's multi-partner behavior, multi-partner fertility, and pregnancy outcomes: findings from the 2004 Pelotas Birth Cohort.

STUDY QUESTION: Do women with multi-partner fertility or multi-partner behavior conceive more often than women with a single partner? SUMMARY ANSWER: Women with multi-partner behavior conceived more frequently and had more children than non-multi-partner women and multi-partner fertility women. WHAT IS KNOWN ALREADY: Some women experience having biological children with more than one partner: those women are considered as multi-partner fertility. Women with multi-partner fertility have more children and are substantially less likely to have planned their first birth. Individuals with multi-partner fertility become parents at a younger age, largely with unintended first births, and often do so outside of marriage, compared to parents with two or more children from only one partner. Unmarried women, particularly, are at greater risk of having unintended births. Studies are still scarce and there is a need to assess the contribution of women's multi-partners fertility and multi-partner behavior to family composition, particularly in low- and middle-income countries. STUDY DESIGN, SIZE, DURATION: This longitudinal birth cohort study evaluated 1215 mothers whose children belonging to the 2004 Pelotas Birth Cohort were their first pregnancy, and who attended the perinatal, 48-month, 6-year, and 11-year follow-ups. Information was obtained from responses to a questionnaire. The number of years at risk of having children was treated as the exposure, and woman's multi-partner behavior and multi-partner fertility, dichotomized as 'Yes' or 'No', were considered endogenous treatment variables. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data from mothers with a first pregnancy, and with information available from the perinatal, 48-month, 6-year, and 11-year follow-ups, were evaluated. The exposures studied were women's multi-partner behavior and multi-partner fertility (i.e. conceiving/giving birth), and the outcomes evaluated were the number of pregnancies, the number of children currently alive, and experience of unintended pregnancies from the birth of the child belonging to the 2004 birth cohort until 11 years later. Crude and adjusted risk ratios (RRs) were estimated through Poisson regression with endogenous treatment effects, robust standard errors, and their respective 95% CI. MAIN RESULTS AND THE ROLE OF CHANCE: Multi-partner behavior women had 16% (RR 1.16; 95% CI: 1.08-1.25) and 11% (RR 1.11; 95% CI 1.03-1.19) greater risk of having a new pregnancy and having more children alive, respectively, than those with non-multi-partner behavior. Women with multi-partner fertility had a 23% (RR 1.23; 95% CI: 1.11-1.37) and 20% (RR 1.20; 95% CI: 1.08-1.33) higher risk of having a new pregnancy and having more children alive, respectively, than single-partner fertility mothers. Women who had multiple partners (i.e. behavior), as well as those with multi-partner fertility, showed a lesser proportion of unintended pregnancies when compared to the non-multi-partner ones (34.08%; 95% CI: 28.12-40.60 vs 36.17%; 95% CI: 31.93-40.63), compared to their counterparts' single partners fertility (33.16%; 95% CI: 26.83-40.17 vs 36.26%; 95% CI: 31.85-40.92), although these findings were not statistically significant. LIMITATIONS, REASONS FOR CAUTION: The mothers who were not included in the study owing to missing data for some of the follow-up had 5-11 years of education, a low socio-economic level, and were younger, thus the number of pregnancies may be underestimated because these groups presented a high number of pregnancies and children alive. We did not have information about the complete woman's conjugal history. Therefore, misclassification error of the exposure may be present and, consequently, the measures of association may be underestimated. Furthermore, this study was not truly representative of the Pelotas study female population. WIDER IMPLICATIONS OF THE FINDINGS: In this study of multi-partner behavior and fertility, women who have multiple partners may be less likely to get married and have a stable partner. Compared to single-partner women, multi-partner fertility and multi-partner behavior women may predominantly become pregnant for the purpose of having children, rather than accidentally. STUDY FUNDING/COMPETING INTEREST(S): This article is based on data from the study 'Pelotas Birth Cohort, 2004' conducted by the Postgraduate Program in Epidemiology at the Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). From 2009 to 2013, the Wellcome Trust supported the 2004 birth cohort study. The World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children's Pastorate supported previous phases of the study, and also was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)-Finance Code 001. The authors declare that the supported agencies have no role in any step of performing this study. No conflicts of interest exist. TRIAL REGISTRATION NUMBER: N/A.

