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Beckman D, Seelke AMH, Bennett J, Dougherty P, Van Rompay KKA, Keesler R, Pesavento PA, Coffey LLA, Morrison JH, Bliss-Moreau E. Neuroanatomical abnormalities in a nonhuman primate model of congenital Zika virus infection. eLife 2022; 11:64734. [PMID: 35261339 PMCID: PMC8906804 DOI: 10.7554/elife.64734] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
We evaluated neuropathological consequences of fetal ZIKV exposure in rhesus monkeys, a translatable animal model for human neural development, by carrying out quantitative neuroanatomical analyses of the nearly full-term brains of fetuses infected with ZIKV and procedure-matched controls. For each animal, a complete cerebral hemisphere was evaluated using immunohistochemical (IHC) and neuroanatomical techniques to detect virus, identify affected cell types, and evaluate gross neuroanatomical abnormalities. IHC staining revealed the presence of ZIKV in the frontal lobe, which contained activated microglia and showed increased apoptosis of immature neurons. ZIKV-infected animals exhibited macrostructural changes within the visual pathway. Regional differences tracked with the developmental timing of the brain, suggesting inflammatory processes related to viral infiltration swept through the cortex, followed by a wave of cell death resulting in morphological changes. These findings may help explain why some infants born with normal sized heads during the ZIKV epidemic manifest developmental challenges as they age.
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Affiliation(s)
- Danielle Beckman
- California National Primate Research Center, UC Davis, Davis, United States
| | - Adele M H Seelke
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Jeffrey Bennett
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Paige Dougherty
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
| | - Koen K A Van Rompay
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - Rebekah Keesler
- California National Primate Research Center, UC Davis, Davis, United States
| | - Patricia A Pesavento
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - Lark L A Coffey
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, UC Davis, Davis, United States
| | - John H Morrison
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Neurology, School of Medicine, UC Davis, Davis, United States
| | - Eliza Bliss-Moreau
- California National Primate Research Center, UC Davis, Davis, United States.,Department of Psychology, UC Davis, Davis, United States
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2
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Impact of the COVID-19 Pandemic on Infectious Diseases in Brazil: A Case Study on Dengue Infections. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2022; 3:97-115. [PMID: 36417270 PMCID: PMC9620889 DOI: 10.3390/epidemiologia3010009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
Brazil is known for being a breeding ground for emerging infectious diseases (EIDs), such as Zika, dengue, and chikungunya. Given that it has been one of the countries most affected by the SARS-CoV-2 pandemic, this article aims to analyze the impact that the COVID-19 pandemic has had on the burden of infectious diseases in Brazil, especially that of dengue. Brazil is a unique territory with a heterogeneous population living in a tropical, wet climate favorable to infectious diseases. In addition, despite being one of the largest emerging economies in the world, the country has been exposed to political instability and a public health system that suffers from large funding shortfalls and a lack of coherent regulation. The findings from this study are multilayered. Firstly, as cases of COVID-19 rose at the start of the pandemic, cases of dengue declined drastically. This may be due, in part, to factors such as seasonal climate and distancing measures. Furthermore, the findings indicate that the diversion of resources away from dengue and other infectious diseases, and mobilization for COVID-19 testing and treatment, likely resulted in a serious underreporting of dengue. While Brazil has incorporated some of the lessons learned from past EID experience in responding to the COVID-19 pandemic, the analysis highlights how the country's structural problems present pitfalls in the epidemiological fight. It was concluded that in a country such as Brazil, where infectious disease outbreaks are only a matter of time, pandemic preparedness should be prioritized over pandemic response.
