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ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

Zika virus was responsible for the microcephaly epidemic in Brazil which began in October 2015 and brought great challenges to the scientific community and health professionals in terms of diagnosis and classification. Due to the difficulties in correctly identifying Zika cases, it is necessary to develop an automatic procedure to classify the probability of a CZS case from the clinical data. This work presents a machine learning algorithm capable of achieving this from structured and unstructured available data. The proposed algorithm reached 83% accuracy with textual information in medical records and image reports and 76% accuracy in classifying data without textual information. Therefore, the proposed algorithm has the potential to classify CZS cases in order to clarify the real effects of this epidemic, as well as to contribute to health surveillance in monitoring possible future epidemics.

Background: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child&rsquo, s health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child&ndash, maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015&ndash, 2017. Methods: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. Results: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2&ndash, 10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15, 95% CI 1.63&ndash, 2.83), and very low birth weight (OR = 3.77, 95% CI 2.20&ndash, 6.46), late preterm births (OR = 1.65, 95% CI 1.21&ndash, 2.23), Apgar &lt, 7 at 1st (OR = 5.98, 95% CI 4.46&ndash, 8.02) and 5th minutes (OR = 4.13, 95% CI 2.78&ndash, 6.13), among others. Conclusions: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

Resumo Objetivo: Propor uma lista de anomalias congênitas com códigos correspondentes na Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde – 10ᵃ Revisão (CID-10), visando a aplicação no âmbito da vigilância em saúde. Métodos: Em dezembro de 2019, realizou-se busca nas seguintes fontes de dados: CID-10; CID-11; anomalias monitoradas por três modelos de vigilância; base de informações sobre doenças raras (Orphanet). Realizou-se extração das anomalias a partir dessas fontes, processamento para correspondência com base na CID-10 e compilação mediante revisão manual. Resultados: Foram identificados 898 códigos, dos quais 619 (68,9%) constavam no capítulo XVII da CID-10. Dos 279 códigos de outros capítulos, 19 foram exclusivos da busca na CID-11, 72 dos modelos de vigilância, 79 da Orphanet e 36 da busca de termos na CID-10. Conclusão: Os códigos que constam do capítulo XVII da CID-10 não captam a totalidade das anomalias congênitas, indicando a necessidade de adoção de uma lista ampliada. Resumen Objetivo: Proponer una lista de anomalías congénitas con códigos correspondientes en la décima revisión de la Clasificación Internacional de Enfermedades (CIE), con el objetivo de su aplicación en el ámbito de la vigilancia de la salud. Métodos: En diciembre de 2019, se buscaron las siguientes fuentes: CIE-10; CIE-11; anomalías monitoreadas por tres modelos de vigilancia; y base de informaciones sobre enfermedades raras (Orphanet). Las anomalías se extrajeron de estas fuentes de datos, se procesó en base a la CIE-10 y se compiló con una revisión manual. Resultados: Se identificaron 898 códigos, de los cuales 619 (68,9%) estaban en el Capítulo XVII de la CIE-10. De los 279 códigos en otros capítulos, 19 fueron exclusivos de la búsqueda en la CIE-11, 72 de los modelos de vigilancia, 79 de Orphanet y 36 de la búsqueda de términos en la CIE-10. Conclusión: Los códigos contenidos en el capítulo XVII de la CIE-10 no capturan la totalidad de las anomalías congénitas, lo que indica la necesidad de adoptar una lista ampliada. Abstract Objective: To propose a list of congenital anomalies having corresponding codes in the International Statistical Classification of Diseases and Related Health Problems, 10thRevision (ICD-10), with the aim of applying it in health surveillance. Methods: In December 2019, the following data sources were searched: ICD-10; ICD-11; anomalies monitored by three surveillance programs; and a database of rare diseases (Orphanet). Anomalies were retrieved from these data sources, processed to check for correspondence with ICD-10 and reviewed manually to compile the list. Results: 898 codes were identified, of which 619 (68.9%) were contained in ICD-10 Chapter XVII. Of the 279 codes contained in other chapters, 19 were exclusive to the ICD-11 search, 72 to the surveillance programs, 79 to Orphanet and 36 to the search for terms in ICD-10. Conclusion: The codes contained in ICD-10 Chapter XVII do not capture the totality of congenital anomalies, indicating the need to adopt an expanded list.

Resumo Objetivo descrever a evolução da COVID-19 no Brasil até a Semana Epidemiológica (SE) 20 de 2020. Métodos estudo ecológico baseado em dados e documentos do Ministério da Saúde brasileiro e órgãos internacionais; foram realizadas comparações do Brasil com outros países e calculadas taxas de incidência e de mortalidade. Resultados até o fim da SE 20, no país havia 233.142 casos, 15.633 óbitos confirmados e 3.240 (58,2%) dos municípios apresentavam pelo menos um caso; o Brasil estava em uma fase anterior da pandemia quando comparado aos demais países, exceto Rússia e Turquia, em casos acumulados, e Canadá, em óbitos acumulados; as maiores taxas foram encontradas em Unidades da Federação da Região Norte, com o Amazonas apresentando as maiores taxas de incidência (4.474,6/1 milhão) e mortalidade (331,8/1 milhão). Conclusão o Brasil está entre os países com maiores números de casos e óbitos confirmados, exibindo notáveis diferenças regionais.

Highlights • Brazil registered 177,589 cases of COVID-19 between March 11 and May 12, 2020. • All of Federative Units in Brazil shows a upward in accumulated cases of COVID-19. • The highest increment were find in the North, Northeast and Southeast regions. • Each Federative Unit in Brazil is at a different stage of the COVID-19 pandemic., Objetive to analyze the trends of COVID-19 in Brazil in 2020 by Federal Units (FU). Method ecological time-series based on cumulative confirmed cases of COVID-19 from March 11 to May 12. Joinpoint regression models were applied to identify points of inflection in COVID-19 trends, considering the days since the 50th confirmed case as time unit. Results Brazil reached the 50th confirmed case of COVID-19 in 11 March 2020 and, 63 days after that, on May 12, 177,589 cases had been confirmed. The trends for all regions and FU are upward. In the last segment, from the 31st to the 63rd day, Brazil presented a DPC of 7.3% (95%CI= 7.2;7.5). For the country the ADPC was 14.2% (95%CI: 13.8;14.5). The highest ADPC values were found in the North, Northeast and Southeast regions. Conclusions In summary, our results show that all FUs in Brazil present upward trends of COVID-19. In some FUs, the slowdown in DPC in the last segment must be considered carefully. Each FUs is at a different stage of the pandemic and, therefore, non-pharmacological measures must be applied accordingly.

Resumo Este artigo apresenta as estrategias e acoes adotadas pelo Ministerio da Saude do Brasil para deter a COVID-19. A resposta a doenca foi imediata e anterior a deteccao do primeiro caso no pais. A informacao e a comunicacao para a populacao e a imprensa foram adotadas como estrategias fundamentais para o enfrentamento da epidemia. A orientacao para a populacao tem sido clara, no sentido de reforcar a importância das medidas de prevencao da transmissao do coronavirus. Esforcos foram direcionados para o fortalecimento da vigilância e da assistencia a saude, bem como para o fomento a pesquisa, desenvolvimento e inovacao. Acoes tem sido direcionadas a capacitacao de recursos humanos e ampliacao da cobertura do Sistema Unico de Saude (SUS). A protecao aos trabalhadores da saude e considerada prioritaria. Todos os trabalhadores, gestores e dirigentes do SUS estao dedicados a preservar a saude e a vida de cada brasileira e brasileiro.

