Zika epidemic and microcephaly in Brazil: Challenges for access to health care and promotion in three epidemic areas

Abstract

Since 2015 Brazil has experienced the social repercussions of the Zika virus epidemic, thus raising a debate about: difficulties of diagnosis; healthcare access for children with Zika Congenital Syndrome (ZCS); the search for benefits by affected families; social and gender inequalities; and a discussion on reproductive rights, among others. The objective of this article is to analyse access to specialized health services for the care of children born with ZCS in three North-eastern states of Brazil. This is an exploratory cross-sectional study which analyses recorded cases of microcephaly at the municipal level between 2015 and 2017. Most of the cases of ZCS were concentrated on the Northeast coast. Rio Grande do Norte and Paraiba had the highest incidence of microcephaly in the study period. The states of Bahia, Paraiba and Rio Grande do Norte were selected for their high incidence of microcephaly due to the Zika Virus. Socio-territorial vulnerability was stratified using access to microcephaly diagnosis and treatment indicators. The specialized care network was mapped according to State Health Secretaries Protocols. A threshold radius of 100 km was stablished as the maximum distance from municipalities centroids to specialised health care for children with microcephaly. Prenatal coverage was satisfactory in most of the study area, although availability of ultrasound equipment was uneven within states and health regions. Western Bahia had the lowest coverage of ultrasound equipment and lacked health rehabilitation services. ZCS's specialized health services were spread out over large areas, some of which were outside the affected patients' home municipalities, so displacements were expensive and very time consuming, representing an extra burden for the affected families. This study is the first to address accessibility of children with microcephaly to specialised health care services and points to the urgent need to expand coverage of these services in Brazil, especially in the northeastern states, which are most affected by the epidemic.

Programas de intervenção precoce em crianças com síndrome congênita do zika vírus: Revisão sistemática

“…Secretaria de Vigilância em Saúde, 2020), requerendo esforços para o fortalecimento dos serviços de atenção à saúde na assistência a essa população e suas famílias, em todos os níveis de atenção, cuja estruturação ainda é um desafio, dada a complexidade do tratamento dessas crianças (D. B. C. dos Santos, Silva, Lima, Reis, & Oliveira, 2019). Estudo de Peiter et al (Peiter et al, 2020) realizado em três estados nordestinos brasileiros aponta o déficit de serviços de saúde e profissionais especializados acessíveis às famílias de crianças com SCZ, havendo maior concentração desses nas capitais dos estados, que também acolhem outras demandas de atendimento especializado e reabilitação, e reforça a necessidade de organização adequada das equipes que prestam o cuidado a essa população.…”

COVID-19, Chikungunya, Dengue and Zika Diseases: An Analytical Platform Based on MALDI-TOF MS, IR Spectroscopy and RT-qPCR for Accurate Diagnosis and Accelerate Epidemics Control

“…Rarely cases have reported CHIKV and DENV infection vertically during pregnancy and via blood-borne transmission [ 46 , 47 , 48 ]. Several cases of ZIKV-infected pregnant women have resulted in congenital and postnatal modification due to intrauterine infection [ 49 ].…”

“…Between 2015 to 2017, Brazilian Ministry of Health notified 2639 cases of microcephaly by Zika disease, pointing out possible underreporting for other newborn congenital malformations [ 49 ]. Conversely, few case reports have linked CHIKV and DENV to vertical transmission during pregnancy [ 46 , 47 , 48 ].…”

Imperfect diagnosis: The truncated legacies of Zika testing

“…Regional and social inequities in the quality of prenatal care in Brazil are well documented, and this includes different levels of access to specialist imaging techniques ( Chazan and Faro, 2016 ). Coverage of ultrasound equipment is uneven, and in rural areas of the Northeast that were heavily affected by the outbreak access to a specialized health care unit often required long and expensive travel ( Peiter et al, 2020 ; see also Viellas et al, 2014 ). Further discrepancies stem from the highly heterogeneous standards of care available in the private market for antenatal imaging.…”