{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T16:23:28Z","timestamp":1778084608680,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T00:00:00Z","timestamp":1529366400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100006162","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Ci\u00eancia e Tecnologia do Estado de Pernambuco","doi-asserted-by":"publisher","award":["APQ-0051-4.06\/16"],"award-info":[{"award-number":["APQ-0051-4.06\/16"]}],"id":[{"id":"10.13039\/501100006162","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We assessed sociodemographic and health care factors of mothers and newborns during a 2015-2016 outbreak of microcephaly in Recife, Brazil, and we analyzed the spatial distribution and incidence risk of newborns with microcephaly in relation to socio-environmental indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We collected data from August 2015 through May 2016 from Brazil\u2019s Live Birth Information System and Bulletin of Microcephaly Notification, and we geocoded the data by maternal residence. We constructed thematic maps of districts, according to socio-environmental and vector indicators. We identified spatial aggregates of newborns with microcephaly by using the Bernoulli model. We performed logistic regression analyses to compare the incidence risk of microcephaly within socio-environmental indicator groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We geocoded 17\u2009990 of 19\u2009554 (92.0%) live births in Recife, of which 202 (1.1%) newborns were classified as having microcephaly, based on a head circumference of \u22652 standard deviations below the mean. Larger proportions of newborns with microcephaly (compared with newborns without microcephaly) were born to mothers who delivered in a public hospital, did not attend college, were aged \u226419, or were black or mixed race. A higher risk of microcephaly (incidence rate ratio [IRR] = 3.90; 95% confidence interval [CI], 1.88-8.06) occurred in districts with the lowest (vs highest) Municipal Human Development Index (ie, an index that assesses longevity, education, and income). The risk of microcephaly was significantly higher where rates of larvae density (IRR = 2.31; 95% CI, 1.19-4.50) and larvae detection (IRR = 2.04; 95% CI, 1.05-4.00) were higher and rates of sewage system (IRR = 2.20; 95% CI, 1.16-4.18) and garbage collection (IRR = 1.96; 95% CI, 0.99-3.88) were lower. Newborns with microcephaly lived predominantly in the poorest areas and in a high-risk cluster (relative risk = 1.89, P = .01) in the north.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The disproportionate incidence of microcephaly in newborns in poor areas of Recife reinforces the need for government and public health authorities to formulate policies that promote social equity and support for families and their children with microcephaly.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0033354918777256","type":"journal-article","created":{"date-parts":[[2018,6,19]],"date-time":"2018-06-19T18:21:23Z","timestamp":1529432483000},"page":"461-471","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["Geography of Microcephaly in the Zika Era: A Study of Newborn Distribution and Socio-environmental Indicators in Recife, Brazil, 2015-2016"],"prefix":"10.1177","volume":"133","author":[{"given":"Ariani Impieri","family":"Souza","sequence":"first","affiliation":[{"name":"Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00edlia Teixeira","family":"de Siqueira","sequence":"additional","affiliation":[{"name":"Faculdade de Ci\u00eancias M\u00e9dicas, Universidade de Pernambuco, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Laura Carneiro Gomes","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clarice Umbelino","family":"de Freitas","sequence":"additional","affiliation":[{"name":"Independent Researcher, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anselmo C\u00e9sar Vasconcelos","family":"Bezerra","sequence":"additional","affiliation":[{"name":"Instituto Federal de Pernambuco, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adeylson Guimar\u00e3es","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculdade de Sa\u00fade P\u00fablica, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelaide C\u00e1ssia","family":"Nardocci","sequence":"additional","affiliation":[{"name":"Faculdade de Sa\u00fade P\u00fablica, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,6,19]]},"reference":[{"key":"bibr1-0033354918777256","volume-title":"Zika: The Emerging Epidemic","author":"McNeil DG","year":"2016"},{"key":"bibr2-0033354918777256","unstructured":"RECIFE. 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Monitoramento Dos Casos de Microcefalia No Brasil. 2016. http:\/\/combateaedes.saude.gov.br\/images\/pdf\/Informe-Epidemiologico-n57-SE-52_2016-09jan2017.pdf. Accessed May 9, 2018."},{"key":"bibr9-0033354918777256","unstructured":"World Health Organization. WHO statement on the first meeting of the International Health Regulations (2005) (IHR. 2005) Emergency Committee on Zika Virus and observed increase in neurological disorders and neonatal malformations. February 2016. http:\/\/www.who.int\/mediacentre\/news\/statements\/2016\/1st-emergency-committee-zika\/en. Accessed May 9, 2018."},{"key":"bibr10-0033354918777256","unstructured":"Instituto Brasileiro de Geografia e Estat\u00edstica. Censo 2010. 2010. http:\/\/censo2010.ibge.gov.br. Accessed May 9, 2018."},{"key":"bibr11-0033354918777256","unstructured":"Profeitura do Recife, Secretaria Municipal de Sa\u00fade. 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