Resumo Objetivo: Descrever os casos hospitalizados pela COVID-19 em profissionais de saúde no Brasil. Métodos: Estudo descritivo de tipo série de casos; foram incluídos aqueles com adoecimento entre 21 de fevereiro e 15 de abril de 2020, registrados no Sistema de Informação de Vigilância da Gripe (SIVEP-Gripe). Resultados: Dos 184 casos, 110 (59,8%) eram do sexo feminino, com mediana de idade de 44 anos (mínima-máxima: 23-85); 89 (48,4%) eram profissionais da enfermagem e 50 (27,2%) eram médicos. Ainda, 92 (50,0%) apresentavam comorbidade, predominando cardiopatias (n=37; 40,2%). Dos 112 profissionais com registro de evolução, 85 (75,9%) alcançaram cura e 27 (24,1%) foram a óbito, 18 destes do sexo masculino. Conclusão: O perfil dos profissionais de saúde hospitalizados por COVID-19 é semelhante ao da população quanto à idade e comorbidades; porém, diferente quanto ao sexo. As áreas profissionais mais acometidas foram a enfermagem e a medicina.

Background Transmission dynamics, vectorial capacity, and co-infections have substantial impacts on vector-borne diseases (VBDs) affecting urban and suburban populations. Reviewing key factors can provide insight into priority research areas and offer suggestions for potential interventions. Main body Through a scoping review, we identify knowledge gaps on transmission dynamics, vectorial capacity, and co-infections regarding VBDs in urban areas. Peer-reviewed and grey literature published between 2000 and 2016 was searched. We screened abstracts and full texts to select studies. Using an extraction grid, we retrieved general data, results, lessons learned and recommendations, future research avenues, and practice implications. We classified studies by VBD and country/continent and identified relevant knowledge gaps. Of 773 articles selected for full-text screening, 50 were included in the review: 23 based on research in the Americas, 15 in Asia, 10 in Africa, and one each in Europe and Australia. The largest body of evidence concerning VBD epidemiology in urban areas concerned dengue and malaria. Other arboviruses covered included chikungunya and West Nile virus, other parasitic diseases such as leishmaniasis and trypanosomiasis, and bacterial rickettsiosis and plague. Most articles retrieved in our review combined transmission dynamics and vectorial capacity; only two combined transmission dynamics and co-infection. The review identified significant knowledge gaps on the role of asymptomatic individuals, the effects of co-infection and other host factors, and the impacts of climatic, environmental, and socioeconomic factors on VBD transmission in urban areas. Limitations included the trade-off from narrowing the search strategy (missing out on classical modelling studies), a lack of studies on co-infections, most studies being only descriptive, and few offering concrete public health recommendations. More research is needed on transmission risk in homes and workplaces, given increasingly dynamic and mobile populations. The lack of studies on co-infection hampers monitoring of infections transmitted by the same vector. Conclusions Strengthening VBD surveillance and control, particularly in asymptomatic cases and mobile populations, as well as using early warning tools to predict increasing transmission, were key strategies identified for public health policy and practice. Electronic supplementary material The online version of this article (10.1186/s40249-018-0475-7) contains supplementary material, which is available to authorized users.

An increase in microcephaly, associated with an epidemic of Zika virus (ZIKV) in Brazil, prompted the World Health Organization to declare a Public Health Emergency of International Concern in February 2016. While knowledge on biological and epidemiological aspects of ZIKV has advanced, demographic impacts remain poorly understood. This study uses time-series analysis to assess the impact of ZIKV on births. Data on births, fetal deaths, and hospitalizations due to abortion complications for Brazilian states, from 2010 to 2016, were used. Forecasts for September 2015 to December 2016 showed that 119,095 fewer births than expected were observed, particularly after April 2016 (a reduction significant at 0.05), demonstrating a link between publicity associated with the ZIKV epidemic and the decline in births. No significant changes were observed in fetal death rates. Although no significant increases in hospitalizations were forecasted, after the ZIKV outbreak hospitalizations happened earlier in the gestational period in most states. We argue that postponement of pregnancy and an increase in abortions may have contributed to the decline in births. Also, it is likely that an increase in safe abortions happened, albeit selective by socioeconomic status. Thus, the ZIKV epidemic resulted in a generation of congenital Zika syndrome (CZS) babies that reflect and exacerbate regional and social inequalities. Since ZIKV transmission has declined, it is unlikely that reductions in births will continue. However, the possibility of a new epidemic is real. There is a need to address gaps in reproductive health and rights, and to understand CZS risk to better inform conception decisions.

ObjectiveThe Latin American Network of Congenital Malformations: ReLAMC was established in 2017 to provide accurate congenital anomaly surveillance. This study used data from ReLAMC registries to quantify the prevalence of microcephaly from 2010 to 2017 (before, during and after the Zika virus epidemic).DesignNine ReLAMC congenital anomaly registries provided case-level data or aggregate data for any live births, still births or terminations of pregnancy with microcephaly. Births to pregnant women infected with Zika virus first occurred in Brazil in 2015, and in the remaining registry areas in 2016 with the exception of Chile that did not experience Zika virus. Therefore the prevalence of microcephaly for 2010–2014 and individual years 2015, 2016 and 2017 was estimated using multilevel random effect Poisson models. Clinical classification and characteristics of the cases were compared pre and post Zika for all centres providing individual case-level data.ResultsThe prevalence of microcephaly for all registries excluding Brazil was 2.3 per 10 000 (95% CI 2.0 to 2.6) for 2010–2014 rising to 5.4 (95% CI 4.8 to 6.0) in 2016 and 5.9 (95% CI 5.3 to 6.6) in 2017. Brazil had a prevalence of 0.6 per 10 000 (95% CI 0.5 to 0.6) in 2010–2014, rising to 5.8 (95% CI 5.6 to 6.1) in 2015, 8.0 (95% CI 7.6 to 8.3) in 2016 and then falling in 2017. Only 29 out of 687 cases of microcephaly were reported as congenital Zika syndrome in countries excluding Brazil.ConclusionsThe prevalence of microcephaly was influenced both by Zika causing congenital Zika syndrome and by increased reporting awareness.

Summary Background On Nov 11, 2015, the Brazilian Ministry of Health declared a Public Health Emergency of National Concern in response to an increased number of microcephaly cases, possibly related to previous Zika virus outbreaks. We describe the course of the dual epidemics of the Zika virus infection during pregnancy and microcephaly in Brazil up to Nov 12, 2016, the first anniversary of this declaration. Methods We used secondary data for Zika virus and microcephaly cases obtained through the Brazilian Ministry of Health's surveillance systems from Jan 1, 2015, to Nov 12, 2016. We deemed possible Zika virus infections during pregnancy as all suspected cases of Zika virus disease and all initially suspected, but later discarded, cases of dengue and chikungunya fever. We defined confirmed infection-related microcephaly in liveborn infants as the presence of a head circumference of at least 2 SDs below the mean for their age and sex, accompanied by diagnostic imaging consistent with an infectious cause, or laboratory, clinical, or epidemiological results positive for Zika virus or STORCH (infectious agents known to cause congenital infection, mainly syphilis, toxoplasmosis, cytomegalovirus, and herpes simplex virus). We excluded cases of congenital anomalies or death without microcephaly. We analyse the spatial clustering of these diseases in Brazil to obtain the kernel density estimation. Findings Two distinct waves of possible Zika virus infection extended across all Brazilian regions in 2015 and 2016. 1 673 272 notified cases were reported, of which 41 473 (2·5%) were in pregnant women. During this period, 1950 cases of infection-related microcephaly were confirmed. Most cases (1373 [70·4%]) occurred in the northeast region after the first wave of Zika virus infection, with peak monthly occurrence estimated at 49·9 cases per 10 000 livebirths. After a major, well documented second wave of Zika virus infection in all regions of Brazil from September, 2015, to September, 2016, occurrence of microcephaly was much lower than that following the first wave of Zika virus infection, reaching epidemic levels in all but the south of Brazil, with estimated monthly peaks varying from 3·2 cases to 15 cases per 10 000 livebirths. Interpretation The distribution of infection-related microcephaly after Zika virus outbreaks has varied across time and Brazilian regions. Reasons for these apparent differences remain to be elucidated. Funding None.

