Analysis of the socio-environmental vulnerability of black and Caucasian pregnant women in Salvador, Bahia, Brazil to the occurrence of microcephaly associated with the congenital syndrome of zika virus

Abstract

To understand the occurrence of the Congenital Zika Syndrome (CZS), the living conditions of pregnant individuals must be considered in order to identify factors and areas of risk. An intersectional approach provides an understanding of the vulnerabilities to which Black women are subjected. To that end, we present an overview of the spatio-temporal distribution of confirmed cases of microcephaly associated with CZS during the 2015-2016 period in Salvador, Bahia, Brazil based on a survey of Black and Caucasian, pregnant women seen through the intersectional lens of race and class. To consider the confirmed cases of microcephaly and other neurological anomalies associated with CZS, a Living Condition Index (LCI) was utilized to rate the socio-environmental vulnerability of pregnant women. There was less information in the notification records with regard to Black, pregnant women resulting in fewer examinations. Twelve, highrisk areas for Black, pregnant women were identified but only two for Caucasian women. CZS cases referred to Black, pregnant women were found to be concentrated in census sectors with a low (31.6%) and very low (34.5%) LCI, while those referred to Caucasian, pregnant women were concentrated in areas with a high (35.6%) and intermediate (29.4%) LCI. The study concludes that inequities in health expose different population groups to different forms of illnesses, and institutional racism solidifies scenarios of exclusion. In this sense, Black women experiences manifest directly in their health. Confrontation with arboviruses requires the implementation of inter-institutional policies aimed at overcoming discriminatory practices of exposure.

Zika virus infection and microcephaly: spatial analysis and socio-environmental determinants in a region of high Aedes aegypti infestation in the Central-West Region of Brazil

“…Additionally, the spatial analysis unit of the present study, which encompassed different social strata, might have made these indicators less discriminatory between municipalities. Other studies that analysed the Northeast and Southeast regions of Brazil found associations between the incidence of ZIKV and factors such as population density, human development index, primary care coverage, violence rate, average household income, and race, thereby reinforcing the association of the social determinants of health with the dispersion of ZIKV and the worsening of congenital cases [ 28 , 67 , 73 ].…”

“…Brazilian studies show a heterogeneous geographical distribution of ZIKV infection and microcephaly [ 23 – 26 ], potentially explained by climatic factors, vector abundance, and unfavourable socioeconomic conditions [ 27 – 29 ]. Epidemiological studies have mostly been conducted in areas with higher incidences of acute ZIKV disease and of microcephaly [ 27 , 28 , 30 ]. However, there is little known about the regions that were less affected in the first wave, such as the Central-West region.…”

Morbidity and mortality of pregnant women due to COVID-19 andracialbiases:an intersectional analysis

“…Other epidemic contexts, such as that of the Zika Virus, revealed that poor Afro-descendant women living in the periphery were the individuals most frequently affected (7) . For example, in 2015 and 2016, 91% of the fetuses affected by Congenital Syndrome caused by the Zika Virus reported in Salvador, capital of Bahia, Brazil, were from Afrodescendant women (8) . Considering the high rates of complications, hospitalizations, and deaths during the gestational period associated with respiratory infections caused by H1N1 and other Coronavirus strains, such as SARS-CoV-2 and MERS-CoV, the Brazilian Ministry of Health instituted in April 2020, through Technical Note No.…”