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Martins LOM, Dos Reis MF, Chaoubah A, Rego G. Distributive justice and equity in resource allocation: a temporal analysis of hospitalization costs in indigenous populations in Brazil. Int J Equity Health 2024; 23:21. [PMID: 38317184 PMCID: PMC10845569 DOI: 10.1186/s12939-024-02102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION In Brazil, a country of continental dimensions, the health needs of each region have an impact. In this context and the name of the principle of equity, the SUS organizes actions especially aimed at social groups such as the elderly, children, pregnant women, and indigenous peoples. The concept of justice proposed by John Rawls is one of equity, which is essential to this country. METHODS This is an ecological, descriptive study, which analyzed hospital spending on cardiovascular diseases in the Unified Health System (SUS) among the indigenous elderly population and other ethnicities/colors in Brazil, between 2010 and 2019. RESULTS Hospitalization costs and fatality rates for indigenous populations and other colors/ethnicities, between 2010 and 2019, were evaluated. A reduction in hospitalization costs for the indigenous population and an increase in other populations was observed throughout the historical series, while there was an increase in fatality rates for both groups. A comparison was made between hospitalization costs and the fatality rates of indigenous populations and other colors/ethnicities according to sex, between 2010 and 2019. It was observed that regardless of sex, there are significant differences (p<0.05) between hospitalization costs and fatality rates, with higher costs for patients of other colors/ethnicities and higher fatality rates for the indigenous population. CONCLUSIONS Hospitalization costs due to cardiovascular diseases in elderly people from indigenous populations were lower compared to other ethnicities in most federative units, which may suggest an unequal allocation of resources or access for this indigenous population to the SUS. Although there is no strong correlation between spending on hospital admissions and fatality rates, it was found that these rates increased between 2010 and 2019, while spending was reduced.
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Novaes TER, Lara DM, da Silva SG. Severe Acute Respiratory Syndrome (SARS) in the Context of the COVID-19 Pandemic Among Indigenous Peoples of Brazil: Epidemiology and Risk Factors Associated with Death. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01660-z. [PMID: 37314690 DOI: 10.1007/s40615-023-01660-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Severe Acute Respiratory Syndrome (SARS) represents a serious public health problem for the indigenous peoples of Brazil, since acute respiratory infections are the main causes of morbidity and mortality in this population. OBJECTIVE To assess cases of SARS in Brazilian indigenous peoples in the context of the COVID-19 pandemic, as well as sociodemographic and health factors associated with deaths from SARS in this population. METHODS Ecological study carried out based on secondary data from the Brazilian Database for Epidemiological Surveillance of Influenza referring to the Brazilian indigenous population with SARS in 2020. The variables included sociodemographic factors and health conditions. Statistical analyses were carried out considering absolute (n) and relative (%) frequencies and logistic regression with odds ratios (OR), with death as the outcome of interest. RESULTS A total of 3062 cases were reported in the analyzed period. Of these, there was a predominance of men (54.6%), adults (41.4%), with comorbidities (52.3%), with low levels of schooling (67.4%) and residents of rural areas (55.8%). Cases and deaths were concentrated in the states of Amazonas and Mato Grosso do Sul, states in the North and Midwest of Brazil. A greater chance of death was observed in elderly indigenous people (OR = 6.29; 95%CI 4.71-8.39), with low levels of schooling (OR = 1.72; 95%CI 1.22-2.28), residents of rural areas (OR = 1.35; 95%CI 1.12-1.62), and with comorbidities (OR = 1.87; 95%CI 1.42-2.46), especially obesity (OR = 2.56; 95%CI 1.07-6.11). CONCLUSION The study was able to trace the clinical-epidemiological profile, as well as identify the groups of indigenous people most vulnerable to SARS as a result of COVID-19 and evolution to death in Brazil. The findings show the high impact on the morbidity and mortality of the Brazilian indigenous population exposed to SARS and are relevant for epidemiological health surveillance, since they can guide preventive public policy actions and quality of life measures for this ethnic group in Brazil.
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Affiliation(s)
| | - Darlan Martins Lara
- Medical School of the Federal University of Fronteira Sul, Campus Passo Fundo, Passo Fundo, Brazil
| | - Shana Ginar da Silva
- Post-Graduate Program in Biomedical Sciences, School of Medicine, Federal University of Fronteira Sul, Campus Passo Fundo, Passo Fundo, Brazil
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Raikes A, Alvarenga Lima JHN, Abuchaim B. Early Childhood Education in Brazil: Child Rights to ECE in Context of Great Disparities. CHILDREN (BASEL, SWITZERLAND) 2023; 10:919. [PMID: 37371151 DOI: 10.3390/children10060919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
One of the world's largest countries, Brazil's national policies on early childhood are some of the most progressive and comprehensive in the world. Notable themes in Brazil's early childhood system include the national protection of children's rights, the integration of children's development, starting at birth, into the national education system, and universal preschool education. These rights are juxtaposed against a highly devolved political structure in the context of significant socioeconomic, racial/ethnic, and geographic disparities. As a result, there is variability in access to quality early childhood settings. This case study explores access to quality early childhood education (ECE) for children aged four to six years. We describe the economic and policy contexts of ECE in Brazil, with emphasis on the role of ECE in addressing regional, racial/ethnic, and economic disparities.
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Affiliation(s)
- Abbie Raikes
- College of Public Health, Omaha Campus, University of Nebraska Medical Center, Omaha, NE 68198, USA
- ECD Measure, Omaha, NE 68132, USA
| | | | - Beatriz Abuchaim
- Fundação Maria Cecilia Souto Vidigal, São Paulo 04536-010, Brazil
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Caldas ADR, Nobre AA, Brickley E, Alexander N, Werneck GL, Farias YN, Garcia Barreto Ferrão CT, Tavares FG, Pantoja LDN, Duarte MCDL, Cardoso AM. How, what, and why: housing, water & sanitation and wealth patterns in a cross-sectional study of the Guarani Birth Cohort, the first Indigenous birth cohort in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2023; 21:100496. [PMID: 37214221 PMCID: PMC10193232 DOI: 10.1016/j.lana.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Background Despite the importance of social determinants of health, studies on the effects of socioeconomic, sanitary, and housing conditions on Indigenous child health are scarce worldwide. This study aims to identify patterns in housing, water & sanitation, and wealth (HSW) in the first Indigenous birth cohort in Brazil-The Guarani Birth Cohort. Methods Cross-sectional study using baseline data from The Guarani Birth Cohort. We used Multiple Correspondence Analysis and Cluster Analysis. The clusters identified were ordered in increasing degrees of access to public policies and wealth, defining the patterns of HSW. Finally, we explored the association between the patterns and one of the health outcomes, hospitalization, in the birth cohort. Findings Three patterns were identified for housing and water & sanitation, and four for wealth status, resulting in 36 combinations of patterns (3 × 3 × 4). More than 62% of children in the cohort were found with the lowest wealth patterns. The distribution of children across patterns in one dimension was not fully determined by the other two dimensions. Statistically significant associations were found between precarious households and extreme poverty, and hospitalization. Interpretation We observed substantial heterogeneity in the distribution of children across the 36 combinations. These findings highlight that, should the dimensions of HSW be associated with health outcomes, as seen for hospitalization, they should be considered separately in multivariable models, in order to improve the estimation of their independent effects. Funding National Council for Scientific and Technological Development, Brazil (CNPq); Oswaldo Cruz Foundation, Brazil (Fiocruz); Research Foundation of the State of Rio de Janeiro, Brazil (FAPERJ).
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Affiliation(s)
| | - Aline Araújo Nobre
- Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Elizabeth Brickley
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neal Alexander
- Institute of Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Felipe Guimarães Tavares
- Department of Epidemiology and Biostatistics, Institute of Collective Health, Fluminense Federal University, Niterói, RJ, Brazil
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Costa JC, de Jesus ACDS, de Jesus JGL, Madruga MF, Souza TN, Louzada MLDC. Differences in food consumption of the Brazilian population by race/skin color in 2017-2018. Rev Saude Publica 2023; 57:4. [PMID: 36820683 PMCID: PMC9933641 DOI: 10.11606/s1518-8787.2023057004000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/11/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To evaluate food consumption in Brazil by race/skin color of the population. METHODS Food consumption data from the Pesquisa de Orçamentos Familiares (POF - Household Budget Survey) 2017-2018 were analyzed. Food and culinary preparations were grouped into 31 items, composing three main groups, defined by industrial processing characteristics: 1 - in natura/minimally processed, 2 - processed, and 3 - ultra-processed. The percentage of calories from each group was estimated by categories of race/skin color - White, Black, Mixed-race, Indigenous, and Yellow- using crude and adjusted linear regression for gender, age, schooling, income, macro-region, and area. RESULTS In the crude analyses, the consumption of in natura/minimally processed foods was lower for Yellow [66.0% (95% Confidence Interval 62.4-69.6)] and White [66.6% (95%CI 66.1-67.1)] groups than for Blacks [69.8% (95%CI 68.9-70.8)] and Mixed-race people [70.2% (95%CI 69.7-70.7)]. Yellow individuals consumed fewer processed foods, with 9.2% of energy (95%CI 7.2-11.1) whereas the other groups consumed approximately 13%. Ultra-processed foods were less consumed by Blacks [16.6% (95%CI 15.6-17.6)] and Mixed-race [16.6% (95%CI 16.2-17.1)], with the highest consumption among White [20.1% (95%CI 19.6-20.6)] and Yellow [24.5% (95%CI 20.0-29.1)] groups. The adjustment of the models reduced the magnitude of the differences between the categories of race/skin color. The difference between Black and Mixed-race individuals from the White ones decreased from 3 percentage points (pp) to 1.2 pp in the consumption of in natura/minimally processed foods and the largest differences remained in the consumption of rice and beans, with a higher percentage in the diet of Black and Mixed-race people. The contribution of processed foods remained approximately 4 pp lower for Yellow individuals. The consumption of ultra-processed products decreased by approximately 2 pp for White and Yellow groups; on the other hand, it increased by 1 pp in the consumption of Black, Mixed-race, and Indigenous peoples. CONCLUSION Differences in food consumption according to race/skin color were found and are influenced by socioeconomic and demographic conditions.
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Affiliation(s)
- Janaína Calu Costa
- Universidade Federal de PelotasCentro Internacional para Equidade em SaúdePrograma de Pós-Graduação em EpidemiologiaPelotasRSBrasil Universidade Federal de Pelotas. Centro Internacional para Equidade em Saúde. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Amanda Cristina da Silva de Jesus
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
| | - Juliana Giaj Levra de Jesus
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
| | - Mariana Ferreira Madruga
- Universidade de São PauloFaculdade de MedicinaPrograma de Pós-Graduação em Saúde ColetivaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. São Paulo, SP, Brasil.