Summary Background Coverage levels for essential interventions aimed at reducing deaths of mothers and children are increasing steadily in most low-income and middle-income countries. We assessed how much poor and rural populations in these countries are benefiting from national-level progress. Methods We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal, newborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014. Trends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approach akin to the calculation of population attributable risk to quantify the contribution of poor and rural populations to national trends. Findings From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in the two poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiest quintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and upper-middle-income countries than in low-income countries. Globally, national level increases in CCI were 17·5% faster than they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidly annually in rural (0·93 percent points) than urban (0·52 percent points) areas. Interpretation National coverage gains were accelerated by important increases among poor and rural mothers and children. Despite progress, important inequalities persist, and need to be addressed to achieve the Sustainable Development Goals. Funding UNICEF, Wellcome Trust.

We aimed to (i) describe both the coverage and the homogeneity of coverage of the first and second doses of measles-containing vaccines (MCV) in Brazil in 2017, and (ii) to investigate the potential influence of contextual factors at municipal level. All 5570 Brazilian municipalities were included. The North and Center-West regions presented the lowest coverages of the first and second doses of MCV, respectively. We found significant associations of both first and second doses of MCV with population size, coverage of Family Health Strategy (FHS) and other indicators of living conditions and inequalities. Monitoring the homogeneity of MCV coverage at national, regional and state levels is essential, as it allows identifying areas at higher risk of measles spread that should be targeted for vaccination. Targeting large cities i.e. 100,000 or more inhabitants, especially poor neighborhoods and areas with low FHS coverage, could lead to improvements in coverage homogeneity.

We report an ongoing measles outbreak in Manaus, Amazonas state, Brazil. As at 3 November 2018, 1,631 cases were confirmed corresponding to an incidence of 75.3 per 100,000 inhabitants; all five sanitary districts presented confirmed cases. Reintroduction of measles virus in Manaus is likely related to the current outbreak in Venezuela and due to recent decline in measles vaccine coverage. Given the current scenario, prevention and control measures should target individuals aged 15–29 years.

This study aimed to assess the extent of agreement between hemoglobin (Hb) and hematocrit (Ht), while also verifying whether anemia prevalence can be determined by hematocrit cut-off points. A hundred pairs of capillary Hb and Ht of children less than 5 years old were analyzed. The Hb and Ht concentrations were measured using HemoCue and microhematocrit centrifuge, respectively. The Bland and Altman’s method was used to assess the agreement between ‘observed Hb’ and ‘Hb estimated through Ht’ (Hb = Ht/3). The ROC curve was constructed based on the reference to anemia classification according to Hb. The subjects were classified according to the status of anemia obtained through the Ht, also evaluating the agreement regarding Hb. The area under the ROC curve identified that Ht

Widespread transmission of Zika virus by Aedes mosquitoes has been recognized in Brazil since late 2014, and in October 2015, an increase in the number of reported cases of microcephaly was reported to the Brazil Ministry of Health.* By January 2016, a total of 3,530 suspected microcephaly cases had been reported, many of which occurred in infants born to women who lived in or had visited areas where Zika virus transmission was occurring. Microcephaly surveillance was enhanced in late 2015 by implementing a more sensitive case definition. Based on the peak number of reported cases of microcephaly, and assuming an average estimated pregnancy duration of 38 weeks in Brazil (1), the first trimester of pregnancy coincided with reports of cases of febrile rash illness compatible with Zika virus disease in pregnant women in Bahia, Paraíba, and Pernambuco states, supporting an association between Zika virus infection during early pregnancy and the occurrence of microcephaly. Pregnant women in areas where Zika virus transmission is occurring should take steps to avoid mosquito bites. Additional studies are needed to further elucidate the relationship between Zika virus infection in pregnancy and microcephaly.

Summary The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years and 20 000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

Resumo Objetivo: descrever as anomalias congênitas (ACs) entre nascidos vivos de mães residentes em Tangará da Serra, MT, Brasil, durante o período 2006-2016. Métodos: estudo descritivo, com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Resultados: de 15.689 nascimentos, 77 foram registrados com ACs (4,9/1.000); houve incremento de 80,7% no registro de AC em 2016, representando 10,3/1.000 nascidos vivos, incluídos cinco casos de microcefalia; a prevalência de AC foi maior entre crianças de mulheres maiores de 35 anos de idade (razão de prevalência [RP] =1,91; intervalo de confiança [IC95%] 1,01;3,60), prematuros (RP=2,22; IC95% 1,26;3,92) e com baixo peso ao nascer (RP=3,21; IC95% 1,86;5,54). Conclusão: observou-se baixa prevalência de AC, possivelmente relacionada ao sub-registro no nascimento; o aumento observado em 2016 pode estar relacionado à epidemia de Zika como causa de microcefalia, e à maior atenção dos profissionais de saúde às ACs durante a emergência em Saúde Pública.

We analyzed the time trends and spatial distribution of MMR vaccine coverage in Brazil during 2007-2017. In early 2018, a measles outbreak started in the North region of Brazil, reaching 11 of the 27 federal units by January 24, 2019. In this period, 10,302 cases were confirmed. Although the reintroduction of measles in Brazil is likely due to migration from Venezuela, the spread of the virus was made possible by the low levels of MMR coverage, as a result of significant decreases during the study period. Areas with high concentration of municipalities with low coverage are more susceptible to the spread of the virus, especially in the North and Northeast regions. Increasing vaccination coverage is essential to block the ongoing outbreak in Brazil. Vaccination strategies might target priority areas, especially those with a marked decrease in coverage. Moreover, it is essential to extend actions to travelers, migrants and refugees.

The findings of studies on the association between physical activity and adiposity are not consistent, and most are cross-sectional and used only self-reported measures. The aims of this study were to evaluate: 1) independent and combined cross-sectional associations of objectively-measured physical activity and sedentary time with body composition outcomes at 30 years, and 2) prospective associations of changes in self-reported physical activity from 23 to 30 years with the same outcomes in participants from the 1982 Pelotas (Brazil) Birth Cohort. Body mass index, waist circumference, visceral abdominal fat, fat mass index, and android/gynoid fat ratio were the outcomes. 3,206 participants were analysed. In cross-sectional analyses, higher objectively-measured moderate-to-vigorous physical activity was associated with lower body mass index (β = 0.017, 95%CI: −0.026; −0.009), waist circumference (β = −0.043, 95%CI: −0.061; −0.025), visceral abdominal fat (β = −0.006, 95%CI: −0.009; −0.003), and fat mass index (β = −0.015, 95%CI: −0.021; −0.009), independent of sedentary time. Sedentary time was independently associated only with higher fat mass index (β = 0.003, 95%CI: 0.001; 0.005). In longitudinal analyses, using self-reported measure, adiposity was lower among those who were consistently active or who became active. Adiposity was similar among the “became inactive” and “consistently inactive” subjects. Our findings suggest metabolic benefits from engagement in physical activity throughout young adulthood, with stronger associations on concurrent levels.

