Abstract
Increased rates of Zika virus have been identified in economically deprived areas in Brazil at the population level; yet, the implications of the interaction between socioeconomic position and prenatal Zika virus exposure on adverse neurodevelopmental outcomes remains insufficiently evaluated at the individual level. Using data collected between September 2015 and September 2019 from 163 children with qRT-PCR and/or IgM-confirmed prenatal exposure to Zika virus participating in a prospective cohort study in Rio de Janeiro, Brazil (NCT03255369), this study evaluated the relationships of socioeconomic indicators with microcephaly at birth and Bayley-III neurodevelopmental scores during the early life course. Adjusted logistic regression models indicated increased odds of microcephaly in children born to families with lower household income (OR, 95% CI: 3.85, 1.43 to 10.37) and higher household crowding (OR, 95% CI: 1.83, 1.16 to 2.91), while maternal secondary and higher education appeared to have a protective effect for microcephaly compared to primary education (OR, 95% CI: 0.33, 0.11 to 0.98 and 0.10, 0.03 to 0.36, respectively). Consistent with these findings, adjusted linear regression models indicated lower composite language (−10.78, 95% CI: −19.87 to −1.69), motor (−10.45, 95% CI: −19.22 to −1.69), and cognitive (−17.20, 95% CI: −26.13 to −8.28) scores in children whose families participated in the Bolsa Família social protection programme. As such, the results from this investigation further emphasise the detrimental effects of childhood disadvantage on human health and development by providing novel evidence on the link between individual level socioeconomic indicators and microcephaly and delayed early life neurodevelopment following prenatal Zika virus exposure.
Highlights
Zika virus (ZIKV) is a mosquito-borne flavivirus [1,2], principally transmitted by the Aedes aegypti vector
This study investigates the associations between socioeconomic factors and two outcomes, microcephaly and neurodevelopmental delays, in a cohort of 163 infants with in utero ZIKV exposure, in the State of Rio de Janeiro, Brazil
Children born with a normal head circumference were followed up with their last Bayley-III neurodevelopmental assessment performed at a median (IQR) age of 19.6 months
Summary
Zika virus (ZIKV) is a mosquito-borne flavivirus [1,2], principally transmitted by the Aedes aegypti vector. Vertical transmission of ZIKV during pregnancy has been associated with adverse developmental consequences in infected offspring, including microcephaly and other neurological impairments, which are collectively recognised as congenital Zika syndrome (CZS) [4]. Studies have demonstrated increased frequencies of ZIKV infection and CZS in economically deprived areas of Brazil at the population level [5,6]. While these studies play an important role in assessing the association between ZIKV and social conditions, the existing evidence base relies on ecological study designs with a geographically defined group as the unit of observation. Risk factors for cognitive and socioemotional developmental delays have been shown to include nutrient deficiencies and social and economic deprivation, whilst known protective factors comprise breastfeeding and maternal education [8]
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