Integrating real-world data from Brazil and Pakistan into the OMOP common data model and standardized health analytics framework to characterize COVID-19 in the Global South.

OBJECTIVES: The aim of this work is to demonstrate the use of a standardized health informatics framework to generate reliable and reproducible real-world evidence from Latin America and South Asia towards characterizing coronavirus disease 2019 (COVID-19) in the Global South. MATERIALS AND METHODS: Patient-level COVID-19 records collected in a patient self-reported notification system, hospital in-patient and out-patient records, and community diagnostic labs were harmonized to the Observational Medical Outcomes Partnership common data model and analyzed using a federated network analytics framework. Clinical characteristics of individuals tested for, diagnosed with or tested positive for, hospitalized with, admitted to intensive care unit with, or dying with COVID-19 were estimated. RESULTS: Two COVID-19 databases covering 8.3 million people from Pakistan and 2.6 million people from Bahia, Brazil were analyzed. 109 504 (Pakistan) and 921 (Brazil) medical concepts were harmonized to Observational Medical Outcomes Partnership common data model. In total, 341 505 (4.1%) people in the Pakistan dataset and 1 312 832 (49.2%) people in the Brazilian dataset were tested for COVID-19 between January 1, 2020 and April 20, 2022, with a median [IQR] age of 36 [25, 76] and 38 (27, 50); 40.3% and 56.5% were female in Pakistan and Brazil, respectively. 1.2% percent individuals in the Pakistan dataset had Afghan ethnicity. In Brazil, 52.3% had mixed ethnicity. In agreement with international findings, COVID-19 outcomes were more severe in men, elderly, and those with underlying health conditions. CONCLUSIONS: COVID-19 data from 2 large countries in the Global South were harmonized and analyzed using a standardized health informatics framework developed by an international community of health informaticians. This proof-of-concept study demonstrates a potential open science framework for global knowledge mobilization and clinical translation for timely response to healthcare needs in pandemics and beyond.

Evaluating the effect of Bolsa Familia, Brazil's conditional cash transfer programme, on maternal and child health: A study protocol.

BACKGROUND: Conditional Cash Transfer Programs have been developed in Latin America in response to poverty and marked social inequalities on the continent. In Brazil, the Bolsa Familia Program (BFP) was implemented to alleviate poverty and improve living conditions, health, and education for socioeconomically vulnerable populations. However, the effect of this intervention on maternal and child health is not well understood. METHODS: We will evaluate the effect of BFP on maternal and child outcomes: 1. Birth weight; 2. Preterm birth; 3. Maternal mortality; and 4. Child growth. Dynamic retrospective cohort data from the 100 Million Brazilian Cohort (2001 to 2015) will be linked to three different databases: Live Birth Information System (2004 to 2015); Mortality Information System (2011 to 2015); and Food and Nutritional Surveillance System (2008 to 2017). The definition of exposure to the BFP varies according to the outcome studied. Those who never received the benefit until the outcome or until the end of the follow-up will be defined as not exposed. The effects of BFP on maternal and child outcomes will be estimated by a combination of propensity score-based methods and weighted logistic regressions. The analyses will be further stratified to reflect changes in the benefit entitlement before and after 2012. DISCUSSION: Harnessing a large linked administrative cohort allows us to assess the effect of the BFP on maternal and child health, while considering a wide range of explanatory and confounding variables.

CoronaVac vaccine is effective in preventing symptomatic and severe COVID-19 in pregnant women in Brazil: a test-negative case-control study.

BACKGROUND: More doses of CoronaVac have been administered worldwide than any other COVID-19 vaccine. However, the effectiveness of COVID-19 inactivated vaccines in pregnant women is still unknown. We estimated the vaccine effectiveness (VE) of CoronaVac against symptomatic and severe COVID-19 in pregnant women in Brazil. METHODS: We conducted a test-negative design study in all pregnant women aged 18-49 years with COVID-19-related symptoms in Brazil from March 15, 2021, to October 03, 2021, linking records of negative and positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) tests to national vaccination records. We also linked records of test-positive cases with notifications of severe, hospitalised or fatal COVID-19. Using logistic regression, we estimated the adjusted odds ratio and VE against symptomatic COVID-19 and against severe COVID-19 by comparing vaccine status in test-negative subjects to test-positive symptomatic cases and severe cases. RESULTS: Of the 19,838 tested pregnant women, 7424 (37.4%) tested positive for COVID-19 and 588 (7.9%) had severe disease. Only 83% of pregnant women who received the first dose of CoronaVac completed the vaccination scheme. A single dose of the CoronaVac vaccine was not effective at preventing symptomatic COVID-19. The effectiveness of two doses of CoronaVac was 41% (95% CI 27.1-52.2) against symptomatic COVID-19 and 85% (95% CI 59.5-94.8) against severe COVID-19. CONCLUSIONS: A complete regimen of CoronaVac in pregnant women was effective in preventing symptomatic COVID-19 and highly effective against severe illness in a setting that combined high disease burden and marked COVID-19-related maternal deaths.

