Camila Abadia Rodrigues Meira

Objective: To compare mortality, intensive care unit (ICU) admission, and use of invasive ventilatory support in hospitalized pregnant and nonpregnant women with severe acute respiratory syndrome due to Coronavirus-2 in Brazil. Methods: It is a cross-sectional study developed with data from the Brazilian Surveillance of Severe Acute Respiratory Syndrome (SARS), Ministry of Health. Three outcomes were investigated: mortality, ICU admission, and use of invasive ventilatory support among COVID-19 cases. Hospitalized pregnant and nonpregnant women were paired according to age group, geographic region, and epidemiological week (33,113 nonpregnant women; 15,567 pregnant women) from March 2020 to March 2022. Associations between pregnancy status and outcomes were analyzed using conditional logistic regression. For 2021 data, an interaction term with vaccination status (no/yes) was included. Results: Mortality (17.6 vs 7.9%), ICU admission (30.3 vs 26.1%), and invasive ventilatory support use (46.6 vs 38.5%) were higher among nonpregnant women, respectively. ICU admission was highest in the second trimester of pregnancy (32.6%). Being in the second trimester increased the likelihood of ICU admission (OR=1.26; 95%CI 1.15–1.39) compared to nonpregnant women. The odds of ICU admission was lower among vaccinated pregnant women in the first (OR=0.71; 95%CI 0.51–0.96), second (OR=0.74; 95%CI 0.62–0.88), and third trimesters (OR=0.65; 95%CI 0.57–0.74). Conclusion: All three outcomes were more frequent among hospitalized nonpregnant women, except for ICU admission in the second trimester. COVID-19 vaccination has proven to be an important protective measure, particularly for pregnant women in the second and third trimesters.

Buscou-se, com este estudo, verificar a associação entre valores do produto interno bruto em paridade do poder de compra (PIB PPC) e escores da ferramenta World Breastfeeding Trends Initiative (WBTi). Estudo ecológico realizado com 98 países de renda baixa (n = 43), média (n = 27) e alta (n = 28). A avaliação das ações pró-aleitamento materno foram obtidas da WBTi e o PIB PPC do Banco Mundial. Foram estimados média e desvio padrão (DP) das pontuações total e de cada item da WBTi. Foram usados o teste ANOVA e o teste de Tukey para comparar as médias da ferramenta WBTi segundo o PIB PPC dos países. A associação entre PIB PPC e as pontuações total e de cada item da WBTi foi analisada por regressão linear. Maiores pontuações da WBTi foram identificadas para os itens de sistemas de cuidado de saúde e nutrição (item 5: média = 6,4; DP: ±2,0) e suporte de informações válidas (item 7: média = 6,4; DP: ±2,5). As médias da pontuação total e dos itens 3 (implementação do código), 7 (suporte de informações válidas), 9 (aleitamento materno em emergências) e 10 (monitoramento e avaliação) foram superiores nos países de baixa e média renda e do item 4 (licença maternidade) nos países de alta renda (p < 0,05). Observamos associação negativa entre PIB PPC e pontuação total da ferramenta (β = -2,67; IC95%: -5,06; -0,29), item 3 (β = -0,50; IC95%: -0,91; -0,08), item 7 (β = -0,67; IC95%: -1,07; -0,27), item 8 (aleitamento materno e HIV; β = -0,59; IC95%: -1,07; -0,11) e item 9 (β = -0,91; IC95%: -1,34; -0,48). Observamos associação positiva entre PIB PPC e o item 4 (proteção à maternidade; β = 0,63; IC95%: 0,24; 1,02). Países com menor PIB PPC apresentaram maiores pontuações da ferramenta, com exceção da proteção à maternidade que apresentou maior pontuação em países com maior PIB PPC.

