O Papel dos Determinantes Sociais na Transmissão e nas Respostas as Emergências de Saúde Pública em Populações Vulnerabilizadas.

Abstract

Emerging infectious diseases continue to be one of the main causes of morbidity and mortality in the world. In recent decades, humanity has faced several problems arising from emerging zoonoses, such as the recent Zika virus epidemic and the current SARS-CoV-2 pandemic. Although these diseases affect populations in different regions of the planet, residents of impoverished urban regions, such as slums, are more vulnerable and exposed to a greater burden of them. In this thesis, the objectives seek to describe the sociodemographic determinants associated with exposure to the zika virus and SARS-CoV-2 infection, as well as the frequency and factors associated with the interest of individuals in vaccinating against COVID-19. These objectives led to the creation of four articles whose results will be presented in a specific section within the thesis. In Article 1, a cross-sectional study was carried out, recruiting 469 pregnant women who gave birth at the obstetric center of an important public hospital in the city of Salvador, between October 2015 and January 2016. For this group of women, a seropositivity of 61% for ZIKV, and a social gradient linked to the result of this exposure. In Article 2, a cross-sectional survey of a cohort of 2,041 residents of an urban slum in the city of Salvador was carried out between November 2020 and February 2021, after the first wave of the COVID-19 pandemic. In this study, seropositivity for the virus was found in approximately 50% of residents, with women and children being more prone to infection. In Article 3, a cross-sectional population-based survey was carried out in 12 districts of the city of Salvador, between November 2020 and January 2021, to identify factors associated with vaccine acceptance for a possible safe vaccine against COVID-19. Among the 2,521 participants, 81.4% reported intending to take a vaccine, and of these, 68.2% also mentioned that if necessary, they would pay to have access to it. In Article 4, we used data from participants aged 18 years or older who participated in the survey referred to in Article 2 to assess the frequency and factors associated with willingness or hesitation to vaccinate against COVID-19. We found that vaccine acceptance in residents of an urban slum is lower than that obtained in the general population, with a percentage of 66%, with the lack of knowledge about the efficacy of the vaccine and the potential side effects of its administration being the main reasons for hesitation. Based on these discoveries, we hope to contribute knowledge to collective health, resulting in more effective health responses and public policies, aimed at reducing inequalities, providing better social conditions for the impoverished population. In addition to making us better prepared, with a strong and vigilant public health system to face these and future health challenges that may arise.