Fetal and infant mortality trend according to avoidability of causes of death and maternal education
Keywords:Fetal mortality, neonatal mortality, time series studies, Underlying Cause of Death, educational status, Health Inequality Monitoring
Objective: To estimate fetal (TMF) and neonatal (TMN) mortality rates trends from preventable causes and maternal education in the city of Rio de Janeiro (2000-2018).
Method: Ecological time series study. Mortality and Live Birth Information System Data. The Brazilian Avoidable List was used for neonatal deaths and an adaptation for fetal deaths, accordingly to maternal education indicators (low<4 and high ≥12, years of study). Joinpoint regression models were used to estimate trends in TMF per thousand births and TMN per thousand live births.
Results: TMF increased from 11.0‰ to 9.3‰ births and TMN from 11.3‰ to 7.8‰ (2000/2018). In 2006, the TMF (10.5‰) exceeds the TMN (9.0‰), remaining higher. From 2000 to 2018, the annual decrease of TMF was 0.8% (2000 to 2018) and of TMN, 3.8% until 2007, decelerating to 1.1% by 2011; from then on, remained stable. Avoidable causes, especially those reducible by attention to pregnancy prevailed, presented higher rates. Both TMF and TMN of low schooling women were higher than those of high school level, the difference being much more pronounced for TMF, and at the end of the period: low and high schooling TMF were, respectively 16.4‰ and 4.5‰ (2000) and 48.5‰ and 3.9‰ (2018), and for TMN, 18.2‰ and 6.7‰ (2000) and 28.4‰ and 5.0‰ (2018).
Conclusions: The favorable trend of decreasing mortality was not observed for children of mothers with low education, revealing inequalities. The causes were mostly preventable, related to prenatal care and childbirth.
Copyright (c) 2020 Pauline Lorena Kale, Sandra Costa Fonseca, Pedro Willian Marques de Oliveira, Alexandre dos Santos Brito
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