Social determinants associated with Zika virus infection in pregnant women

Abstract

This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil. Methods We recruited women who gave birth between October 2015 and January 2016 to a cross-sectional study at a referral maternity hospital in Salvador, Brazil. We collected information on their demographic, socioeconomic, and clinical characteristics, and evaluated their ZIKV exposure using a plaque reduction neutralization test. Logistic regression was then used to assess the relationship between these social determinants and ZIKV exposure status. Results We included 469 pregnant women, of whom 61% had a positive ZIKV result. Multivariate analysis found that lower education (adjusted Prevalence Rate [aPR] 1.21; 95%CI 1.04–1.35) and food insecurity (aPR 1.17; 95%CI 1.01–1.30) were positively associated with ZIKV exposure. Additionally, age was negatively associated with the infection risk (aPR 0.99; 95%CI 0.97–0.998). Conclusion Eve after controlling for age, differences in key social determinants, as education and food security, were associated with the risk of ZIKV infection among pregnant women in Brazil. Our findings elucidate risk factors that can be targeted by future interventions to reduce the impact of ZIKV infection in this vulnerable population.

Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil

“…Another ecological study also conducted in Recife found microcephaly cases were up to 5.6 times more prevalent in districts of low socioeconomic status than those of high socioeconomic status 17. Similarly, a cross-sectional hospital-based study in Salvador, Bahia state, found that lower education and food insecurity were associated with ZIKV exposure among pregnant persons 11. In the Southeast region of Brazil, a prospective cohort study of ZIKV during pregnancy in Rio de Janeiro also found higher risks of microcephaly among children born to families with lower household income, lower maternal education, and greater household crowding 43.…”

“… 17 Similarly, a cross-sectional hospital-based study in Salvador, Bahia state, found that lower education and food insecurity were associated with ZIKV exposure among pregnant persons. 11 In the Southeast region of Brazil, a prospective cohort study of ZIKV during pregnancy in Rio de Janeiro also found higher risks of microcephaly among children born to families with lower household income, lower maternal education, and greater household crowding. 43 Conversely, a small case-control study of mothers exposed to ZIKV during pregnancy in Rio de Janeiro found no differences in CZS risk according to the income of the mothers.…”

“…We estimated the crude prevalence of CZS in all individuals with available data for each potential socioeconomic risk markers as well as described patterns of missing data. Based on the literature,4 8–13 we developed a framework to investigate the social determinants of CZS in Brazil (figure 1). The framework defined three levels, which included model 1: a minimally adjusted model for the effect of year of birth, Brazilian region of birth and newborn sex on CZS; model 2: a model estimating the effect of maternal race/ethnicity (ie, as a proxy for systemic and structural/institutional racism27 adjusted for a priori confounders (year, region and sex) and model 3: a model estimating (1) the effect of race/ethnicity not mediated via other explanatory variables (maternal age, maternal education, maternal marital status, number of prenatal care appointments) and26 the effect of other explanatory variables.…”

“…Emerging evidence suggests that children with CZS have lifelong health sequelae that can increase mortality risk6 and require costly interventions with widespread social and economic impacts on the affected individual and their family 7. While it is well known that social risk markers at the community (eg, sanitation), household (eg, crowding, housing materials) and individual (eg, education) levels are associated with a higher risk of infectious diseases4 8–13 including arboviruses,14 research on the relationship between socioeconomic factors and CZS remains limited.…”

Zika virus as a cause of birth defects: Were the teratogenic effects of Zika virus missed for decades?

“…It appears more likely that the large number of babies born with birth defects in Brazil is due to high numbers of ZIKV infections among pregnancies in Brazil, not to a higher risk of birth defects. The higher number of ZIKV‐infected pregnancies might be related to socioeconomic conditions (including lower education rate and food insecurity; Nery Jr. et al, 2021), as well as barriers to health services, inadequate sanitation, and poor water supply (Morgan et al, 2021). In addition, countries with transmission starting after recognition of the association between ZIKV and birth defects could better advise pregnant persons on ways to avoid ZIKV transmission.…”