Resumo Objetivo: descrever a distribuição temporal e espacial dos casos notificados e confirmados de síndrome congênita associada à infecção pelo vírus Zika (SCZ) em nascidos vivos no Brasil, no período 2015-2016. Métodos: estudo descritivo com dados do Registro de Eventos em Saúde Pública, incluindo casos nascidos em 2015 ou 2016 e notificados entre as semanas epidemiológicas 45/2015 e 2/2017. Resultados: foram analisadas 9.953 notificações, das quais 2.018 (20,3%) foram confirmadas para relação com infecção congênita e 2.819 (28,3%) continuavam em investigação na semana 2/2017; 404 (4,1%) das 9.953 notificações apresentavam confirmação laboratorial para o vírus Zika; o coeficiente de prevalência de casos confirmados para SCZ foi de 3,8/10 mil nascidos vivos em 2015 e 3,1/10 mil nascidos vivos em 2016. Conclusão: um quinto das notificações do período foi confirmada como SCZ, reforçando sua relevância como problema de Saúde Pública; esforços na confirmação diagnóstica da síndrome devem ser priorizados. Resumen Objetivo: describir la distribución temporal y espacial de los casos notificados y confirmados de síndrome congénito del virus Zika (SCZ) en nacidos vivos en Brasil, durante 2015-2016. Métodos: se realizó un estudio descriptivo con datos del Registro de Eventos de Salud Pública, incluyendo casos nascidos en 2015 o 2016 y reportados entre las semanas epidemiológicas 45/2015 y 2/2017. Resultados: se analizaron 9.953 casos, de los cuales 2.018 (20.3%) fueron confirmados y 2.819 (28.3%) aún estaban bajo investigación en la semana epidemiológica 2/2017; 404 (4,1%) de los 9.953 casos tuvieron confirmación de laboratorio para SCZ; la prevalencia de casos confirmados de SCZ fue 3,8/10 mil nacidos vivos en 2015 y 3,1/10 mil nacidos vivos en 2016. Conclusión: una quinta parte de los casos reportados en 2015-16 se confirmaron como SCZ, lo que refuerza su relevancia como un problema de salud pública; se deben priorizar los esfuerzos dirigidos a la confirmación diagnóstica del síndrome. Abstract Objective: to describe the temporal and spatial distribution of reported and confirmed cases of congenital Zika virus syndrome (CZS) in live births in Brazil during 2015-2016. Methods: we conducted a descriptive study with data from the Public Health Events Registry, including cases born in 2015 or 2016, and registered between epidemiological week 45/2015 and 2/2017. Results: we analyzed 9.953 reported cases, of which 2.018 (20.3%) were confirmed and 2.819 (28.3%) were still under investigation at the epidemiological week 2/2017; 404 (4.1%) out of the 9.953 cases had laboratory confirmation for Zika virus; the prevalence of confirmed cases of CZS was 3.8/10 thousand livebirths in 2015 and 3.1/10 thousand live births in 2016. Conclusion: one fifth of the cases reported in 2015-16 were confirmed the CZS, reinforcing their relevance as a public health problem; efforts aimed at the diagnostic confirmation of the syndrome should be prioritized.

Background Several studies have verified body fat distribution in association with pulmonary function (PF), mainly waist circumference, but few have used measures able to distinguish abdominal fat compartments. The present study aims to verify the association of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with PF measures. Methods In 1982, all hospital births occurring in Pelotas, Brazil, were identified and those livebirths have been followed. In 2012–13, the cohort participants were evaluated and VAT and SAT measured using ultrasound; forced expiratory volume in the first second (FEV1) or forced vital capacity (FVC) were patronized in z-scores stratified by sex. The associations were verified using crude and adjusted linear regressions. Results The present analyses comprised 3438 individuals (1721 women). VAT was inversely associated with spirometric parameters, in both crude and adjusted models. SAT showed inverse associations in the crude analyzes in males and a positive trend after adjustment, except for SAT and FVC in males. To each centimeter of VAT, mean adjusted FEV1 z-scores decreased 0.072 (95% CI -0.107; −0.036) in men and 0.127 (95% CI -0.164; −0.090) in women, and FVC z-scores decreased −0.075 (95% CI -0.111; −0.039) and 0.121 (95% CI -0.158; −0.083), in men and women, respectively. Conclusions VAT has a consistent inverse association with FEV1 and FVC in both sexes. On the other hand, SAT showed inconsistent results with PF parameters. Electronic supplementary material The online version of this article (10.1186/s12890-017-0510-7) contains supplementary material, which is available to authorized users.

This study assessed the association of breastfeeding with body composition at 30 years, among subjects who have been prospectively followed since birth in a southern Brazilian city. We also evaluated whether breastfeeding moderated the association between the rs9939609 variant in the FTO gene and adiposity. At 30 years, total and predominant breastfeeding were positively associated with lean mass index and inversely with visceral fat thickness. Among subjects breastfed for FTO genotype (rs9939609). Associations among subjects breastfed for one month or longer tended to be in the same direction but showed lower magnitude and were less consistent; for all outcomes. Interactions had p values ≤ 0.05 for body mass index, fat mass index and waist circumference. Even among young adults, breastfeeding moderates the association between the FTO variant rs9939609 and body composition.

Objectives Pulse wave velocity (PWV) is an early marker of arterial stiffness and a strong predictor of cardiovascular disease (CVD). Body fat measures, such as body mass index (BMI), waist circumference (WC), and visceral fat, have been associated with CVD in adulthood. The aim of this study was to evaluate the association of PWV at 30 y of age using body fat measures. Methods In 1982, the maternity hospitals in Pelotas, Brazil, were visited daily and all live births were identified. These infants have been prospectively followed several times. At 30 y, we tried to follow the cohort; the individuals were interviewed and had PWV, anthropometric parameters, abdominal fat, and visceral fat measured. Results The present study included 1576 individuals. PWV was highly correlated with BMI, WC, visceral fat thickness, and fat mass compared with other body composition measures. In linear regression analysis, the highest regression coefficients were observed for BMI (r = 0.30; 95% confidence interval [CI], 0.25–0.35), visceral fat thickness (r = 0.30; 95% CI, 0.24–0.35), and fat mass (r = 0.30; 95% CI, 0.24–0.35), even after controlling for potential confounders (sex, race, birth weight, family income, family education, and maternal smoking during pregnancy). Conclusion In the present study, BMI, visceral fat thickness, and fat mass were the strongest body fat measures related to PWV.

