Trend of preventable neonatal mortality in the States of Brazil

Prezotto, Kelly Holanda; Oliveira, Rosana Rosseto de; Pelloso, Sandra Marisa; Fernandes, Carlos Alexandre Molena

doi:10.1590/1806-93042021000100015

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 21 (1) • Jan-Mar 2021 • https://doi.org/10.1590/1806-93042021000100015 copy

Trend of preventable neonatal mortality in the States of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to describe the trend of preventable neonatal mortality due to interventions by the Unified Health System in Brazil from 2000 to 2018, according to groups of causes of death and maternal residence.

Methods:

mixed ecological study with data from the Mortality Information System and Information System on Live Births. The analysis occurred based on the number and rates of avoidable neonatal mortality, polynomial regression models by least squares method and thematic maps.

Results:

the avoidable neonatal mortality rate decreased from 10.98 in 2000 to 6.76 per 1,000 live births in 2018. Preventable causes prevailed due to adequate care for women during pregnancy, childbirth, fetus and newborn. Deaths from preventable causes from health promotion actions during pregnancy increased in Maranhão (p=0.003) and the Federal District (p=0.001) and remained stable in nine states. There was stability in the rates of mortality due to delivery in Maranhão, Piauí and Amazonas. The causes avoidable by actions with the newborn showed a decreasing trend, except for Roraima where there was stability.

Conclusions:

there are inequalities in trends of avoidable neonatal mortality rates in the states second according to the group of causes and the need to improve access to and quality of maternal and child health care in these places

Key words:
Neonatal mortality; Trend; Mortality records; Spatial distribution

Region/State	2000-2002	2008-2010	2016-2018	PV
North
Rondônia	12.69	8.61	5.78	-54.41
Acre	10.99	7.76	6.45	-41.32
Amazonas	11.51	7.49	7.97	-30.71
Roraima	7.17	6.91	8.08	12.64
Para	11.67	9.83	8.56	-26.69
Amapá	15.13	13.59	9.88	-34.73
Tocantins	10.81	7.99	6.45	-40.31
Northeast
Maranhão	7.60	8.97	8.12	6.94
Piauí	9.47	10.15	8.19	-13.47
Ceará	11.01	8.07	6.65	-39.65
Rio Grande do Norte	10.73	7.77	6.41	-40.20
Paraíba	11.23	8.41	6.57	-41.47
Pernambuco	12.14	8.73	6.73	-44.59
Alagoas	13.83	10.00	7.05	-49.03
Sergipe	16.69	9.09	9.41	-43.59
Bahia	11.85	10.11	8.80	-25.77
Southeast
Minas Gerais	10.35	7.46	5.71	-44.83
Espírito Santo	9.13	6.53	5.49	-39.86
Rio de Janeiro	10.13	7.25	6.54	-35.42
São Paulo	8.47	6.36	5.57	-34.24
South
Paraná	9.34	6.55	5.43	-41.86
Santa Catarina	7.33	5.49	4.75	-35.27
Rio Grande do Sul	7.32	5.88	5.17	-29.41
Midwest
Mato Grosso do Sul	11.33	8.48	5.27	-53.47
Mato Grosso	11.70	7.90	6.30	-46.14
Goiás	8.55	6.84	6.74	-21.13
Distrito Federal	7.90	6.39	5.92	-25.11
Brazil	9.99	7.67	6.48	-35.10

Cause group	2000-2002			2008-2010			2016-2018			PV
Cause group	n	%	rate	n	%	rate	n	%	rate	PV
Care during pregnancy	34,622	36.93	3.69	30,829	46.32	3.55	27,783	49.12	3.18	-13.73
Care to the NB	39,223	41.83	4.18	21,533	32.35	2.48	17,262	30.52	1.98	-52.68
Attention to childbirth	17,347	18.50	1.85	12,824	19.27	1.48	10,314	18.24	1.18	-36.08
Health promotion	1,243	1.33	0.13	778	1.17	0.09	790	1.40	0.09	-31.67
Diagnosis / adequate treatment	1,229	1.31	0.13	571	0.86	0.07	401	0.71	0.05	-64.92
Immunization	99	0.11	0.01	27	0.04	0.003	10	0.02	0.001	-89.14

