Abstract

Objective was to analyze the knowledge and attitude of high risk pregnant women about zika. This is a cross-sectional study, quantitative, with a sample of 201 high risk women who perform prenatal the Ambulatory Medical Specialties. A self-administered instrument, was applied after consultation with the doctor. Inclusion criteria were the presence of pregnant women on the day of the interview and their consent to participate. Exclusion criteria were those who did not agree to participate and were not performing prenatal care during the study period. For the data analysis we used chi square and fisher exact, in software Epi info 7.1 and Bioestat 5.0. Of the pregnant women, 76% believed that their neighborhood was likely to be infected by the virus and used measures to control mosquito proliferation, such as not leaving standing water (n = 154). In relation to knowledge, there was an association between Zika and microcephaly (p≤ 0.0001) and the need for more information (p = 0.0439). To prevent infection, 76% took no action, there was an association between the need for knowledge about the subject and the actions taken to combat the virus (p = 0.0049). We conclude that pregnant women’s knowledge and attitude about zika is failed.

Key words:
Pregnant women; Public health; Zika virus

Introduction

The evolution of pregnancy mostly occurs without complications, only causing physical, hormonal, psychical or social interaction changes in mothers’ body and daily life. It is a physiological phenomenon in some women’s life¹1 Anjos JCS, Pereira RR, Ferreira PRC, Mesquita TBP, Picanço Junior OM. Perfil epidemiológico das gestantes atendidas em um centro de referência em pré-natal de alto risco. Rev Para Med 2014; 28(2):23-33.^,22 Brasil. Ministério da Saúde (MS). Atenção ao pré-natal de baixo risco. Brasília: MS; 2012.. However, some women can present clinical complications that increase risks of a series of adverse results, such as preeclampsia, gestational diabetes, and preterm labor. Every pregnancy brings some risk to the mother and the fetus, but it is expected to pass without complications, since this is a natural process, despite the changes³3 Brasil. Ministério da Saúde (MS). Gestação de alto risco. Brasília: MS; 2000..

In high-risk pregnancies, the mother and/or the fetus have health problems or some complications, with higher probability of an unfavorable evolution of pregnancy. This can occur due to several reasons, and one of them is the transmission of the Zika virus during pregnancy³3 Brasil. Ministério da Saúde (MS). Gestação de alto risco. Brasília: MS; 2000.^,44 Moimaz SAS, Rós DT, Saliba TA, Garbin CAS. Aspectos da saúde geral e bucal de gestantes de alto risco: revisão da literatura. J Health Sci Inst 2017; 35(3):223-230..

Zyka is a viral disease transmitted by the mosquito Aedes aegypti. The fast propagation of this virus has drawn attention of national and international health authorities to execute actions to diagnose and quickly intervene in patients, mainly pregnant women, infected by the virus. This concern is mainly due to the connection between the virus and severe neurological disorders in newborns from mothers exposed to the Zika virus during pregnancy⁵5 Saiz JC, Martín-Acebes MA, Bueno-Marí R, Salomón OD, Villamil-Jiménez LC, Heukelbach J, Alencar CH, Armstrong PK, Ortiga-Carvalho TM, Mendez-Otero R, Rosado-de-Castro PH, Pimentel-Coelho PM. Zika Virus: What have we learnt since the start of the recent epidemic. Front Microbiol 2017; 8:1554.

6 Haddow AD, Schuh AJ, Yasuda CY, Kasper MR, Heang V, Huy R, Guzman H, Tesh RB, Weaver SC. Genetic characterization of zika virus strains: geographic expansion of the Asian lineage. PLoS Negl Trop Dis 2012; 6:e1477.^-77 Torres A. Enfermedad por virus de Zika y sus complicaciones neurológicas. Pediátr Panamá 2017; 46(2):41-45..

