Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

Abstract

Background Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. Methods Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. Results All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income—expressed in deaths per 1000 births—were reduced over time but relative inequalities—expressed as ratios of mortality rates—tended to remain stable. Conclusion The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.

Mortalidad infantil y desigualdades sociales en Argentina, 1980-2017

“…En la ciudad de Pelotas, Brasil, se registró un 62,0% de descenso de la TMI para un período de 33 años (1982-2015), según lo reportado por Menezes y cols. ( 30 ). En Chile, la reducción fue mayor: en el período 1970-2003, durante el cual la TMI se redujo un 90,1%, según reportaron Kaempffer y Medina ( 31 ).…”

Annual trend of neonatal mortality and its underlying causes: population-based study – São Paulo State, Brazil, 2004–2013

“…When women and their babies do present to a medical center there may also be a delay in them receiving the right care [ 8 ]. It seems that in Brazil, where a public and accessible health care system does exist [ 9 ], but inequalities are pervasive throughout society [ 10 ], further improvement in maternal and newborn health outcomes will depend on the ability to understand and address the gap between coverage and quality [ 11 ].…”

Annual Trend of Neonatal Mortality and Its Underlying Causes: Populational Study – SÃO Paulo State, Brazil, 2004-2013

“…Using the three-delay model, problems may be related to delays in recognizing the need for care or in arriving at a health facility or in receiving the right care when women and their babies do attend for care at a healthcare facility [8]. It seems that in Brazil, where a public and accessible health care system does exist [9], but inequalities are pervasive throughout society [10], further improvement in maternal and newborn health outcomes will depend on the ability to understand and address the gap between coverage and quality [11].…”