Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil.

Autor: Andrews K; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America., Bourroul MLM; Children's Institute of the Clinics Hospital, School of Medicine at the University of São Paulo, São Paulo, Brazil., Fink G; Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland., Grisi S; Department of Pediatrics, School of Medicine at the University of São Paulo, São Paulo, Brazil., Scoleze Ferrer AP; Children's Institute of the Clinics Hospital, School of Medicine at the University of São Paulo, São Paulo, Brazil., Diniz EMA; Department of Pediatrics, School of Medicine at the University of São Paulo, São Paulo, Brazil., Brentani A; Department of Pediatrics, School of Medicine at the University of São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2017 Dec 22; Vol. 12 (12), pp. e0190060. Date of Electronic Publication: 2017 Dec 22 (Print Publication: 2017).
DOI: 10.1371/journal.pone.0190060
Abstrakt: Background: Differential trends in mortality suggest that stillbirths may dominate neonatal mortality in the medium to long run. Brazil has made major efforts to improve data collection on health indicators at granular geographic levels, and provides an ideal environment to test this hypothesis. Our goals were to examine levels and trends in stillbirths and neonatal deaths and the extent to which the mortality burden caused by stillbirths dominates neonatal mortality at the municipality- and state-level.
Methods: We used data from the Brazilian Ministry of Health's repository on births, fetal, and neonatal deaths (2010-2014) to calculate stillbirth and neonatal mortality rates for São Paulo state's 645 municipalities.
Results: At the state level, 7.9 per 1000 pregnancies ended in stillbirth (fetal death >22 weeks gestation or fetal weight >500g), but this varied from 0.0 to 28.4 per 1000 across municipalities. 7.9 per 1000 live births also died within the first 28 days. 42% of municipalities had a higher stillbirth rate than neonatal mortality rate, and in 61% of areas with low neonatal mortality (<8.0 per 1000), stillbirth rates exceeded neonatal mortality rates.
Conclusions: This analysis suggests large variability and inequality in mortality outcomes at the sub-national level. The results also imply that stillbirth mortality may exceed neonatal mortality in Brazil and similar settings in the next few decades, which suggests a need for a shift in policy. This work further underscores the importance of continued research into causes and prevention of stillbirth.
Databáze: MEDLINE
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