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Thays Nascimento Souza
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Maria Laura da Costa Louzada
- Universidade de São PauloFaculdade de Saúde PúblicaPrograma de Pós-Graduação em Nutrição em Saúde PúblicaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Programa de Pós-Graduação em Nutrição em Saúde Pública. São Paulo, SP, Brasil
- Universidade de São PauloNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
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C. Jardim PT, Dias JM, Grande AJ, Veras AB, Ferri ÉK, Quadros FAA, Peixoto C, Botelho FCS, I. M. G. Oliveira M, Dias IMAV, O’Keeffe M, Elia C, Dazzan P, Wolfe I, Harding S. Co-developing a health promotion programme for indigenous youths in Brazil: A concept mapping report. PLoS One 2023; 18:e0269653. [PMID: 36791063 PMCID: PMC9931109 DOI: 10.1371/journal.pone.0269653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/25/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Latin America and the Caribbean Region are home to about 42 million Indigenous people, with about 900,000 living in Brazil. The little routinely collected population-level data from Indigenous communities in the region available shows stark inequities in health and well-being. There are 305 Indigenous ethnic groups, speaking 274 languages, spread across the remote national territory, who have endured long-lasting inequities related to poverty, poor health, and limited access to health care. Malnutrition and mental health are key concerns for young people. Building on our Indigenous communities-academic partnerships over the last two decades, we collaborated with young people from the Terena Indigenous ethnic group, village leaders, teachers, parents, and local health practitioners from the Polo Base (community health centres) to obtain their perspectives on important and feasible actions for a youth health promotion programme. METHODS The report was conducted in the Tereré Village in Mato Grosso do Sul. Concept mapping, a participatory mixed method approach, was conducted in 7 workshops, 15 adults and 40 youths aged 9-17 years. Art-based concept mapping was used with 9 to 11 years old children (N = 20). Concept systems software was used to create concept maps, which were finalised during the workshops. Focused prompts related to factors that may influence the health and happiness of youths. The participatory method gave Terena youths a significant voice in shaping an agenda that can improve their health. RESULTS Terena youths identified priority actions that clustered under 'Family', 'School', 'Education', 'Socio-economic circumstances', 'Respect' and 'Sport' in response to protecting happiness; and 'Nutrition pattern', 'Physical activity', 'Local environment', and 'Well-being' in response to having a healthy body. Through the participatory lens of concept mapping, youths articulated the interconnectedness of priority actions across these clusters such that behaviours (e.g. Nutrition pattern, drinking water, physical activity) and aspirations (being able to read, to have a good job) were recognised to be dependent on a wider ecology of factors (e.g. loss of eco-systems, parent-child relationships, student- teacher relationships, parental unemployment). In response to developing youth health, Terena adults suggested priority actions that clustered under 'Relationships', 'Health issues', 'Prevention at Polo Base', 'Access to health care', 'Communication with young people', 'Community life', 'Raising awareness' and 'School support'. Their priorities reflected the need for structural transformative actions (e.g. Polo Base and school staff working together) and for embedding actions to protect Indigenous culture (e.g. integrating their cultural knowledge into training programmes). CONCLUSIONS Concept maps of Indigenous youths emphasised the need for a health promotion programme that engages with the structural and social determinants of health to protect their happiness and health, whilst those of adults emphasised the need to address specific health issues through preventative care via a school-Polo Base collaboration. Investment in a co-developed school-Polo-Base health promotion programme, with intersectoral engagement, has potential for making Indigenous health systems responsive to the inequalities of youth health, to yield dividends for healthy ageing trajectories as well as for the health of the next generation.
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Affiliation(s)
- Paulo T. C. Jardim
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Josiliane M. Dias
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Antonio J. Grande
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - André B. Veras
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Érika K. Ferri
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Fatima A. A. Quadros
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | - Clayton Peixoto
- Medicine School, State University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil
| | | | | | | | - Majella O’Keeffe
- Faculty of Life Sciences & Medicine, Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Christelle Elia
- Faculty of Life Sciences & Medicine, Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - Ingrid Wolfe
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Seeromanie Harding
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Moraes AODS, Magalhães EIDS, Orellana JDY, Gatica-Domínguez G, Neves PAR, Basta PC, Vaz JDS. Food profile of Yanomami indigenous children aged 6 to 59 months from the Brazilian Amazon, according to the degree of food processing: a cross-sectional study. Public Health Nutr 2023; 26:208-218. [PMID: 35620933 PMCID: PMC11077455 DOI: 10.1017/s1368980022001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/13/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The current study aimed to characterise the food profile of Yanomami indigenous children according to the degree of food processing and its associated factors. DESIGN This is a cross-sectional study with Yanomami indigenous children aged 6 to 59 months. Socio-demographic, maternal and infant data were collected through a standardised questionnaire. The food profile was obtained by using a list of thirty-four foods to verify the child's consumption of these foods on the day preceding the interview. Foods were classified according to the degree of processing based on the NOVA system (in natura or minimally processed, processed culinary ingredients, processed and ultra-processed). In natura and minimally processed foods were subdivided into 'regional' and 'urban' foods. Poisson regression analysis was applied to estimate the associated factors according to the 90 % CI. SETTING Three villages (Auaris, Maturacá and Ariabú) in the Yanomami indigenous territory, in the Brazilian Amazon. PARTICIPANTS In total, 251 Yanomami children aged 6 to 59 months were evaluated. RESULTS The prevalence of consumption of 'regional' and 'urban' in natura or minimally processed foods was 93 % and 56 %, respectively, and consumption of ultra-processed foods was 32 %. Ultra-processed food consumption was 11·6 times higher in children of Maturacá and 9·2 times higher in Ariabú when compared with the children of Auaris and 31 % lower in children who had mothers with shorter stature. CONCLUSION Despite the high frequency of consumption of in natura and minimally processed foods, the consumption of ultra-processed foods was substantial and was associated with demographic and maternal factors in Yanomani indigenous children under 5 years of age.
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Affiliation(s)
| | | | | | | | | | - Paulo Cesar Basta
- Samuel Pessoa Department of Endemics, National School of Public
Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ,
Brazil
| | - Juliana dos Santos Vaz
- Postgraduate Program in Nutrition and Food, Federal
University of Pelotas, Pelotas, RS,
Brazil
- Faculty of Nutrition, Federal University of
Pelotas, Rua Gomes Carneiro, nº 1, 2º Andar, Sala 227, Centro,
Pelotas, RS96010-610, Brazil
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Ortega F, Müller MR. Rethinking structural competency: Continuing education in mental health and practices of territorialisation in Brazil. Glob Public Health 2022:1-16. [DOI: 10.1080/17441692.2022.2157034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Francisco Ortega
- Catalan institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Manuela Rodrigues Müller
- Faculdade de Ciências Médicas, Universidade do Estado do Rio, de Janeiro (FCM-UERJ), Rio de Janeiro, Brazil
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Kramer CK, Leitão CB, Viana LV. The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry. Lancet 2022; 400:2074-2083. [PMID: 36502845 DOI: 10.1016/s0140-6736(22)00625-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes. METHODS In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480. FINDINGS 46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions. INTERPRETATION The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. FUNDING None.
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Affiliation(s)
- Caroline K Kramer
- Department of Medicine, Division of Endocrinology, University of Toronto, Toronto, ON, Canada; Leadership Sinai Centre for Diabetes and Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
| | - Cristiane B Leitão
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana V Viana
- Serviço de Nutrologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Cardoso AM, Tavares IDN, Werneck GL. Indigenous health in Brazil: from vulnerable to protagonists. Lancet 2022; 400:2011-2014. [PMID: 36502826 DOI: 10.1016/s0140-6736(22)02419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz, Rio de Janeiro, 21041-210, Brazil.
| | - Inara do Nascimento Tavares
- Instituto Insikiran de Formação Superior Indígena/UFRR, Boa Vista, Brazil; Programa de Pós-Graduação de Ciências Sociais em Desenvolvimento, Agricultura e Sociedade-CPDA/UFRRJ, Rio de Janeiro, Brazil
| | - Guilherme Loureiro Werneck
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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de Aguiar MF, Meireles BM, Monteiro WM, Gonçalves MJF. Malaria in indigenous and non-indigenous patients aged under 15 years between 2007-2018, Amazonas state, Brazil. Rev Soc Bras Med Trop 2022; 55:e06172021. [PMID: 36287509 PMCID: PMC9592102 DOI: 10.1590/0037-8682-0617-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Malaria is a serious problem in children because the immune system is less developed, thus, causing more severe symptoms. This study aimed to identify factors associated with malaria in indigenous and non-indigenous patients aged under 15 years in Amazonas, Brazil, from 2007 to 2018. METHODS An epidemiological, quantitative, cross-sectional study was conducted. Cases included patients aged under 15 years, using data from health system notifications between 2007 and 2018 in the state of Amazonas, Brazil. The variables included clinical-epidemiological, laboratory findings, and monitoring of cases. The outcome was ethnicity: indigenous, non-indigenous, and entries for which no ethnicity data were provided. A multivariable logistic regression model was used to compare the indigenous and non-indigenous populations. RESULTS Among malaria cases in patients aged under 15 years, there was a greater chance of being indigenous and having the following associated factors: female sex, children aged 0-4 years, passive case surveillance, a high load of parasitemia and the lack of data regarding the level of parasitemia, Plasmodium falciparum infections were more frequent, and timeliness of treatment, i.e., the interval between the onset of symptoms and time of treatment was within 48 hours. CONCLUSIONS The factors associated with malaria are more frequent in indigenous populations and highlight differences according to ethnicity, suggesting that the severity of the disease is attributable to the increased number of malarial infections within this population. As a result, malaria has a greater impact on the health of indigenous people.
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Affiliation(s)
| | | | - Wuelton Marcelo Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus,
AM, Brasil., Universidade do Estado do Amazonas, Manaus, AM, Brasil
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12
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Rebouças P, Goes E, Pescarini J, Ramos D, Ichihara MY, Sena S, Veiga R, Rodrigues LC, Barreto ML, Paixão ES. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies. Lancet Glob Health 2022; 10:e1453-e1462. [PMID: 36113530 PMCID: PMC9638038 DOI: 10.1016/s2214-109x(22)00333-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
| | - Emanuelle Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Samila Sena
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael Veiga
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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13
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Sansone NMS, Boschiero MN, Ortega MM, Ribeiro IA, Peixoto AO, Mendes RT, Marson FAL. Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100177. [PMID: 35018359 PMCID: PMC8739500 DOI: 10.1016/j.lana.2021.100177] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals. Methods The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05. Findings A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2(7)=65.187; P-value<0.001]. Among the patients’ features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2(9)=293.694; P-value<0.001]. Among the patients’ features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)]. Interpretation The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).
