Examining the Association of Socioeconomic Position with Microcephaly and Delayed Childhood Neurodevelopment among Children with Prenatal Zika Virus Exposure

Abstract

Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.

Causes of Phenotypic Variability and Disabilities after Prenatal Viral Infections

“…Multiple studies have identified socioeconomic drivers for neurodevelopmental disabilities. For instance, higher maternal education reduced the risk of microcephaly prior to the pandemic in Brazil [ 128 , 129 ]. Further, lower household income and higher crowding was a risk factor for microcephaly [ 56 , 129 ].…”

“…For instance, higher maternal education reduced the risk of microcephaly prior to the pandemic in Brazil [ 128 , 129 ]. Further, lower household income and higher crowding was a risk factor for microcephaly [ 56 , 129 ]. Co-occurring health risks, such as malnutrition, increase the risk to the fetus [ 129 ].…”

“…Further, lower household income and higher crowding was a risk factor for microcephaly [ 56 , 129 ]. Co-occurring health risks, such as malnutrition, increase the risk to the fetus [ 129 ]. Similar socioeconomic health modifiers should be considered and modeled in more developmental diseases [ 128 ].…”

“…Similar socioeconomic health modifiers should be considered and modeled in more developmental diseases [ 128 ]. Local efforts, for example, educating lower income households on Zika, can increase health-seeking behavior in socially marginalized groups and may decrease disease burden in future pandemics [ 129 , 130 ].…”

Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015–2017

“…At the same time, thousands of families of children with CZS continue to grapple with significant health and social consequences from the last epidemic. Children with CZS have been observed to experience a vast range of clinical manifestations, including dysphagia,14 hearing and visual abnormalities,15 16 early epilepsy,17 neurodevelopmental delays,18 19 adenoid hypertrophy,20 cryptorchidism,21 22 endocrine dysfunction23 and an estimated case fatality rate of 10% 24…”