Introduction: Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF).Purpose: Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in the 1990s, 2000s, and 2010s.Methods: Cross-sectional time-series study using data from Demographic and Health Surveys between the 1990s and 2010s in Colombia (1995–2010), Haiti (1994–2017), and Peru (1996–2012) accounting for a sample of 12,775 infants under 6 months. Hierarchical logistic multilevel regression models were used to estimate the adjusted association between infant feeding outcomes (EBF, MixMF, exclusive use of IF) and contextual level DHS survey decade (1990s, 2000s and 2010s) and economic factors (Gross Domestic Product by purchasing power parity, female wage and salaried workers, labor force participation rate female) as well as individual level sociodemographic (maternal age, maternal education, number of children in the household, wealth index, mother living with a partner, area of residence, mother working outside of home), and health factors (breastfed in the first hour, C-section).Results: Factors associated with EBF cessation were c-section (OR: 0.76; 95%CI: 0.64, 0.92), mothers working outside of the home (OR: 0.79; 95%CI: 0.69, 0.90), families in the highest income quintile (OR: 0.64; 95%CI: 0.49, 0.84), and female wage and salaried workers (OR: 0.92; 95%CI: 0.91, 0.94). MixMF was associated with women with higher education (OR: 1.54; 95%CI: 1.21, 1.97), mother working outside of the home (OR: 1.26; 95%CI: 1.10, 1.43), c-section (OR: 1.37; 95%CI: 1.15, 1.62), families in the highest income quintiles (OR: 2.77; 2.10, 3.65). and female wage and salaried workers (OR: 1.08;95% CI: 1.05, 1.09). Exclusive use of IF was associated with a mother working outside of the home (OR: 2.09; 95%CI: 1.41, 3.08), c-section (OR: 1.65; 95%CI: 1.09, 2.51), families in the highest income quintiles (OR: 12.08; 95% CI: 4.26, 34.28), the 2010s (OR: 3.81; 95%CI: 1.86, 7.79), and female wage and salaried workers (OR: 1.12; 95%CI: 1.07, 1.16).Discussion/Conclusion: Factors related to women empowerment and gender equality jeopardized EBF and favored the exclusive use of IF in Latin America. Therefore, workplace interventions to promote, protect, and support breastfeeding practices are key to reducing exclusive use of IF.

Resumo Nosso objetivo foi analisar a associação entre a duração do trabalho remoto e o diagnóstico positivo da COVID-19 entre pessoas ocupadas no Brasil. Foram utilizados dados da PNAD COVID19 (2020). As variáveis sobre a situação do trabalho descritas foram: afastamento do trabalho em função do distanciamento físico, segmento de trabalho (setor de trabalho e formalidade: privado formal/informal, militar, servidor público estatutário, setor público CLT/informal, empregador, conta-própria/trabalhador não remunerado) e duração do trabalho remoto (sem trabalho remoto, 1-2 meses, 3-4 meses, 5-7 meses). Associação entre duração do trabalho remoto (exposição) e diagnóstico positivo para COVID-19 (desfecho) foi estimada por regressão de Cox, com ajuste para variáveis sociodemográficas e segmento de trabalho. O diagnóstico positivo da COVID-19 aumentou de 2,1% para 4,8% entre julho e novembro, e a frequência de trabalho remoto reduziu de 11,6% para 9,5% entre maio e novembro. O risco de diagnóstico positivo da COVID-19 foi menor para pessoas que trabalharam remotamente por 3-4 meses (RR=0,79; IC95%=0,67;0,92) e 5 meses (RR=0,57; IC95%=0,48;0,67) comparadas àquelas que não trabalharam remotamente. Houve discreta redução do percentual de trabalhadores em trabalho remoto e sua maior extensão reduziu o risco de diagnóstico positivo para COVID-19.