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Key Words
- %, Percentage
- 95%CI, 95% Confidence Interval
- COVID-19
- COVID-19, Coronavirus Disease (2019)
- Ethnicity
- H1N1, H1N1 Strain of the Flu (Influenzae) virus
- HRCT, High-Resolution Computed Tomography
- ICU, Intensive Care Unit
- Indigenous
- Intensive Care Unit
- MV, Mechanical Ventilation
- NA, Not Applicable
- OEA, Other Etiologic Agents
- OR, Odds Ratio
- Pandemic
- RT-PCR, Real Time-Polymerase Chain Reaction
- Race
- Respiratory Disease
- SAH, Systemic Arterial Hypertension
- SARS, Severe Acute Respiratory Syndrome
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SIVEP-Gripe, Information System for Epidemiological Surveillance of Influenza (Sistema de Informação de Vigilância Epidemiológica da Gripe)
- SUS, Sistema Único de Saúde (Brazilian Public Health System)
- Severe Acute Respiratory Syndrome
- Virus
- y.o., Years Old
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Affiliation(s)
- Nathália M S Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Matheus N Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | - Manoela M Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Isadora A Ribeiro
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Andressa O Peixoto
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Roberto T Mendes
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Fernando A L Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
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Maciel JAC, Monteiro AKA, Pará JWDS, Sousa JR, Castro-Silva II. “Com dor de dente, tudo é ruim nesta vida!”: saúde bucal na comunidade indígena de Tremembé, Ceará, Brasil. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2022. [DOI: 10.1590/interface220239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Este estudo teve por objetivo analisar a importância do cuidado em saúde bucal de informantes da comunidade indígena Tremembé, em Itarema, Ceará, Brasil. Neste estudo exploratório de caráter qualitativo, foram realizadas entrevistas semiestruturadas com seis adultos considerados informantes-chave da comunidade. As percepções mais presentes nos discursos indicaram o reconhecimento da importância no cuidado em saúde bucal, com foco na higiene dentária, necessária para a socialização. As falas relacionaram a valorização da alimentação saudável, associada à boa qualidade da saúde bucal, com a valorização do conhecimento tradicional como prática de cuidado. No entanto, os discursos apresentaram uma focalização na assistência clínica para adultos, em detrimento de aspectos educativos. As percepções revelaram potencial para integração de cuidados dos profissionais de saúde e dos atores sociais que possuem papel de liderança na comunidade indígena.
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15
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Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022; 9:2227-2236. [PMID: 34581998 PMCID: PMC8477716 DOI: 10.1007/s40615-021-01162-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/29/2022]
Abstract
This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018-1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.
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Maciel JAC, Monteiro AKA, Pará JWDS, Sousa JR, Castro-Silva II. “With a toothache, everything seems to be bad in life!”: oral health in the indigenous community of Tremembé, Ceará, Brazil. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2022. [DOI: 10.1590/interface220567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to analyze the importance of oral healthcare in the Tremembé indigenous community, municipality of Itarema, state of Ceará, Brazil. In this exploratory and qualitative study, semi-structured interviews were carried out with six adults considered key informants in the community. The perceptions most frequently found in the discourses indicated that the informants recognize the importance of oral healthcare and focus on dental hygiene, necessary for socialization. The discourses related valuation of healthy eating - associated with good oral health - to valuation of traditional knowledge as a care practice. However, the discourses focused on clinical care for adults at the expense of educational aspects. The perceptions showed that it is possible to int egrate the care delivered by health professionals with the care provided by social actors who have a leadership role in the indigenous community.
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Oliveira MVG, Abreu ÂMM, Welch JR, Coimbra CEA. Coping with Hypertension among Indigenous Peoples in Brazil and the Role of the Primary Care Nurse: A Critical Review from a Transcultural Perspective. NURSING REPORTS 2021; 11:942-954. [PMID: 34968280 PMCID: PMC8715468 DOI: 10.3390/nursrep11040086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022] Open
Abstract
Our objective is to critically review the literature addressing the strategic role of nurses in the daily primary care of arterial hypertension in Indigenous communities in Brazil. We selected studies based on an initial keyword search of major bibliographic indexing databases for the years 2000 to 2020 and manual search. Further selection was based on topical, methodological, and thematic relevance, as well as evaluation of scholarship quality and pertinence to our chosen narrative. The literature demonstrates Indigenous peoples do not receive health services that measure up to national standards in large part due to a marked lack of academic and employer preparation for nurses operating in transcultural settings. Inequities were apparent in recurrent reports of victim-blaming, deficient clinical communication with patients, clinical malpractice, devaluation of hypertension as a problem for Indigenous peoples, insufficient intercultural training for nurses, and discrimination against Indigenous students in nursing education programs. This systemic problem needs to be addressed by universities and the Indigenous Health Care Subsystem in Brazil.
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Affiliation(s)
| | - Ângela Maria Mendes Abreu
- Escola de Enfermagem Anna Nery, Universidade Federal de Rio de Janeiro, Rio de Janeiro 20211-130, Brazil;
| | - James R. Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
| | - Carlos E. A. Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21041-210, Brazil; (J.R.W.); (C.E.A.C.J.)
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18
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de Campos MB, Santos RV, Vilela EM, de Noronha CLA, da Silva LO, Coimbra Jr CEA, Bastos JL, Welch JR. Indigenous migration patterns in Brazil based on the 2010 national demographic census: analysis and critical reflection. SN SOCIAL SCIENCES 2021; 1:257. [PMID: 34723200 PMCID: PMC8549969 DOI: 10.1007/s43545-021-00264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Research in several Latin American countries points to violence, loss of traditional territories, and seeking education, health, and wage labor as key variables in triggering rural-urban migration among Indigenous people. This study presents an analysis of the migration patterns of Indigenous people in Brazil, compared to non-indigenous people, based on data from the most recent national census, conducted in 2010. Migration characteristics related to lifetime migration and recent migration were investigated by means of descriptive and multivariable logistic regression analyses. The findings pointed to complex mobility scenarios according to migrants' Indigenous status and geographical regions of origin and destination. Indigenous people living in urban areas presented high levels of mobility (approximately 50% lived in different municipalities from those where they were born), which were more pronounced than those of non-Indigenous people. Indigenous people living in rural areas presented the lowest levels of migration (approximately 90% residing in their municipality of birth). Statistical modeling confirmed the patterns observed in descriptive analysis, highlighting the marked mobility of Indigenous subjects in urban areas. We emphasize the limitations of using census data for characterizing Indigenous mobility profiles, although no other nationally representative data are available. The finding that the Indigenous population living in urban areas presents rates of migration higher than their non-Indigenous counterparts is particularly important for the planning and implementation of a broad range of public policies aimed at ethnic minorities in the country, including health, education, and housing initiatives.
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Affiliation(s)
- Marden Barbosa de Campos
- Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil
| | | | - Elaine Meire Vilela
- Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Belo Horizonte, MG Brazil
| | | | | | | | - João Luiz Bastos
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC Brazil
| | - James R. Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ Brazil
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Kempton JW, Périssé ARS, Hofer CB, de Vasconcellos ACS, de Sousa Viana PV, de Oliveira Lima M, de Jesus IM, de Souza Hacon S, Basta PC. An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10091. [PMID: 34639393 PMCID: PMC8508331 DOI: 10.3390/ijerph181910091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/04/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.
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Affiliation(s)
| | - André Reynaldo Santos Périssé
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Cristina Barroso Hofer
- Instituto de Pediatria e Puericultura Martagão Gesteira, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro 21941-912, Brazil;
| | - Ana Claudia Santiago de Vasconcellos
- Laboratório de Educação Profissional em Vigilância em Saúde, Escola Politécnica de Saúde Joaquim Venân-cio, Fundação Oswaldo Cruz (EPSJV/Fiocruz), Av. Brasil, 4365, Manguinhos, Rio de Janeiro 21040-900, Brazil;
| | - Paulo Victor de Sousa Viana
- Centro de Referência Professor Hélio Fraga, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (CRPHF/ENSP/Fiocruz), Estrada de Curicica, 2000, Curicica, Rio de Janeiro 22780-195, Brazil;
| | - Marcelo de Oliveira Lima
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Iracina Maura de Jesus
- Seção de Meio Ambiente, Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (SEAMB/IEC/SVS/MS), Rodovia BR-316 km 7 s/n, Levilândia 67030-000, Brazil; (M.d.O.L.); (I.M.d.J.)
| | - Sandra de Souza Hacon
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
| | - Paulo Cesar Basta
- Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP/Fiocruz), Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro 21041-210, Brazil; (A.R.S.P.); (S.d.S.H.)
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Snakebites in Rural Areas of Brazil by Race: Indigenous the Most Exposed Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179365. [PMID: 34501955 PMCID: PMC8431164 DOI: 10.3390/ijerph18179365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/28/2021] [Accepted: 09/03/2021] [Indexed: 01/02/2023]
Abstract
Animal stings are environmental hazards that threaten millions annually and cause a significant socioeconomic impact. Snakebite envenoming affects 2.7 million people globally every year, mostly the poorest and rural communities, with approximately 27,000 annual cases in Brazil. This study’s objective is to identify the most exposed racial group for snakebites in rural areas of Brazil and analyze possible differences in the outcome of an accident. A retrospective epidemiological study was conducted using a database of rural snakebite cases from Brazil’s Ministry of Health (2017). Descriptive analysis and a regression model were performed to examine the association of bad outcomes after a snakebite with several covariables. While mixed-race individuals presented the highest number of cases (61.79%), indigenous and white populations were the racial groups with the highest and lowest exposure rates (194.3 and 34.1 per 100,000 population, respectively). The fatality rate was 3.5 times higher in the indigenous population compared to the white population. In the multivariable model, the number of hours between the accident and health care received and the case classification suggested an association with a bad outcome. Snakebite is prominent in Brazil, particularly among indigenous groups. Antivenom is available in the Brazilian Health System; however, efforts need to be made for decentralization.