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3
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Bancroft D, Power GM, Jones RT, Massad E, Iriat JB, Preet R, Kinsman J, Logan JG. Vector control strategies in Brazil: a qualitative investigation into community knowledge, attitudes and perceptions following the 2015-2016 Zika virus epidemic. BMJ Open 2022; 12:e050991. [PMID: 35105618 PMCID: PMC8808399 DOI: 10.1136/bmjopen-2021-050991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The World Health Organization declared a Public Health Emergency of International Concern following the rapid emergence of neonatal microcephaly in Brazil during the 2015-2016 Zika virus (ZIKV) epidemic. In response, a national campaign sought to control Aedes mosquito populations and reduce ZIKV transmission. Achieving adherence to vector control or mosquito-bite reduction behaviours, including the use of topical mosquito repellents, is challenging. Coproduction of research at the community level is needed to understand and mitigate social determinants of lower engagement with Aedes preventive measures, particularly within disempowered groups. DESIGN In 2017, the Zika Preparedness Latin America Network (ZikaPLAN) conducted a qualitative study to understand individual and community level experiences of ZIKV and other mosquito-borne disease outbreaks. Presented here is a thematic analysis of 33 transcripts from community focus groups and semistructured interviews, applying the Health Belief Model (HBM) to elaborate knowledge, attitudes and perceptions of ZIKV and vector control strategies. PARTICIPANTS 120 purposively sampled adults of approximate reproductive age (18-45); 103 women participated in focus groups and 17 men in semistructured interviews. SETTING Two sociopolitically and epidemiologically distinct cities in Brazil: Jundiaí (57 km north of São Paolo) and Salvador (Bahia state capital). RESULTS Four key and 12 major themes emerged from the analysis: (1) knowledge and cues to action; (2) attitudes and normative beliefs (perceived threat, barriers, benefits and self-efficacy); (3) behaviour change (household prevention and community participation); and (4) community preferences for novel repellent tools, vector control strategies and ZIKV messaging. CONCLUSIONS Common barriers to repellent adherence were accessibility, appearance and effectiveness. A strong case is made for the transferability of the HBM to inform epidemic preparedness for mosquito-borne disease outbreaks at the community level. Nationally, a health campaign targeting men is recommended, in addition to local mobilisation of funding to strengthen surveillance, risk communication and community engagement.
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Affiliation(s)
- Dani Bancroft
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace M Power
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert T Jones
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Eduardo Massad
- School of Medicine, University of São Paulo, São Paulo, SP, Brazil
- School of Applied Mathematics, Fundação Getulio Vargas, Rio de Janeiro, RJ, Brazil
| | | | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - James G Logan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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4
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Lying in wait: the resurgence of dengue virus after the Zika epidemic in Brazil. Nat Commun 2021; 12:2619. [PMID: 33976183 PMCID: PMC8113494 DOI: 10.1038/s41467-021-22921-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022] Open
Abstract
After the Zika virus (ZIKV) epidemic in the Americas in 2016, both Zika and dengue incidence declined to record lows in many countries in 2017–2018, but in 2019 dengue resurged in Brazil, causing ~2.1 million cases. In this study we use epidemiological, climatological and genomic data to investigate dengue dynamics in recent years in Brazil. First, we estimate dengue virus force of infection (FOI) and model mosquito-borne transmission suitability since the early 2000s. Our estimates reveal that DENV transmission was low in 2017–2018, despite conditions being suitable for viral spread. Our study also shows a marked decline in dengue susceptibility between 2002 and 2019, which could explain the synchronous decline of dengue in the country, partially as a result of protective immunity from prior ZIKV and/or DENV infections. Furthermore, we performed phylogeographic analyses using 69 newly sequenced genomes of dengue virus serotype 1 and 2 from Brazil, and found that the outbreaks in 2018–2019 were caused by local DENV lineages that persisted for 5–10 years, circulating cryptically before and after the Zika epidemic. We hypothesize that DENV lineages may circulate at low transmission levels for many years, until local conditions are suitable for higher transmission, when they cause major outbreaks. Zika and dengue incidence in the Americas declined in 2017–2018, but dengue resurged in 2019 in Brazil. This study uses epidemiological, climatological and genomic data to show that the decline of dengue may be explained by protective immunity from pre-exposure to ZIKV and/or DENV in prior years.
