Social determinants of health associated with topical repellent use in pregnancy: a cross-sectional study during a Zika outbreak in Brazil

Background Repellent use during pregnancy was strongly recommended after uncovering Zika virus (ZIKV) involvement with congenital malformations. In this context, Pernambuco, Brazil played a key role since it was the epicentre for the main studies suggesting ZIKV teratogenicity and one of Brazil's most affected states during the 2014-2016 epidemics. Thus we aimed to identify possible associations between social determinants of health and repellent use in pregnancy during the ZIKV outbreak in Pernambuco. Methods We conducted a cross-sectional study (July-December 2016) with 539 pregnant women residing in Pernambuco and estimated the associations by prevalence ratio and multivariable logistic regression. Results Repellents were associated with pregnant women 30 y; graduates, employed, health professionals, private health system users and with a monthly income per person greater than two minimum wages. Women whose domiciles favour mosquitoes (ground-floor houses, intermittent water supply from general distribution or water trucks and for 6 d/week, cesspools/open wastewater, indoor household water storage) were less likely to use repellents. There was no association for peridomiciles. Conclusions Repellents were not associated with ZIKV in most vulnerable pregnant women, despite all the general recommendations made during the Pernambuco epidemic. This study observed a demand for public policies focused on health, education and sanitation problems related to deprived social groups along with their co-responsibility rather than focusing on individual attitudes against mosquitoes.