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21
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Alves FTA, Prates EJS, Carneiro LHP, Sá ACMGND, Pena ÉD, Malta DC. Mortalidade proporcional nos povos indígenas no Brasil nos anos 2000, 2010 e 2018. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202113010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do estudo foi analisar a mortalidade indígena no Brasil em 2000, 2010 e 2018. Estudo descritivo com dados do Sistema de Informação sobre Mortalidade. Calculou-se a mortalidade proporcional entre indígenas e restante da população brasileira, segundo idade, sexo, causa e regiões do Brasil. A proporção de óbitos em indígenas menores de 1 ano em 2000, 2010 e 2018 foi de 15,3%, 17,7% e 16,2%; e no restante do Brasil, foi de 7,2%, 3,5% e 2,7% respectivamente. A proporção de óbitos a partir de 50 anos nos indígenas nos mesmos anos foi de 47,0%, 48,1% e 52,0%; e no restante do Brasil, foi de 66,8%, 74,4% e 79,4%. Em 2018, indígenas menores de 1 ano morreram mais de afecções perinatais (39,4%), doenças infecciosas e parasitárias (10,1%) e causas externas (9,8%). Em menores de 1 ano do restante da população brasileira, essas causas corresponderam a 57,8%, 3,8% e 2,8%. Indígenas acima de 50 anos morreram mais por doenças circulatórias (28,6%), respiratórias (15,4%) e neoplasias (14,6%); e no restante da população brasileira, essas causas representaram 31,5%, 13,6% e 19,0%. Evidenciaram-se desigualdades em saúde e piores indicadores nos povos indígenas no Brasil.
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Flores-Ramírez R, Berumen-Rodríguez AA, Martínez-Castillo MA, Alcántara-Quintana LE, Díaz-Barriga F, Díaz de León-Martínez L. A review of Environmental risks and vulnerability factors of indigenous populations from Latin America and the Caribbean in the face of the COVID-19. Glob Public Health 2021; 16:975-999. [PMID: 33966608 DOI: 10.1080/17441692.2021.1923777] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Latin America and the Caribbean (LAC) was declared a new epicentre of the coronavirus pandemic by the World Health Organization (WHO) on 22 May 2020. As of 13 January 2021, the numbers of deaths and cases caused by COVID-19 in LAC reported are 552,000 and 17'485,000 respectively. LAC concentrates the largest percentage of indigenous populations throughout the world. In this region, poverty is persistent and particularly rural indigenous peoples hold the steepest barriers to health services and experience profound discrimination based on ethnicity, poverty, and language, compared to their non-indigenous counterparts. The information regarding the health of indigenous populations, in general, is scarce, and this problem is aggravated in the face of the COVID-19 pandemic. Therefore, the main objective of this work is to address the overall scenario of indigenous peoples in the Latin American and Caribbean region from March 2020 to January 2021, in this manner gathering information regarding health problems, economic, social, cultural and environmental factors that make indigenous populations in LAC particularly vulnerable to serious health effects from the COVID-19 pandemic, as well as compiling the mitigation strategies implemented in indigenous communities.
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Affiliation(s)
- Rogelio Flores-Ramírez
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), San Luis Potosí, México
| | | | | | - Luz Eugenia Alcántara-Quintana
- CONACYT Research Fellow, Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología (CIACYT), San Luis Potosí, México
| | - Fernando Díaz-Barriga
- Centro de Investigación Aplicada en Ambiente y Salud (CIAAS), San Luis Potosí, México
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23
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McCambridge AB, Elkins MR. If we can't see race and ethnicity in research, how will we see racial inequality? J Physiother 2021; 67:82-83. [PMID: 33744189 DOI: 10.1016/j.jphys.2021.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Alana B McCambridge
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia.
| | - Mark R Elkins
- Editor, Journal of Physiotherapy; Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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24
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Ferreira AA, Souza MCD, Cardoso AM, Horta BL, Santos RV, Welch JR, A Coimbra CE. Birth weight of indigenous children in Brazil: results of the First National Survey of Indigenous People's Health and Nutrition. CAD SAUDE PUBLICA 2021; 37:e00228120. [PMID: 33440414 DOI: 10.1590/0102-311x00228120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
Birth weight is an important predictor of perinatal, infant, and preschool-age children morbimortality. However, information about indigenous children's birth weight is still scarce. This study aimed to analyze the birth weight of indigenous children based on data from the First National Survey of Indigenous People's Health and Nutrition, Brazil (2008-2009). This is the first study to address indigenous children's birth weight based on a nationwide representative sample. Mean birth weights and the respective standard deviations were calculated according to geopolitical region, sex, type of birth, and birthplace. The chi-square test was used to analyze differences in proportions, and Kruskal-Wallis and Mann-Whitney U tests in means, considering sample design and data normality. We found no records on birth weight in the researched documents for 26.7% of the 6,128 sampled children. The mean birth weight for the 3,994 children included in the analyses was 3,201g (standard deviation - SD ± 18.6g), regardless of sex, type of birth, and birthplace. The prevalence of low birth weight was 7.6% (n = 302) and was significantly higher among girls. Boys presented significantly higher mean birth weight than girls, regardless of the geopolitical region. Low birth weight was slightly less frequent among indigenous children when compared to Brazilian children in general. Our study indicates the need to improve prenatal care and the quality of consultation records for indigenous women as a strategy to promote safe pregnancy and childbirth.
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Affiliation(s)
- Aline Alves Ferreira
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Andrey Moreira Cardoso
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Bernardo Lessa Horta
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | - Ricardo Ventura Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - James R Welch
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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25
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Deaconu A, Mercille G, Batal M. Promoting traditional foods for human and environmental health: lessons from agroecology and Indigenous communities in Ecuador. BMC Nutr 2021; 7:1. [PMID: 33413686 PMCID: PMC7792355 DOI: 10.1186/s40795-020-00395-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 10/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The displacement of traditional dietary practices is associated with negative nutritional consequences for rural Indigenous people, who already face the brunt of both nutritional inadequacies and excesses. Traditional food (TF) consumption and production practices can improve nutritional security by mitigating disruptive dietary transitions, providing nutrients and improving agricultural resilience. Meanwhile, traditional agricultural practices regenerate biodiversity to support healthy ecosystems. In Ecuador, Indigenous people have inserted TF agricultural and dietary practices as central elements of the country's agroecological farming movement. This study assesses factors that may promote TF practices in rural populations and explores the role of agroecology in strengthening such factors. METHODS Mixed methods include a cross-sectional comparative survey of dietary, food acquisition, production and socioeconomic characteristics of agroecological farmers (n = 61) and neighboring reference farmers (n = 30) in Ecuador's Imbabura province. Instruments include 24-h dietary recall and a food frequency questionnaire of indicator traditional foods. We triangulate results using eight focus group discussions with farmers' associations. RESULTS Compared to their neighbors, agroecological farmers produce and consume more TFs, and particularly underutilized TFs. Farm production diversity, reliance on non-market foods and agroecology participation act on a pathway in which TF production diversity predicts higher TF consumption diversity and ultimately TF consumption frequency. Age, income, market distance and education are not consistently associated with TF practices. Focus group discussions corroborate survey results and also identify affective (e.g. emotional) and commercial relationships in agroecological spaces as likely drivers of stronger TF practices. CONCLUSIONS Traditional food practices in the Ecuadorian highlands are not relics of old, poor and isolated populations but rather an established part of life for diverse rural people. However, many TFs are underutilized. Sustainable agriculture initiatives may improve TF practices by integrating TFs into production diversity increases and into consumption of own production. Agroecology may be particularly effective because it is a self-expanding global movement that not only promotes the agricultural practices that are associated with TF production, but also appears to intensify affective sentiments toward TFs and inserts TFs in commercial spaces. Understanding how to promote TFs is necessary in order to scale up their potential to strengthen nutritional health.
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Affiliation(s)
- Ana Deaconu
- Transnut WHO Collaborating Centre on Nutrition Changes and Development at Université de Montréal, Faculty of Medicine, Nutrition Department, 2900, boul. Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada.
- Centre de Recherche en Santé Publique (CReSP), 7101, avenue du Parc, Montréal, Québec, H3N, 1X9, Canada.
| | - Geneviève Mercille
- Transnut WHO Collaborating Centre on Nutrition Changes and Development at Université de Montréal, Faculty of Medicine, Nutrition Department, 2900, boul. Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
- Centre de Recherche en Santé Publique (CReSP), 7101, avenue du Parc, Montréal, Québec, H3N, 1X9, Canada
| | - Malek Batal
- Transnut WHO Collaborating Centre on Nutrition Changes and Development at Université de Montréal, Faculty of Medicine, Nutrition Department, 2900, boul. Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
- Centre de Recherche en Santé Publique (CReSP), 7101, avenue du Parc, Montréal, Québec, H3N, 1X9, Canada
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26
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Fellows M, Paye V, Alencar A, Nicácio M, Castro I, Coelho ME, Silva CVJ, Bandeira M, Lourival R, Basta PC. Under-Reporting of COVID-19 Cases Among Indigenous Peoples in Brazil: A New Expression of Old Inequalities. Front Psychiatry 2021; 12:638359. [PMID: 33912084 PMCID: PMC8071995 DOI: 10.3389/fpsyt.2021.638359] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: To estimate the incidence, mortality and lethality rates of COVID-19 among Indigenous Peoples in the Brazilian Amazon. Additionally, to analyze how external threats can contribute to spread the disease in Indigenous Lands (IL). Methods: The Brazilian Amazon is home to nearly half a million Indigenous persons, representing more than 170 ethnic groups. As a pioneer in heading Indigenous community-based surveillance (I-CBS) in Brazil, the Coordination of the Indigenous Organizations of the Brazilian Amazon (COIAB) started to monitor Indigenous COVID-19 cases in March of 2020. Brazil's Ministry of Health (MOH) was the main source of data regarding non-Indigenous cases and deaths; to contrast the government's tally, we used the information collected by I-CBS covering 25 Special Indigenous Sanitary Districts (DSEI) in the Brazilian Amazon. The incidence and mortality rates of COVID-19 were calculated using the total number of new cases and deaths accumulated between the 9th and 40th epidemiological weeks. We studied (a) the availability of health care facilities to attend to Indigenous Peoples; (b) illegal mines, land grabbing, and deforestation to perform a geospatial analysis to assess how external threats affect Indigenous incidence and mortality rates. We used the Generalized Linear Model (GLM) with Poisson regression to show the results. Results: MOH registered 22,127 cases and 330 deaths, while COIAB's survey recorded 25,356 confirmed cases and 670 deaths, indicating an under-reporting of 14 and 103%, respectively. Likewise, the incidence and mortality rates were 136 and 110% higher among Indigenous when compared with the national average. In terms of mortality, the most critical DSEIs were Alto Rio Solimões, Cuiabá, Xavante, Vilhena and Kaiapó do Pará. The GLM model reveals a direct correlation between deforestation, land grabbing and mining, and the incidence of cases among the Indigenous. Conclusion: Through this investigation it was possible to verify that not only the incidence and mortality rates due to COVID-19 among Indigenous Peoples are higher than those observed in the general population, but also that the data presented by the federal government are underreported. Additionally, it was evident that the presence of illegal economic activities increased the risk of spreading COVID-19 in ILs.