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Scientometric Analysis of Research Output from Brazil in Response to the Zika Crisis Using e-Lattes. JOURNAL OF DATA AND INFORMATION SCIENCE 2020. [DOI: 10.2478/jdis-2020-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Purpose
This paper aims to test the use of e-Lattes to map the Brazilian scientific output in a recent research health subject: Zika Virus.
Design/methodology/approach
From a set of Lattes CVs of Zika researchers registered on the Lattes Platform, we used the e-Lattes to map the Brazilian scientific response to the Zika crisis.
Findings
Brazilian science articulated quickly during the public health emergency of international concern (PHEIC) due to the creation of mechanisms to streamline funding of scientific research.
Research limitations
We did not assess any dimension of research quality, including the scientific impact and societal value.
Practical implications
e-Lattes can provide useful guidelines for different stakeholders in research groups from Lattes CVs of members.
Originality/value
The information included in Lattes CVs permits us to assess science from a broader perspective taking into account not only scientific research production but also the training of human resources and scientific collaboration.
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Raynor B, Díaz EW, Shinnick J, Zegarra E, Monroy Y, Mena C, Castillo-Neyra R. The impact of the COVID-19 pandemic on rabies reemergence in Latin America: the case of Arequipa, Peru. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.08.06.20169581. [PMID: 32817966 PMCID: PMC7430610 DOI: 10.1101/2020.08.06.20169581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over the past decades, there has been tremendous progress towards eliminating canine rabies in Latin America. Major components of rabies prevention programs in Latin America leading to these successes have been constant and intense surveillance for rabid dogs and uninterrupted yearly mass dog vaccination campaigns. However, vital measures to control COVID-19 in Latin America have had the negative trade-off of jeopardizing these rabies elimination and prevention activities. In this paper, we aimed to assess the effect of interrupting canine rabies surveillance and mass dog vaccination campaigns on rabies trends. We built a deterministic compartment model of dog rabies dynamics parameterized for conditions found in Arequipa, Peru, where there is an ongoing dog rabies epidemic. Our model suggests that a decrease in canine vaccination coverage as well as decreased surveillance leading to an increased length of survival of infected dogs could lead to a sharp rise in canine rabies and, subsequently, human rabies risk. We examined our results over the best estimate of the basic reproductive number in Arequipa (R0 = 1.44) and a range of plausible values for R0 (1.36 - 2). The rising trend was consistent. It is very possible that COVID-19 will continue to challenge our public health departments in the short- and medium-term. Innovative strategies to conduct dog vaccination and rabies surveillance during these trying times should be considered to safeguard the achievements made in Latin America towards the elimination of dog-mediated human rabies.
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Affiliation(s)
- Brinkley Raynor
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
| | - Elvis W. Díaz
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Julianna Shinnick
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
| | - Edith Zegarra
- Gerencia Regional de Salud de Arequipa, Ministerio de Salud, Arequipa 04002, Peru
| | - Ynes Monroy
- Gerencia Regional de Salud de Arequipa, Ministerio de Salud, Arequipa 04002, Peru
| | - Claudia Mena
- Red de Salud Arequipa Caylloma, Ministerio de Salud, Arequipa 04001, Peru
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States of America
- Zoonotic Disease Research Lab, One Health Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
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7
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Anderson EJ, Ernst KC, Martins FF, Martins CDS, Koss MP. Women's Health Perceptions and Beliefs Related to Zika Virus Exposure during the 2016 Outbreak in Northern Brazil. Am J Trop Med Hyg 2020; 102:629-633. [PMID: 31933455 DOI: 10.4269/ajtmh.19-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the 2016 Zika pandemic in Brazil, women's perceptions of infection risk, ability to adhere to Zika prevention strategies, or access to services following exposure were not emphasized in the public health response. Women in Fortaleza, Brazil, responded to a questionnaire on social factors related to perceived Zika risk and access to health care in June 2016. Data were coded using prespecified categories, and response frequency was reported. Of 37 respondents, most reported a lack of public services to support mosquito control (n = 19) or delayed access to reproductive health care (n = 14). Only 22% described specific maternal risks or fetal outcomes as a consequence of Zika infection. Respondents indicated an overall disconnect between public health efforts and women's perceptions of their reproductive control, including limited support concerning microcephaly in infants. Interventions targeting Zika may require a greater emphasis on strengthening health systems and infrastructure to realistically prevent transmission.