This disease, which possibly migrated to Brazil in 2014, has spread in the Brazilian Northeast and in the Americas⁷7 Torres A. Enfermedad por virus de Zika y sus complicaciones neurológicas. Pediátr Panamá 2017; 46(2):41-45.^,88 Nunes ML, Carlini OR, Marinowic D, Kalil Neto F, Fiori HH, Scotta MC, Zanella PLA, Soder RB, Costa JC. Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil. J Pediatr 2016; 92(3):230-240.. Scientific results have contributed to increase the global concern about the virus, since, besides being transmitted through the bite of an infected mosquito, Zika can be congenitally or vertically transmitted, and some evidence indicate a significant potential of transmission through sexual contact⁸8 Nunes ML, Carlini OR, Marinowic D, Kalil Neto F, Fiori HH, Scotta MC, Zanella PLA, Soder RB, Costa JC. Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil. J Pediatr 2016; 92(3):230-240.

9 Luz KG, Santos GIV, Vieira RM. Zika virus fever. Epidemiol Serv Saúde 2015; 24(4):785-788.^-1010 Possas C, Brasil P, Marzochi MCA, Tanuri A, Martins RM, Marques ETA, Bonaldo MC, Ferreira AGP, Oliveira RL, Nogueira RMR, Sequeira PC, Marzochi KBF, Homma A. Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination: a review. Mem Inst Oswaldo Cruz 2017; 112(5):319-327..

With the spread of the Zika virus, the World Health Organization issued a warning and declared international public health emergency due to the increase in the incidence of microcephaly in endemic zones⁸8 Nunes ML, Carlini OR, Marinowic D, Kalil Neto F, Fiori HH, Scotta MC, Zanella PLA, Soder RB, Costa JC. Microcephaly and Zika virus: a clinical and epidemiological analysis of the current outbreak in Brazil. J Pediatr 2016; 92(3):230-240.^,1111 Gulland A. Zika virus is a global public health emergency, declares WHO. BMJ 2016; 352:i657.. Six months after the beginning of the virus outbreak, there was an unusual increase in the number of newborns with microcephaly in Brazil¹²12 Ventura CM, Maia M, Ventura BV, Linden VVD, Araújo EB, Ramos RC, Rocha MAW, Carvalho MDCG, Belfort Jr R, Ventura LO. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016; 79(1):1-3., which led the Brazilian Ministry of Public Health to associate this malformation with the Zika virus and the mother-to-child transmission¹⁰10 Possas C, Brasil P, Marzochi MCA, Tanuri A, Martins RM, Marques ETA, Bonaldo MC, Ferreira AGP, Oliveira RL, Nogueira RMR, Sequeira PC, Marzochi KBF, Homma A. Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination: a review. Mem Inst Oswaldo Cruz 2017; 112(5):319-327.^,1212 Ventura CM, Maia M, Ventura BV, Linden VVD, Araújo EB, Ramos RC, Rocha MAW, Carvalho MDCG, Belfort Jr R, Ventura LO. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016; 79(1):1-3.^,1313 Donalisio MR, Freitas ARR, Zuben APBV. Arboviruses emerging in Brazil: challenges for clinic and implications for public healt. Rev Saúde Pública 2017; 51:30..

Microcephaly is a severe, irreversible neurological condition that can be caused by the infection of the Zika virus during pregnancy. It causes a reduction in the cephalic perimeter, usually due to improper development and/or destruction of neural cells. It can be detected by ultrasound scans, tomography, or measurement of the cephalic perimeter¹⁴14 Instituto Evandro Chagas (IEC). IEC Comprova relação do vírus zika com microcefalia e diagnostica os primeiros óbitos relacionados ao vírus [Internet]. 2015 [acessado 2016 Mar 13]. Disponível em: http://www.iec.gov.br/portal/iec-comprova-relacao-do-virus-zika-com-a-microcefalia-e-diagnostica-os-primeiros-obitos-relacionados-ao-virus/
http://www.iec.gov.br/portal/iec-comprov... .