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Affiliation(s)
- Martha Fellows
- Amazon Environmental Research Institute, Brasilia, Brazil
| | - Valéria Paye
- Coordination of the Indigenous Organizations of the Brazilian Amazon, Manaus, Brazil
| | - Ane Alencar
- Amazon Environmental Research Institute, Brasilia, Brazil
| | - Mário Nicácio
- Coordination of the Indigenous Organizations of the Brazilian Amazon, Manaus, Brazil
| | - Isabel Castro
- Amazon Environmental Research Institute, Brasilia, Brazil
| | - Maria Emília Coelho
- Coordination of the Indigenous Organizations of the Brazilian Amazon, Manaus, Brazil.,University of Brasilia, Latin American Studies, Brasilia, Brazil
| | - Camila V J Silva
- Amazon Environmental Research Institute, Brasilia, Brazil.,Lancaster Environment Centre, Lancaster, United Kingdom
| | | | - Reinaldo Lourival
- Nature and Culture International, Brasilia, Brazil.,International Institute of Education of Brazil, Brasilia, Brazil
| | - Paulo Cesar Basta
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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27
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Moreto Santos C, Palinkas M, Mestriner-Júnior W, Hallak Regalo I, Batista de Vasconcelos P, José Dias F, Eduardo Cecilio Hallak J, Siéssere S, Cecilio Hallak Regalo S. Stomathognatic system function in indigenous people from Brazilian Xingu villages: An electromyographic analysis. PLoS One 2020; 15:e0243495. [PMID: 33320876 PMCID: PMC7737974 DOI: 10.1371/journal.pone.0243495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
The maintenance of postural balance can be influenced by the lifestyle of a population. This study aimed to determine the electromyographic activity of the masseter and temporalis muscles during mandibular tasks and habitual and non-habitual chewing in indigenous individuals to reveal the differences among white Brazilian individuals. Sixty Brazilians (18 and 28 years) were divided into two groups: 30 Xingu indigenous individuals and 30 white Brazilian individuals, with 20 men and 10 women in each group. The individuals were assessed using the normalized electromyographic activity of mandibular tasks (rest, protrusion, right and left laterality) and electromyographic activity of masticatory cycles in habitual (peanuts and raisins) and non-habitual (Parafilm M) chewing. Data were analyzed using Student's t-test (p < .05). Comparisons between the groups demonstrated significant differences. Indigenous individuals group presented a decrease in the normalized electromyographic activity of the masticatory muscles during mandibular rest [right masseter (p = .002) and left masseter (p = .004) muscles]. There was increase in the normalized electromyographic activity during protrusion [left temporal (p = .03) muscle]. There was increase in the electromyographic activity during chewing: peanuts [right masseter (p = .001), left masseter (p = .001) and right temporal (p = .01) muscles], raisins [right masseter (p = .001), left masseter (p = .002), right temporal (p = .008), left temporal (p = .01) muscles] and Parafilm M [left masseter muscle (p = .05)]. From the findings of this study, we concluded that in the comparison between indigenous and white individuals, positive changes were observed in the electromyographic pattern of the masticatory muscles in the mandibular postural conditions, with greater masticatory efficiency in the indigenous group.
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Affiliation(s)
- Carla Moreto Santos
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marcelo Palinkas
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Nursing, Faculty Anhanguera, Ribeirão Preto, Brazil
- Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo and National Institute and Technology - Translational Medicine (INCT.TM), Ribeirão Preto - São Paulo, Brazil
- * E-mail:
| | - Wilson Mestriner-Júnior
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Isabela Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo and National Institute and Technology - Translational Medicine (INCT.TM), Ribeirão Preto - São Paulo, Brazil
| | - Paulo Batista de Vasconcelos
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fernando José Dias
- Department of Integral Adults Dentistry, Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
| | - Jaime Eduardo Cecilio Hallak
- Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo and National Institute and Technology - Translational Medicine (INCT.TM), Ribeirão Preto - São Paulo, Brazil
| | - Selma Siéssere
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo and National Institute and Technology - Translational Medicine (INCT.TM), Ribeirão Preto - São Paulo, Brazil
| | - Simone Cecilio Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Neuroscience and Behavioral Sciences, Faculty of Medicine of Ribeirão Preto, University of São Paulo and National Institute and Technology - Translational Medicine (INCT.TM), Ribeirão Preto - São Paulo, Brazil
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Barreto CTG, Tavares FG, Theme-Filha M, Farias YN, Pantoja LDN, Cardoso AM. Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani). BMC Pregnancy Childbirth 2020; 20:748. [PMID: 33267830 PMCID: PMC7709282 DOI: 10.1186/s12884-020-03396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRATO FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica. RESULTADOS As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.
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Affiliation(s)
- Carla Tatiana Garcia Barreto
- Universidade do Estado do Rio de Janeiro (UERJ), Av. Marechal Rondon, 381. São Francisco Xavier, Rio de Janeiro, RJ, CEP: 20950-000, Brazil.
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Felipe Guimarães Tavares
- Escola de Enfermagem Aurora de Afonso Costa. Faculdade de Enfermagem, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Mariza Theme-Filha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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29
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Santos RV, Pontes AL, Coimbra CEA. A "total social fact": COVID-19 and indigenous peoples in Brazil. CAD SAUDE PUBLICA 2020; 36:e00268220. [PMID: 33027432 DOI: 10.1590/0102-311x00268220] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ricardo Ventura Santos
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Lucia Pontes
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Shimabuku RL, Delgado CA, Nakachi G, Teruya AA, Velasquez PM. Double Burden of Excess Weight and Anemia in Latin American Children up to 2019. TOHOKU J EXP MED 2020; 252:159-168. [PMID: 33041315 DOI: 10.1620/tjem.252.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The double burden of malnutrition is the coexistence of two different conditions, mainly reflected as excess or deficit in weight. Anemia is a specific nutritional deficit not always included in the double burden assessment. We reviewed overweight and/or obesity (OW/OB) and anemia studies from Latin-American Children over the last ten years up to 2019. Two authors evaluated the MEDLINE, SCOPUS, and LILACS databases. A scale of ten questions was used to assess the risk of bias in prevalence studies. Fourteen studies were selected. The population studies' size ranged from 147 to 20,342 children with different socio-economic backgrounds, such as urban, peri-urban and rural settings, socio-economic status, schooling, population (ethnic minorities and indigenous), and environmental differences (sea level or high altitude). The prevalence of OW/OB ranged from 4.9% to 42%. The prevalence of anemia was from 3.4% to 67%. The double burden, including OW/OB and anemia, ranged from 0.7% to 67%. A higher prevalence of excess weight and anemia was found in rural and high altitude above sea level environments, extreme poverty, low education level, and indigenous communities. These heterogeneous data, before the 2020 (COVID-19 pandemic), reflect the vast inequities between countries and within each country. Food insecurity linked to poverty and the induced change in eating habits and lifestyles threaten optimal child nutrition in ongoing and future scenarios. The existence of OW/OB and anemia and their simultaneous coexistence in the community, home, and individual levels, indicates that interventions should be comprehensive to face the double burden of malnutrition.
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Affiliation(s)
- Roberto L Shimabuku
- Department of Pediatrics, Faculty of Medicine, Universidad Nacional Mayor de San Marcos
| | - Carlos A Delgado
- Department of Pediatrics, Faculty of Medicine, Universidad Nacional Mayor de San Marcos
- Neonatal Unit, Instituto Nacional de Salud del Niño
| | | | - Alberto A Teruya
- Department of Endocrinology, Hospital Edgardo Rebagliati Martins
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Raupp L, Cunha GM, Fávaro TR, Santos RV. Sanitation conditions of indigenous and nonindigenous households in Brazil according the 2000 and 2010 national censuses. CIENCIA & SAUDE COLETIVA 2020; 25:3753-3763. [PMID: 32997009 DOI: 10.1590/1413-812320202510.04602019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/08/2019] [Indexed: 11/22/2022] Open
Abstract
This study compares the availability of basic sanitation infrastructure in indigenous and nonindigenous household located in urban and rural areas using data from the 2000 and 2010 Brazilian National Censuses. The analyses were based on descriptive statistics and modelling with multiple logistic regression. While there was an increase in the availability of basic sanitation in Brazilian households over the decade, indigenous households continued to have worse conditions in 2010. Sewage was the sanitation service with the lowest coverage in both censuses, and indigenous households had a lower rate of sewage services than nonindigenous households did. Logistic regression results confirmed the findings of the descriptive analyses, attesting to the fact that sanitation conditions are worse in indigenous households. In some areas, such as the urban North and Southeast and rural areas of the Central-West region, the gap in basic sanitation infrastructure between indigenous and nonindigenous households increased from 2000 to 2010. This study not only indicates the less-adequate sanitation conditions in indigenous households in Brazil but also attests to the persistence of major inequalities associated with race or color in the country.
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Affiliation(s)
- Ludimila Raupp
- Pontifícia Universidade Católica do Rio de Janeiro. R. Marquês de São Vicente 225, Gávea. 22451-900 Rio de Janeiro RJ Brasil.
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Báscolo E, Houghton N, Del Riego A. Leveraging household survey data to measure barriers to health services access in the Americas. Rev Panam Salud Publica 2020; 44:e100. [PMID: 32821260 PMCID: PMC7429927 DOI: 10.26633/rpsp.2020.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/02/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify advantages and challenges of using household survey data to measure access barriers to health services in the Americas and to report findings from most recent surveys. METHODS Descriptive cross-sectional study using data retrieved from publicly available nationally representative household surveys carried out in 27 countries of the Americas. Values for indicators of access barriers for forgone care were generated using available datasets and reports from the countries. Results were disaggregated by wealth quintiles according to income or asset-based wealth levels. RESULTS Most surveys were similar in general approach and in the categories of their content. However, country-specific questionnaires varied by country, which hindered cross-country comparisons. On average, about one-third of people experienced multiple barriers to forgone appropriate care. There was great variability between countries in the experience of these barriers, although disparities were relatively consistent across countries. People in the poorest wealth quintile were more likely to experience barriers related to acceptability issues, financial and geographic access, and availability of resources. CONCLUSIONS The analysis indicates major inequalities by wealth status and uneven progress in multiple access barriers that hinder progress towards the goals of equity as part of the Sustainable Development Goals and universal health in the Americas. Access barriers were multiple, which highlights the need for integrated and multisectoral approaches to tackle them. Given the variability between instruments across countries, future efforts are needed to standardize questionnaires and improve data quality and availability for regional monitoring of access barriers.