Ultra-processed food consumption and nutritional status in Uruguayan and Brazilian children between three to five years / Consumo de alimentos ultraprocesados y estado nutricional en niños de tres a cinco años uruguayos y brasileños

Introduction. There is growing consensus globally that the consumption of ultra- processed food (UPF) can negatively affect the nutritional status of children. Objective. The present study aims to evaluate associations between the consumption of UPF and the nutritional status in a sample of Uruguayan and Brazilian preschoolers belonging to two studies: the ENDIS Study and the Pelotas 2015 Birth Cohort. Materials and methods. We conducted a cross-sectional analysis. The main outcome measure was obesity defined as BMI for age and sex ≥ +3 z-scores. The score of UPF consumption was the main exposure measured. Each positive answer of habitual intake was added up to create a UPF score ranging from zero to six or more UPF. Crude and adjusted logistic regressions were performed for the associations between UPF consumption and nutritional status in preschoolers. Results. The final sample consisted of 8,687 preschool children, 50.8% belonging to the Uruguayan study, while the remaining 49.2% belonged to the Brazilian study. Nearly 5% of the sample of young children were obese. We didn't observe a relationship between the score of UPF consumption and obesity, the odds ratio (OR) was 1.04 (95% CI, 1.00­1.09). Adjustments resulted in modest attenuation of the relationship and a lack of statistical significance. However, in children under 48 months, the score of UPF consumption was directly associated with childhood obesity. Conclusions. Results suggest that higher consumption of UPF is associated with obesity in Uruguayan and Brazilian preschool children under 4 years of age. These findings suggest that actions to reduce ultra- processed food consumption could lead to diminish obesity patterns and bring important public health benefits(AU)

Introducción. Existe creciente consenso a nivel mundial de que el consumo de alimentos ultraprocesados puede afectar negativamente el estado nutricional de los niños. Objetivo. El presente estudio tiene como objetivo evaluar asociaciones entre el consumo de ultraprocesados y el estado nutricional en una muestra de preescolares uruguayos y brasileños pertenecientes a dos estudios: el Estudio ENDIS y la Cohorte de Nacimiento de Pelotas 2015. Materiales y métodos. Se realizó un análisis transversal. La principal medida de resultado fue la obesidad definida como el IMC/edad y sexo ≥ +3 puntuaciones z. La puntuación del consumo de ultraprocesados fue la principal exposición. Cada respuesta positiva de la ingesta habitual se sumó para crear una puntuación de ultraprocesados que oscilaba entre cero y seis o más. Se realizaron regresiones logísticas crudas y ajustadas. Resultados. La muestra final estuvo constituida por 8.687 niños, de los cuales el 50,8% pertenecía al estudio uruguayo, mientras que el 49,2% restante pertenecía al estudio brasileño. Casi el 5% de la muestra de niños pequeños eran obesos. No observamos relación entre la puntuación del consumo de ultraprocesados y la obesidad, el odds ratio (OR) fue de 1,04 (IC 95%, 1,00-1,09). Los ajustes dieron lugar a modesta atenuación de la relación y falta de significación estadística. Sin embargo, en menores de 48 meses la puntuación de consumo de ultraprocesados se asoció directamente con la obesidad infantil. Conclusiones. Los resultados sugieren que un mayor consumo de ultraprocesados se asocia con obesidad en prescolares uruguayos y brasileños menores de 4 años. Estos hallazgos sugieren que las acciones para reducir el consumo de alimentos ultraprocesados podrían conducir a una disminución de los patrones de obesidad y traer importantes beneficios para la salud pública(AU)

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort.

OBJECTIVE: To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS: Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS: The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS: Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

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.

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.

Ultra-processed food consumption and the incidence of obesity in two cohorts of Latin-American young children: A longitudinal study.