In 2016, the Ministry of Health reported an alarming number of 7,438 suspect cases of microcephaly during the 18th epidemiological week of 2016. Among these cases, 1,326 were confirmed as mother-to-child infection. Most of the microcephaly cases (5,706) have been reported in the Northeast region¹⁴14 Instituto Evandro Chagas (IEC). IEC Comprova relação do vírus zika com microcefalia e diagnostica os primeiros óbitos relacionados ao vírus [Internet]. 2015 [acessado 2016 Mar 13]. Disponível em: http://www.iec.gov.br/portal/iec-comprova-relacao-do-virus-zika-com-a-microcefalia-e-diagnostica-os-primeiros-obitos-relacionados-ao-virus/
http://www.iec.gov.br/portal/iec-comprov... .

Regarding the consequences of the congenital Zika, brain changes appear in the second and third quarters of pregnancy. Other dysmorphic features, such as severe protuberance of the occipital bone, closed fontanelles in birth, excess skin and/or skin folds on the scalp, and umbilical hernia, are often observed in newborns of mothers infected by the virus¹⁵15 Miranda-Filho DB, Martelli CMT, Ximenes RAA, Araújo TVB, Rocha MAW, Ramos RCF, Dhalia R, França RF, Marques Júnior ET, Rodrigues LC. Initial description of the presumed congenital Zika syndrome. Am J Public Health 2016; 106(4):598-600.^,1616 Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brains abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016; 47(1):6-7..

Current evidence on the natural evolution of the disease and its pathogenesis is strong enough to establish a causal relationship between the infection by the Zika virus during pregnancy and the increase in the frequency of miscarriages, stillborn babies, and early mortality, besides microcephaly¹⁵15 Miranda-Filho DB, Martelli CMT, Ximenes RAA, Araújo TVB, Rocha MAW, Ramos RCF, Dhalia R, França RF, Marques Júnior ET, Rodrigues LC. Initial description of the presumed congenital Zika syndrome. Am J Public Health 2016; 106(4):598-600.

16 Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brains abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 2016; 47(1):6-7.^-1717 Calvet G, Aguiar RS, Melo AS, Sampaio SA, Filippis I, Fabri A, Araujo ESM, Sequeira PC, Mendonça MCL, Oliveira L, Tschoeke DA, Schrago CG, Thompson FL, Brasil P, Santos FB, Nogueira RMR, Tanuri A, Filippis AMBD. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Inf Dis 2016; 16(6):653-660.. Therefore, the Zika virus is a growing public health problem in the whole world, mainly due to its power of dispersion and adaptability to new hosts and environments, its possibility to cause large epidemics, the universal susceptibility, and the large number of severe neurological cases¹⁸18 Brasil. Ministério da Saúde (MS). Monitoramento dos casos de microcefalia no Brasil até a Semana Epidemiológica 47, 2015. Brasília: MS; 2015..

Due to the aforementioned dimensions of this problem, this study aimed to analyze the knowledge and attitude of women with high-risk pregnancies about the Zika virus, for they are more susceptible to this problem. This analysis is important because of the need for pregnant women to act in order to prevent the virus infection. Such prevention can only occur through a process of knowledge acquiring about the disease and its risks, which must rise from a notion of respect to beliefs already developed by pregnant women about the issues at stake.

Methods

This cross-sectional, quantitative study assessed a sample of 201 women with high-risk pregnancy that attended prenatal care at the Outpatient Clinic of Specialties (AME). All of them have the same socioeconomic condition and have prenatal follow-up in Basic Health Units (UBS) in their neighborhoods. The AMEs are a reference in the health field and they are in several regions of the state of São Paulo. They are outpatient diagnostic centers regulated by the Brazilian Unified Health System (SUS), which provide medical specialties focused on the needs of the basic health care.

This study was conducted in the AME of Araçatuba-SP, Brazil, which provides health care to Regional Health Departments (DRSII), including 28 cities from the northwest of São Paulo. Every month the AME of Araçatuba records around 80 pregnant women with high-risk pregnancy. The sample comprised of all pregnant women with high-risk pregnancy during 30 days that met the inclusion criteria: to be present on the day of interview and their consent to participate in the study.

The exclusion criteria were those who did not agree to participate in the research and were not performing prenatal care during the study period.

