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The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.

BackgroundThe COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic.MethodsThis study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335.ResultsThere were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths.ConclusionsExcess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.

Accurate estimates of the COVID-19 pandemic's indirect impacts are crucial, especially in low- and middle-income countries. This study aims to update estimates of excess maternal deaths in Brazil during the first two years of the COVID-19 pandemic. This was an exploratory mixed ecological study using the counterfactual approach. The observed maternal deaths were gathered from the Mortality Information System (SIM) for the period between March 2015 and February 2022. Expected deaths from March 2020 to February 2022 were estimated using quasipoisson generalized additive models, considering quadrimester, age group, and their interaction as predictor variables. Analyses were performed in R version 4.1.2, RStudio, version 2023.03.1+446 and carried out with support from the \"mgcv\" and \"plot_model\" libraries. A total of 5,040 maternal deaths were reported, with varying excess mortality across regions and age groups, resulting in 69% excess maternal mortality throughout Brazil during the first two years of the pandemic. The Southeast region had 50% excess mortality throughout the first two years and 76% excess in the second year. The North region had 69% excess mortality, increasing in the second year, particularly among women aged 20-34. The Northeast region showed 80% excess mortality, with a significant increase in the second year, especially among women aged 35-49. The Central-West region had 75% excess mortality, higher in the second year and statistically significant among women aged 35-49. The South region showed 117% excess mortality, reaching 203% in the second year among women aged 20-34, but no excess mortality in the 10-19 age category. Over two years, Brazil saw a significant impact on maternal excess deaths, regardless of region and pandemic year. The highest peak occurred between March and June 2021, emphasizing the importance of timely and effective epidemic responses to prevent avoidable deaths and prepare for new crises.

ABSTRACT Objective: To identify the types of institutional violence of childbirth reported by the woman, the birth companion and health professionals. Method: Integrative review that analyzed 33 articles in the LILACS, BDENF, INDEXPSI, regional SciELO, Scopus, Web Of Science and PubMed databases. Results: Women were the main violence rapporteur, with predominance of the psychological type. Precarious infrastructure and the imposition of professional decisions were identified by the companion as violence. For health professionals, performing procedures without consent does not characterize violence, but guarantees childbirth security. Final considerations: The most common types of violence in Brazilian maternity hospitals are psychological, physical and structural. Most of the time, violence is reported by women, although professionals also perceive and admit its perpetuation. RESUMEN Objetivo: Identificar las clases de violencia institucional durante el parto reportadas por la mujer, por el acompañante del parto y por profesionales de la salud. Método: Revisión integradora que analizó 33 artículos en las bases LILACS, BDENF, INDEXPSI, SciELO regional, Scopus, Web Of Science y PubMed. Resultados: La mujer fue la principal informante de la violencia, con predominio del tipo psicológico. La infraestructura precaria y la imposición de las decisiones profesionales fueron identificadas por el acompañante como violencia. Para los profesionales de la salud, la realización de procedimientos sin consentimiento no caracteriza violencia, sino una garantía de seguridad en el parto. Consideraciones finales: Las clases de violencia más comunes en las maternidades brasileñas son las psicológicas, las físicas y las estructurales. La mayoría de las veces, son las mujeres quienes informan sobre la violencia, aunque los profesionales también perciban y admitan su perpetración. RESUMO Objetivo: Identificar os tipos de violência institucional no parto relatados pela mulher, pelo acompanhante de parto e por profissionais de saúde. Método: Revisão integrativa que analisou 33 artigos nas bases LILACS, BDENF, INDEXPSI, SciELO regional, Scopus, Web Of Science e PubMed. Resultados: A mulher foi a principal relatora da violência, com predominância do tipo psicológica. A infraestrutura precária e a imposição das decisões profissionais foram identificadas pelo acompanhante como violência. Para os profissionais de saúde, a realização de procedimentos sem consentimento não caracteriza violência, mas garantia de segurança no parto. Considerações finais: Os tipos de violência mais comuns nas maternidades brasileiras são as psicológicas, as físicas e a estrutural. Na maioria das vezes, a violência é relatada pelas mulheres, embora profissionais também percebam e admitam sua perpetuação.

Objective: To estimate the prevalence and the factors associated with institutional violence against women during hospitalization for delivery, as reported by companions. Method: Cross-sectional study conducted in three public maternity hospitals in the metropolitan region of Florianópolis, Santa Catarina, with 1,147 birth companions. Data were obtained through structured interviews conducted from March 2015 to May 2016. Data analysis was performed using single and multiple Poisson regression. Results: Institutional violence against women was more frequently reported by male companions, who were partners of the women and/or father of the baby (74.7%). At least one type of violence was mentioned (73.5%). Structural (59.2%) and physical (31.4%) violence were the most prevalent. The factors associated with the outcome were term vaginal deliveries, occurred between Tuesday and Friday, and higher level of education of the companion. Conclusion: The results of this study show that the presence of the companion does not prevent the occurrence of institutional violence. The prevalence of structural, physical, psychological and verbal violence against women during childbirth, as reported by the companion, points to the need for macrostructural changes to ensure care free of violence, with respect to women's role and rights.