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Affiliation(s)
- Ernesto Báscolo
- Pan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaPan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Natalia Houghton
- Pan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaPan American Health Organization/World Health Organization, Washington, DC, United States of America.
| | - Amalia Del Riego
- Pan American Health Organization/World Health OrganizationWashington, DCUnited States of AmericaPan American Health Organization/World Health Organization, Washington, DC, United States of America.
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Lima JFB, Silva RAR, D'Eça Júnior A, Batista RFL, Rolim ILTP. Analysis of the mortality trend in the indigenous population of Brazil, 2000-2016. Public Health 2020; 186:87-94. [PMID: 32791342 DOI: 10.1016/j.puhe.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the study is to analyze the mortality trend in indigenous peoples in Brazil. STUDY DESIGN The study design used is an ecological study. METHODS A study carried out with data from the indigenous deaths recorded on the Mortality Information System in Brazil between 2000 and 2016. The Prais Winsten regression was used to analyze the trend of overall mortality in the country and in its geopolitical regions, in addition to the trend by sex, age groups, and groups of basic causes of death. RESULTS Of all deaths, 47,806 indigenous deaths were recorded between 2000 and 2016. The majority was male (56.5%) and 27.2% in children aged younger than 5 years. The major groups of causes of death were the circulatory diseases (15.8%) and external causes (14.9%). The affections of the perinatal period (23.7%) and infectious and parasitic diseases (18.5%) were the main causes in children aged younger than 5 years. The indigenous mortality rates showed an increasing trend in the country (annual percent change [APC] = 2.37%). There was growth in both sexes and in most age ranges. Mortality from external causes (APC = 4.71%), neoplasms (APC = 4.67%), and respiratory causes (APC = 4.14%) also presented growth. The infectious and parasitic causes and genitourinary causes showed a stable trend in the studied period. CONCLUSIONS The increasing trend of mortality in the analyzed variables showed disparities between indigenous and non-indigenous peoples in Brazil, pointing to the need for greater investment in basic social sectors, such as health, education, housing, and sanitation.
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Affiliation(s)
- J F B Lima
- Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.
| | - R A R Silva
- Department of Nursing, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - A D'Eça Júnior
- Department of Nursing, Federal University of Maranhão, São Luís, Maranhão, Brazil.
| | - R F L Batista
- Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.
| | - I L T P Rolim
- Department of Nursing, Federal University of Maranhão, São Luís, Maranhão, Brazil.
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Garnelo L, Parente RCP, Puchiarelli MLR, Correia PC, Torres MV, Herkrath FJ. Barriers to access and organization of primary health care services for rural riverside populations in the Amazon. Int J Equity Health 2020; 19:54. [PMID: 32731874 PMCID: PMC7394681 DOI: 10.1186/s12939-020-01171-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ways of life in the Amazon are diverse and not widely known. In addition, social inequities, large geographic distances and inadequate health care network noticeably limit access to health services in rural areas. Over the last decades, Brazilian health authorities have implemented fluvial mobile units (FMU) as an alternative to increase access and healthcare coverage. The aim of the study was to identify the strategies of access and utilization of primary health care (PHC) services by assessing the strengths and limitations of the healthcare model offered by the FMU to reduce barriers to services and ensure the right to healthcare. METHODS Qualitative and ethnographic research involving participant observation and semi-structured interviews. Data collection consisted of interviews with users and health professionals and the observation of service organization and healthcare delivered by the FMU, in addition to the therapeutic itineraries that determine demand, access and interaction of users with healthcare services. RESULTS Primary care is offered by the monthly locomotion of the FMU that serves approximately 20 rural riverside communities. The effectiveness of the actions of the FMU proved to be adequate for conditions such as antenatal care for low-risk pregnancy, which require periodic consultations. However, conditions that require continued attention are not adequately met through the organization of care established in the FMU. The underutilization of the workforce of community health workers and disarrangement between their tasks and those of the rest of the multi-professional team are some of the reasons pointed out, making the healthcare continuity unfeasible within the intervals between the trips of the FMU. From the users' perspective, although the presence of the FMU provides healthcare coverage, the financial burden generated by the pursuit for services persists, since the dispersed housing pattern requires the locomotion of users to reach the mobile unit services as well as for specialized care in the urban centers. CONCLUSIONS The implementation of the FMU represents an advance in terms of accessibility to PHC. However, the organization of their activity uncritically replicates the routines adopted in the daily routine of health services located in urban spaces, proving to be inadequate for providing healthcare strategies capable of mitigating social and health inequalities faced by the users.
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Affiliation(s)
- Luiza Garnelo
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Rosana Cristina Pereira Parente
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Maria Laura Rezende Puchiarelli
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Priscilla Cabral Correia
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Matheus Vasconcelos Torres
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil
| | - Fernando José Herkrath
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
- Programa de Pós-Graduação em Condições de Vida e Situações de Saúde na Amazônia, Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Rua Teresina, 476, Adrianópolis, Manaus, Amazonas, 69057-070, Brazil.
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Welch JR, Ferreira AA, Souza MCD, Coimbra CEA. Food Profiles of Indigenous Households in Brazil: Results of the First National Survey of Indigenous Peoples' Health and Nutrition. Ecol Food Nutr 2020; 60:4-24. [PMID: 33573410 DOI: 10.1080/03670244.2020.1781105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objective of the present study was to characterize the food profiles in Indigenous households participating in the First National Survey of Indigenous People's Health and Nutrition in Brazil. Multiple correspondence analysis was used to estimate distances between regions and foods from three sources (local Indigenous production, purchased, and external donation), in addition to "not consumed." The combined distribution of the first two dimensions revealed three distinct profiles of food acquisition. Observed proximities between geopolitical regions and distinct modes of food acquisition speak to regional contrasts in food sovereignty among the Indigenous population that are closely linked to historical occupation and economic expansion in the country. Considering the concept of food sovereignty as involving rights to dietary autonomy, healthy diets, and resource management, our data suggest Brazil's North region is the closest of the four regions analyzed to these goals. Food sovereignty in the Northeast and South/Southeast regions is reduced due to greater monetarization and proximity to market economy resources. The advance of agribusiness in the Amazon has been a hallmark of the Brazilian government's current environmental policy, directly threatening the survival of Indigenous peoples living in that region.
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Affiliation(s)
- James R Welch
- Escola Nacional De Saúde Pública, Fundação Oswaldo Cruz , Rio De Janeiro, Brazil
| | - Aline Alves Ferreira
- Instituto De Nutrição Josué De Castro, Universidade Federal Do Rio De Janeiro , Rio De Janeiro, Brazil
| | | | - Carlos E A Coimbra
- Escola Nacional De Saúde Pública, Fundação Oswaldo Cruz , Rio De Janeiro, Brazil
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Santos KMD, Tsutsui MLDS, Mazzucchetti L, Galvão PPDO, Granado FS, Rodrigues D, Tomita LY, Maia RDRP, Gimeno SGA. Agreement between nutritional status and perception of body image in indigenous Khisêdjê of the Xingu Indigenous Park. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200040. [PMID: 32491046 DOI: 10.1590/1980-549720200040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/03/2019] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE To determine the agreement between body self-image (based on the Stunkard figure rating scale) and nutritional status and to evaluate body satisfaction among the Khisêdjê indigenous people of Parque Indígena do Xingu (Xingu Indigenous Park). METHODS A cross-sectional study involving 131 natives aged 20 and older. Data on body image, body mass index and waist circumference were collected. Kappa statistics, χ2 (p < 0.05), crude and adjusted prevalence ratios and Student's t-test were used for data analysis. RESULTS The prevalence of overweight and obesity was respectively 42 and 5.3%. The percentage of satisfaction with body profile was 61.8% with no difference between the sexes. There was good agreement between actual and ideal self-image (p < 0.001), but poor agreement between actual and ideal self-image with nutritional status for both sexes. A higher prevalence of body dissatisfaction due to overweight was detected in individuals with central obesity and overweight. CONCLUSION The results suggest that body self-image evaluated by the Stunkard silhouette scale has little applicability as an indicator of nutritional status among the indigenous Khisêdjê of Xingu Indigenous Park.
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Affiliation(s)
- Kennedy Maia Dos Santos
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Lalucha Mazzucchetti
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Douglas Rodrigues
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Luciana Yuki Tomita
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Socioeconomic determinants of excess weight and obesity among Indigenous women: findings from the First National Survey of Indigenous People's Health and Nutrition in Brazil. Public Health Nutr 2020; 24:1941-1951. [PMID: 32476634 PMCID: PMC8094432 DOI: 10.1017/s1368980020000610] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: This article assesses the nutritional status of Indigenous women from 14 to 49 years of age in Brazil. Design: Sample size was calculated for each region considering a prevalence of 50 % for all disease outcomes, a relative error of 5 % and a CI of 95 %. In the initial data analysis, the prevalence of excess weight and obesity was calculated according to independent variables. Multivariate multilevel hierarchical analyses were conducted based on a theoretical model of two ranked blocks. Setting: The 2010 Indigenous population in Brazil was 896 000, with approximately 300 Indigenous ethnic groups, making Brazil one of the most ethnically diverse countries in the Americas and the world. Participants: Of the total target sample of 6722 women evaluated by the National Survey, thirty did not participate, 939 were not eligible for analyses due to pregnancy or unknown pregnancy status, and thirty-nine were excluded due to missing anthropometric data. Results: The evaluation of nutritional status was completed for 5714 non-pregnant women (99·3 % of eligible participants for this outcome). High prevalence rates were encountered for both excess weight (46·2 %) and obesity (15·8 %) among the sampled women. In the multivariate analyses, higher socioeconomic indicators, market-integrated living conditions and less reliance on local food production, as well as increased age and parity were associated with excess weight and obesity. Conclusion: Results point to distinct patterns of associations between socioeconomic indicators and the occurrence of excess weight and obesity among Indigenous women, which have potentially significant implications from a public policy perspective for Indigenous peoples in Brazil.
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Normando D, Barbosa MS, Mecenas P, Quintão C. Tooth wear as an indicator of acculturation process in remote Amazonian populations. PLoS One 2020; 15:e0230809. [PMID: 32315345 PMCID: PMC7173625 DOI: 10.1371/journal.pone.0230809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/09/2020] [Indexed: 12/03/2022] Open
Abstract
Riverine populations are typical of the Amazon region that depend on nature for subsistence. These people are considered an intermediate population between the urban and indigenous, the original Amazon habitants. The aim of this cross-sectional study was to evaluate the relationship between tooth wear and age in a remote riverine population from the Amazon, located by the Tucumanduba River (n = 94), and to compare them to previous findings obtained from semi-isolated indigenous (n = 223) and urban populations (n = 40) from the Amazon region, which were examined using the same methodology. Using linear regression, tooth wear explained 54.5% of the variation in the ages of the riverine subjects (p<0.001). This coefficient is mid-way between those obtained in semi-isolated indigenous populations (65–86%) and urban subjects (12%) living in the Amazon. Our findings suggest that tooth wear, a direct evidence of what an individual ate in the past, may be an indicator of the acculturation process in remote populations.