For data collection, a self-applied instrument approached subjects related to knowledge and attitude of pregnant women with high-risk pregnancy about the Zika virus based on questionnaires from the World Health Organization. The questionnaires had only multiple-choice questions and they were applied in the AME after an appointment with a gynecologist, without the interference of any employees and in an isolate place.

For data analysis, we used descriptive statistics, chi-square and Fisher’s exact test in the software programs Epi info 7.1 and Bioestat 5.0, considering a significance level of 5% for all analysis. Incomplete questionnaires were considered losses (n = 32).

This research was approved by the Ethics and Research Committee. All ethical procedures were followed. Pregnant women younger than 18 years old signed the Informed Consent and were accompanied by a guardian.

Results

The sample comprised of 201 women with high-risk pregnancy, average age of 27.4 years, with complete high school (n = 121), complete higher education (n = 14), complete elementary school (n = 21), and incomplete elementary school (n = 6). Most women available for answering the questionnaire were in the second trimester of pregnancy (n = 91) (Table 1).

According to pregnant women’s answers, 25% did not know that the mosquito transmitting the Zika virus is the Aedes aegypti, the same vector of dengue fever (Table 2). During the study, 76% answered they believed that infection by the Zika virus was possible in their neighborhoods. This same number of participants reported that the responsibility to avoid the increase in the number of cases is of all citizens (n = 153) and that they perform measures to control the breeding of mosquitoes, such as cleaning pots with standing water (n = 154), maintaining a clean garden (n = 139) and using pesticides (n = 131) (Table 2).

When questioned about the main symptoms of Zika, the most mentioned were headache (n = 102), fever (n = 93) and joint pain (n = 76). Seventy-five participants stated they did not know the symptoms of Zika (Table 2). Regarding virus transmission, most participants (n = 108) did not know the virus can be transmitted through means other than the mosquito. Further, 79% were not satisfied with the information about the disease (Table 2).

Regarding knowledge about this issue, the Zika virus was associated with microcephaly (p < 0.0001) and the lack of knowledge was associated with the need for more information about the virus (p = 0.0439) (Table 3). When questioned about any actions the participants carried out to avoid infection by the Zika virus during pregnancy, 76% answered they did not take any measures. There was also an association between the need for knowledge about the subject and the actions carried out to fight the virus (p = 0.0049) (Table 3). Regarding information about the Zika virus, most participants (n = 121) obtained information through the social networks Facebook and Instagram.

Discussion

As highlighted previously, the concern about the Zika virus infection has increased due to the epidemics in Latin America. This concern has increased because the disease causes brain defects in newborns, such as microcephaly¹⁹19 Regadas VC, Silva MC, Abud LG, Labadessa LMPL, Oliveira RGG, Miyake CH, Queiroz RM. Microcefalia causada por infecção congênita pelo Zika virus e detecção viral na urina materna durante a gestação. Rev Assoc Med Bras 2018; 64(1):11-14.

20 Williamson KE. Cuidado nos tempos de Zika: notas da pós-epidemia em Salvador (Bahia), Brasil. Interface (Botucatu) 2018; 22(66):685-696.^-2121 Carneiro R, Fleischer SR. "Yo no lo esperaba. Fue un susto": concebir, gestar y parir en tiempos de Zika en la visión de las mujeres de Recife, estado de Pernambuco, Brasil. Interface (Botucatu) 2018; 22(66):709-719..

The mosquito is more common in urban areas, and breeding is more intense in the summer, when temperatures are higher and rains are more frequent²²22 World Health Organization (WHO). Avaliação de bebés com microcefalia no contexto de vírus Zika [Internet]. 2016 [acessado 2016 Dez 17]. Disponível em: http://apps.who.int/iris/bitstream/handle/10665/204475/WHO_ZIKV_MOC_16.3_por.pdf?sequence=8
http://apps.who.int/iris/bitstream/handl... ^,2323 Leatte EP, Pont AMD. Epidemiologia da dengue e zika vírus na 13ª Regional de Saúde do Paraná-Brasil. Rev Saúde Pesq 2017; 10(2):259-269..

