A survey led by the Institute of Collective Health (ISC) of the Federal University of Bahia (UFBA) shows that 36.5% of caregivers of children with congenital Zika virus syndrome are diagnosed with depression. Also according to the study, significant delays in cognitive, motor and language development of children born with microcephaly or other neurological disorders caused by Zika were also identified.
Created after the outbreak of the disease in 2015, the project “Child Development in the Community” (DICa) aims to accompany these children in the context of primary care. “It is a proposal that involves innovative ideas on the issue of early childhood care and social inclusion,” explains Professor Darci Neves (ISC / UFBA), study coordinator.
According to the survey, cognitive ability, such as perception, memory and reasoning, was identified with delay in 79.4% of children with congenital syndrome. Regarding motor development, responsible for activities such as grabbing objects, walking and jumping, the percentage of delay was perceived in 81.7% of them. Language also showed delay in 77.9% of cases.
“At the time of the evaluation, these children were approximately 3 years old, but their mental functioning was on average about 1 year old,” notes the coordinator.
Monitoring and intervention
To reach the results, the researchers evaluated 165 children with congenital Zika virus syndrome in the city of Salvador. The number represents approximately 75% of the total of 224 confirmed cases in the Bahian capital during the study period. “We use the Epidemiological Surveillance database to select which children would be evaluated within our research,” says Letícia Marques, a professor at IHAC / UFBA, who is also part of the study team.
In addition to microcephaly, congenital syndrome encompasses motor and neurological problems that can affect a child’s vision, hearing and development. “Microcephaly was what caught the most attention at first, but it was observed later that not all children had this condition. They also had other important neurological changes ”, explains Neves.
Among fellows, professionals and consultants, about 60 people participated in the elaboration and execution of the project. The researchers compared the development of these children to a group of 100 other neighboring families whose children were born at the same time but were unchanged by Zika.
While one group followed the development in the child’s own home, another team worked in health units in four neighborhoods of Salvador: Cabula, Boca do Rio, Itapuã and Brotas. At these locations, care was provided to families through psychological support and stimulation groups.
“It is important to have a look at the mental health of caregivers. Taking care of those who take care of these children will also help in their own development ”, highlights Ana Paula Medeiros, coordinator of intervention and field activities of DICa.
Stimulation activities were performed by speech therapy, physiotherapy or occupational therapy professionals, areas closely related to rehabilitation. Participation was only allowed with the presence of the child and the caregiver. The goal was to provide support so that stimulation activities could be learned and practiced at home by the family.
To broaden the perspective on children’s development, the project has recently adopted a type of consultation with the simultaneous participation of two professionals, one from the nursing area and the other from psychology, through the so-called interconsultation. “We take advantage of this moment to advise on games that can favor the child’s development while using the space for the caregiver to talk about feelings,” explains Gabriela Evangelista Pereira, DICa coordinator for childcare development activities.
Future of the project
Now another question worries researchers: What will happen to certain project activities after funding ends next year? “We reached the third year and completed the collections. All we have produced so far has been with this money, which is running out, ”warns the study coordinator.
In 2016, the project received funding of R $ 774.5 thousand from the main research funding agencies: CNPq (National Council for Scientific and Technological Development), Capes (Coordination for the Improvement of Higher Education Personnel), Decit ( Department of Science and Technology of the Ministry of Health) and FNDCT (National Fund for Scientific and Technological Development) for a period of four years. Financing ends in September 2020.
But while not being adopted as a public health policy, the team is betting on the ISC / UFBA Multiprofessional Residency Program in Collective Health to continue the work done so far. “Since March 2018, residents have been part of the four health districts where the intervention was already performed, which has strengthened this work,” says Débora Moura Passos, pedagogical coordinator of Residency in Early Childhood (REDICa).
The Residence is a postgraduate education in the form of a two-year specialization course. The professionals selected by the program receive a scholarship currently set at R $ 3,330.43 by the Federal Government. In March this year, ISC / UFBA started the second class of residents. However, for the implementation of more classes, the program will depend on the structuring of a pedagogical body independent of the Research Project, to continue the ongoing program, as well as to maintain the scholarships available to the Residence.
For DICa coordinator Darci Neves, in addition to being a relevant arm of the project, the residence also meets the training of professionals anchored in an innovative proposal. “I am sorry if we lose this residence because there is no other in Brazil with this design in primary care.”
Even in the face of threats, the teacher announces the next stage of the DiCa project: reaching the schools. “We understand that where the child is, health should be present as well.” The idea is to closely follow the first steps of children with congenital Zika virus syndrome in the school environment and to collaborate with educators for another important stage in child development.
The work developed by DICa can also be seen through the documentary “After Zika: The Consequences of an Epidemic and the Struggle for Social Inclusion in Primary Care”. Directed by Jacinta Lomba, a Fulbright-funded international grantee, and produced in partnership with the project team, the video shows the impacts after the outbreak in 2015, and the follow-up offered to families to ensure children born with the syndrome. can access resources necessary for the development of language, motor and cognitive skills.