Early life stunting may have long-term effects on body composition, resulting in obesity-related comorbidities. We tested the hypothesis that individuals stunted in early childhood may be at higher cardiometabolic risk later in adulthood. 1753 men and 1781 women participating in the 1982 Pelotas (Brazil) birth cohort study had measurements of anthropometry, body composition, lipids, glucose, blood pressure, and other cardiometabolic traits at age 30 years. Early stunting was defined as height-for-age Z-score at age 2 years below -2 against the World Health Organization growth standards. Linear regression models were performed controlling for sex, maternal race/ethnicity, family income at birth, and birthweight. Analyses were stratified by sex when p-interaction

Resumo: A hospitalização é um evento frequente nos primeiros anos de vida. No Brasil, a Pesquisa Nacional por Amostra de Domicílios de 2008 registrou uma taxa de hospitalização de 9% entre crianças menores de quatro anos. O estudo objetivou descrever as características da hospitalização nos seis primeiros anos de vida e analisar os fatores precoces associados à hospitalização em uma coorte de nascimentos no sul do Brasil. Foi usado o modelo de Poisson Inflacionado de Zeros para examinar os efeitos de covariáveis simultaneamente para a ocorrência ou não de algum evento e para a contagem de eventos. A frequência de pelo menos um episódio de hospitalização no período foi de 33,4% (IC95%: 31,8-34,9), sendo mais elevada durante o primeiro ano (19,1%; IC95%: 17,9-20,4), permanecendo estável em aproximadamente 10% entre o primeiro e o quarto anos, reduzindo para 8,4% (IC95%: 7,6-9,4) entre os quatro e seis anos. As doenças do aparelho respiratório estiveram entre as principais causas de hospitalização, seguidas pelas doenças infecciosas e parasitárias. A história de hospitalização prévia foi um dos preditores mais importantes para a chance de hospitalização e para o risco de múltiplas hospitalizações. Nos primeiros anos de vida o peso ao nascer, idade gestacional, Apgar, sexo e tipo de gestação mostraram-se inversamente associados à hospitalização, e as características ambientais como fumo materno na gestação, cor da mãe e baixa renda familiar apresentaram associação com o número de hospitalizações. Os resultados apontam para a importância em destinar esforços para a redução das hospitalizações por doenças do aparelho respiratório principalmente em crianças menores de um ano. Resumen: La hospitalización es un evento frecuente en los primeros años de vida. En Brasil, la Encuesta Nacional por Muestra de Domicilios de 2008 registró una tasa de hospitalización de un 9% entre niños menores de cuatro años. El objetivo del estudio fue describir las características de la hospitalización durante los seis primeros años de vida y analizar factores precoces, asociados a la hospitalización, en una cohorte de nacimientos en el sur de Brasil. Se usó el modelo de Poisson Inflado por Ceros para examinar los efectos de covariables simultáneamente para la ocurrencia o no de algún evento y para el cómputo de eventos. La frecuencia de por lo menos un episodio de hospitalización en el período fue de un 33,4% (IC95%: 31,8-34,9%), siendo más elevada durante el primer año (19,1%; IC95%: 17,9-20,4%), permaneciendo estable en aproximadamente un 10% entre el primero y el cuarto año, reduciéndose hasta el 8,4% (IC95%: 7,6-9,4%) entre los cuatro y seis años. Las enfermedades del aparato respiratorio estuvieron entre las principales causas de hospitalización, seguidas de las enfermedades infecciosas y parasitarias. La historia de hospitalización previa fue uno de los predictores más importantes para la oportunidad de hospitalización y para el riesgo de múltiples hospitalizaciones. Durante los primeros años de vida el peso al nacer, edad gestacional, Apgar, sexo y tipo de gestación se mostraron inversamente asociados a la hospitalización, y las características ambientales como consumo de tabaco por parte de la madre durante la gestación, el color de piel de la madre y baja renta familiar presentaron una asociación con el número de hospitalizaciones. Los resultados apuntan la importancia en destinar esfuerzos para la reducción de las hospitalizaciones por enfermedades del aparato respiratorio, principalmente en niños menores de un año. Abstract: Hospitalization is a frequent event in early childhood. In Brazil, the National Household Sample Survey of 2008 showed a 9% hospitalization rate among children in the first four years of life. The study aimed to describe the characteristics of hospitalization in the first six years of life and analyze the early factors associated with hospitalization in a birth cohort in southern Brazil. A zero-inflated Poisson model was used to simultaneously examine the effects of co-variables for the occurrence of a given event and to count events. The frequency of at least one episode of hospitalization during the study period was 33.4% (95%CI: 31.8-34.9), and was highest in the first year (19.1%; 95%CI: 17.9-20.4), remaining stable at approximately 10% between the first and fourth years, decreasing to 8.4% (95%CI: 7.6-9.4) between the fourth and sixth years. diseases of the respiratory system were among the leading causes of hospitalization, followed by infectious and parasitic diseases. History of prior hospitalization was one of the most important predictors of odds of hospitalization and risk of multiple hospitalizations. In early childhood, birth weight, gestational age, Apgar score, sex, and type of pregnancy were inversely associated with hospitalization, and environmental characteristics such as maternal smoking in pregnancy, mother’s skin color, and low family income were associated statistically with number of hospitalizations. The results point to the importance of focusing efforts on reducing hospitalizations from diseases of the respiratory system, especially in children under one year.

We aimed to identify the independent associations of genomic ancestry and education level with abdominal fat distributions in the 1982 Pelotas birth cohort study, Brazil. In 2,890 participants (1,409 men and 1,481 women), genomic ancestry was assessed using genotype data on 370,539 genome-wide variants to quantify ancestral proportions in each individual. Years of completed education was used to indicate socio-economic position. Visceral fat depth and subcutaneous abdominal fat thickness were measured by ultrasound at age 29-31y; these measures were adjusted for BMI to indicate abdominal fat distributions. Linear regression models were performed, separately by sex. Admixture was observed between European (median proportion 85.3), African (6.6), and Native American (6.3) ancestries, with a strong inverse correlation between the African and European ancestry scores (ρ = -0.93; p

BackgroundThere is no consensus on the effects that low birth weight, premature birth and intrauterine growth have on later depression.AimsTo review systematically the evidence on the relationship of low birth weight, smallness for gestational age (SGA) and premature birth with adult depression.MethodWe searched the literature for original studies assessing the effect of low birth weight, premature birth and SGA on adult depression. Separate meta-analyses were carried out for each exposure using random and fixed effects models. We evaluated the contribution of methodological covariates to heterogeneity using meta-regression.ResultsWe identified 14 studies evaluating low birth weight, 9 premature birth and 4 SGA. Low birth weight increased the odds of depression (OR = 1.39, 95% CI 1.21–1.60). Premature birth and SGA were not associated with depression, but publication bias might have underestimated the effect of the former and only four studies evaluated SGA.ConclusionsLow birth weight was associated with depression. Future studies evaluating premature birth and SGA are needed.

In October 2015, Zika virus (ZIKV) outbreak the Brazilian Ministry of Health (MoH). In response, the Brazilian Society of Medical Genetics established a task force (SBGM-ZETF) to study the phenotype of infants born with microcephaly due to ZIKV congenital infection and delineate the phenotypic spectrum of this newly recognized teratogen. This study was based on the clinical evaluation and neuroimaging of 83 infants born during the period from July, 2015 to March, 2016 and registered by the SBGM-ZETF. All 83 infants had significant findings on neuroimaging consistent with ZIKV congenital infection and 12 had confirmed ZIKV IgM in CSF. A recognizable phenotype of microcephaly, anomalies of the shape of skull and redundancy of the scalp consistent with the Fetal Brain Disruption Sequence (FBDS) was present in 70% of infants, but was most often subtle. In addition, features consistent with fetal immobility, ranging from dimples (30.1%), distal hand/finger contractures (20.5%), and feet malpositions (15.7%), to generalized arthrogryposis (9.6%), were present in these infants. Some cases had milder microcephaly or even a normal head circumference (HC), and other less distinctive findings. The detailed observation of the dysmorphic and neurologic features in these infants provides insight into the mechanisms and timings of the brain disruption and the sequence of developmental anomalies that may occur after prenatal infection by the ZIKV.