The mosquito has caused many deaths from dengue fever, which shows that Brazil has had problems with the Aedes aegypti²²22 World Health Organization (WHO). Avaliação de bebés com microcefalia no contexto de vírus Zika [Internet]. 2016 [acessado 2016 Dez 17]. Disponível em: http://apps.who.int/iris/bitstream/handle/10665/204475/WHO_ZIKV_MOC_16.3_por.pdf?sequence=8
http://apps.who.int/iris/bitstream/handl... . The dengue virus has severely affected the Brazilian population for many decades, but there has not been any proper social, political or sanitary response to handle vector control of this disease²³23 Leatte EP, Pont AMD. Epidemiologia da dengue e zika vírus na 13ª Regional de Saúde do Paraná-Brasil. Rev Saúde Pesq 2017; 10(2):259-269.. The endemic situation of these diseases reveals the inefficacy of preventive and vector control actions and highlights problems in urbanization, use of soil, and social inequalities, which demand structural changes with effective measures to fight the Zika virus²³23 Leatte EP, Pont AMD. Epidemiologia da dengue e zika vírus na 13ª Regional de Saúde do Paraná-Brasil. Rev Saúde Pesq 2017; 10(2):259-269.^,2424 Bueno FTC. Vigilância e resposta em saúde no plano regional: um estudo preliminar do caso da febre do Zika vírus. Cien Saude Colet 2017; 22(7):2305-2314..

The Zika virus is a pathogenic microorganism of the family Flaviviridae, genus Flavivirus. The disease caused by this virus is a great public health issue not only by the infestation of the mosquito Aedes aegypti, but also by the population increase in Brazil and the lack of public policies of basic sanitation and lack of raising the population’s awareness²³23 Leatte EP, Pont AMD. Epidemiologia da dengue e zika vírus na 13ª Regional de Saúde do Paraná-Brasil. Rev Saúde Pesq 2017; 10(2):259-269.^,2525 Randow RMV, Silva JS, Brandão JFC, Oliveira IBC, Barbara JKO, Nascimento NG. Juntos no controle do aedes aegypti: educação em saúde. J Manag Prim Heal Care 2016; 7(1):137.. Therefore, it is necessary to raise awareness not only to clarify topics on preventing infestations, but also to indicate the consequences caused by diseases transmitted by this mosquito²⁵25 Randow RMV, Silva JS, Brandão JFC, Oliveira IBC, Barbara JKO, Nascimento NG. Juntos no controle do aedes aegypti: educação em saúde. J Manag Prim Heal Care 2016; 7(1):137.. The result of this study can illustrate this lack of information, where 25% of pregnant women did not know the vector of the Zika virus is the same as dengue’s.

The most frequent symptoms of Zika mentioned by the participants were headache, fever, and joint pain. On the other hand, 35.7% of participants answered they did not know the symptoms. According to Maguinã et al.²⁶26 Maguiña C, Rodas EG. The Zika vírus: a literature review. Acta Med Peru 2016; 33(1):35-41. and Cruz et al.²⁷27 Cruz RSBLC, Batista Filho M, Caminha MFC, Souza ES. Protocols on prenatal care for pregnant women with Zika infection and children with microcephaly: nutritional approach. Rev Bras Saúde Mater Infant 2016; 16(Supl. 1):S95-S102., the viral incubation period ranges from 3 to 12 days, and 80% of those affected by the virus do not have symptoms; therefore, only 25% have light fever, rash, conjunctivitis (a typical symptom of high prevalence), headaches and joint pain²⁶26 Maguiña C, Rodas EG. The Zika vírus: a literature review. Acta Med Peru 2016; 33(1):35-41.^,2727 Cruz RSBLC, Batista Filho M, Caminha MFC, Souza ES. Protocols on prenatal care for pregnant women with Zika infection and children with microcephaly: nutritional approach. Rev Bras Saúde Mater Infant 2016; 16(Supl. 1):S95-S102..