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Affiliation(s)
- David Normando
- Dental School, Department of Orthodontics, Federal University of Pará, Belém, Pará, Brazil
| | - Mayara Silva Barbosa
- Dental School, Department of Orthodontics, State University of Rio de Janeiro-UERJ, Rio de Janeiro, Brazil
| | - Paulo Mecenas
- Post-graduation Program of Dentistry, Federal University of Pará-UFPA, Belém, Pará, Brazil
| | - Cátia Quintão
- Dental School, Department of Orthodontics, State University of Rio de Janeiro-UERJ, Rio de Janeiro, Brazil
- * E-mail:
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Montiel J, Zuluaga LM, Aguirre DC, Segura C, Tobon-Castaño A, Vásquez AM. Microscopic and submicroscopic Plasmodium infections in indigenous and non-indigenous communities in Colombia. Malar J 2020; 19:157. [PMID: 32299449 PMCID: PMC7164158 DOI: 10.1186/s12936-020-03226-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The indigenous population is considered a highly susceptible group to malaria because individuals usually live in areas with high exposure to Anopheles and poverty, and have limited access to health services. There is a great diversity of indigenous communities in Colombia living in malaria-endemic areas; however, the burden of infection in these populations has not been studied extensively. This study aimed to determine the prevalence of Plasmodium infections in indigenous and non-indigenous communities in two malaria-endemic areas in Colombia. METHODS A community-based cross-sectional survey was conducted in seven villages of Turbo and El Bagre municipalities; three of these villages were indigenous communities. Inhabitants of all ages willing to participate were included. Sociodemographic and clinical data were recorded as well as household information. The parasitological diagnosis was performed by microscopy and nested PCR. The prevalence of microscopy and submicroscopic infection was estimated. An adjusted GEE model was used to explore risk factors associated with the infection. RESULTS Among 713 participants, 60.7% were from indigenous communities. Plasmodium spp. was detected in 30 subjects (4.2%, CI 95% 2.9-5.9); from those, 29 were in the indigenous population, 47% of infections were afebrile, and most of them submicroscopic (10/14). Microscopic and submicroscopic prevalence was 2.5% (CI 95% 1.6-3.9) and 1.7% (CI 95% 0.9-2.9), respectively. In El Bagre, all infections occurred in indigenous participants (3.9%, CI 95% 2.2-7.1), and 81% were submicroscopic. By contrast, in Turbo, the highest prevalence occurred in indigenous people (11.5%; CI 95%: 7.3-17.5), but 88.8% were microscopic. Living in an indigenous population increased the prevalence of infection compared with a non-indigenous population (PR 19.4; CI 95% 2.3-166.7). CONCLUSION There is a high proportion of Plasmodium infection in indigenous communities. A substantial proportion of asymptomatic and submicroscopic carriers were detected. The identification of these infections, not only in indigenous but also in the non-indigenous population, as well as their associated factors, could help to implement specific malaria strategies for each context.
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Affiliation(s)
- Jehidys Montiel
- Grupo Malaria-Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | - Lina M Zuluaga
- Grupo Malaria-Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | - Daniel C Aguirre
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Cesar Segura
- Grupo Malaria-Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | - Alberto Tobon-Castaño
- Grupo Malaria-Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia
| | - Ana M Vásquez
- Grupo Malaria-Facultad de Medicina, Universidad de Antioquia, Carrera 53 No. 61-30, Lab 610, Medellín, Colombia.
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Ortega F, Wenceslau LD. Challenges for implementing a global mental health agenda in Brazil: The "silencing" of culture. Transcult Psychiatry 2020; 57:57-70. [PMID: 32106796 DOI: 10.1177/1363461518824433] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Since its emergence in 2007, Global Mental Health has been a growing and polemic area of study, research and practice in mental health worldwide. Despite having a significant endogenous academic production and innovative policy experiences, the Brazilian mental health field and its actors make few references to, and scarcely dialogue with, the Global Mental Health agenda. This article explores an aspect of this divergence between Global Mental Health initiatives and public mental health care in Brazil regarding the role of culture within mental health policies and practices. Our hypothesis is that part of this difficulty can be attributed to the low relevance of the cultural dimension for the Brazilian mental health field, here referred to as the "silencing of culture." We examine the possible historical roots of this process with reference to theories of "anthropophagy" and "cultural uniformity" in the context of Brazilian cultural matrices. We then describe two recent experiences in public mental health care that incorporate cultural competence through the work of community health workers and the example of community therapy. We argue that the development of cultural competence can be decisive in enabling an improved dialogue between research and practice in Brazilian mental health and global mental health initiatives.
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Santos RV, Borges GM, Campos MBD, Queiroz BL, Coimbra CEA, Welch JR. Indigenous children and adolescent mortality inequity in Brazil: What can we learn from the 2010 National Demographic Census? SSM Popul Health 2020; 10:100537. [PMID: 31989016 PMCID: PMC6970167 DOI: 10.1016/j.ssmph.2020.100537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
Indigenous peoples worldwide are highly disadvantaged compared to national baseline populations. Given historical challenges to accessing relevant data for Brazil, the present study innovates by using 2010 Brazilian National Demographic Census data to estimate mortality curves in Indigenous children and adolescents <20 years. The non-parametric smoothing approach TOPALS (tool for projecting age-specific rates using linear splines) was employed. Analyses included stratifications by sex, rural or urban residence, and geopolitical region. The mortality of children and adolescents classified as Indigenous was higher for all analyzed strata. Mortality of Indigenous and non-Indigenous individuals in rural areas was higher than those in urban areas in almost all strata analyzed. Mortality levels in the Indigenous segment exceed those of children and adolescents classified as non-Indigenous in all four geopolitical regions, with few exceptions. This is the first study to compare mortality curves of children and adolescents in Brazil according to social variables based on national census data. More Indigenous children and adolescents die than their non-Indigenous counterparts, including those classified as black or brown, in both rural and urban residential settings. Indigenous children and adolescents are consistently at the most disadvantaged end of a marked gradient of ethnic-racial inequality in Brazil, independently of sex, age, and geopolitical region.
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Affiliation(s)
- Ricardo Ventura Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil.,Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Quinta da Boa Vista s/n, Rio de Janeiro, RJ, 20940-040, Brazil
| | - Gabriel Mendes Borges
- Instituto Brasileiro de Geografia e Estatística, Av. Presidente Antonio Carlos 25, Rio de Janeiro, RJ, 20020-010, Brazil
| | - Marden Barbosa de Campos
- Departamento de Sociologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Bernardo Lanza Queiroz
- Centro de Desenvolvimento e Planejamento Regional, Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil
| | - James R Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ, 21041-210, Brazil
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LEITE MS, FERREIRA AA, BRESAN D, ARAUJO JR, TAVARES IDN, SANTOS RV. Indigenous protagonism in the context of food insecurity in times of Covid-19. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e200171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT In Brazil, indigenous peoples present a complex reality characterized by a marked social vulnerability that is manifested in health and nutritional indicators. In this scenario, poor sanitary conditions prevail, with a high burden of chronic noncommunicable diseases; infectious/parasitic diseases; and nutritional disorders, including malnutrition and anemia. This situation is reflected in numerous aspects of food insecurity, placing this population in a position of particular vulnerability to the coronavirus disease 2019 pandemic and its effects. The objective of our study was to present a set of preliminary reflections on food insecurity and indigenous protagonism in times of Covid-19. The pandemic has deepened the inequalities that affect the indigenous peoples, with a direct impact on food security conditions. Amid the effects of the pandemic, indigenous protagonism has played a fundamental role in guaranteeing these peoples’ rights and access to food, denouncing the absent and slow official responses as acts of institutional violence, which will have serious and lasting effects on the lives of indigenous peoples.
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Affiliation(s)
| | | | - Deise BRESAN
- Universidade Federal de Mato Grosso do Sul, Brasil
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Thiede BC, Gray C. Characterizing the Indigenous Forest Peoples of Latin America: Results from Census Data. WORLD DEVELOPMENT 2020; 125:10.1016/j.worlddev.2019.104685. [PMID: 32123463 PMCID: PMC7051013 DOI: 10.1016/j.worlddev.2019.104685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Indigenous populations in Latin America are central to regional and global efforts toward achieving socially and environmentally sustainable development. However, existing demographic research on indigenous forest peoples (IFPs) has many limitations, including a lack of comparable cross-national evidence. We address this gap by linking representative census microdata to satellite-derived tree cover estimates for nine countries in the region. Our analyses describe the demographic and socioeconomic characteristics of IFPs, and draw comparisons with reference groups. Our first goal is to examine within- and between-population variation in the age structure, human capital attainment, and economic status of IFPs. We then analyze patterns of fertility among indigenous forest-dwelling women and comparison groups. Finally, we examine the association between migration patterns and tree cover among indigenous and non-indigenous populations. Findings demonstrate that Latin America's IFPs are materially deprived and characterized by high fertility levels overall. Importantly for sustainable development efforts, we show that non-indigenous forest-dwellers outnumber IFPs by more than eight to one and that IFPs have lower fertility than their non-indigenous counterparts when other characteristics are accounted for. Additionally, we find that most in-migrants to heavily-forested areas are non-indigenous, and that in-migrants tend to settle in areas that are forested but have few indigenous inhabitants. These results provide new cross-national evidence on the state of IFPs in Latin America, and highlight the need to empower these groups in the face of growing social and environmental crises in the region.
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Affiliation(s)
- Brian C. Thiede
- Corresponding Author: Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, 111A Armsby Building, University Park, PA 16802, , 814-865-2561
| | - Clark Gray
- The University of North Carolina at Chapel Hill
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Chagas CA, Castro TGD, Leite MS, Viana MACBM, Beinner MA, Pimenta AM. [Estimated prevalence of hypertension and associated factors in Krenak indigenous adults in the state of Minas Gerais, Brazil]. CAD SAUDE PUBLICA 2019; 36:e00206818. [PMID: 31939548 DOI: 10.1590/0102-311x00206818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/26/2019] [Indexed: 11/22/2022] Open
Abstract
This cross-sectional study in 2016 aimed to describe the estimated prevalence of systemic arterial hypertension and associated factors in Krenak adults and elderly in an indigenous community located along the Rio Doce in eastern Minas Gerais state, Brazil. We measured weight, height, waist circumference, systolic blood pressure, diastolic blood pressure, and capillary blood glucose. Sociodemographic and lifestyle information was obtained from a face-to-face questionnaire. Poisson regression models were constructed to estimate independent associations between the target variables and hypertension. Prevalence of hypertension was 31.2% (95%CI: 24.4-37.9) in Krenak indigenous. The final model showed an independent association with increasing age, abdominal obesity, and hyperglycemia. The results highlight the need for effective measures in prevention, diagnosis, and follow-up of modifiable risk factors for hypertension, since high prevalence of this condition was observed in the Krenak indigenous community.