BackgroundThe Brazilian SUS (Unified Health System) was created in 1988 within the new constitution, based on the premises of being universal, comprehensive, and equitable. The SUS offers free health care, independent of contribution or affiliation. Since then, great efforts and increasing investments have been made for the system to achieve its goals. We assessed how coverage and equity in selected reproductive and maternal interventions progressed in Brazil from 1986 to 2013.MethodsWe reanalysed data from four national health surveys carried out in Brazil in 1986, 1996, 2006 and 2013. We estimated coverage for six interventions [use of modern contraceptives; antenatal care (ANC) 1+ visits by any provider; ANC 4+ visits by any provider; first ANC visit during the first trimester of pregnancy; institutional delivery; and Caesarean sections] using standard international definitions, and stratified results by wealth quintile, urban or rural residence and country regions. We also calculated two inequality indicators: the slope index of inequality (SII) and the concentration index (CIX).ResultsAll indicators showed steady increases in coverage over time. ANC 1+ and 4+ and institutional delivery reached coverage above 90 % in 2013. Prevalence of use of modern contraceptives was 83 % in 2013, indicating nearly universal satisfaction of need for contraception. On a less positive note, the proportion of C-sections has also grown continuously, reaching 55 % in 2013. There were marked reductions in wealth inequalities for all preventive interventions. Inequalities were significantly reduced for all indicators except for the C-section rate (p = 0.06), particularly in absolute terms (SII).ConclusionsDespite the difficulties faced in the implementation of SUS, coverage of essential interventions increased and equity has improved dramatically, due in most cases to marked increase in coverage among the poorest 40 %. An increase in unnecessary Caesarean sections was also observed during the period. Further evaluation on the quality of healthcare provided is needed.

Summary Background In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival. Methods We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams. Findings Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores −1·54 vs −3·13, difference 1·58 [95% CI 1·45–1·72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 [95% CI 0·14–0·56]); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 [95% CI 0·27–0·42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above −2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015. Interpretation Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Funding Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.

To compare two summary indicators for monitoring universal coverage of reproductive, maternal, newborn and child health care.Using our experience of the Countdown to 2015 initiative, we describe the characteristics of the composite coverage index (a weighted average of eight preventive and curative interventions along the continuum of care) and co-coverage index (a cumulative count of eight preventive interventions that should be received by all mothers and children). For in-depth analysis and comparisons, we extracted data from 49 demographic and health surveys. We calculated percentage coverage for the two summary indices, and correlated these with each other and with outcome indicators of mortality and undernutrition. We also stratified the summary indicators by wealth quintiles for a subset of nine countries.Data on the component indicators in the required age range were less often available for co-coverage than for the composite coverage index. The composite coverage index and co-coverage with 6+ indicators were strongly correlated (PearsonThe composite coverage index, based on the average value of separate coverage indicators, is easy to calculate and could be useful for monitoring progress and inequalities in universal health coverage.Comparer deux indicateurs synthétiques pour le suivi de la couverture universelle en matière de santé reproductive, maternelle, néonatale et infantile.En nous appuyant sur l'expérience que nous avons acquise dans le cadre de l'initiative Compte à rebours 2015, nous décrivons les caractéristiques de l'indice de couverture composé (moyenne pondérée de huit interventions préventives et curatives tout au long du cycle continu de soins) et de l'indice de co-couverture (total cumulatif de huit interventions préventives dont doivent bénéficier toutes les mères et tous les enfants). En vue d'une analyse et de comparaisons approfondies, nous avons extrait des données de 49 enquêtes démographiques et sanitaires. Nous avons calculé le taux de couverture pour chacun des deux indices synthétiques, puis nous les avons corrélés entre eux et avec des indicateurs de résultats en matière de mortalité et de dénutrition. Nous avons également stratifié les indicateurs synthétiques par quintile de richesse pour un sous-ensemble de neuf pays.Les données relatives aux indicateurs des composantes dans la tranche d'âge requise étaient moins souvent disponibles pour la co-couverture que pour l'indice de couverture composé. Une forte corrélation a été établie entre l'indice de couverture composé et la co-couverture avec 6 indicateurs ou plus (PearsonL'indice de couverture composé, basé sur la valeur moyenne de différents indicateurs de couverture, est facile à calculer et pourrait être utile pour suivre les progrès et les inégalités en matière de couverture sanitaire universelle.Comparar dos indicadores de resumen para controlar la cobertura universal de atención sanitaria reproductora, materna, obstétrica e infantil.A través de la experiencia de la iniciativa “Cuenta atrás para 2015”, se describen las características del índice de cobertura compuesto (una media ponderada de ocho intervenciones preventivas y curativas a lo largo de una atención continua) y el índice de cocobertura (una cuenta acumulativa de ocho intervenciones preventivas que deberían recibir todas las madres y niños). Para obtener un análisis profundo y comparaciones, se ha recopilado información de 49 encuestas sobre demografía y salud. Se ha calculado el porcentaje de cobertura para ambos índices de resumen y se han correlacionado entre ellos y con los indicadores de resultados de mortalidad y desnutrición. También se han estratificado los indicadores de resumen con quintiles de riqueza en un subconjunto de nueve países.La información sobre los indicadores de componentes del grupo de edades necesario podía obtenerse con menos asiduidad para el índice de cocobertura que para el índice de cobertura compuesto. El índice de cobertura compuesto y el índice de cocobertura con más de 6 indicadores se correlacionaban muy estrechamente (Es fácil calcular el índice de cobertura compuesto, según el valor medio de los indicadores de cobertura individuales, y podría resultar de utilidad para controlar el progreso y la poca adecuación de la cobertura sanitaria universal.المقارنة بين مؤشرين موجزين لرصد التغطية العالمية للإنجاب وصحة الأم والوليد والرعاية الصحية للأطفال.بالاعتماد على خبرتنا بالعد التنازلي لمبادرة عام 2015، فإننا نصف خصائص مؤشر التغطية المركب (متوسط مُرجح للإجراءات الثمانية الوقائية والعلاجية بجانب استمرارية الرعاية) ومؤشر التغطية المشتركة (العد التراكمي للإجراءات الثمانية الوقائية التي ينبغي على جميع الأمهات والأطفال تلقيها). وللحصول على تحليل ومقارنة متعمقين، فقد استخرجنا البيانات من 49 دراسة ديموغرافية وصحية. وقمنا بحساب نسبة تغطية المؤشرين الموجزين، وربطهما مع بعضها ومع كل مؤشرات نتائج الوفيات ونقص التغذية الأخرى. كما قمنا بتطبيق المؤشرات الموجزة عن طريق أخماس الثروة لمجموعة فرعية من تسعة بلدان.كانت البيانات الصادرة بشأن المؤشرات المركبة في الفئة العمرية المطلوبة أقل توفرًا في الغالب بالنسبة التغطية المشتركة وذلك بالمقارنة مع مؤشر التغطية المركب. وقد ارتبط مؤشر التغطية المركب والتغطية المشتركة ارتباطًا وثيقًا بأكثر من 6 مؤشرات (يعتمد مؤشر التغطية المُركب على متوسط قيمة مؤشرات التغطية المنفصلة، كما يسهل حسابه وقد يكون مفيدًا لرصد التقدم المحرز وأوجه عدم المساواة في التغطية الصحية العالمية.旨在比较两个生育、孕产妇、新生儿和儿童医疗保健普遍覆盖率综合监测指数。.根据我们在“2015 年倒计时”方案方面的经验，我们描述了综合覆盖率指数（连续护理过程中八种预防与治疗干预的加权平均数）和共同覆盖率指数（所有母亲和儿童都应该接受的八种预防干预的累计计数）的特征。 为了深度分析和比较，我们提取了来自 49 项人口与健康调查的数据。 我们计算了这两个综合指标的百分比占有率，对其进行了相互对照，并与死亡和营养不良的结果指标进行了对照。 我们使用财富五分位数对九个国家构成的子集的综合指数进行了分层。.与综合覆盖率指数相比，可用于共同覆盖率指数的所需年龄段组指标数据更难获取。 综合覆盖率指数和带有 6 个以上指标的共同覆盖率指数之间的关联性非常强 (Pearson基于单个覆盖率指标平均值的综合覆盖率指数方便计算，并且有助于监测普遍医疗保健覆盖率的进程及不均衡性。.Сравнить два сводных показателя мониторинга всемирной охраны репродуктивного здоровья, материнства, новорожденных и детей других возрастных групп.Используя собственный опыт инициативы «К 2015 году», авторы описывают параметры составного индекса охвата (средневзвешенный показатель восьми профилактических и оздоровительных мероприятий в ходе профилактики) и индекса совместного охвата (кумулятивная частота этих восьми профилактических мероприятий для всех матерей и детей). Для проведения подробного анализа и сравнений были получены данные из 49 демографических и медико-санитарных обследований. Авторы рассчитали в процентах степень охвата для двух суммарных показателей и определили, как они коррелируют друг с другом и с результирующими показателями смертности и недоедания. Кроме того, для подгруппы, состоящей из девяти стран, сводные показатели были разбиты по квинтилям по уровню благосостояния.Данные по показателям составляющих для требуемого возрастного диапазона были менее доступны для индекса совместного охвата, чем для составного индекса охвата. Между составным индексом охвата и совместным охватом, включающим шесть и более показателей, была установлена сильная корреляция (коэффициент корреляции ПирсонаСоставной индекс охвата, основывающийся на среднем значении отдельных показателей охвата, прост для расчета и может применяться для контроля улучшения или неравномерности в мировом обеспечении услугами системы здравоохранения.