State	Attention to pregnancy			Attention to childbirth			Attention to newborn
State	model	r²	p	model	r²	p	model	r²	p
Rondônia	$y = 3.291 - 0.142 x$	0.95	<0.001	$y = 1.713 - 0.102 x$	0.94	<0.001	$y = 3.408 - 0.176 x$	0.87	<0.001
Acre	$y = 2.848 - 0.042 x$	0.37	0.009	$y = 1.706 - 0.115 x$	0.77	<0.001	$y = 3.061 - 0.051 x$	0.41	0.006
Amazonas	$y = 3.088 + 0.012 x$	0.71	0.303	$y = 1.585 - 0.014 x$	0.18	0.088	$y = 3.121 - 0.165 x$	0.78	<0.001
Roraima	$y = 3.096 - 0.001 x$	0.01	0.931	$y = 1.224 - 0.046 x$	0.79	<0.001	$y = 1.745 + 0.020 x$	0.14	0.138
Para	$y = 3.685 - 0.006 x$	0.02	0.587	$y = 2.027 - 0.036 x$	0.82	<0.001	$y = 4.006 - 0.134 x$	0.90	<0.001
Amapá	$y = 3.984 - 0.018 x$	0.01	0.671	$y = 2.569 - 0.100 x$	0.86	<0.001	$y = 6.127 - 0.278 x$	0.91	<0.001
Tocantins	$y = 3.654 - 0.009 x$	0.14	0.657	$y = 1.797 - 0.087 x$	0.84	<0.001	$y = 2.308 - 0.180 x$	0.79	<0.001
Maranhão	$y = 3.146 + 0.077 x$	0.47	0.002	$y = 2.051 + 0.021 x$	0.22	0.055	$y = 2.960 - 0.057 x$	0.56	0.001
Piauí	$y = 4.661 + 0.058 x$	0.10	0.215	$y = 2.210 + 0.006 x$	0.02	0.585	$y = 2.627 - 0.175 x$	0.76	<0.001
Ceará	$y = 3.508 - 0.118 x$	0.87	<0.001	$y = 1.699 - 0.069 x$	0.84	<0.001	$y = 3.066 - 0.109 x$	0.84	0.001
Rio Grande do Norte	$y = 3.779 - 0.028 x$	0.13	0.142	$y = 1.583 - 0.097 x$	0.87	<0.001	$y = 2.813 - 0.108 x$	0.52	0.001
Paraíba	$y = 3.148 - 0.075 x$	0.78	<0.001	$y = 1.776 - 0.049 x$	0.50	0.002	$y = 3.627 - 0.177 x$	0.96	<0.001
Pernambuco	$y = 4.232 - 0.091 x$	0.77	<0.001	$y = 1.713 - 0.084 x$	0.98	<0.001	$y = 2.705 - 0.156 x$	0.79	<0.001
Alagoas	$y = 3.703 - 0.110 x$	0.86	<0.001	$y = 1.886 - 0.082 x$	0.88	<0.001	$y = 4.296 - 0.188 x$	0.88	<0.001
Sergipe	$y = 4.822 - 0.162 x$	0.73	<0.001	$y = 2.429 - 0.096 x$	0.86	<0.001	$y = 3.555 - 0.261 x$	0.61	<0.001
Bahia	$y = 4.379 - 0.049 x$	0.21	0.058	$y = 2.213 - 0.040 x$	0.79	<0.001	$y = 3.762 - 0.130 x$	0.73	<0.001
Minas Gerais	$y = 3.517 - 0.069 x$	0.86	<0.001	$y = 1.247 - 0.062 x$	0.94	<0.001	$y = 2.693 - 0.153 x$	0.91	<0.001
Espírito Santo	$y = 3.599 - 0.075 x$	0.78	<0.001	$y = 1.387 - 0.047 x$	0.81	<0.001	$y = 1.793 - 0.113 x$	0.79	<0.001
Rio de Janeiro	$y = 3.726 - 0.037 x$	0.77	<0.001	$y = 1.412 - 0.046 x$	0.95	<0.001	$y = 2.382 - 0.140 x$	0.80	<0.001
São Paulo	$y = 2.914 - 0.018 x$	0.40	0.006	$y = 1.018 - 0.019 x$	0.65	<0.001	$y = 2.423 - 0.120 x$	0.94	<0.001
Paraná	$y = 3.849 - 0.041 x$	0.89	<0.001	$y = 1.270 - 0.073 x$	0.94	<0.001	$y = 1.549 - 0.123 x$	0.85	<0.001
Santa Catarina	$y = 2.617 - 0.029 x$	0.55	0.001	$y = 1.005 - 0.039 x$	0.78	<0.001	$y = 2.075 - 0.095 x$	0.94	<0.001
Rio Grande do Sul	$y = 3.238 - 0.051 x$	0.66	<0.001	$y = 0.964 - 0.029 x$	0.93	<0.001	$y = 1.704 - 0.072 x$	0.87	<0.001
Mato Grosso do Sul	$y = 3.426 - 0.133 x$	0.91	<0.001	$y = 1.733 - 0.075 x$	0.80	<0.001	$y = 2.650 - 0.171 x$	0.88	<0.001
Mato Grosso	$y = 3.607 - 0.059 x$	0.70	<0.001	$y = 1.438 - 0.068 x$	0.96	<0.001	$y = 3.065 - 0.174 x$	0.74	<0.001
Goiás	$y = 3.475 + 0.016 x$	0.16	0.107	$y = 1.275 - 0.024 x$	0.53	0.001	$y = 2.673 - 0.105 x$	0.91	<0.001
Distrito Federal	$y = 3.762 + 0.057 x$	0.54	0.001	$y = 1.005 - 0.039 x$	0.68	<0.001	$y = 1.690 - 0.084 x$	0.90	<0.001

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[1] Authors’ contribution

Prezotto KH and Fernandes CAM elaborated the initial project, which was reviewed by Oliveira RR and Pelloso SM. Prezotto KH was responsible for the statistical collection and analysis of the data. Prezotto KH and Fernandes CAM participated in the preliminary version of the article, which was reviewed by Oliveira RR and Pelloso SM. All authors read and approved the final version of the manuscript.