Besides transmission by the Aedes aegypti, some evidence indicate a significant possibility that global Zika outbreaks increase through sexual transmission - including the longstanding presence of the virus in the semen -, blood transfusion, and placenta¹⁰10 Possas C, Brasil P, Marzochi MCA, Tanuri A, Martins RM, Marques ETA, Bonaldo MC, Ferreira AGP, Oliveira RL, Nogueira RMR, Sequeira PC, Marzochi KBF, Homma A. Zika puzzle in Brazil: peculiar conditions of viral introduction and dissemination: a review. Mem Inst Oswaldo Cruz 2017; 112(5):319-327.^,1818 Brasil. Ministério da Saúde (MS). Monitoramento dos casos de microcefalia no Brasil até a Semana Epidemiológica 47, 2015. Brasília: MS; 2015.^,2626 Maguiña C, Rodas EG. The Zika vírus: a literature review. Acta Med Peru 2016; 33(1):35-41.

27 Cruz RSBLC, Batista Filho M, Caminha MFC, Souza ES. Protocols on prenatal care for pregnant women with Zika infection and children with microcephaly: nutritional approach. Rev Bras Saúde Mater Infant 2016; 16(Supl. 1):S95-S102.

28 Gonçalves Neto VS, Monteiro SG, Gonçalves AG, Rebêlo JMM. Public knowledge and attitudes concerning dengue in the Municipality of São Luís, Maranhão, Brasil, 2004. Cad Saúde Pública 2006; 22(10):2191-2200.

29 Coelho FC, Durovni B, Saraceni V, Lemos C, Codeço CT, Camargo S, Carvalho LM, Bastos L, Arduini D, Villela DA, Armstrong M. Higher incidence of Zika in adult women than adult men in Rio de Janeiro suggests a significant contribution of sexual transmission from men to women. Int J Infect Dis 2016; 51:128-132.

30 Calvet G, Aguiar RS, Melo ASO, Sampaio SA, Filippis I, Fabri A, Araujo ESM, Sequeira PC, Mendonça MCL, Oliveira L, Tschoeke DA, Schrago CG, Thompson FL, Brasil P, Santos FB, Nogueira RMR, Tanuri A, Filippis AMB. Detection and sequencing of Zika virus from amniotic fluid of fetuses with microcephaly in Brazil: a case study. Lancet Infect Dis 2016; 16(6):653-660.

31 Nicastri E, Castilletti C, Liuzzi G, Iannetta M, Capobianchi MR, Ippolito G. Persistent detection of Zika virus RNA in semen for six months after symptom onset in a traveller returning from Haiti to Italy, February 2016. Euro Surveill 2016; 21:32.^-3232 Mansuy JM, Dutertre M, Mengelle C, Fourcade C, Marchou B, Delobel P, Izopet J, Martin-Blondelet G. Zika virus: high infectious viral load in semen, a new sexually transmitted pathogen. Lancet Infect Dis 2016; 16(4):405., as it occurs with the HIV virus. In Brazil, epidemiological data show that until June 2005 around 83.7% of children younger than 13 years old that have the HIV virus were infected via mother-to-child transmission. In this study, most pregnant women did not know that the Zika virus could be transmitted via means other than the mosquito³³33 Sá FE, Andrade MMG, Nogueira EMC, Lopes JSM, Silva APEP, Assis AMV. Produção de sentidos parentais no cuidado de crianças com microcefalia por vírus zika. Rev Bras Promoç Saúde 2017; 30(4):1-10..

