ABSTRACT
ObjectiveTo analyze cesarean prevalence at a baby-friendly hospital in Southern Brazil between 2017 and 2020 and possible annual and monthly changes due to the novel coronavirus (COVID-19) pandemic. MethodsDescriptive cross-sectional study using secondary data retrieved from the electronic information system of a Baby-Friendly Hospital in the municipality of Rio Grande, RS, Brazil. Data was retrieved for all hospitalizations at the obstetric center between January 1st 2017 and December 31st 2020. Data on COVID-19 deaths were obtained from the municipal government website. Annual and monthly cesarean prevalence rates were calculated in comparison to the same periods in 2017, 2018 and 2019. Differences in prevalence rates were tested using a chi-square test, taking a significance level of less than 5%. Prevalence ratios were estimated for 2018/2017, 2019/2018, and 2020/2019. Results7,294 childbirths were included. Cesarean prevalence was 42.6% in 2017, 44.3% in 2018, 40.2% in 2019, and 51.0% in 2020. In 2018/2017, there was no statistically significant difference in cesarean prevalence (95%CI: 0.90-1.20). Between 2019/2018, there was a reduction of approximately 20% in prevalence (95%CI: 0.69-0.93). The scenario changes between 2020/2019 with a 40% increase in cesareans (95%CI: 1.20-1.62). The period comprising July to December 2020 was the only period in which over half the deliveries were done by cesarean section, exceeding 60% in July. ConclusionCesarean prevalence rates increased in 2020 in relation to the three preceding years. The data highlight the need to reinforce compliance with childbirth protocols to reduce cesarean sections in baby-friendly hospitals.
ABSTRACT
BackgroundThe EPICOVID19-RS study conducted 10 population-based surveys in Rio Grande do Sul (Southern Brazil), starting early in the epidemic. The sensitivity of the rapid point-of-care test used in the first eight surveys has been shown to decrease over time after some phases of the study were concluded. The 9th survey used both the rapid test and an enzyme-linked immunosorbent assay (ELISA) test, which has a higher and stable sensitivity. MethodsWe provide a theoretical justification for a correction procedure of the rapid test estimates, assess its performance in a simulated dataset and apply it to empirical data from the EPICOVID19-RS study. COVID-19 deaths from official statistics were used as an indicator of the temporal distribution of the epidemic, under the assumption that fatality is constant over time. Both the indicator and results from the 9th survey were used to calibrate the temporal decay function of the rapid tests sensitivity from a previous validation study, which was used to estimate the true sensitivity in each survey and adjust the rapid test estimates accordingly. ResultsSimulations corroborated the procedure is valid. Corrected seroprevalence estimates were substantially larger than uncorrected estimates, which were substantially smaller than respective estimates from confirmed cases and therefore clearly underestimate the true infection prevalence. ConclusionCorrecting biased estimates requires a combination of data and modelling assumptions. This work illustrates the practical utility of analytical procedures, but also the critical need for good quality, populationally-representative data for tracking the progress of the epidemic and substantiate both projection models and policy making.
ABSTRACT
Population based data on COVID-19 are essential for guiding public policies. We report on the first of a series of planned seroprevalence surveys relying upon on household probabilistic samples of 133 large sentinel cities in Brazil, including 25,025 participants from all 26 states and the Federal District. Seroprevalence of antibodies to SARS-CoV-2, assessed using a lateral flow rapid test, varied markedly across the countrys cities and regions, from below 1% in most cities in the South and Center-West regions to up to 25% in the city of Breves in the Amazon (North) region. Eleven of the 15 cities with the highest seroprevalence were located in the North, including the six cities with highest prevalence which were located along a 2,000 km stretch of the Amazon river. Overall seroprevalence for the 90 cities with sample size of 200 or greater was 1.4% (95% CI 1.3-1.6). Extrapolating this figure to the population of these cities, which represent 25% of the countrys population, led to an estimate of 760,000 cases, as compared to the 104,782 cases reported in official statistics. Seroprevalence did not vary significantly between infancy and age 79 years, but fell by approximately two-thirds after age 80 years. Prevalence was highest among indigenous people (3.7%) and lowest among whites (0.6%), a difference which was maintained when analyses were restricted to the North region, where most indigenous people live. Our results suggest that pandemic is highly heterogenous, with rapid escalation in Brazils North and Northeast, and slow progression in the South and Center-West regions.
ABSTRACT
This study aims to describe methodological approaches to measure and monitor health inequalities and to illustrate their applicability. The measures most frequently used in the literature were reviewed. Data on coverage and quality of pre-natal care in Brazil, from the Demographic and Maternal and Child Health Survey (PNDS-2006) and the National Health Survey (PNS-2013) were used to illustrate their applicability. Absolute and relative measures of inequalities were presented, highlighting their complementary character. Despite the progress achieved in the national indicators of pre-natal care, important inequalities were still identified between population subgroups, with no change in the magnitude of the differences throughout the studied period. Brazil has important social inequalities, whose consequences still lead to health inequalities. Their description and monitoring are highly relevant to support polices focused on those vulnerable population groups who have been left behind.
O objetivo deste artigo é apresentar os principais métodos de mensuração e monitoramento das desigualdades sociais em saúde e ilustrar suas aplicações. Foram revisadas as medidas mais frequentemente empregadas na literatura. Dados de cobertura e qualidade do cuidado pré-natal no Brasil, provenientes da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) e da Pesquisa Nacional de Saúde (PNS-2013), foram utilizados para exemplificar as aplicações. Medidas de desigualdade absoluta e relativa foram apresentadas, destacando-se sua complementaridade. Apesar dos avanços evidenciados nos indicadores nacionais de pré-natal, importantes desigualdades foram identificadas entre subgrupos da população, sem que houvesse redução da magnitude dessas diferenças no período estudado. O Brasil apresenta importantes desigualdades sociais, que ainda se refletem em persistentes desigualdades em saúde. A descrição e monitoramento dessas desigualdades são fundamentais para o direcionamento de políticas de saúde, com foco em grupos mais vulneráveis que vêm sendo deixados para trás.
El objetivo de este artículo es presentar los principales métodos de medición y monitoreo de las desigualdades sociales en salud, y demostrar sus aplicaciones prácticas. Se realizó una revisión de los métodos más frecuentemente utilizados en la literatura. Datos sobre cobertura y calidad de la atención prenatal en Brasil, provenientes de la Encuesta Nacional de Demografía y Salud del Niño y la Mujer (PNDS-2006) y de la Encuesta Nacional de Salud (PNS-2013) fueran usados como ejemplo. Fueron presentadas medidas de desigualdad absoluta y relativa, destacando su complementariedad. A pesar de los avances evidenciados en los indicadores de atención prenatal en Brasil, fueron identificadas desigualdades importantes, sin que hubiese una reducción de la magnitud de esas diferencias en el periodo estudiado. Brasil presenta desigualdades sociales importantes, que aún se ven reflejadas en las persistentes desigualdades en salud. Su descripción y seguimiento son fundamentales para el direccionamiento de políticas en salud, focalizadas en grupos más vulnerables que han sido relegados.
