Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babiesby Poliana Rebouças et al.
Background Racism is a social determinant of health inequities. In Brazil, racial injustices lead to poor outcomes in maternal and child health for Black and Indigenous populations, including greater risks of pregnancy-related complications; decreased access to antenatal, delivery, and postnatal care; and higher childhood mortality rates. In this study, we aimed to estimate inequalities in childhood mortality rates by maternal race and skin colour in a cohort of more than 19 million newborns in Brazil. Methods We did a nationwide population-based, retrospective cohort study using linked data on all births and deaths in Brazil between Jan 1, 2012, and Dec 31, 2018. The data consisted of livebirths followed up to age 5 years, death, or Dec 31, 2018. Data for livebirths were extracted from the National Information System for livebirths, SINASC, and for deaths from the Mortality Information System, SIM. The final sample consisted of complete data for all cases regarding maternal race and skin colour, and no inconsistencies were present between date of birth and death after linkage. We fitted Cox proportional hazard regression models to calculate the crude and adjusted hazard ratios (HRs) and 95% CIs for the association between maternal race and skin colour and all-cause and cause-specific younger than age 5 mortality rates, by age subgroups. We calculated the trend of HRs (and 95% CI) by time of observation (calendar year) to indicate trends in inequalities. Findings From the 20 526 714 livebirths registered in SINASC between Jan 1, 2012, and Dec 31, 2018, 238 436 were linked to death records identified from SIM. After linkage, 1 010 871 records were excluded due to missing data on maternal race or skin colour or inconsistent date of death. 19 515 843 livebirths were classified by mother's race, of which 224 213 died. Compared with children of White mothers, mortality risk for children younger than age 5 years was higher among children of Indigenous (HR 1·98 [95% CI 1·92–2·06]), Black (HR 1·39 [1·36–1·41]), and Brown or Mixed race (HR 1·19 [1·18–1·20]) mothers. The highest hazard ratios were observed during the post-neonatal period (Indigenous, HR 2·78 [95% CI 2·64–2·95], Black, HR 1·54 [1·48–1·59]), and Brown or Mixed race, HR 1·25 [1·23–1·27]) and between the ages of 1 year and 4 years (Indigenous, HR 3·82 [95% CI 3·52–4·15]), Black, HR 1·51 [1·42–1·60], and Brown or Mixed race, HR 1·30 [1·26–1·35]). Children of Indigenous (HR 16·39 [95% CI 12·88–20·85]), Black (HR 2·34 [1·78–3·06]), and Brown or Mixed race mothers (HR 2·05 [1·71–2·45]) had a higher risk of death from malnutrition than did children of White mothers. Similar patterns were observed for death from diarrhoea (Indigenous, HR 14·28 [95% CI 12·25–16·65]; Black, HR 1·72 [1·44–2·05]; and Brown or Mixed race mothers, HR 1·78 [1·61–1·98]) and influenza and pneumonia (Indigenous, HR 6·49 [95% CI 5·78–7·27]; Black, HR 1·78 [1·62–1·96]; and Brown or Mixed race mothers, HR 1·60 [1·51–1·69]). Interpretation Substantial ethnoracial inequalities were observed in child mortality in Brazil, especially among the Indigenous and Black populations. These findings demonstrate the importance of regular racial inequality assessments and monitoring. We suggest implementing policies to promote ethnoracial equity to reduce the impact of racism on child health. Funding MCTI/CNPq/MS/SCTIE/Decit/Bill & Melinda Gates Foundation's Grandes Desafios Brasil, Desenvolvimento Saudável para Todas as Crianças, and Wellcome Trust core support grant awarded to CIDACS-Center for Data and Knowledge Integration for Health. Full Text
By the first week of June, Brazil had reached almost 17 million cases and a little more than 472,000 deaths. A notable demographic change has been observed within this period, in which young and middle-aged adults representing an increasing share of patients in wards and intensive care units (ICU).
Epidemiology, Biodiversity, and Technological Trajectories in the Brazilian Amazon: From Malaria to COVID-19by Claudia Codeço et al.
The Amazon biome is under severe threat due to increasing deforestation rates and loss of biodiversity and ecosystem services while sustaining a high burden of neglected tropical diseases. Approximately two thirds of this biome are located within Brazilian territory. There, socio-economic and environmental landscape transformations are linked to the regional agrarian economy dynamics, which has developed into six techno-productive trajectories (TTs).
Trust, attitudes, information: a study on the perception of the COVID-19 pandemic in 12 Brazilian citiesby Luisa Massarani et al.
In this study, we analyze the perception of Brazilians about COVID-19 in 12 cities in the country. Issues about the severity and dangers of the disease, sources of information and reliability, checking information, attitudes, precautions and priorities for coping and trusting relationships in science were addressed.
Abstract Brazil deposited at the UN Secretariat its ratification of Nagoya Protocol on March 4, 2021. 90 (ninety) days from this date, the country becomes a member of the Nagoya Protocol, assuming rights and duties. This paper aims to contribute to the challenge that the country will have in harmonizing the Nagoya Protocol and its internal legal framework (Law 13.123/2015 regulated by Decree 8.772 /2016)
The emergence of COVID-19 in Brazil further explained the massive discrepancy between different social realities coexisting in the country, rekindling the discussions about food and nutrition security, similarly to what has been happening in other countries facing the same pandemic situation. In this paper, we argue that the risks to hunger and food security in Brazil have been present since 2016 and are now being exacerbated due to the emergence of the COVID-19 epidemic.
The dynamics underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection remain poorly understood. We identified a small cluster of patients in Brazil who experienced 2 episodes of coronavirus disease (COVID-19) in March and late May 2020. In the first episode, patients manifested an enhanced innate response compared with healthy persons, but neutralizing humoral immunity was not fully achieved. The second episode was associated with different SARS-CoV-2 strains, higher viral loads, and clinical symptoms. Our finding that persons with mild COVID-19 may have controlled SARS-CoV-2 replication without developing detectable humoral immunity suggests that reinfection is more frequent than supposed, but this hypothesis is not well documented.
*Portuguese content* Com objetivo de avaliar como as famílias dessas crianças foram impactadas, a pesquisa Impactos econômicos e sociais do vírus Zika foi realizada no IFF-Fiocruz, hospital público federal situado no Rio de Janeiro, que atua em ensino, pesquisa e atendimento a mulheres, crianças e adolescentes.
COVID-19 en América Latina y Caribe: Determinación de prioridades en investigación y llamado a la acciónby Nicole Feune de Colombi et al.
The Global Health Network (www.tghn.org) established in January 2020 a community of practice to address research on COVID-19 in low/middle-income countries.
Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazilby Leandro Giatti et al.
In this article, we explore elements that highlight the interdependent nature of demands for knowledge production and decision-making related to the appearance of emerging diseases. To this end, we refer to scientific production and current contextual evidence to verify situations mainly related to the Brazilian Amazon, which suffers systematic disturbances and is characterized as a possible source of pathogenic microorganisms.