PURPOSE: We evaluated the potential associations between the consumption of ultra-processed food (UPF) and the incidence of obesity among Uruguayan and Brazilian preschoolers. DESIGN AND METHODS: We conducted a longitudinal analysis using data from preschool children from Uruguay and Brazil. The "Health, child development and nutritional survey" (ENDIS) was conducted in Uruguay in 2013-2014 and 2015-2016. The Brazilian survey (Pelotas 2015 Birth Cohort) has measures from 2017 and 2019. The main outcome measure was obesity defined as body mass index (BMI) for age and sex ≥ +3 z-scores. The score of UPF consumption was the main exposure measured. Multilevel crude and adjusted Poisson regressions were performed to estimate risk ratios and the respective 95% Confidence Intervals (95% CI). RESULTS: The overall incidence of obesity in this group of young Latin-American children with a mean age of 48 months was 4.1%. We observed a relationship between UPF and obesity with statistical significance (RR: 1.10 (95% CI, 1.02-1.18). Adjustment for weight at birth, age, sex, breastfeeding, country, and time between waves resulted in a similar relationship but lack of statistical significance. CONCLUSIONS: Whilst in this study we did not find strong evidence of an association between the incidence of obesity and the intake at baseline and currently of UPF, results suggest that higher UPF consumption is more favorable than reduced consumption for the development of obesity. PRACTICE IMPLICATIONS: The present study reinforces the importance of nutrition education and more effective public policies for promoting healthier food choices in early childhood.

Demand and unmet need for modern contraception among mothers from a Pelotas Birth Cohort

ABSTRACT OBJECTIVE To determine the total demand and unmet need for contraception with modern methods and their determinants among mothers participating in the 2015 Pelotas Birth Cohort. METHODS Data from the 48-month follow-up of mothers participating in the 2015 Pelotas Birth Cohort were analyzed. Only biological mothers (aged up to 49 years) of children belonging to the 2015 Birth Cohort and who answered the 48-month questionnaire were included in the study sample. Logistic regression and respective 95% confidence intervals were used to determine associated factors. RESULTS The study sample consisted of 3577 biological mothers. The prevalence of use of any contraceptive and of modern contraceptives was 86.0% (95%CI: 84.8-87.1) and 84.9% (95%CI: 83.7-86.1), respectively. The prevalence of unmet need for modern contraceptives was 10.7% (95%CI: 9.7-11.7), and the total demand for contraceptives was 95.6%. The factors associated with an unmet need for modern contraception were being over 34 years of age (OR = 0.6, 95%CI: 0.5-0.8), not having a husband or partner (OR = 1.9, 95%CI: 1.4-2.6), not being the head of the household (OR = 0.6, 95%CI: 0.4-0.9), having had three or more pregnancies (OR = 1.9, 95%CI: 1.3-2.6), and having had an abortion at least once after the birth of the child participating in the cohort (OR = 1.9, 95%CI: 1.0-3.6). CONCLUSIONS Despite the high prevalence of modern contraceptive use, one in ten women had an unmet need for modern contraception and was at risk of unplanned pregnancy.

Primary Health Care during the COVID-19 pandemic in Fortaleza, Brazil: associated factors and pattern of use by mothers and children up to 18 months of age.

OBJECTIVE: To analyze the delay or failure to seek primary health care by the mother-child dyads during the COVID-19 pandemic, a practice that has a high potential to increase maternal and child morbidity and mortality. METHODS: Data from three survey rounds of the Iracema-COVID cohort study, collected 6, 12, and 18 months after birth, showed the patterns of postpartum attendance to primary health care consultation of the mother-child dyad. Crude and adjusted multinomial logistic regressions with robust variance were used to assess factors associated with nonattendance. RESULTS: Among the 314 cohort mothers, 25% did not attend any primary health care consultation during the 18-months postpartum, while 30% of the mothers did all three. Regarding the child, 75% had regular primary health care consultations in all three survey rounds, while 4% did not attend any in their first 18 months of life. By the end of the first COVID-19 wave, the proportion of mother and child who attended the consultations had fallen by 23 and 18%, respectively. The main factors associated with nonattendance were mothers aged below 25 years, and mothers with more than one child. CONCLUSION: An important delay or nonattendance to primary health care consultation by the mother-child dyad was observed during the COVID-19 pandemic. Such practice, with a high potential to increase maternal and child morbidity and mortality, was particularly frequent among younger mothers and those with more than one child.