Background: Early introduction of liquid/solid food before 6 months of age is one of the major barriers to exclusive breastfeeding. Our objective was to analyze the evolution of infant feeding practices for infants under 6 months of age in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010.Method: Cross-sectional time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six Latin America and Caribbean countries: Bolivia (1994 to 2008), Colombia (1995 to 2010), Dominican Republic (1996 to 2013), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2018). Pooled sample comprised of 22,545 infants under the age of 6 months. Surveys were grouped in three decades: 1990s for surveys from 1990 to 1999, 2000s for surveys from 2000 to 2009, and 2010s for surveys from 2010 to 2017. Exclusive breastfeeding (EBF), predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, infant formula, semi-solid/solid) were analyzed. Prevalence of breastfeeding and food indicators were calculated in pooled sample, according to the infant monthly age groups, decade of survey and residence area(rural/urban).Results: Between 1990s and 2010s, there was an increase in the exclusive breastfeeding prevalence (1990s = 38.1%, 2010s = 46.6%) and a reduction in the PBF prevalence (1990s = 51.7%, 2010 s = 43.1%). There was a decrease in the liquids (1990s = 40.7%, 2010s = 15.8%) and milk prevalence (1990s = 20.4%, 2010s = 8.3%) and an increase in water (1990s = 32.3%, 2010s = 37.6%), and infant formula (1990s = 16.6%, 2010s = 25.5%) prevalence. All breastfeeding indicators, except exclusive breastfeeding, progressively increased according to the monthly age group in three decades, and EBF prevalence sharply decreased from 2 to 3 months of age in all decades. Exclusive breastfeeding prevalence was higher in rural area in the three decades (1990s_rural = 43.8%, 1990s_urban = 32.4%, 2010s_rural = 51.1%, 2010s_urban = 42.4%) and infant formula prevalence was higher in urban area (1990s_rural = 8.6%, 1990s_urban = 24.6%, 2010s_rural = 15.9%, 2010s_urban = 34.1%).Conclusions: In the last three decades, in all age groups, there was an increase in exclusive breastfeeding prevalence, as well as a significant reduction in liquids and milk. In the rural area, EBF prevalence remains higher than in urban. Increased water and infant formula feeding are the main barriers to achieving the Global Nutrition Target 2025 for exclusive breastfeeding.

Background: The World Health Organization set a global nutrition target to increase the rate of exclusive breastfeeding (EBF) among infants younger than 6 months to at least 50% by the year 2025. Yet, the early introduction of solid food (before 6 months of age) occurs in approximately one in three infants, making it a major barrier to EBF. The aim of this study was to analyze the evolution of the early introduction of foods offered to infant under the age of six months in Latin American and Caribbean countries in the last three decades (1990, 2000,2010).Method: This is a time series study with data from Demographic and Health Surveys carried out between 1990 and 2017 in six countries in Latin America and the Caribbean: Bolivia (1994 to 2008); Colombia (1995 to 2010), Guatemala (1995 to 2015), Haiti (1994/1995 to 2016/2017), Peru (1996 to 2012) and the Dominican Republic (1996 to 2013). The total sample consisted of 20,633 infants under the age of six months. Surveys were grouped in three decades as following: 1990s for surveys from 1990 to 1999; 2000s for surveys from 2000 to 2009; and 2010s for surveys from 2010 to 2017. EBF, predominant breastfeeding (PBF), mixed breastfeeding (mixed BF), supplemented breastfeeding (supplemented BF) and non-breastfeeding (non-BF), and individual foods (water, liquids, milk, formula and semi-solid/solid) were analyzed. Mean prevalence rates of breastfeeding and food indicators were calculated for all countries, according to monthly age groups and decade of survey.Results: Between 1990s and 2010s, there was an increase in the mean prevalence of EBF (38.6% and 46.2%, respectively) and a reduction in the mean prevalence of PBF (50.8% and 43.0%, respectively). There was a reduction in the means of liquids (1990s=40.4%,2010s=15.9%) and milk (1990s=20.3%,2010s=8.4%) and an increase in water (1990s=31.7%,2010s=37.5%), and formula (1990s=16.4%, 2010s=25.8%).Conclusions: In the last three decades, n all age groups, there was an increase in the prevalence of EBF, as well as a significant reduction in fluids and milk. The increased supply of water and infant formula are the main barriers to achieving the Global Nutrition Target 2025 for EBF.