Confiabilidade de instrumentos de avaliação de retração de cintura escapular em uma unidade de cuidados intermediários neonatal / Reliability of the evaluation of shoulder girdle retraction instrument in a neonatal intermediate unit care

OBJETIVO: Avaliar a confiabilidade inter e intraexaminador, na utilização de instrumentos de avaliação da retração de cintura escapular em crianças internadas em uma unidade de cuidados intermediários neonatal. MATERIAL E MÉTODOS: Estudo quantitativo, transversal e observacional, realizado com recém-nascidos e lactentes que necessitaram de internamento em uma unidade de cuidados intermediários neonatal. A coleta de dados ocorreu de outubro de 2019 a fevereiro de 2020. Para avaliação da retração da cintura escapular foi utilizado um protocolo de inspeção biomecânica elaborado pelas pesquisadoras, que possibilitou a realização de medidas (em centímetros) das bordas mediais superiores e inferiores, direita e esquerda, até a coluna vertebral, com a cabeça em rotação para a direita e para a esquerda, e o sinal do cachecol. As avaliações foram realizadas sempre pelos mesmos avaliadores. Para estimar a confiabilidade inter e intraexaminador do protocolo de inspeção biomecânica e sinal do cachecol, foi utilizado o Índice de Kappa e para as medidas do posicionamento das escápulas, o Coeficiente de Correlação Intraclasse. RESULTADOS: O protocolo de inspeção biomecânica dos sinais sugestivos de retração de cintura escapular demostrou concordância leve a moderada interexaminadores, e substancial a quase perfeita intraexaminador. A concordância interexaminadores obtida no sinal do cachecol foi leve a moderada, e quase perfeita intraexaminador. O posicionamento das escápulas apresentou concordância interexaminadores considerada como boa, e concordância excelente intraexaminador. CONCLUSÃO: A avaliação de sinais sugestivos de retração de cintura escapular, em recém-nascidos e lactentes, apresenta baixos índices confiabilidade interexaminadores e altíssima confiabilidade intraexaminador

OBJECTIVE: To evaluate inter and intra-examiner reliability in the use of instruments to assess shoulder girdle retraction in children hospitalized in a neonatal intermediate care unit. METHODS: Quantitative, cross-sectional and observational study carried out with newborns and infants who required hospitalization in a neonatal intermediate care unit. Data collection took place from October 2019 to February 2020. To evaluate shoulder girdle retraction, a biomechanical inspection protocol developed by the researchers was used, which made it possible to measure (in centimeters) from the upper and lower medial edges, right and left, to the spine, with the head in rotation to the right and left, and the scarf sign. The evaluations were always carried out by the same evaluators. To estimate inter and intra-examiner reliability of the biomechanical inspection protocol and scarf signal, the Kappa Index was used and, for measurements of scapular positioning, the Intraclass Correlation Coefficient. RESULTS: The biomechanical inspection protocol for suggestive signs of scapular girdle retraction showed mild to moderate inter-examiner agreement and substantial to almost perfect intra-examiner agreement. The intra-examiner agreement obtained in the scarf sign was mild to moderate and almost perfect intra-examiner. The positioning of the scapulae showed good inter-examiner agreement and excellent intra-examiner agreement. CONCLUSION: The evaluation of suggestive signs of scapular girdle retraction in newborns and infants has low inter-examiner reliability and very high intra-examiner reliability.

Conditional cash transfer program and child mortality: A cross-sectional analysis nested within the 100 Million Brazilian Cohort.

