Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015

Teixeira, João Alexandre Mendes; Araujo, Waleska Regina Machado; Maranhão, Ana Goretti Kalume; Cortez-Escalante, Juan José; Rezende, Leandro Fórnias Machado de; Matijasevich, Alicia

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 28 (1) • 2019 • https://doi.org/10.5123/S1679-49742019000100006 copy

Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015^* * This article is derived from the Master's dissertation entitled 'Mortality on the first day of life in Brazil: Causes and prevention", defended by João Alexandre Mendes Teixeira at the Postgraduate Program in Preventive Medicine, Department of Preventive Medicine, University of São Paulo in 2018. João Alexandre Mendes Teixeira and Waleska Regina Machado Araujo received support from the Coordination for the Improvement of Higher Level Personnel (CAPES) / Ministry of Education by means of a master’s degree scholarship and a doctoral scholarship, respectively. Leandro Fórnias Machado de Rezende received a doctoral scholarship from the São Paulo State Foundation for Research Support (FAPESP) - Process No. 2014/25614-4. Alicia Matijasevich holds a scientific productivity scholarship from the National Council for Scientific and Technological Development (CNPq) / Ministry of Science, Technology and Innovation (MCTI).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability.

Methods:

this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the ‘Brazilian list of avoidable causes of death’.

Results:

21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable.

Conclusion:

2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Keywords:
Infant Mortality; Causes of Death; Child Health; Information Systems; Vital Statistics

Indicator	2010	2011	2012	2013	2014	2015	2010-2015
Number of deaths in children younger than 1 year old	16,188	16,233	16,110	15,855	16,119	15,665	96,170
Number of LB^b	1,322,755	1,347,588	1,359,709	1,362,801	1,401,060	1,424,720	8,218,633
Infant mortality rate/1,000 LB^b	12.7	12.0	11.8	11.6	11.5	11.0	11.7
Number of deaths on the 1^st day of life	3,600	3,579	3,385	3,386	3,558	3,283	20,791
Proportion (%) of deaths on 1^st day of life	22.2	22.0	21.0	21.4	22.0	20.9	21.6
Mortality rate on the 1^st day of life/1,000 LB^b	2.7	2.6	2.5	2.5	2.5	2.3	2.5

Federative Unit	Mortality rate on the first day of life/1,000 LB^a
Federative Unit	2010	2011	2012	2013	2014	2015	2010-2015	Mudança no período ^b	Valor de p^c
Espírito Santo	3.0	2.7	2.6	2.4	2.7	2.7	2.7	-9%	0.349
Rio de Janeiro	2.9	2.9	2.5	2.5	2.7	2.3	2.6	-23%	0.059
São Paulo	2.5	2.4	2.4	2.4	2.4	2.2	2.4	-12%	0.048
Paraná	3.1	2.8	2.7	2.6	2.7	2.2	2.7	-29%	0.016
Santa Catarina	2.4	3.0	2.5	2.6	2.7	2.5	2.6	5%	0.888
Rio Grande do Sul	2.4	2.5	2.1	2.2	2.3	2.1	2.3	-10%	0.158
Mato Grosso do Sul	4.1	3.7	3.4	3.2	3.1	3.0	3.4	-28%	0.002
Federal District	3.7	3.1	3.2	3.2	3.7	3.4	3.4	-6%	0.909