This study evaluates the nutritional status of children and women of an indigenous Yanomamigroup, and seeks to clarify associated factors. It was a cross-sectional study, carried out in 17 villages, in 2014. For evaluation of nutritional status we used 2006 growth standards to assign height-for-age (stunting)Z-scores (Z), weight-for-age Z (underweight) and weight-for-height Z (wasting and overweight), using the software WHO-Anthro and WHO-AnthroPlus. Short stature (SS) was defined as values lower 145cm for mothers over the age of 18. The Poisson regression was made in R software. Among children under 60 months the prevalences were: stunting 83.8%; underweight 50%; wasting 5.4%; and overweight 2.7%. In 59.5% of the children there was severe stunting, and 68.1% of the mothers were SS. Prevalence ratio (PR) for severe stunting was higher in age group 36-59 months, in comparison with age group 0.1-23 (PR = 1.3; CI 95%: 1.1-2.3), as did also children of mothers with SS, when compared to the children of mothers without SS (PR = 2.1; CI 95%; 1.2-3.6). The alarming rates of stunting and severe stunting reveal the seriousness of the nutritional situation children. The association of severe stunting in infants and in mothers reflects the intergenerational nature of the problem.

In developing countries, pneumonia is the leading cause of sickness and mortality in childhood, especially among vulnerable groups. The scope of this study was to analyze the factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care Sensitive Conditions (ACSC). Hospital admissions were divided into two groups: i) pneumonia; and ii) other causes, according to the Brazilian ACSC list. Adjusted hospitalization rates were estimated and unconditional logistic regression was used to analyze factors associated with pneumonia. Over 90% of the registered cases were considered ACSC. The adjusted rate of ACSC was 18.6/1000. The odds ratio of hospitalization for pneumonia was 2.7 (CI: 1.3-5.4) times higher in children aged between 0.1 and 5.9 months; 1.9 (CI: 1.1-3.3) times higher in children who were hospitalized for 8-14 days; and three (CI: 1.2-7.5) times higher in children with a secondary diagnosis of malnutrition. The excess of avoidable hospitalizations is a clear indication of the low quality of care and limited accessibility to primary health care in indigenous territories, which is contrary to the assistance model proposed by the indigenous healthcare subsystem in Brazil, which should in theory focus on welfare technologies based on primary health care.

Resumo O objetivo do estudo foi avaliar o estado nutricional de crianças e mulheres indígenas Yanomami e elucidar fatores associados. Estudo transversal, realizado em 17 aldeias, em 2014. Para a avaliação do estado nutricional utilizou-se as curvas de crescimento de 2006 e os escores-Z (ESZ) de estatura/idade (E/I), peso/idade (P/I), peso/estatura (P/E), os quais foram gerados nos programas WHO-Anthro e WHO-AnthroPlus. Estatura inferior a 145cm foi o descritor de baixa estatura materna nas > 18 anos. A regressão de Poisson e as análises estatísticas foram efetuadas no software R, versão 3.1.2. Nos < 5 anos a prevalência de baixa E/I foi 83,8%, de baixo P/I 50%, de baixo P/E 5,4% e de sobrepeso 2,7%. Em 59,5% das crianças observou-se muito baixa E/I e em 68,1% das mães baixa estatura. As crianças de 36-59 meses apresentaram maior risco de baixa estatura severa, em comparação com as de 0,1-23 (RP = 1,3; IC 95%: 1,1-2,3), assim como os filhos de mães com estatura < 145cm, em relação aos filhos de mães com estatura > 144cm (RP = 2,1; IC 95%;1,2-3,6). As alarmantes prevalências de baixa estatura severa revelam a grave situação nutricional das crianças. Já a associação de baixa estatura severa nas crianças e baixa estatura materna reflete o caráter intergeracional do problema. Abstract This study evaluates the nutritional status of children and women of an indigenous Yanomamigroup, and seeks to clarify associated factors. It was a cross-sectional study, carried out in 17 villages, in 2014. For evaluation of nutritional status we used 2006 growth standards to assign height-for-age (stunting)Z-scores (Z), weight-for-age Z (underweight) and weight-for-height Z (wasting and overweight), using the software WHO-Anthro and WHO-AnthroPlus. Short stature (SS) was defined as values lower 145cm for mothers over the age of 18. The Poisson regression was made in R software. Among children under 60 months the prevalences were: stunting 83.8%; underweight 50%; wasting 5.4%; and overweight 2.7%. In 59.5% of the children there was severe stunting, and 68.1% of the mothers were SS. Prevalence ratio (PR) for severe stunting was higher in age group 36-59 months, in comparison with age group 0.1-23 (PR = 1.3; CI 95%: 1.1-2.3), as did also children of mothers with SS, when compared to the children of mothers without SS (PR = 2.1; CI 95%; 1.2-3.6). The alarming rates of stunting and severe stunting reveal the seriousness of the nutritional situation children. The association of severe stunting in infants and in mothers reflects the intergenerational nature of the problem.