Qualidade de vida e saúde mental das cuidadoras de crianças nascidas durante a epidemia de Zika vírus: análise em tempos de COVID-19.

Abstract

The discovery of the causal relationship between Zika infection and microcephaly/Congenital Zika Syndrome (CZS) further strengthened the discussion on the impact of vector-borne diseases on the quality of life of Brazilian families. In addition to the health and functional challenges that encompass the child development of children with SCZ, the quality of life and mental health of affected families is related to sociodemographic structures and access to health services, closely related to income, formal employment relationships, social benefits, number of children and access to preventive health care, especially in the context of Primary Health Care. This study had the general objective “to investigate the factors associated with the quality of life of caregivers of children diagnosed with Congenital Zika Syndrome, during the Covid-19 pandemic”. We respond to this objective through three articles. Article 1“Factors associated with the quality of life of caregivers of children diagnosed with Congenital Zika Syndrome, during the first wave of the Covid-19 pandemic”, where we describe the quality of life among caregivers of children with microcephaly associated with SCZ and we analyzed the factors associated with it, using the WHOQOL-bref instrument. This was a cross-sectional study, carried out using descriptive data analysis, bivariate analysis and linear regression as multivariate analysis. Socioeconomic and clinical factors of the caregiver, such as returning to the job market after the child's birth (p<0.001) and number of children (p<0.005) and number of prenatal consultations (p<0.001) showed a negative association with QoL overall, in the multivariate analysis. Aspects related to child neurodevelopment increased the variation in the prediction of caregivers' quality of life, after their inclusion in the multivariate model for all QoL domains, except psychological. In Article 2, “Longitudinal dynamics of quality of life in caregivers of children with Congenital Zika Syndrome during the Covid-19 pandemic”, we analyze the influence of social support on quality of life during the first and second wave of the pandemic of Covid-19, for caregivers of children with microcephaly associated with SCZ. Emotional, material support and social interaction tended to improve between the first and second wave of Covid-19, as well as QoL. This was a longitudinal article conducted with 50 caregivers recruited from a hospital-based cohort. There was an association between the social support subscales and the outcome, quality of life of caregivers during the first and second wave of Covid-19, through bivariate and multivariate analysis with a multiple linear regression model with the Jackknife resampling method to standard error correction for small samples. The results of this manuscript showed a statistically significant difference between the evaluations of the environmental domain of QoL over time. In the multivariate analysis, emotional and material support predicted quality of life in 34% in the psychological domain and in 19% in the environmental domain. Article 3: “Factors associated with the mental health of caregivers of children born during the Zika virus epidemic: analysis in times of covid-19”, we analyze the factors associated with the mental health of caregivers during the first wave of the Covid-19 pandemic. 19. This manuscript was cross-sectional and carried out with 53 caregivers. There was an association between the independent sociodemographic and access variables of children and their caregivers and the outcome, mental health, through bivariate and multivariate analysis with multiple linear regression models with the Jackknife resampling method to correct the standard error of small samples. The results showed that access to monitoring in Primary Health Care for children and their caregivers and the caregiver's routine consultations were predictors of stress and anxiety in caregivers. For the depression subscale, the final model was predicted in 30% by experience of unemployment in the family, care provided by the caregiver at the basic health unit and the caregiver's routine appointments. Factors related to the socioeconomic profile, social support and access to health services of caregivers and their children were associated with the outcomes quality of life and mental health of caregivers of children with SCZ. Caregivers with socioeconomic disadvantages, low social support and limited access to preventive services for families are more likely to experience low quality of life and greater stress, anxiety and depression. The integrated surveillance and health care monitoring of cases of changes in the growth and development of children affected by the Zika virus, as well as their impact on the mental health and quality of life of the caregiver, is crucial for a targeted approach to these caregivers and children, promoting public health interventions as early as possible in order to enhance favorable outcomes and assist in the evaluation of rehabilitation results, fostering the qualification of decision-making by managers.