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.

Medication use in children from the 2015 Pelotas (Brazil) birth cohort aged between three months and four years.

Medication use is an important part of the health process and prevalence of its use among infants can reach up to 65% in their first months of life. The excessive use of medication could lead to an increase in their potential harm, surpassing their benefits. Considering this, this study aimed to describe medication use in children aged 3, 12, 24, and 48 months. Standardized questionnaires were applied to assess patterns and covariables of medication use. Medication use was investigated as an outcome and defined as the receipt of any medication within 15 days before the interview. Prevalence of medication use and 95% confidence intervals (95%CI) were described using chi-squared tests. Prescription source and frequency of use were also reported, along with the most frequent medication in each follow-up. Medication use prevalence was 67.2% (95%CI: 65.8; 68.6), 68.2% (95%CI: 66.8; 69.6), 52.4% (95%CI: 50.9; 54.0), 47.2% (95%CI: 45.7; 48.8), at 3, 12, 24, and 48 months, respectively. We observed a decrease in the proportion of medically prescribed medications and an increase in self-medication over the years. Drugs for gastrointestinal disorders (A03), vitamins (A11), analgesics (N02), anti-inflammatories (M01), and nasal formulations (R01) were the most frequently used medications. We found that children under four years of age comprised over 50% of the total use of medications and self-medication. These results highlight the need to warn caregivers on the importance of proper professional examination and prescription before they administer medications to children.

Medication use in children from the 2015 Pelotas (Brazil) birth cohort aged between three months and four years / Uso de medicação em crianças da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 2015 com três meses a quatro anos de idade / Uso de medicación en niños, desde los tres meses hasta los cuatro años de edad, en una cohorte de nacimiento de 2015 en Pelotas, Rio Grande do Sul, Brasil

Medication use is an important part of the health process and prevalence of its use among infants can reach up to 65% in their first months of life. The excessive use of medication could lead to an increase in their potential harm, surpassing their benefits. Considering this, this study aimed to describe medication use in children aged 3, 12, 24, and 48 months. Standardized questionnaires were applied to assess patterns and covariables of medication use. Medication use was investigated as an outcome and defined as the receipt of any medication within 15 days before the interview. Prevalence of medication use and 95% confidence intervals (95%CI) were described using chi-squared tests. Prescription source and frequency of use were also reported, along with the most frequent medication in each follow-up. Medication use prevalence was 67.2% (95%CI: 65.8; 68.6), 68.2% (95%CI: 66.8; 69.6), 52.4% (95%CI: 50.9; 54.0), 47.2% (95%CI: 45.7; 48.8), at 3, 12, 24, and 48 months, respectively. We observed a decrease in the proportion of medically prescribed medications and an increase in self-medication over the years. Drugs for gastrointestinal disorders (A03), vitamins (A11), analgesics (N02), anti-inflammatories (M01), and nasal formulations (R01) were the most frequently used medications. We found that children under four years of age comprised over 50% of the total use of medications and self-medication. These results highlight the need to warn caregivers on the importance of proper professional examination and prescription before they administer medications to children.

O uso de medicação é parte importante do processo de saúde, e a prevalência de uso entre lactentes pode chegar a 65% nos primeiros meses de vida. O uso excessivo de medicação pode levar a um aumento dos danos potenciais em relação aos benefícios. Levando isso em conta, o estudo atual buscou descrever o uso de medicação em crianças aos 3, 12, 24 e 48 meses. Foram aplicados questionários padronizados para avaliar os padrões de uso de medicação e covariáveis. O uso de medicação foi investigado enquanto desfecho, e definido como história de ter recebido qualquer medicação nos 15 dias anteriores à entrevista. A prevalência do uso de medicação e os intervalos de 95% de confiança (IC95%) foram descritos através do teste de qui-quadrado. Também foram relatadas a fonte da prescrição e a frequência de uso, junto com a medicação mais frequente em cada consulta. A prevalência do uso de medicação foi de 67,2% (IC95%: 65,8; 68,6), 68,2% (IC95%: 66,8; 69,6), 52,4% (IC95%: 50,9; 54,0) e 47,2% (IC95%: 45,7; 48,8), aos 3, 12, 24 e 48 meses, respectivamente. Ao longo dos anos, foram observados uma diminuição na proporção de medicamentos com prescrição médica e um aumento na automedicação (indicação pelos pais ou responsáveis). Os medicamentos mais frequentes eram para transtornos gastrointestinais (A03), vitaminas (A11), analgésicos (N02), anti-inflamatórios (M01) e formulações nasais (R01). Encontramos mais de 50% de uso total e de automedicação (indicação pelos pais/responsáveis) em crianças abaixo de 4 anos de idade. Os resultados destacam a necessidade de alertar os cuidadores sobre a importância do exame profissional e prescrição adequados antes da administração de medicamentos a crianças.