To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries.In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage - i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine - in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries.In each of the World Health Organization's regions, it appeared that about 56-69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations.Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.Étudier les disparités en matière de couverture vaccinale complète (disparités entre pays et au sein des pays), à partir des données obtenues pour 86 pays à revenu faible ou intermédiaire.En mai 2015, en utilisant des données issues des plus récentes enquêtes démographiques et sanitaires et d'enquêtes en grappes à indicateurs multiples, nous avons étudié les inégalités dans la couverture vaccinale complète (soit l'administration d'une dose du vaccin bilié de Calmette et Guérin, d'une dose de vaccin antirougeoleux, de trois doses de vaccin diphtérie-coqueluche-tétanos et de trois doses de vaccin antipoliomyélitique), dans 86 pays à revenu faible ou intermédiaire. Nous avons ensuite analysé l’évolution au fil du temps du niveau de couverture et des inégalités de cette couverture dans huit des pays étudiés.Dans chacune des régions de l'Organisation mondiale de la Santé, près de 56 à 69% des enfants éligibles vivant dans un pays à revenu faible ou intermédiaire a bénéficié d'une couverture vaccinale complète. Néanmoins, dans chaque région, le taux de couverture moyen enregistré varie énormément. Dans la Région africaine, par exemple, ce taux est compris entre 11,4% au Tchad et 90,3% au Rwanda. Nous avons décelé une inégalité en faveur des riches dans 45 des 83 pays pour lesquels nous avons obtenu des données exploitables et une inégalité favorable aux urbains dans 35 des 86 pays étudiés. Parmi les pays pour lesquels nous avons analysé l’évolution de la couverture vaccinale au fil du temps, Madagascar et le Mozambique sont ceux qui ont fait les plus gros progrès dans l'amélioration du niveau de couverture vaccinale complète au cours des vingt dernières années, notamment auprès des quintiles les plus pauvres de leur population.Dans la majorité des pays à revenu faible ou intermédiaire, il existe des inégalités en faveur des riches et des urbains en matière de couverture vaccinale complète; des inégalités qui ne sont pas observables lorsque l'on considère uniquement les moyennes nationales.Investigar las disparidades en la cobertura de inmunización completa entre y dentro de 86 países con ingresos bajos y medios.En mayo de 2015, mediante el uso de datos provenientes de las Encuestas de Demografía y Salud y las Encuestas de Conglomerados de Indicadores Múltiples más recientes, se investigaron las desigualdades en la cobertura de inmunización completa, es decir, una dosis de la vacuna del bacilo Calmette-Guérin, una dosis de la vacuna contra el sarampión, tres dosis de la vacuna contra la difteria, el tétanos y la tos ferina y tres dosis de la vacuna contra el polio, en 86 países con ingresos bajos o medios. Posteriormente, se investigaron las tendencias temporales en el nivel y la desigualdad de dicha cobertura en ocho de los países.En todas las regiones de la Organización Mundial de la Salud, parecía que alrededor de entre un 56 y un 69% de los niños aptos en los países de ingresos bajos y medios habían recibido una inmunización completa. No obstante, dentro de cada región, el nivel medio registrado de dicha cobertura era muy diferente. En la región africana, por ejemplo, osciló de un 11,4% en Chad hasta un 90,3% en Rwanda. Se detectó una desigualdad que favorecía a los ricos en dicha cobertura en 45 de los 83 países de los cuales de disponía de información importante, y una desigualdad que favorecía a las zonas urbanas en 35 de los 86 países del estudio. Entre los países en los que se investigaron las tendencias de cobertura, Madagascar y Mozambique parecían ser los que habían progresado más a la hora de mejorar los niveles de una cobertura de inmunización completa durante las dos últimas décadas, principalmente entre la población más pobre.La mayoría de los países con ingresos bajos y medios se ven afectados por las desigualdades que favorecen a la población rica y a las zonas urbanas en relación con la cobertura de inmunización completa, las cuales no resultan aparentes cuando se informa únicamente de los valores nacionales medios de dicha cobertura.التحقيق بشأن التفاوت في تغطية عمليات التمنيع الكاملة عبر وداخل 86قمنا في شهر مايو/أيار من عاملقد بدا أن الأطفال المؤهلين في البلدان ذات الدخل المنخفض والمتوسط الذين تتراوح نسبتهم من 56 إلى 69‏% تقريبًا قد تلقوا التمنيع الكامل في كل منطقة من المناطق التابعة لمنظمة الصحة العالمية. ومع ذلك، اختلف متوسط المستوى المسجل لهذه التغطية بصورة كبيرة داخل كل منطقة. فقد اختلف مستوى التغطية على سبيل المثال في المناطق الأفريقية من ‏11.4% في تشاد إلى ‏90.3% في رواندا. واكتشفنا وجود حالات من عدم المساواة الموالية للمناطق الغنية في هذه التغطية في 45 بلدًا من إجمالي 83 بلدًا والتي توفرت البيانات ذات الصلة الخاصة بها ووجود حالات من عدم المساواة الموالية للمناطق الحضرية في 35 بلدًا من إجمالي 86 بلدًا شملتها هذه الدراسة. ومن بين البلدان التي قمنا فيها بالتحقيق بشأن نزعات التغطية، بدا أن مدغشقر وموزامبيق حققتا النسبة الأكبر من التقدم في مجال تحسين مستويات تغطية عمليات التمنيع الكاملة على مدار العقدين الماضيين، وبالأخص بين خُمس السكان الأكثر فقرًا.تتأثر معظم البلدان ذات الدخل المنخفض والمتوسط من حالات عدم المساواة الموالية للمناطق الغنية والموالية للمناطق الحضرية فيما يتعلق بتغطية عمليات التمنيع الكاملة التي لا تكون واضحة عندما يتم الإبلاغ عن قيم المتوسط الوطني فقط لهذه التغطية.旨在调查 86 个中低收入国家之间和之内全程免疫接种率的差异。.2015 年 5 月，我们采用了最新人口与健康调查和多指标类集调查数据，研究了全程免疫接种率——即一剂卡介苗、一剂麻疹疫苗、三剂百日咳、白喉、破伤风疫苗和三剂脊髓灰质炎疫苗——在 86 个中低收入国家的不均衡性。 然后，我们研究了接种率水平和不均衡性在其中八个国家的变化趋势。.在各个世界卫生组织地区，中低收入国家 56–69% 的符合条件的儿童接受了全程免疫接种。 但是，在各个地区，所记录的平均接种率水平差别很大。 例如在非洲地区，乍得的接种率仅为 11.4%，而卢旺达的接种率高达 90.3%。 我们发现，在我们使用其相关数据的 83 个国家中，有 45 个国家的接种率体现出了贫富差距；在 86 个研究国中，有 35 个国家的接种率体现出了城市化水平的不均衡性。 在我们研究了其接种率趋势的国家中，马达加斯加和莫桑比克过去二十年间在提高全程免疫接种率水平方面取得的进步最为显著，尤其是在占其人口五分之一的最贫穷群体中。.大多数中低收入国家都受全程免疫接种率上贫富差距和城市化水平不均衡性的影响，而在仅报告全国接种率平均值时，这种不均衡性却不明显。.Изучить неравномерность охвата населения полной вакцинацией в 86 странах с низким и средним уровнем дохода.В мае 2015 года на основе последних данных демографических исследований состояния здоровья населения, а также кластерных исследований с множественными показателями была изучена неравномерность охвата населения полной (т. е. включающей одну дозу вакцины БЦЖ, одну дозу противокоревой вакцины, три дозы вакцины КДС и три дозы вакцины против полиомиелита) вакцинацией в 86 странах с низким и средним уровнем дохода. Затем были исследованы тенденции во времени неравномерности охвата вакцинацией в восьми из этих стран.Было обнаружено, что в каждом регионе Всемирной организации здравоохранения в странах с низким и средним уровнем дохода полной вакцинацией было охвачено приблизительно 56–69% отвечающих соответствующим критериям детей. Однако внутри каждого региона средний уровень вакцинации значительно различался. Например, в африканском регионе доля привитых варьировалась от 11,4% в Чаде до 90,3% в Руанде. Была обнаружена неравномерность вакцинации по признаку обеспеченности в 45 из 83 стран, для которых имелись соответствующие данные, и по признаку проживания в городе в 35 из 86 исследованных стран. Среди стран, в которых были изучены эти тенденции, Мадагаскар и Мозамбик добились наибольшего успеха в увеличении охвата населения полной вакцинацией за последние два десятилетия, в особенности среди наименее обеспеченных квинтилей населения.В большинстве стран с низким и средним уровнем дохода существует неравномерность охвата полной вакцинацией, которая связана с уровнем обеспеченности и проживанием в городе, причем эта неравномерность не выявляется, когда учитываются только средние национальные показатели.

