Social Inequalities in Child Development: Analysis of Low-Birth-Weight Trends in Brazil, 2010-2020.

INTRODUCTION: Low birth weight (LBW) is a global issue prevalent in low-income countries. Economic assessments of interventions to reduce this burden are crucial to guide health policies. However, there is a relative scarcity of research that illustrates the magnitude of LBW by country and region to support the design of public policies. OBJECTIVE: This study aimed to analyze the temporal trend of fetal growth in newborns in Brazil between 2010 and 2020. METHODS: A time series study was conducted using data from the Live Births Information System (SINASC), which is managed by the Department of Information and Informatics of the Unified Health System (DATASUS) of the Brazilian Ministry of Health. The Prais-Winsten linear model was applied to analyze the annual proportions of LBW. The annual percentage changes (APC) and their respective 95% confidence intervals (95%CI) were calculated. Prevalence rate averages of LBW were calculated and displayed on thematic maps to visualize the evolution dynamics in each Federation Unit (FU). RESULTS: A total of 31,887,329 women from all Federative Units of Brazil were included in the study from 2010 to 2020. The Southeast region had the largest proportion of participants, with records from 2015 accounting for 9.5% of the total. Among the women in the study, 49.6% were between the ages of 20 and 29, and the majority (75.5%) had between 8 and 12 years of schooling. The newborns of these women were predominantly male (58.8%) and non-white (59.5%). The study found that there was a trend towards stabilization of increasing proportions of LBW in the North, Northeast, and Centre-West regions between 2010 and 2020. In Brazil and other regions, these tendencies remained stable. CONCLUSION: To improve living conditions and reduce social inequalities and health inequities, public policies and actions are necessary. Strengthening the Unified Health System (SUS), income transfer programs, quota policies for vulnerable groups, and gender equality measures such as improving access to education for women and the labor sector are among the suggested approaches.

Association between food environments and fetal growth in pregnant Brazilian women.

INTRODUCTION: Birth weight is described as one of the main determinants of newborns' chances of survival. Among the associated causes, or risk factors, the mother's nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. DESIGN: This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn's size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest. RESULTS: We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05-1.07)] and LBW [OR2nd tertile: 1.11 (1.09-1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02-1.06)] and LBW [OR2nd tertile: 1.13 (1.11-1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01-1.18)] and [OR3rd tertile: 1.06 (1.04-1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14-1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01-1.45)]. CONCLUSION: The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.

Resposta de Cuba e Uruguai no enfrentamento à pandemia de COVID-19 / Response of Cuba and Uruguay in tackling the COVID-19 pandemic

Resumo O presente estudo tem por objetivo analisar a resposta à pandemia de COVID-19 no Uruguai e em Cuba nos anos de 2020 e 2021, sistematizando possíveis lições. Trata-se de um estudo de casos comparado, apoiado em revisão integrativa, análise documental e dados secundários. Ambos os países podem ser descritos como casos de sucesso no enfrentamento à COVID-19 em 2020, tendo sofrido porém uma reviravolta na situação em 2021. Como elementos de destaque na primeira fase, aponta-se a coordenação da resposta, exercida pelo chefe de governo e por instituições de saúde pública e do campo acadêmico, além de características preexistentes em seus sistemas de saúde e proteção social. O insucesso em 2021 pode estar relacionado, por sua vez, ao desalinhamento entre as autoridades do governo uruguaio e a assessoria científica na flexibilização das medidas; à reabertura do turismo em Cuba; à entrada de novas variantes; e ao afrouxamento das medidas de distanciamento social. Nesse ano, a contenção da doença se deu principalmente por meio da imunização rápida nos dois países, apesar de relativo retardo em sua iniciação. A partir das experiências relatadas, discutiu-se aspectos que podem auxiliar respostas futuras no enfrentamento de emergências sanitárias.

Abstract The present study aims to analyze the response to the COVID-19 pandemic in Uruguay and Cuba in the years 2020 and 2021, systematizing possible lessons. This is a comparative case study, supported by an integrative review, document analysis and secondary data. Both countries can be described as successful cases in fighting COVID-19 in 2020, having suffered, however, a turnaround in the situation in 2021. As highlighted elements in the first phase, the coordination of the response, exercised by the chief government, public health institutions and the academic field, in addition to pre-existing characteristics of their health and social protection systems. The failure in 2021 may be related, in turn, to the misalignment between Uruguayan government authorities and scientific advice, in the relaxation of measures, and the entry of new variants; the reopening of tourism in Cuba; the loosening of social distancing measures and the emergence and spread of new variants in both cases. This year, the disease was contained mainly through rapid immunization in both countries, despite a relative delay in its initiation. Based on the experiences reported, aspects that can help future responses in dealing with health emergencies were discussed.

Inappropriate use of antibiotics and its predictors in pediatric patients admitted at the Central Hospital of Nampula, Mozambique.

BACKGROUND: Antibiotics are synthetic or natural substances used to treat bacterial infectious diseases. When used incorrectly, they can be a factor in the development of antimicrobial resistance, increased treatment time, costs, and mortality. The present study aimed to assess the pattern of inappropriate use of antibiotics and their predictors in pediatric patients admitted to the Central Hospital in Nampula, Mozambique. METHODS: A cross-sectional, retrospective study with a quantitative approach was conducted between January and July 2019. The population consisted of children ages 0-10 years hospitalized in the pediatric ward I. Binary logistic regression was used to determine risk factors for the inappropriate use of antibiotics with 95% confidence interval. RESULTS: The prevalence of antibiotic use among pediatric patients was 97.5%. Of the 464 antibiotics prescribed, 39.9% were for patients suffering from gastroenteritis, 21.8% and 9.1% for those affected with pneumonia and malaria, respectively. Most antibiotics were for parenteral use (95.9%, 445/464). Many (36.5%) of the prescriptions had errors, primarily in the duration of treatment (74.0%) or dosage (24.4%). Binary logistic regression analysis revealed that patients prescribed ≥ 3 antibiotics (OR = 2.83, 95% CI 1.245-6.462, p-value = 0.013) or hospitalized for a short time (OR = 1.88, 95% CI 1.133-2.3140, p-value = 0.015) were more likely to experience inappropriate use of antibiotics. CONCLUSION: The study showed both a high prevalence of antibiotic use and a high error rate in prescriptions, especially among patients prescribed ≥ 3 antibiotics or hospitalized for a short time. These results are concerning, since inappropriate and excessive use of antibiotics is a major factor in the development of antibiotic-resistant microorganisms. Therefore, policies to reduce the inappropriate and excessive use of antibiotics are necessary.