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Affiliation(s)
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | | | | | - Mary P Koss
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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8
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Tirado V, Morales Mesa SA, Kinsman J, Ekström AM, Restrepo Jaramillo BN. Women's reluctance for pregnancy: Experiences and perceptions of Zika virus in Medellin, Colombia. Int J Gynaecol Obstet 2020; 148 Suppl 2:36-44. [PMID: 31975395 PMCID: PMC7064904 DOI: 10.1002/ijgo.13046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective To explore how being infected with the Zika virus during pregnancy was experienced by affected women, and how it influenced their family relationships and future family planning. Methods We conducted a qualitative study, including 19 semistructured interviews with women of reproductive age and confirmed Zika infection during 2015–2018 in Medellin, Colombia. Purposeful sampling was applied, and participants were identified through National Public Health Surveillance System records. Interviews were recorded, transcribed verbatim, and analyzed using content analysis with inductive and deductive approaches. Results Of 19 women interviewed, eight women identified the pregnancy as unexpected and two women had undergone permanent sterilization. Women had mixed views about decision‐making related to family planning, and not having an abortion in a future pregnancy was influenced by religious beliefs. Women knew about vector‐borne transmission but were not well informed about sexual transmission of the virus. Women desired better support and guidance to ease concerns about Zika virus. Conclusion All interviewed women expressed a need for more information about Zika virus and continuous support, specifically after delivery, from healthcare professionals. Communication strategies to enhance culturally sensitive messages and for accurate perception of information are recommended during Zika outbreaks. Women interviewed were unaware of sexual transmission of the Zika virus. Women desired continuous counselling and support during their pregnancy and after the birth.
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Affiliation(s)
- Veronika Tirado
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Santiago A Morales Mesa
- Faculty of Psychology, Institute of Health Sciences (CES University), University, Medellín, Colombia.,Faculty of Law and Political Sciences, Catholic University Luis Amigó, Medellín, Colombia
| | - John Kinsman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Berta N Restrepo Jaramillo
- Department of Virology, Colombian Institute of Tropical Medicine - Institute of Health Sciences (CES University), Medellín, Colombia
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9
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Abstract
Pandemics of influenza, cholera, and plague are part of global history. Regional
epidemics and pandemics of infectious diseases, primarily influenza A, continue
to cause significant morbidity and mortality while remaining unpredictable in
nature. Sudden-onset disasters such as earthquakes and floods occur with little
warning. The consequences of climate change and environmental degradation can
only be expected to increase the incidence of some infectious diseases and
weather-related crises, adding to the unpredictability of such events. Health
system leaders, both in public health and healthcare, need to understand the
international context and how coordination and response across or within
jurisdictions will improve the likelihood of successful management of
challenges. Public health emergencies respect no borders or political
structures. The ability of institutions to adapt quickly can make a difference
in health outcomes and a community’s trust in those institutions.