Regarding knowledge, there was significance in the association between Zika and microcephaly (p ≤ 0.0001). The intrauterine period is a critical stage for growth and development of fetal organs and tissues, so injuries suffered in this stage interfere with this process. Pregnant women infected by the Zika virus can transmit it vertically through the placenta¹²12 Ventura CM, Maia M, Ventura BV, Linden VVD, Araújo EB, Ramos RC, Rocha MAW, Carvalho MDCG, Belfort Jr R, Ventura LO. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016; 79(1):1-3.^,1818 Brasil. Ministério da Saúde (MS). Monitoramento dos casos de microcefalia no Brasil até a Semana Epidemiológica 47, 2015. Brasília: MS; 2015.^,3434 Albuquerque MFPM, Souza WV, Araújo TVB, Braga MC, Miranda-Filho DB, Ximenes RAA, Brito CAA, Melo Filho DA, Valongueiro S, Melo APL, Brandão-Filho SP, Martell CMT. Epidemia de microcefalia e vírus Zika: a construção do conhecimento em epidemiologia. Cad Saúde Pública 2018; 34(10):e00069018.^,3535 Chan JFW, Choi GKY, Yip CCY, Cheng VCC, Yuen K-Y. Zika fever and congenital Zika syndrome: an unexpected emerging arboviral disease. J Infect 2016; 72(5):507-524.. The mother-to-child transmission of Zika has already been demonstrated, because, in Brazil, the virus has been detected in the amniotic fluid of two pregnant women with babies with microcephaly. Thus, in November 11, 2015, the Ministry of Health recognized the association between the epidemics of Zika and the increase in the number of cases of microcephaly, characterized by a skull measure or cephalic perimeter lower than 2 (-2) and standard deviations below the specific average for the baby’s sex and the gestational age¹²12 Ventura CM, Maia M, Ventura BV, Linden VVD, Araújo EB, Ramos RC, Rocha MAW, Carvalho MDCG, Belfort Jr R, Ventura LO. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection. Arq Bras Oftalmol 2016; 79(1):1-3.^,1818 Brasil. Ministério da Saúde (MS). Monitoramento dos casos de microcefalia no Brasil até a Semana Epidemiológica 47, 2015. Brasília: MS; 2015.^,3434 Albuquerque MFPM, Souza WV, Araújo TVB, Braga MC, Miranda-Filho DB, Ximenes RAA, Brito CAA, Melo Filho DA, Valongueiro S, Melo APL, Brandão-Filho SP, Martell CMT. Epidemia de microcefalia e vírus Zika: a construção do conhecimento em epidemiologia. Cad Saúde Pública 2018; 34(10):e00069018.^,3535 Chan JFW, Choi GKY, Yip CCY, Cheng VCC, Yuen K-Y. Zika fever and congenital Zika syndrome: an unexpected emerging arboviral disease. J Infect 2016; 72(5):507-524..

Therefore, it is worth resuming the words by Chan et al.³⁵35 Chan JFW, Choi GKY, Yip CCY, Cheng VCC, Yuen K-Y. Zika fever and congenital Zika syndrome: an unexpected emerging arboviral disease. J Infect 2016; 72(5):507-524., who indicated the sudden expansion of the epidemics by the virus as one of the main causes of neuropsychomotor disorders and disabilities in a generation of newborns with microcephaly following their mothers’ infection by the Zika virus. Therefore, the situation studied is a great burden to the families involved and a high socioeconomic onus to the countries affected by the disease³³33 Sá FE, Andrade MMG, Nogueira EMC, Lopes JSM, Silva APEP, Assis AMV. Produção de sentidos parentais no cuidado de crianças com microcefalia por vírus zika. Rev Bras Promoç Saúde 2017; 30(4):1-10.^,3535 Chan JFW, Choi GKY, Yip CCY, Cheng VCC, Yuen K-Y. Zika fever and congenital Zika syndrome: an unexpected emerging arboviral disease. J Infect 2016; 72(5):507-524..

Regarding the information about this subject, according to Gonçalves et al.³⁶36 Gonçalves RP, Lima EC, Lima JWO, Silva MGC, Caprara A. Contribuições recentes sobre conhecimentos, atitudes e práticas da população brasileira acerca da dengue. Saude Soc 2015; 24(2):578-593., there is some difficulty in changing people’s behavior in the short term, either in the collective or individual level, because perceptions and habits are internally entrenched and they are automatically passed on through generations³⁶36 Gonçalves RP, Lima EC, Lima JWO, Silva MGC, Caprara A. Contribuições recentes sobre conhecimentos, atitudes e práticas da população brasileira acerca da dengue. Saude Soc 2015; 24(2):578-593.. That is why it is necessary to invest in raising awareness as a process rather than isolated actions about the disease. A large part of people involved in research, for example, has a good level of knowledge about the disease, but some predatory attitudes that can increase the number of cases persist³⁶36 Gonçalves RP, Lima EC, Lima JWO, Silva MGC, Caprara A. Contribuições recentes sobre conhecimentos, atitudes e práticas da população brasileira acerca da dengue. Saude Soc 2015; 24(2):578-593..