Characteristics of LB^b and delivery	2010-2015
Characteristics of LB^b and delivery	n^c	LB^b	Rate^d	Relative risk	p^e	Attributable risk
Sex	20,637				<0.001
Male	11,454	4,209,135	2.7	1.18 (1.15;1.22)		0.4
Female	9,183	4,008,464	2.3	1.00		(reference)
Ethnicity/skin color	19,310				<0.001
Black	531	392,374	1.4	0.50 (0.46;0.55)		-1.3
Asian	34	29,189	1.2	0.43 (0.31;0.60)		-1.5
Brown	4,984	2,508,899	2.0	0.74 (0.71;0.76)		-0.7
Indigenous	108	28,919	3.7	1.40 (1.15;1.68)		1.1
White	13,653	5,095,435	2.7	1.00		(reference)
Multiple Pregnancy	19,957				<0.001
Yes	2,516	184,850	13.6	6.26 (6.00;6.53)		11.4
No	17,441	8,027,587	2.2	1.00		(reference)
Type of delivery	19,886				<0.001
Cesarean section	8,361	4,985,021	1.7	0.46 (0.45;0.48)		-1.9
Vaginal delivery	11,525	3,226,968	3.6	1.00		(reference)
Birth weight (in grams)	19,775				<0.001
<1,500	12,579	115,110	109.3	227.50 (219.32;235.99)		108.8
1,500-2,499	3,603	620,557	5.8	12.08 (11.54;12.65)		5.3
≥2,500	3,593	7,480,349	0.5	1.00		(reference)
Gestational age (in weeks)	19,237				<0.001
<37	15,743	865,195	18.2	37.87 (36.50;39.30)		17.7
37-41	3,416	7,110,518	0.5	1.00		(reference)
≥42	78	151,969	0.5	1.06 (0.85;1.33)		0.0
Mother's age (in years)	19,298				<0.001
<19	4,310	1,318,618	3.3	1.47 (1.41;1.52)		1.1
≥30	6,006	2,858,240	2.1	0.94 (0.91;0.97)		-0.1
20-29	8,982	4,041,617	2.2	1.00		(reference)
Maternal education level (in years of schooling)^f	18,014
No schooling	591	21,616	23.7	17.10 (15.66;18.67)		25.7
1-3	753	188,274	4.0	2.50 (2.30;2.71)		2.4
4-7	4,398	1,506,753	2.9	1.82 (1.74;1.91)		1.3
8-11	9,520	4,710,602	2.0	1.26 (1.21;1.32)		0.4
≥12	2,752	1,720,840	1.6	1.00		(reference)
Total	20,791	8,218,633	2.5

Position	ICD-10 code^a	Name of the cause of death	N (% of the total number of deaths on the first day of life)	Preventable causes^c
1	P22.0	Respiratory distress syndrome of newborn	1,856 (8.9)	1
2	P07.2	Extreme immaturity of newborn	1,087 (5.2)	1
3	P07.0	Extremely low birth weight newborn	1,074 (5.2)	1
4	Q00.0	Anencephaly	819 (3.9)	4
5	P01.1	Fetus and newborn affected by premature rupture of membranes	757 (3.6)	1
6	P21.9	Asphyxia at birth, unspecified	754 (3.6)	2
7	P02.1	Fetus and newborn affected by other forms of placental separation and hemorrhage	742 (3.6)	4
8	P28.0	Primary atelectasis of newborn	615 (3.0)	3
9	Q89.7	Multiple congenital malformations, not classified elsewhere	606 (2.9)	4
10	Q33.6	Congenital hypoplasia and dysplasia of lung	541 (2.6)	4
11	P00.1	Fetus and newborn affected by maternal renal and urinary tract diseases	471 (2.3)	1
12	P02.7	Fetus and newborn affected by chorioamnionitis	458 (2.2)	4
13	P07.3	Preterm (premature) newborn (other)	452 (2.2)	1
14	P00.0	Fetus and newborn affected by maternal hypertensive disorders	446 (2.1)	1
15	P01.5	Fetus and newborn affected by multiple pregnancy	437 (2.1)	1
16	P20.9	Intrauterine hypoxia, unspecified	435 (2.1)	2
17	P36.9	Bacterial sepsis of newborn, unspecified	430 (2.1)	3
18	P01.0	Fetus and newborn affected by incompetent cervix	406 (1.9)	1
19	Q89.9	Congenital malformations, unspecified	396 (1.9)	4
20	P96.9	Condition originating in the perinatal period, unspecified	368 (1.8)	3

Preventability	Birth weight (in grams)
Preventability	<1,500 %	1,500-2,499 %	≥2,500 %
Reducible by adequate care for pregnant women	56.3	17.6	12.0
Reducible by adequate care for women during childbirth	8.8	8.2	26.3
Reducible by adequate care for the fetus and newborn	12.1	12.9	16.5
Reducible by appropriate health promotion actions, together with appropriate health care actions	-	0.1	0.3
Reducible by adequate diagnosis and treatment	-	-	-
Other causes (Not clearly avoidable)	22.7	61.0	44.2
Underlying causes of death	0.1	0.1	0.7

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Waleska Regina Machado Araujo - Avenida Doutor Arnaldo, No. 455, São Paulo, SP, Brazil. Postcode: 01246-903. E-mail: waleskaregina@usp.br