El consumo de medicamentos es una parte importante del proceso de salud y la prevalencia de su uso entre bebés puede llegar a un 65% durante los primeros meses de vida. El excesivo consumo de medicamentos podría conducir a un incremento en sus perjuicios potenciales frente a sus beneficios. Teniendo esto en cuenta, el objetivo de este estudio fue describir el uso de la medicación en niños de 3, 12, 24, y 48 meses. Se aplicaron cuestionarios estandarizados para evaluar los patrones de uso de la medicación y sus covariables. Se investigó el uso de la medicación como un resultado y se definió como haber recibido alguna medicación en los últimos 15 días antes de la entrevista. Se describieron la prevalencia del IC95%uso de la medicación y los intervalos de 95% de confianza (IC95%), usando tests chi-cuadrado. También se informó de la fuente de prescripción y frecuencia del consumo, junto a la medicación más frecuente en cada seguimiento. La prevalencia en el uso de la medicación fue de un 67,2% (IC95%: 65,8; 68,6), 68,2% (IC95%: 66,8; 69,6), 52,4% (IC95%: 50,9; 54,0), 47,2% (IC95%: 45,7; 48,8), a los 3, 12, 24, y 48 meses, respectivamente. Se observó una disminución en la proporción de medicamentos recetados médicamente y un incremento en la automedicación a lo largo de los años. Los medicamentos más frecuentemente usados fueron los destinados para desórdenes gastrointestinales (A03), vitaminas (A11), analgésicos (N02), antiinflamatorios (M01), y preparados nasales (R01). Descubrimos que más de un 50% del total y automedicación en el consumo de medicinas en niños menores de 4 años. Estos resultados subrayan la necesidad de avisar a los cuidadores sobre la importancia de un examen profesional apropiado y la receta antes de la administración del medicamento a niños.

Primary Health Care during the COVID-19 pandemic in Fortaleza, Brazil: associated factors and pattern of use by mothers and children up to 18 months of age / Atenção Primária à Saúde durante a pandemia de COVID-19 em Fortaleza, Brasil: fatores associados e padrão de uso por mães e crianças de até 18 meses de idade

ABSTRACT Objective: To analyze the delay or failure to seek primary health care by the mother-child dyads during the COVID-19 pandemic, a practice that has a high potential to increase maternal and child morbidity and mortality. Methods: Data from three survey rounds of the Iracema-COVID cohort study, collected 6, 12, and 18 months after birth, showed the patterns of postpartum attendance to primary health care consultation of the mother-child dyad. Crude and adjusted multinomial logistic regressions with robust variance were used to assess factors associated with nonattendance. Results: Among the 314 cohort mothers, 25% did not attend any primary health care consultation during the 18-months postpartum, while 30% of the mothers did all three. Regarding the child, 75% had regular primary health care consultations in all three survey rounds, while 4% did not attend any in their first 18 months of life. By the end of the first COVID-19 wave, the proportion of mother and child who attended the consultations had fallen by 23 and 18%, respectively. The main factors associated with nonattendance were mothers aged below 25 years, and mothers with more than one child. Conclusion: An important delay or nonattendance to primary health care consultation by the mother-child dyad was observed during the COVID-19 pandemic. Such practice, with a high potential to increase maternal and child morbidity and mortality, was particularly frequent among younger mothers and those with more than one child.

