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Parental Stress in Primary Caregivers of Children with Evidence of Congenital Zika Virus Infection in Northeastern Brazil

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Abstract

Background

Despite the well-known role of parents as caregivers, few studies have addressed their health outcomes related to the Zika virus epidemic.

Methods

A cross-sectional study was carried out with 146 primary caregivers of children 15–26 months of age, with laboratory and/or clinical evidence of Zika infection between August and October 2017 in three Brazilian municipalities: João Pessoa and Campina Grande in the state of Paraíba and Fortaleza in the state of Ceará. Caregivers reported on their child's life and health, family circumstances and underwent screening for stress using the Parenting Stress Index-Short Form. Children were evaluated for developmental delays and clinical outcomes. Differences in the prevalence of risk factors between caregivers with high or clinically relevant stress and those with normal stress were evaluated.

Results

Of the 146 participants, 13% (n = 19) were classified as having high or clinically relevant stress, all of them mothers. The two risk factors significantly and independently associated with high levels of stress, compared with individuals with normal stress levels, were “reporting difficulty in covering basic expenses” (adjusted OR 3.6 (95% CI 1.1–11.8; p = 0.034)) and “having a child with sleep problems” (adjusted OR 10.4 (95% CI 1.3–81.7; p = 0.026)).

Conclusions

Some factors seem to contribute significantly more than others to the level of stress experienced by caregivers of children with evidence of Zika virus congenital infection. Interventions and preventive strategies should also target caregivers, who in turn will be able to respond to the unique characteristics of their child.

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Abbreviations

ASQ:

Ages and stages questionnaire

CONEP:

National Committee for Ethics in Research

CP:

Cerebral palsy

CZI:

Congenital Zika infection

DAG:

Directed acyclic graph

DQ:

Developmental quotients

ELISA:

Enzyme-linked immunosorbent assay

INTERGROWTH:

International Consortium for Fetal and Neonatal Growth for the 21st century

HINE:

Hammersmith infant neurological examination

OR:

Odds ratio

PSI:

Parenting stress index

PRNT:

Plaque reduction neutralization test

REDCap:

Research Electronic Data Capture software

RESP:

Registry of Public Health Events-Microcephaly

SD:

Standard deviation

ZIKV:

Zika virus

ZODIAC:

Zika outcomes and development in infants and children

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Acknowledgments

Alanna dos Santos Delfino, Analine de Souza Bandeira Correia, Ashley Satterfield-Nash Bruna Valerio Correia, Camila Carla de Arruda Silva, Camille Harden, Camille Smith, Charles Rose, Christine Coeli Moreira da Silva, Claudia Ferreira Ribeiro Leão, Cláudia Luciana de Sousa Mascena Veras, Eric Dziuban, Erlane Marques Ribeiro, Jória Guerreiro, Larissa Ribeiro Do Amaral, Maria Celeste Dantas Jotha De Lima, Myrian Carvalho, Daniele Ribeiro Magalhães Camelo, Eliza Gordon-Lipkin, Fabio Ramon Bezerra Clementino, Flawber Antonio Cruz, Georgia Medeiros Lopes De Souza Lucio, Isadora Silveira Xavier, Ivanice Jacinto da Silva, Jeanete Romao dos Santos, Jennita Reefhuis, Juliana Carneiro Monteiro Wanderley, Juliana Sousa Soares De Araujo, Kallytuana Mell Silva Sarmento, Karla Naraiane de Araujo, Karoline Marques Dantas, Mariana Bernardo Bezerra, Mariana Braatz Krueger, Michael Fox, Nathalie Maitre, Nevin Krishna, Pâmela Rodrigues Barbosa, Patricia Karla Guimaraes Brito, Rafaela Domingos da Cunha, Rafaela Soares Barros de Menezes, Rafaella Alves Sarmento Costa, Rebecca Bitsko, Renato Lima, Rogerio Alves de Santana, Saile Cavalcante Kerbage, Suzanne Gilboa, Thalita Analyane Bezerra de Albuquerque, Thayse Elaine Costa Figueiredo, Vandezita Dantas De Medeiros Mazzaro, Virginia Batista de Morais.

Funding

The original study was supported by the Office of Infectious Diseases, Bureau of Global Health, U.S. Agency for International Development (USAID), under the terms of an Interagency Agreement with the Centers for Disease Control and Prevention (CDC) and Cooperative Agreement Number NU2G GH001152.

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Authors and Affiliations

  1. Secretariat of Health Surveillance (SVS), Ministry of Health of Brazil, SRTVN Quadra 701, Lote D, Ed. PO700, 5º andar, Brasília, DF, 70719-040, Brazil

    Isabela Ornelas Pereira

  2. Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Country Office in Brazil, Brasília, 70719-040, Brazil

    Ana C. F. S. Santelli

  3. Foundation for Scientific and Technological Development in Health (FIOTEC), Rio de Janeiro, 21040-361, Brazil

    Priscila L. Leite

  4. Eagle Global Scientific, LLC, Atlanta, GA, 30341, USA

    Jacob Attell

  5. Booz Allen Hamilton, 8283 Greensboro Drive, Hamilton Building, McLean, VA, 22102, USA

    Jacob Attell

  6. National Center on Birth Defects and Developmental Disability (NCBDDD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, 30329, USA

    Jeanne Bertolli & Georgina Peacock

  7. Oak Ridge Institute for Science and Education, Oak Ridge, TN, 37830, USA

    Kim Kotzky

  8. Faculty of Ceilandia (FCE) & Health Collective Post Graduation Program, University of Brasília (UnB), Brasília, 72220-275, Brazil

    Wildo N. Araújo

Authors
  1. Isabela Ornelas Pereira
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  2. Ana C. F. S. Santelli
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  3. Priscila L. Leite
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  4. Jacob Attell
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  5. Jeanne Bertolli
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  6. Kim Kotzky
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  7. Wildo N. Araújo
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  8. Georgina Peacock
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Correspondence to Isabela Ornelas Pereira.

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Ornelas Pereira, I., Santelli, A.C.F.S., Leite, P.L. et al. Parental Stress in Primary Caregivers of Children with Evidence of Congenital Zika Virus Infection in Northeastern Brazil. Matern Child Health J 25, 360–367 (2021). https://doi.org/10.1007/s10995-020-03053-8

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