Background The epidemiology of childhood SARS-CoV-2 infection and COVID-19-related illness remains little studied in high-transmission tropical settings, partly due to the less severe clinical manifestations typically developed by children and the limited availability of diagnostic tests. To address this knowledge gap, we investigate the prevalence and predictors of SARS-CoV-2 infection (either symptomatic or not) and disease in 5 years-old Amazonian children. Methodology/Principal findings We retrospectively estimated SARS-CoV-2 attack rates and the proportion of infections leading to COVID-19-related illness among 660 participants in a population-based birth cohort study in the Juruá Valley, Amazonian Brazil. Children were physically examined, tested for SARS-CoV-2 IgG and IgM antibodies, and had a comprehensive health questionnaire administered during a follow-up visit at the age of 5 years carried out in January or June-July 2021. We found serological evidence of past SARS-CoV-2 infection in 297 (45.0%; 95% confidence interval [CI], 41.2–48.9%) of 660 cohort participants, but only 15 (5.1%; 95% CI, 2.9–8.2%) seropositive children had a prior medical diagnosis of COVID-19 reported by their mothers or guardians. The period prevalence of clinically apparent COVID-19, defined as the presence of specific antibodies plus one or more clinical symptoms suggestive of COVID-19 (cough, shortness of breath, and loss of taste or smell) reported by their mothers or guardians since the pandemic onset, was estimated at 7.3% (95% CI, 5.4–9.5%). Importantly, children from the poorest households and those with less educated mothers were significantly more likely to be seropositive, after controlling for potential confounders by mixed-effects multiple Poisson regression analysis. Likewise, the period prevalence of COVID-19 was 1.8-fold (95%, CI 1.2–2.6-fold) higher among cohort participants exposed to food insecurity and 3.0-fold (95% CI, 2.8–3.5-fold) higher among those born to non-White mothers. Finally, children exposed to household and family contacts who had COVID-19 were at an increased risk of being SARS-CoV-2 seropositive and–even more markedly–of having had clinically apparent COVID-19 by the age of 5 years. Conclusions/Significance Childhood SARS-CoV-2 infection and COVID-19-associated illness are substantially underdiagnosed and underreported in the Amazon. Children in the most socioeconomically vulnerable households are disproportionately affected by SARS-CoV-2 infection and disease.
RESUMO A alimentação adequada e saudável é crucial para o desenvolvimento infantil, principalmente nos primeiros mil dias de vida. Sendo a alimentação não saudável um fator de risco modificável para doenças e desnutrição, ações que promovam as orientações do ‘Guia alimentar para crianças brasileiras menores de 2 anos’ são necessárias. O presente relato compartilha o processo de planejamento, construção, divulgação, oferecimento e avaliação de uma oficina virtual para profissionais da Atenção Primária à Saúde no Acre, Amazônia Ocidental brasileira, com destaque para os desafios encontrados e as lições aprendidas. A oficina contou com 170 inscritos e foi assíncrona para facilitar o acesso dos participantes diante da baixa disponibilidade de tempo e instabilidade do sinal de internet na região. O uso de diferentes ferramentas virtuais favoreceu o diálogo entre os participantes e as coordenadoras da oficina. Participantes relataram preferir vídeos curtos com animações, e os conteúdos considerados mais importantes abordaram avaliação antropométrica, processamento e classificação de alimentos e desafios da alimentação. Ressalta-se a importância das parcerias com secretarias de saúde para o adequado planejamento e divulgação da oficina, e da colaboração de pesquisadoras e profissionais da área para a definição e elaboração de conteúdo relevante.
Grenada, West Indies, with a dual focus on: (1) enhancing neurodevelopment, and thereby human capital, by imparting knowledge and skills to adult caregivers that build emotional regulation and a strong social emotional connection with the child, thereby enhancing child safety, exploration, and stimulation, while (2) addressing culturally entrenched, postcolonial practices of harsh corporal punishment and related violence against children.The Programme uses an adapted Conscious Discipline (CD) curriculum, which is a trauma-informed triune brain state model with a specific focus on adult skill-building in a context in which licks, spanks, and beatings are culturally normative despite overwhelming evidence that violence is harmful for children's health and brain development. The curriculum is delivered to families through a home visiting program by community-based social workers (i.e., Roving Caregivers) to communities through a mobile unit (The Saving Brains Bus) and, more recently, to pre-primary schools through an adaptable coaching system administered both in-person and virtually.A key element is the Programme's brain-based focus on safe, connected relationships in which to maintain composure, resolve conflicts, and solve problems.A parallel single-blind waitlist-controlled trial design was used in which children from age 0-2 and their parents were enrolled in the home visiting program and assigned to a CD Intervention group versus a Waitlist Control (WC) group. The total number of parents and children under age two years enrolled in this study was 1,043, which represented 19.8% of all children under this age in Grenada at that time. A total of 752 parents and their children were recruited by the Roving Caregiver program and served as the CD Intervention group. A total of 291 parents and their children were recruited into the WC group. A total of 333 participants (Intervention: n=165; WC: n=168) remained after the data was cleaned. Upon turning 2 years of age, children were assessed and the CD Intervention group was compared to the WC group on measures of neurodevelopmental outcomes (INTERGROWTH-21st Neurodevelopment Assessment [INTER-NDA], demographics, mother pregnancy and birth outcomes, maternal mental health indicators, home environment, food security). Mothers were also assessed for attitudes and behaviors around corporal punishment.Results demonstrated: (1) improved neurodevelopment in children; (2) significant shifts in knowledge about developmentally appropriate child rearing practices and skills among teachers, Roving Caregivers, and parents; (3) moderate shifts in attitudes toward the use of corporal punishment in teachers and Roving Caregivers, and (4) incremental shifts in attitudes toward the use of corporal punishment among parents. Whether a reduction in attitudes and behaviors toward corporal punishment is needed for improvement (or greater improvement) in neurodevelopment remains an outstanding question.
Breastfeeding practices and weight gain predicted head circumference in young Amazonian children The human brain experiences intensive connectivity and size transformations after birth. 1 Head circumference (HC) shows important increments in size, specifically in the first year; then, this growth rate decelerates over time. 2 Identifying the different elements required We are grateful to the families, health professionals and MINA-Brazil Study Group members:
OBJECTIVE: To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS: A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children <2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS: From the 4229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS: Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required.
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