RESUMO Objetivo: Analisar o retardo ou a não procura por atenção primária à saúde por parte do bionômio mãe-filho durante a pandemia de COVID-19, uma prática que apresenta elevado potencial de aumentar a morbimortalidade materno-infantil. Métodos: Dados de três levantamentos do estudo longitudinal Iracema-COVID, realizados aos seis, 12 e 18 meses após o parto, identificaram padrões de procura por consultas na Atenção Primária à Saúde (APS) por parte do binômio mãe-filho. A regressão multinomial bruta e adjustada com variância robusta foi utilizada para avaliar os fatores associados com a não procura. Resultados: Entre as 314 mães da coorte, 25% não realizaram nenhuma consulta na APS durante o período de 18 meses pós-parto, enquanto 30% das mães o fizeram nos três contatos do seguimento. Com relação à consulta da criança, 75% realizaram consultas de APS nos três momentos, ao passo que 4% não realizaram nenhuma consulta em seus primeiros 18 meses de vida. Ao fim da primeira onda de COVID-19, a proporção de consultas na APS de mães e crianças caiu 23 e 18%, respectivamente. Os principais fatores associados à não procura por APS foram mães com idade abaixo de 25 anos e mães com mais de um filho. Conclusão: Houve importante retardo ou não procura por APS pelo bionômio mãe-filho durante a pandemia de COVID-19. Essa prática, com elevado potencial de aumentar a morbimortalidade materno-infantil, foi mais frequente entre mães mais jovens e com mais de um filho.

Sociodemographic profile of primiparous mothers from nine birth cohorts in three Brazilian cities.

Fertility reduction is a phenomenon observed in demographic transition. The demographic changes noted in female fertility represent a need for adjustment on health services regarding female health and family planning support. Thus, this study aimed to perform a descriptive analysis by tracing the sociodemographic profile of primiparous mothers belonging to nine Brazilian birth cohorts, in three cities from different states. Standardized questionnaires were applied to assess reproductive characteristics and covariables. Primiparous mothers were defined as women whose child included in birth cohorts was their firstborn child. Sample description was performed using analysis of variance (continuous variables) and chi-square (categorical variables). In total, 44,615 women were included in the analyses and 41.8% (95%CI: 41.3; 42.2) were categorized as primiparous. The primiparity rates were the lowest in Ribeirão Preto (São Paulo State) 1978 (32%; 95%CI: 30.9; 33.1) and the highest in most recent cohorts, reaching up to 50% of the participants (São Luís - Maranhão State 2010: 47.2%; 95%CI: 45.8; 48.6; Ribeirão Preto 2010: 50.2%; 95%CI: 49.1; 51.4); Pelotas (Rio Grande do Sul State) 2015: 49.4% (95%CI: 47.9; 50.9). Primiparous mothers' age and schooling increased over the years in all cohorts. Maternal age at the first childbirth behaved similarly in the three studied cities. There was an increase in the proportion of first-time mothers that were older, higher educated and belonged to richer income groups. Also, the proportion of teenage mothers (aged 15 years or younger) increased until the early 2000's and started decreasing around the years 2010, especially among women in the poorer income groups.

Combined hormonal contraceptives use among women with contraindications according to the WHO criteria: A systematic review.

INTRODUCTION: Combined hormonal contraceptives (CHC), containing estrogen, remain the most popular choice of contraceptive among women. While the method offers many benefits, the use of CHC involves potential health risks. The aim of this study was to analyze the available evidence on the prevalence of CHC use among women with contraindications to their use according to the WHO recommendations (2015). METHODS: Pubmed, Lilacs, and Web of Sciences databases were searched. Selection was based on articles that described the use of combined hormonal contraceptives according to the characteristics that are listed as contraindications in WHO medical eligibility criteria for contraceptive use. RESULTS: A total of 4363 articles were identified and 18 articles were selected for the review. The most prevalent contraindications against use of CHC were systemic arterial hypertension, migraine, and smoking (in women aged 35 years or older). Prevalence rates of contraindications against use of CHC ranged from 5.9% to 41.9%. CONCLUSIONS: A high proportion of women still use CHC when contraindicated to do so according to the WHO criteria. Health policies should focus on highlighting the importance of a detailed health evaluation on CHC candidates, to reduce the proportion of inappropriate prescriptions.