Resumo: O conhecimento da incidência de acidentes na infância, de acordo com o estágio de desenvolvimento da criança, é importante para a formulação de programas de prevenção dirigidos para cada faixa etária. O objetivo deste estudo foi descrever a incidência de quedas, cortes e queimaduras, até os quatro anos de idade, conforme nível econômico da família e idade e escolaridade maternas, entre as crianças da coorte de nascimentos de Pelotas, Rio Grande do Sul, Brasil, 2004. Foram calculadas as taxas de incidências e razões de taxas de incidências entre 0-12, 12-24 e 24-48 meses. As quedas foram os acidentes mais relatados em todos os períodos, seguidas dos cortes e queimaduras. Os meninos sofreram mais quedas e cortes do que as meninas nos dois primeiros anos de vida. No segundo ano de vida, a incidência de quedas e queimaduras praticamente triplicou e a de cortes dobrou, em comparação ao primeiro ano, dentre ambos os sexos. As queimaduras ocorreram com igual frequência entre meninas e meninos nos três períodos de idade analisados. Em suma, a incidência de quedas e cortes foi maior entre os meninos. Em ambos os sexos, ter mãe adolescente foi associado a quedas e cortes nos três períodos analisados; ter mãe com baixa escolaridade esteve associado a queimaduras e cortes aos 48 meses; e ser de família de baixo nível socioeconômico, a quedas e cortes aos 48 meses. Resumen: El conocimiento de la incidencia de accidentes en la infancia, de acuerdo con el grado de desarrollo del niño, es importante para la formulación de programas de prevención dirigidos para cada franja de edad. El objetivo de este estudio fue describir la incidencia de caídas, cortes y quemaduras, hasta los cuatro años de edad, conforme el nivel económico de la familia y edad y escolaridad maternas, entre los niños de la cohorte de nacimientos de Pelotas, Rio Grande do Sul, Brasil, 2004. Se calcularon las tasas de incidencias y razones de tasas de incidencias entre 0-12, 12-24 y 24-48 meses. Las caídas fueron los accidentes más relatados en todos los períodos, seguidos de los cortes y quemaduras. Los niños sufrieron más caídas y cortes que las niñas durante los dos primeros años de vida. En el segundo año de vida, la incidencia de caídas y quemaduras prácticamente se triplicó y la de cortes se duplicó, en comparación con el primer año, entre ambos sexos. Las quemaduras se produjeron con igual frecuencia entre niñas y niños durante los tres períodos de edad analizados. En resumen, la incidencia de caídas y cortes fue mayor entre los niños. En ambos sexos, tener madre adolescente se asoció a caídas y cortes en los tres períodos analizados; tener madre con baja escolaridad estuvo asociado a quemaduras y cortes a los 48 meses; y ser de familia de bajo nivel socioeconómico, a caídas y cortes a los 48 meses. Abstract: Knowledge on the incidence of childhood accidents according to the child's stage of development is important for designing preventive programs targeting each age bracket. The aim of this study was to describe the incidence of falls, cuts, and burns in children up to four years of age according to family economic status and maternal age and schooling, in children from the 2004 Pelotas (Brazil) birth cohort. We calculated the incidence rates and incidence rates ratios for the 0-12, 12-24, and 24-48- months of age. Falls were the most frequently reported accidents in all the age brackets, followed by cuts and burns. Boys suffered more falls and cuts than girls in the first two years of life. In the second year of life, the incidence of falls and burns practically tripled, while cuts nearly doubled when compared to the first year, in both sexes. Burns were equally frequent in girls and boys in all three age brackets. The incidence of falls and cuts was higher in boys. In both sexes, having an adolescent mother was associated with falls and cuts in all three age brackets; low maternal schooling was associated with burns and cuts at 48 months; and low family socioeconomic status was associated with falls and cuts at 48 months.