BACKGROUND: Brazil has made great progress in reducing child mortality over the past decades, and a parcel of this achievement has been credited to the Bolsa Família program (BFP). We examined the association between being a BFP beneficiary and child mortality (1-4 years of age), also examining how this association differs by maternal race/skin color, gestational age at birth (term versus preterm), municipality income level, and index of quality of BFP management. METHODS AND FINDINGS: This is a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a population-based cohort primarily built from Brazil's Unified Registry for Social Programs (Cadastro Único). We analyzed data from 6,309,366 children under 5 years of age whose families enrolled between 2006 and 2015. Through deterministic linkage with the BFP payroll datasets, and similarity linkage with the Brazilian Mortality Information System, 4,858,253 children were identified as beneficiaries (77%) and 1,451,113 (23%) were not. Our analysis consisted of a combination of kernel matching and weighted logistic regressions. After kernel matching, 5,308,989 (84.1%) children were included in the final weighted logistic analysis, with 4,107,920 (77.4%) of those being beneficiaries and 1,201,069 (22.6%) not, with a total of 14,897 linked deaths. Overall, BFP participation was associated with a reduction in child mortality (weighted odds ratio [OR] = 0.83; 95% CI: 0.79 to 0.88; p < 0.001). This association was stronger for preterm children (weighted OR = 0.78; 95% CI: 0.68 to 0.90; p < 0.001), children of Black mothers (weighted OR = 0.74; 95% CI: 0.57 to 0.97; p < 0.001), children living in municipalities in the lowest income quintile (first quintile of municipal income: weighted OR = 0.72; 95% CI: 0.62 to 0.82; p < 0.001), and municipalities with better index of BFP management (5th quintile of the Decentralized Management Index: weighted OR = 0.76; 95% CI: 0.66 to 0.88; p < 0.001). The main limitation of our methodology is that our propensity score approach does not account for possible unmeasured confounders. Furthermore, sensitivity analysis showed that loss of nameless death records before linkage may have resulted in overestimation of the associations between BFP participation and mortality, with loss of statistical significance in municipalities with greater losses of data and change in the direction of the association in municipalities with no losses. CONCLUSIONS: In this study, we observed a significant association between BFP participation and child mortality in children aged 1-4 years and found that this association was stronger for children living in municipalities in the lowest quintile of wealth, in municipalities with better index of program management, and also in preterm children and children of Black mothers. These findings reinforce the evidence that programs like BFP, already proven effective in poverty reduction, have a great potential to improve child health and survival. Subgroup analysis revealed heterogeneous results, useful for policy improvement and better targeting of BFP.

Methodological proposal for the redistribution of deaths due to garbage codes in mortality estimates for Noncommunicable Chronic Diseases / Proposta metodológica para redistribuição de óbitos por causas garbage nas estimativas de mortalidade para Doenças Crônicas Não Transmissíveis

Objective: to propose a method for improving mortality estimates from non-communicable chronic diseases (NCD), including the redistribution of garbage causes in the municipalities of Brazil. Methods: Information Mortality System (SIM) data was used in the three-year periods from 2010 to 2012 and 2015 to 2017, with comparison of age standardized rates before and after correction of NCDs (cardiovascular, chronic respiratory, diabetes and neoplasms). The treatment for data correction included missing data, under-registration and causes of garbage redistribution (CG). The trienniums and Bayesian method were used to estimate mortality rates by improving the fluctuation caused by small numbers at the municipal level. Results: The CG redistribution stage showed greater weight in the corrections, about 40% in 2000 and about 20% from 2007, with stabilization from this year.. Throughout the historical series, the quality of information on causes of death has improved in Brazil, with heterogeneous results being observed among the municipalities. Conclusions: methodological studies that propose the correction and improvement of the SIM are essential for monitoring the mortality rates due to NCDs at regional levels. The methodological proposal applied, for the first time in real data from Brazilian municipalities, is challenging and deserves further improvements. Despite the improvement in the data, the use of rates with raw data is not recommended, as the treatment in the data, the method used in this study for the treatment of raw data showed a great impact on the final estimates.

Objetivo: propor método para melhoria das estimativas de mortalidade por doenças crônicas não transmissíveis (DCNT), incluindo a redistribuição de causas garbage nos municípios Brasileiros. Métodos: foram utilizados os dados do Sistema de Informações sobre Mortalidade (SIM) nos triênios de 2010-2012 e 2015-2017, comparadas com as taxas padronizadas por idade, antes e após correção das DCNT (cardiovasculares, respiratória crônicas, diabetes e neoplasias). O tratamento para correção dos dados abordou dados faltantes, sub-registro e redistribuição de causas garbage (CG). Foram utilizados triênios e método bayesiano para estimar as taxas de mortalidade diminuindo o efeito da flutuação provocada pelos pequenos números no nível municipal. Resultados: a etapa de redistribuição CG mostrou maior peso nas correções, cerca de 40% em 2000 e cerca de 20% a  partir de 2007, com estabilização a partir deste ano. Ao longo da série histórica a qualidade da informação sobre causas de morte melhorou no Brasil, sendo observados resultados heterogêneos nos municípios. Observou-se clusters com as maiores proporções de correção nas regiões Nordeste e Norte. O diabetes foi a causa com maior proporção de acréscimo (mais de 40% em 2000). Conclusões: estudos metodológicos que propõem correção e melhoria do SIM são essenciais para o monitoramento das taxas de mortalidade por DCNT em níveis regionais. A proposta metodológica aplicada, pela primeira vez em dados reais de municípios brasileiros, é desafiadora e merece maiores aprimoramentos. Apesar da melhora nos dados, o método utilizado neste estudo para o tratamento dos dados brutos mostrou um grande impacto nas estimativas finais.

Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. / Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil.

The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

A pandemia de COVID-19 tem desafiado pesquisadores e gestores a encontrar medidas de saúde pública que evitem o colapso dos sistemas de saúde e reduzam os óbitos. Esta revisão narrativa buscou sistematizar as evidências sobre o impacto das medidas de distanciamento social na epidemia de COVID-19 e discutir sua implementação no Brasil. Foram triados artigos sobre o efeito do distanciamento social na COVID-19 no PubMed, medRXiv e bioRvix, e analisados atos do poder público nos níveis federal e estadual para sumarizar as estratégias implementadas no Brasil. Os achados sugerem que o distanciamento social adotado por população é efetivo, especialmente quando combinado ao isolamento de casos e à quarentena dos contatos. Recomenda-se a implementação de medidas de distanciamento social e de políticas de proteção social para garantir a sustentabilidade dessas medidas. Para o controle da COVID-19 no Brasil, é imprescindível que essas medidas estejam aliadas ao fortalecimento do sistema de vigilância nos três níveis do SUS, que inclui a avaliação e uso de indicadores adicionais para monitorar a evolução da pandemia e o efeito das medidas de controle, a ampliação da capacidade de testagem, e divulgação ampla e transparente das notificações e de testagem desagregadas.

Características dos óbitos infantis em um munícipio de médio porte da região Nordeste do Brasil / Characteristics of infant deaths in medium towns from brazilian northeast region

Introdução: A mortalidade infantil é um importante indicador de saúde e desenvolvimento dos municípios, revelando importantes aspectos da organização da assistência à saúde. Objetivo: Descrever as características dos óbitos infantis em um munícipio de médio porte da região Nordeste do Brasil. Métodos: Estudo epidemiológico, descritivo, utilizando dados da Declaração de Óbito de crianças com idade de 0 a 364 dias, classificados segundo os critérios de evitabilidade, referentes ao município Jequié, Bahia, entre os anos 2007 a 2012. A análise estatística consistiu no cálculo de frequências absolutas e relativas. Resultados: Entre 2007 e 2012, foram notificados 286 óbitos infantis, dos quais 64,7% foram considerados evitáveis. Entre os 185 óbitos infantis evitáveis, 38,4% se caracterizavam como redutíveis por ações de prevenção, diagnóstico e tratamento precoce. As caraterísticas relacionadas aos óbitos infantis evidenciaram que, entre os óbitos, 53,6% nasceram com baixo peso, 42,1%, prematuros e 63,1% morreram no período neonatal precoce. Conclusões: Os óbitos infantis, especialmente aqueles considerados evitáveis, ainda representam um grave problema de saúde pública. Nesse contexto, analisar os óbitos, quanto aos critérios de evitabilidade, constituiu-se em um instrumento importante na avaliação da qualidade da atenção à saúde materno-infantil, colaborando na elaboração de estratégias de políticas públicas específicas regionais. (AU)

Introduction: Infant mortality is an important health and development indicator of municipalities, revealing important aspects of health care organizations. Objective: To describe the characteristics of infant deaths in a midsized municipality in the Northeast region of Brazil. Methods: This is an epidemiological descriptive study, which has made use of data from death certificates of children aged 0-364 days, selected according to the preventability criteria for the city of Jequié, Bahia, between the years 2007-2012. Statistical analysis included the calculation of absolute and relative frequencies. Results: Between 2007 and 2012, 286 infant deaths were reported, of which 64.7% were considered preventable. Among the 185 preventable child deaths, 38.4% were characterized as reducible by prevention, early diagnosis and treatment. The features related to infant deaths showed that among the deaths, 53.6% had been born with low birth weight; preterm 42.1% and 63.1% died in the early neonatal period. Conclusion: Infant deaths, especially those considered preventable, still represent a serious public health problem. In this context, the analysis of the deaths, as to the preventability criteria, constituted an important tool in assessing the quality of care for maternal and child health, collaborating in the development of regional specific public policy strategies. (AU)