According to Gonçalves Neto et al.²⁸28 Gonçalves Neto VS, Monteiro SG, Gonçalves AG, Rebêlo JMM. Public knowledge and attitudes concerning dengue in the Municipality of São Luís, Maranhão, Brasil, 2004. Cad Saúde Pública 2006; 22(10):2191-2200., control and breeding of Aedes aegypti happen mainly in the collective context and requires an effort from the whole society. Thus, the population of areas with occurrence of transmission needs information to change their attitude, in order to prevent and control the disease. On this matter, this study identified the association between the lack of knowledge about the virus and the actions performed to fight the mosquito (p = 0.0049): 76% of participants did not take any measures to prevent the infection by the Zika virus during pregnancy.

Therefore, the actions of epidemiological surveillance have been essential to monitor the evolution of the Zika virus epidemics in Brazil and to enhance comprehension about the manifestation of the disease and its possible consequences, both in pregnant women and their babies and in adults³⁷37 Garbin CAS, Garbin AJI, Moimaz SAS, Rocha NB. A transmissão vertical do HIV na percepção de mulheres brasileiras. Rev Odontol Araçatuba 2012; 33(1):41-45.^,3838 Garcia LP, Duarte E. Evidências da vigilância epidemiológica para o avanço do conhecimento sobre a epidemia do vírus Zika. Epidemiol Serv Saúde 2016; 25(4):679-481.. However, public policies are necessary to improve information about the virus because, as pointed out in this study, there is an association between the lack of knowledge and the need for more information about the Zika virus (p = 0.0439), which puts pregnant women at risk.

Regarding information about the Zika virus, most pregnant women (n = 121) obtained it through the social networks Facebook and Instagram, which corroborates studies by Camilo et al.³⁹39 Camilo EL, Santos GMMD, Valencoela LP, Barbosa JAS. A educação física no combate a dengue: Acadêmicos em foco. Rev Magsul 2016; 1(1):17-30. and Gonçalves Neto et al.²⁸28 Gonçalves Neto VS, Monteiro SG, Gonçalves AG, Rebêlo JMM. Public knowledge and attitudes concerning dengue in the Municipality of São Luís, Maranhão, Brasil, 2004. Cad Saúde Pública 2006; 22(10):2191-2200. They observed that the media provides clarifying information and encourages social mobilization; television and radio have an important role because they are easily accessible broadcast means²⁸28 Gonçalves Neto VS, Monteiro SG, Gonçalves AG, Rebêlo JMM. Public knowledge and attitudes concerning dengue in the Municipality of São Luís, Maranhão, Brasil, 2004. Cad Saúde Pública 2006; 22(10):2191-2200.^,3939 Camilo EL, Santos GMMD, Valencoela LP, Barbosa JAS. A educação física no combate a dengue: Acadêmicos em foco. Rev Magsul 2016; 1(1):17-30..

Conclusion

The knowledge of pregnant women about the Zyka virus is still poor. Therefore, it is necessary to raise awareness about this subject, mainly through social networks, because, as demonstrated in this study, this is the most used platform by pregnant women to access information about the subject. It is also necessary to invest in public policies that mobilize communities and provide guidelines about the importance of collective actions to fight diseases transmitted by Aedes aegypti.

This analysis corroborated this need considering the scenario of answers studied in this research, which indicated lack of necessary precaution against virus transmission. Therefore, preventing the disease and following up pregnant women probably infected by the Zika virus are very important considering the possible consequences of congenital infection, mainly microcephaly and other neurological anomalies.

References

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