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Affiliation(s)
| | | | - Maurício Soares Leite
- Departamento de Nutrição, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | | | - Mark Anthony Beinner
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Brito RS, Carmo Filho JRD, Vila VDSC, Souza ACSE. Epidemiological characteristics and strategies for the prevention of diarrheal disease in indigenous children: A scoping review. ENFERMERIA CLINICA 2019; 30:53-62. [PMID: 31791883 DOI: 10.1016/j.enfcli.2019.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/18/2022]
Abstract
AIM The aim of the present scoping review was to map the scientific evidence about diarrheal disease in indigenous children and the strategies that can be used to prevent it. METHODS The subject headings were indigenous population; child; diarrhea; dysentery; epidemiology; and prevention, primary; also the following keywords characteristic, epidemiologic study; and children. The databases consulted were Latin American and Caribbean Health Sciences Literature, MEDLINE via the US National Library of Medicine/National Institutes of Health, and Web of Science. Initially, 268 studies were identified, and after being screened using the eligibility criteria, six were selected. Finally, via reference tracking, five more were identified. The final sample was made up of eleven articles. RESULTS The results confirmed higher mortality rates due to diarrheal disease among indigenous children who are socially disadvantaged and living in poor hygienic and basic sanitation conditions. Among the primary prevention strategies are basic sanitation, health education better hygiene habits, animal control, breastfeeding, supplementing the diet with zinc, vitamins, and the rotavirus vaccine. The preventive strategies included the use of oral rehydration solutions, adequate nutrition, prescribed antimicrobials, and intravenous fluid replacement with glycaemic and electrolyte correction in severe cases. CONCLUSION In conclusion, public policies regarding the indigenous population and cross-cultural care should be strengthened. The present study confirmed that, at a global level, there is a lack of publications studying this issue.
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Affiliation(s)
- Raquel Santos Brito
- Master in Health Care, Feral University of Mato Grosso, Av: Valdon Varjão, N° 6.390, CEP: 78.600-000 Barra do Garças, Mato Grosso, Brazil
| | - José Rodrigues do Carmo Filho
- Master's Program in Health Care, School of Social and Health Sciences Pontifical Catholic University of Goiás, Mestrado em Atenção à Saúde, Área IV, Av, Universitária 1.440, Setor Leste Universitário, CEP: 74605-010 Goiânia, Goiás, Brazil.
| | - Vanessa da Silva Carvalho Vila
- Master's Program in Health Care, School of Social and Health Sciences Pontifical Catholic University of Goiás, Mestrado em Atenção à Saúde, Área IV, Av, Universitária 1.440, Setor Leste Universitário, CEP: 74605-010 Goiânia, Goiás, Brazil
| | - Adenícia Custódia Silva E Souza
- Master's Program in Health Care, School of Social and Health Sciences Pontifical Catholic University of Goiás, Mestrado em Atenção à Saúde, Área IV, Av, Universitária 1.440, Setor Leste Universitário, CEP: 74605-010 Goiânia, Goiás, Brazil
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Welch JR, Ferreira AA, Tavares FG, Lucena JRM, Gomes de Oliveira MV, Santos RV, Coimbra CEA. The Xavante Longitudinal Health Study in Brazil: Objectives, design, and key results. Am J Hum Biol 2019; 32:e23339. [PMID: 31654538 PMCID: PMC7154686 DOI: 10.1002/ajhb.23339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The Xavante Longitudinal Health Study was developed to permit granular tracking of contemporary health challenges faced by indigenous communities in Brazil, taking into consideration ongoing historical processes that may be associated with increases in child undernutrition, adult obesity, and cardiovascular disease risks. METHODS This was an open-cohort study with six semiannual data collection waves from 2009 to 2012. The study was undertaken in two Xavante villages, Pimentel Barbosa and Etênhiritipá, State of Mato Grosso, Central Brazil. No sampling technique was used. Data collection placed emphasis on growth and nutrition of children under five and nutrition status, blood pressure, and blood glucose levels of adolescents and adults. RESULTS Baseline data collection began in July/August 2009 with a population census (656 individuals). Between the first and final waves, the study population increased by 17%. At baseline, stunting and wasting was elevated for most age groups <10 years. Overweight, obesity, and increased risk of metabolic complications were expressive among individuals >17 years, disproportionately affecting females. Anemia was elevated in most age groups, especially among females. Mean systolic and diastolic blood pressure was moderate. The overall prevalence of high blood pressure was relatively low. CONCLUSIONS Our findings reveal marked health disparities relative to the Brazilian national population and a complex dietary health epidemiology involving the double burden of malnutrition, rapidly changing nutritional indicators, and elevated metabolic disease risk. The topically broad multidisciplinary focus permitted construction of the richest longitudinal data set of socio-epidemiological information for an indigenous population in Brazil.
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Affiliation(s)
- James R Welch
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Aline A Ferreira
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Felipe G Tavares
- Escola de Enfermagem Aurora de Afonso Costa, Universidade Federal Fluminense, Niterói, Brazil
| | - J Rodolfo M Lucena
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Ricardo V Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos E A Coimbra
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Abstract
AbstractObjective:To describe malnutrition (undernutrition and excess weight) by income, education and race/ethnicity in the Brazilian population.Design:Cross-sectional study.Setting:Brazil.Participants:Children aged <5 years (n 14 580), adolescents aged 11–19 years (n 31 892) and adults aged 20–49 years (n 84 660).Results:Among children, prevalence of excess weight, wasting and stunting was 16·9, 2·8 and 6·0 %, respectively. Differences related to income, education and race/ethnicity were verified, except for prevalence of wasting by education level. Girls and boys presented 18·4 and 20·5 % of excess weight, 2·8 and 3·7 % of underweight and 5·5 and 7·3 % of stunting, respectively. Prevalence of excess weight was lower among poorer, lower-educated (only for boys) and white adolescents, while stunting was lower among higher-income, higher-educated and white adolescents. Over three-quarters of women and almost half of men presented excess weight. Among adults, 3·9 % of women and 1·7 % of men were underweight, and 5·7 % of women and 0·2 % of men presented short stature. Prevalence of excess weight for women was higher among lower education and black, while for men it was higher among higher income and education and white. Short stature was more prevalent among black and mixed-race, low-educated and low-income women. Underweight prevalence was higher among low-educated, black and mixed-race women.Conclusions:In Brazil, the prevalence of excess weight was at least threefold higher than that of undernutrition for children and adolescents and at least sevenfold higher for adults. Social inequalities were observed in the distribution of malnutrition across the lifespan and by gender.
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Silva AB, Andrade Filha IGD, Benevides KMM, Silva DMD, Rodrigues PMDA, Silva SC, Garzón MIC. Cultura dos povos originários da floresta amazônica na gestação e no puerpério: uma revisão de escopo sob o ponto de vista da segurança alimentar e nutricional. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-1104201912319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A desnutrição na população indígena é um problema de saúde pública atual e uma das principais causas de morbimortalidade das crianças desses grupos no Brasil. Para subsidiar ações de promoção da educação alimentar e nutricional, abrangendo povos da floresta do estado do Amazonas, Brasil, cujo território faz fronteira com a Colômbia, além da visita de campo em 2018, fez-se necessário, concomitantemente, mapear na literatura como essa população vive e de que maneira o cuidado é prestado. A revisão de escopo buscou tópicos referentes ao modo de vida das mulheres e crianças na Amazônia, à dieta durante o período gestacional e do puerpério, a práticas de aleitamento, à introdução de alimentos sólidos ao bebê e aos cuidados dos serviços de saúde. Como resultado, foram recuperados 21 estudos multidisciplinares. Encontrou-se que a comida tradicional tem valor nutricional maior do que a industrializada, a culinária local é uma fonte de renda das mulheres indígenas no meio urbano e um elo entre etnias. Conclui-se que as pesquisas devem incorporar o paradigma da promoção da saúde e abranger temas como a aculturação indígena nos centros urbanos amazônicos, a chegada da internet nas aldeias e o papel do cuidado à distância, que necessitam ser investigados para melhor enfrentamento do problema.
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Maciel VBDS, Coca KP, Castro LSD, Abrão ACFDV. Food diversity among indigenous children from two municipalities of the Brazilian Western Amazon. CIENCIA & SAUDE COLETIVA 2019; 26:2921-2928. [PMID: 34231704 DOI: 10.1590/1413-81232021267.14232019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/16/2019] [Indexed: 11/21/2022] Open
Abstract
Our aim was to explore the feeding practices of indigenous children younger than two years old, living in Cruzeiro do Sul and Mâncio Lima, in Acre, Brazil. A cross-sectional study was conducted with indigenous children of the Katukina (Cruzeiro do Sul), Nukini, Nawa and Poyanawa (Mâncio Lima) ethnicities in October 2013. We used a structured questionnaire on the food consumption of the day before the collection, based on the food indicators proposed by the Ministry of Health. A total of 94 children (50% Katukina, 27% Poyanawa, 13% Nukini, and 10% Nawa) were studied. Among children under 6 months of age, although the majority was breastfed, 42.1% drank water, 15.8%, savory food, and 11.1%, local cuisine. In the age groups of 6 to 12 months and 13 to 23 months, a high consumption of ultra-processed foods was identified (52.6% and 28.6% respectively), while the consumption of complementary food was insufficient (33% of fruits and 25% of savory food between 6 and 13 months, and 41.2% of fruits and 19.6% of savory food between 13 and 23 months). The feeding profile of these indigenous children was inadequate for their age, revealing a concerning situation for this population.
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Affiliation(s)
- Vanizia Barboza da Silva Maciel
- Centro Multidisciplinar, Universidade Federal do Acre. Estrada do Canela Fina Km 12, Campus Floresta. 69980-000 Cruzeiro do Sul AC Brasil.
| | - Kelly Pereira Coca
- Departamento de Enfermagem na Saúde da Mulher, Escola Paulista de Enfermagem, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Lucíola Sant'Anna de Castro
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. São Paulo SP Brasil. São Paulo SP Brasil
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