Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

Tiguman, Gustavo Magno Baldin; Silva, Marcus Tolentino; Galvão, Taís Freire

doi:10.11606/s1518-8787.2022056003663

Cited by 3 publications

(3 citation statements)

References 48 publications

(39 reference statements)

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“…Part of the differences found in excess maternal mortality in our study may be explained by the striking socioeconomic inequalities in the North and Northeast regions of Brazil [ 39 , 40 ] which have the worst infrastructure and access to health services in the country [ 41 ]. The North region, most harshly punished across all trimesters assessed, was not as prepared to face the epidemic since, proportionally, it possessed the lowest number of ICU beds, physicians, and ventilators, an essential device for facing COVID-19 complications [ 42 ], of all macroregions.…”

Section: Discussionmentioning

confidence: 99%

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

Orellana

Jacques²,

Leventhal³

et al. 2022

PLoS ONE

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Background The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. Methods This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. Results There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. Conclusions Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic’s greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil’s health crisis.

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Section: Discussionmentioning

confidence: 99%

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

Orellana

Jacques²,

Leventhal³

et al. 2022

PLoS ONE

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“…The substantial burden of excess suicide found in the North and Northeast regions is not surprising and may be partially explained by well-known socioeconomic inequalities, lower mental health service use and by the strongest direct effect of the Covid-19 pandemic in comparison with South region, for example (da Costa Dantas et al, 2023; Paula et al, 2014; Szwarcwald et al, 2016; Tiguman et al, 2022). In 2020 and especially in 2021, the Northeast region had the lowest average income in the employed population, regarding other Brazilian regions.…”

Section: Discussionmentioning

confidence: 99%

Excess suicides in Brazil during the first 2 years of the COVID-19 pandemic: Gender, regional and age group inequalities

Orellana,

de Souza,

Horta

2023

Int J Soc Psychiatry

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Background: While the COVID-19 pandemic’s total impact on global mortality is uncertain, an estimated 15 million excess deaths occurred during the first two pandemic years, suggesting that a broad impact, since several causes of death showed a substantial rise. Aims: To estimate excess suicides in Brazil and evaluate differences within and between subgroups during the first 2 years of the COVID-19 pandemic. Method: Based on suicide data from the mortality information system of the Brazilian Ministry of Health, the expected number of suicides was estimated by age group, gender, 4-month periods and regions through quasi-Poisson generalized additive models. Analyses were performed in R software and RStudio. Results: Between March 2020 and February 2022, 29,295 suicides were reported in Brazil, close to what would be expected (30,116; 95% Confidence Interval (95% CI): [28,009, 32,224]), albeit in males and females aged 30 to 59 years and 60 years and over, there were excess suicides in at least one of the six 4-month periods evaluated, especially in the second pandemic year. In the Southeast region, a 28% increase was observed in women 60 years and older during the second year. In the North region, suicide increased 23% and 32% among women aged 30 to 59 years during the first and second pandemic years, respectively. The Northeast region had a 16% excess in suicides among men aged 30 to 59 years and 61% among women 60 years old and older during the second pandemic year, reaching 83% in July to October 2021. Conclusions: During the first 2 pandemic years, the pattern of suicides was not homogeneous in Brazil. There were substantial excess suicides in women aged 30 to 59 years from the North and Northeast, while among the elderly and men there was a consistent pattern in several four-month periods throughout Brazil.

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“…Thus, the environment should be seen as a significant but not sufficient factor that affects the origin of diseases [12]. Additionally, limited research conducted in South Africa and Brazil reveals that the respective health systems are largely unprepared for the increasing strain that climate change would bring [13,14].…”

Section: 1mentioning

confidence: 99%

Climate Change, Air Pollution, and Human Health in the Kruger to Canyons Biosphere Region, South Africa, and Amazonas, Brazil: A Narrative Review

dos Santos

2024

Atmosphere

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There is a 50% possibility that global temperatures will have risen by more than 5 °C by the year 2100. As demands on Earth’s systems grow more unsustainable, human security is clearly at stake. This narrative review provides an overview and synthesis of findings in relation to climate change, air pollution, and human health within the Global South context, focusing on case study geographic locations in South Africa and Brazil. Two case study regions—the Kruger to Canyons Biosphere region of South Africa and the Amazon region of Brazil—were the subjects of PubMed literature searches. Technical reports, policy briefs, and grey literature were also narratively synthesized. The burning of wood for fuel, as witnessed in Agincourt, and forest fires, such as those seen in the Amazon rainforest, release air pollutants such as methane and black carbon, which are strong short-lived climate pollutants (SLCPs) which fuel climate change and adversely affect human health. SLCPs have a brief lifetime in the atmosphere, but they frequently have a far larger potential for global warming than carbon dioxide (CO2). Most air pollution in geographic case study areas, that are home to human settlements, is due to the burning of wood and other biomasses that are pollutants. These areas are seen to be important for climate and health responses, and if constructive action is taken to switch to other modes of electricity generation (such as solar power) and the prevention of deforestation, the worst of the impacts may still be mitigated in these regions. Authorities should also establish a monitoring strategy for air quality, as well as enforce air quality regulations that safeguard public health.

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Health services utilization in the Brazilian Amazon: panel of two cross-sectional studies

Cited by 3 publications

References 48 publications

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic

Excess suicides in Brazil during the first 2 years of the COVID-19 pandemic: Gender, regional and age group inequalities

Climate Change, Air Pollution, and Human Health in the Kruger to Canyons Biosphere Region, South Africa, and Amazonas, Brazil: A Narrative Review

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