Catastrophic expenditure on congenital Zika syndrome: results of a cross-sectional study of caregivers of children in Rio de Janeiro, Brazil

In 2015, there was an increase in cases of congenital malformations in newborns in Brazil, associated with maternal Zika virus infection, having serious social and economic repercussions for the families. The study aimed to estimate the prevalence of catastrophic expenditure by families of children with severe or mild/moderate congenital Zika syndrome (CZS) in comparison to families of children without a diagnosis of CZS in the state of Rio de Janeiro. Catastrophic expenditure occurs when spending exceeds a given proportion of the family income due to a disease. Family caregivers of children with severe CZS were younger and had less schooling and lower income. Prevalence of catastrophic expenditure was higher in families of children with CZS. Among caregivers of children with severe CZS, the prevalence of catastrophic expenditure was higher in those with severe or very severe depression, anxiety, and stress. Low social support among caregivers was also a determinant factor for increased prevalence of catastrophic expenditure. The burden on caregivers of children with severe CZS exacerbates a situation of vulnerability that requires the expansion of mechanisms for financial and social protection, through linkage of various policies capable of effectively reaching this group.

2015年，巴西新生儿先天性畸形病例数量有所上升，该情况与孕产妇寨卡病毒感染相关，并给相关家庭带来了严重的社会与经济负面影响。本研究旨在对比里约热内卢州内，患有重症或轻中度先天性寨卡综合征（Congenital Zika Syndrome，CZS）的儿童家庭，与未诊断为CZS的儿童家庭的灾难性医疗支出患病率。灾难性医疗支出指因罹患疾病导致家庭花费超出其既定收入比例的情况。重症CZS儿童的家庭照护者普遍年龄更小、受教育程度更低且家庭收入更少。CZS患儿家庭的灾难性医疗支出患病率高于非CZS患儿家庭。其中，在重症CZS儿童的照护者中，伴随重度或极重度抑郁、焦虑及应激症状者，其家庭灾难性医疗支出患病率更高。照护者获得的社会支持水平较低，同样是灾难性医疗支出患病率升高的决定性因素。重症CZS儿童的照护者所承担的照护负担，进一步加剧了该群体的脆弱处境，这要求我们扩大财政与社会保护机制的覆盖范围，通过联动各类政策切实惠及这一群体。