ABSTRACT
BACKGROUND: The COVID-19 pandemic brought a new challenge to maternal mortality in Brazil. Throughout 2020, Brazil registered 549 maternal deaths, mainly in second and third-trimester pregnant women. The objective of this study was to estimate the excess maternal deaths in Brazil caused directly and indirectly by Covid-19 in the year 2020. In addition, we sought to identify clinical, social and health care factors associated with the direct maternal deaths caused by Covid-19. METHODS: We performed nationwide analyses based on data from the Mortality Information System (SIM) for general and maternal deaths and the Influenza Epidemiological Surveillance System (SIVEP-Influenza) for estimates of female and maternal deaths due to COVID-19. Two distinct techniques were adopted. First, we describe maternal deaths directly caused by covid-19 and compare them with the historical series of deaths from covid-19 among women of childbearing age (15 to 49 years). Next, we estimated the total excess maternal mortality. Then, we calculated odds ratios for symptoms, comorbidities, social determination proxies and hospital care aspects between COVID-19 maternal deaths and deaths of women of childbearing age who were not pregnant or no maternal deaths. We chose women of childbearing age (15 to 49 years) as a reference because sex and age introduce differentials in the risk of COVID-19 death. RESULTS: Most maternal deaths occurred during pregnancy compared to postpartum deaths month by month in 2020 (µ = 59.8%, SD = 14.3%). The excess maternal mortality in 2020 in Brazil was 1.40 (95% CI 1.35-1.46). Even considering excess mortality due to COVID-19 for the childbearing age female population (MMR 1.14; 95% CI 1.13-1.15), maternal mortality exceeded the expected number. The odds of being a black woman, living in a rural area and being hospitalized outside the residence municipality among maternal deaths were 44, 61 and 28% higher than the control group. Odds of hospitalization (OR 4.37; 95% CI 3.39-5.37), ICU admission (OR 1.73; 95% CI 1.50-1.98) and invasive ventilatory support use (OR 1.64; CI 95% 1.42-1.86) among maternal deaths were higher than in the control group. CONCLUSIONS: There was excess maternal mortality in 2020 in Brazil. Even with adjustment for the expected excess mortality from Covid-19 in women of childbearing age, the number of maternal deaths exceeds expectations, suggesting that there were deaths among pregnant and postpartum women indirectly caused by the pandemic, compromising access to prenatal care., adequate childbirth and puerperium.
Subject(s)
COVID-19 , Influenza, Human , Maternal Death , Pregnancy Complications , Female , Pregnancy , Humans , Adolescent , Young Adult , Adult , Middle Aged , COVID-19/epidemiology , Brazil/epidemiology , Pandemics , Influenza, Human/epidemiology , Pregnancy Complications/epidemiologyABSTRACT
Resumo: A pandemia por COVID-19 representa um dos maiores desafios da saúde pública deste século, causando impactos na saúde e nas condições de vida das populações em todo o mundo. Tem sido apontado pela literatura que a pandemia afeta de diversas formas o sistema alimentar hegemônico. No Brasil, a pandemia amplifica as desigualdades sociais, raciais e de gênero já existentes, comprometendo ainda mais a garantia do Direito Humano à Alimentação Adequada (DHAA) e a concretização da segurança alimentar e nutricional, especialmente entre os mais vulneráveis. Nesse contexto, este artigo tem como objetivo analisar as primeiras ações, em âmbito federal, do governo brasileiro para a mitigação dos efeitos da pandemia que podem repercutir na segurança alimentar e nutricional, considerando as recentes mudanças institucionais das políticas e programas. Foi realizada uma revisão narrativa da literatura e utilizado como fontes de informação os boletins do Centro de Coordenação de Operações do Comitê de Crise para Supervisão e Monitoramento dos Impactos da COVID-19 e homepages de ministérios setoriais, de março a maio de 2020. As ações foram sistematizadas segundo as diretrizes da Política Nacional de Segurança Alimentar e Nutricional. Foi identificada a criação de arranjos institucionais para o gerenciamento da crise. Dentre as ações propostas, destacam-se aquelas relacionadas ao acesso à renda, como o auxílio emergencial, e a alimentos, como a autorização para a distribuição de alimentos fora do ambiente escolar com os recursos federais do Programa Nacional de Alimentação Escolar. No entanto, os retrocessos e desmontes na área de segurança alimentar e nutricional podem comprometer a capacidade de resposta do Governo Federal no contexto da COVID-19. Resumen: La pandemia por COVID-19 representa uno de los mayores desafíos de la salud pública de este siglo, causando impactos en la salud y condiciones de vida de las poblaciones en todo el mundo. Se ha señalado por parte de la literatura que la pandemia afecta de diversas formas el sistema alimentario hegemónico. En Brasil, la pandemia amplifica las desigualdades sociales, raciales y de género ya existentes, comprometiendo todavía más la garantía del Derecho Humano a la Alimentación Adecuada (DHAA) y la concretización de la seguridad alimentaria y nutricional, especialmente entre los más vulnerables. En este contexto, el objetivo de este artículo es analizar las primeras acciones, en el ámbito federal, del gobierno brasileño para la mitigación de los efectos de la pandemia que puedan repercutir en la seguridad alimentaria y nutricional, considerando los recientes cambios institucionales de las políticas y programas. Se realizó una revisión narrativa de la literatura y se utilizaron como fuentes de información los boletines del Centro de Coordinación de Operaciones del Comité de Crisis para la Supervisión y Monitoreo de los Impactos de la COVID-19 y homepages de ministerios sectoriales, de marzo a mayo de 2020. Las acciones se sistematizaron según las directrices de la Política Nacional de Seguridad Alimentaria y Nutricional. Se identificó la creación de soluciones institucionales para la gestión de la crisis. Entre las acciones propuestas, se destacan aquellas relacionadas con el acceso a la renta, como el apoyo de emergencia, y de alimentos, como la autorización para la distribución de alimentos fuera del ambiente escolar con los recursos federales del Programa Nacional de Alimentación Escolar. No obstante, los retrocesos y recortes en el área de seguridad alimentaria y nutricional pueden comprometer la capacidad de respuesta del Gobierno Federal en el contexto de la COVID-19. Abstract: The COVID-19 pandemic poses one of this century's greatest public health challenges, with impacts on the health and living conditions of populations worldwide. The literature has reported that the pandemic affects the hegemonic food system in various ways. In Brazil, the pandemic amplifies existing social, racial, and gender inequalities, further jeopardizing the Human Right to Adequate Food (HRAF) and the attainment of food and nutritional security, especially among more vulnerable groups. In this context, the article aims to analyze the first measures by the Brazilian Federal Government to mitigate the pandemic's effects and that may have repercussions on food and nutritional security, considering the recent institutional changes in policies and programs. A narrative literature review was performed, and the information sources were the bulletins of the Center for Coordination of Operations by the Crisis Committee for Supervising and Monitoring the Impacts of COVID-19 and homepages of various government ministries, from March to May 2020. The actions were systematized according to the guidelines of the National Policy for Food and Nutritional Security. The analysis identified the creation of institutional crisis management arrangements. The proposed actions feature those involving access to income, emergency aid, and food, such as authorization for food distribution outside schools with federal funds from the National School Feeding Program. However, the setbacks and dismantlement in food and nutritional security may undermine the Federal Government's capacity to respond to COVID-19.