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Affiliation(s)
- Paul R Gully
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
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10
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Lima MDRQ, Chouin-Carneiro T, Azeredo E, Barbosa LS, Souza TMA, Silva JBCD, Nunes PCG, Dal Fabbro M, Facco IHR, Venâncio-da-Cunha R, Dos Santos FB. The inability of a dengue NS1 ELISA to detect Zika infections. Sci Rep 2019; 9:18596. [PMID: 31819129 PMCID: PMC6901494 DOI: 10.1038/s41598-019-55160-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/25/2019] [Indexed: 12/27/2022] Open
Abstract
The presence of dengue virus (DENV), Zika virus (ZIKV) and Chikungunya virus (CHIKV) in Brazil, may result in a difficult diagnosis due to the signs and symptoms shared by those. Moreover, as DENV and ZIKV belong to the same family, serological assays may show a high rate of cross-reactivity. Here, we evaluated a Dengue NS1 capture assay for early and differential diagnosis of dengue during the Zika epidemic occurred in Brazil in 2016. Samples (n = 227) from 218 patients included sera, plasma and urine from previously confirmed acute cases of Zika, dengue and Zika/dengue co-infections. Nine of those patients presented two specimens. The Dengue NS1 test was very specific for dengue diagnosis (99.32%), even in the co-circulation with ZIKV, and exhibited a high accuracy in not detecting acute Zika infections (92.43%). Our findings showed that the dengue NS1 capture test analyzed here was not able to recognize the ZIKV NS1 and its potential for cross-reaction.
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Affiliation(s)
| | - Thais Chouin-Carneiro
- Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, 21045-360, Brazil
| | - Elzinandes Azeredo
- Viral Immunology Laboratory, Oswaldo Cruz Institute, Rio de Janeiro, 21045-360, Brazil
| | | | | | | | | | - Márcia Dal Fabbro
- Medical Clinic Department, Federal University of Mato Grosso do Sul, Campo Grande, 79070-900, Brazil
| | | | - Rivaldo Venâncio-da-Cunha
- Medical Clinic Department, Federal University of Mato Grosso do Sul, Campo Grande, 79070-900, Brazil
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11
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Duttine A, Smythe T, Calheiro de Sá MR, Ferrite S, Moreira ME, Kuper H. Development and assessment of the feasibility of a Zika family support programme: a study protocol. Wellcome Open Res 2019; 4:80. [PMID: 31289753 PMCID: PMC6600857 DOI: 10.12688/wellcomeopenres.15085.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 01/09/2023] Open
Abstract
The Zika virus outbreak in Brazil in 2015 affected thousands of people. Zika is now known to cause congenital malformations leading to impairments and developmental delays in affected children, including Congenital Zika Syndrome (CZS). Children with CZS have complex care needs. Caregivers require significant levels of support to meet these needs, and there are large gaps in healthcare services. This study aims to develop, pilot and assess the feasibility and scalability of a community-based Family Support Programme for caregivers of children with CZS. The programme is adapted from the Getting to Know Cerebral Palsy (GTKCP) programme for the context of CZS in Brazil. GTKCP is a 10-session programme held with 6-10 caregivers in the local community. It includes practical, educational, peer-support and psychosocial aspects, which aim to improve confidence and capacity to care for a child with CP, and quality of life and empowerment of caregivers. The research project contains four components: Ascertaining need for the caregiver programme: a mixed-methods approach that included two literature reviews, interviews with key stakeholders in country, and incorporation of findings from the Social and Economic Impact of Zika study.Adapting GTKCP for the context of CZS and Brazil: undertaken with guidance from technical experts.Pilot testing the intervention: deliver the 10-session programme to one group of caregivers of children with CZS in Rio de Janeiro and another in Greater Salvador.Update the manual through fast-track learning from participant and facilitator feedback. Assessing the feasibility of the intervention for scale up: deliver the updated programme to two groups each in Rio de Janeiro and Greater Salvador, and evaluate the acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited efficacy, through questionnaires, direct observation, semi-structured interviews and cost calculation. The project has ethics approval in both the UK and Brazil.
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Affiliation(s)
- Antony Duttine
- London School of Hygiene & Tropical Medicine, London, UK
| | - Tracey Smythe
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Silvia Ferrite
- Department of Hearing and Speech Sciences, Federal University of Bahia, Salvador, Brazil
| | | | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, UK
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