Social determinants of deaths from pneumonia and tuberculosis in children in Brazil: an ecological study

Abstract

ObjectiveTo identify the risk areas of deaths due to unspecified pneumonia and tuberculosis (TB) in children, and to identify if there is a relationship between these events with higher TB incidence and social determinants.MethodsEcological study carried out in Brazil. All cases of TB or unspecified pneumonia deaths in children under 5 years of age reported between 2006 and 2016 were included and collected through Department of Informatics of the Unified Health System (Brazil’s electronic database). The Spatial Scan Statistics was used to identify areas at higher risk of dying from this event. The spatial association was verified through the Getis-Ord techniques. The Bivariate Moran Global Index was used to verify the spatial autocorrelation between the two events. To identify the association of TB and pneumonia deaths with endemic areas of pulmonary TB and social determinants, four explanatory statistical models were identified.ResultsA total of 21 391 cases of pneumonia and 238 cases of TB were identified. Spatial scanning analysis enabled the detection of four clusters of risk for TB (relative risk, RR, between 3.30 and 18.18) and 22 clusters for pneumonia (RR between 1.38 and 5.24). The spatial association of the events was confirmed (z-score 3.74 and 64.34) and spatial autocorrelation between events (Moran Index:0.031 (p=0.001)). The zero-inflated negative binomial distribution was chosen, and an association for both events was identified with the TB incidence rate (OR 5.3, 95% CI 2.85 to 9.84; OR 6.63, 95% CI 5.62 to 7.81), with the Gini Index (OR 1.78, 95% CI 1.12 to 2.82; OR 4.22, 95% CI 3.63 to4.92). Primary care coverage showed an inverse association for both events (OR 0.10, 95% CI 0.67 to 0.17; OR 0.18, 95% CI 0.15 to 0.21) for pneumonia). Finally, a family that benefited from the Bolsa Família Programme had an inverse association for deaths from pneumonia (OR 0.81, 95% CI 0.52 to 1.25).ConclusionsThe results do not just contribute to reduce mortality in children, but mainly contribute to prevent premature deaths through identification of critical areas in Brazil, which is crucial to qualify health surveillance services.

Reporting of Social Determinants of Health in Pediatric Sepsis Studies*

“…The overall reporting of the WHO SDOH categories is summarized in Table 1, and the geographic distribution of included articles is shown in (10), UMIC (13), LMIC ( 14), and LIC (1) Argentina (1), Bangladesh (3), Brazil (4), China (5), Colombia (1), Egypt (3), Europe (1), France (1), Ghana (1), India (5), Ireland 1). For nutrition, 38 articles reported 24 different measures reflecting nutrition, weight, height, or body mass index.…”

“…Given that numerous studies have documented the importance of SDOH on outcomes of critically ill children across the globe (2,3,5,8,20,23,24,70,(73)(74)(75), researchers have a collective responsibility to design studies to include SDOH variables so as not to perpetuate implicit and explicit biases regarding minoritized groups and to ensure consistent and standardized collection and reporting of these variables when conducting future studies in pediatric sepsis.…”

“…Sepsis is one of the leading causes of morbidity and mortality in children worldwide (1), and much research has focused on biological and medical factors related to outcomes. However, there has been renewed focus on the social determinants of health (SDOH) and their impact on multiple issues such as child health (2, 3), hospital acquired infections (4), deaths from tuberculosis and pneumonia (5), and risk of readmission after sepsis in adults (6). SDOH are increasingly recognized as significant contributors to the severity and outcome of sepsis in children (3).…”

Spatial analysis of tuberculosis cure in primary care in Rio de Janeiro, Brazil

“…It is important that governments take responsibility for ensuring universal health coverage as a key element in achieving global goals [5,41]. In one study, primary care coverage was inversely associated with TB mortality in children [9]. Ross et al (2018) concluded that greater population coverage of Family Health Program teams (PHC) was associated with lower TB and HIV mortality [11].…”

“…Simple policies can be delivered effectively in primary healthcare (PHC) to prevent TB in individuals at high risk [8,9]. A consistent supply of primary care services can lead to improved access, better contact tracing, shorter waiting times for patients [10], and enhanced TB case detection [9].…”