Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012

Rodrigues, Nádia Cristina Pinheiro; Monteiro, Denise Leite Maia; Almeida, Andréa Sobral de; Barros, Mônica Barros de Lima; Pereira Neto, André; O'Dwyer, Gisele; Andrade, Mônica Kramer de Noronha; Flynn, Matthew Brian; Lino, Valéria Teresa Saraiva

doi:10.1016/j.jped.2016.03.004

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Original articles • J. Pediatr. (Rio J.) 92 (6) • Nov-Dec 2016 • https://doi.org/10.1016/j.jped.2016.03.004 copy

Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012^☆ ☆ Please cite this article as: Rodrigues NC, Monteiro DL, Almeida AS, Barros MB, Pereira Neto A, O'Dwyer G, et al. Temporal and spatial evolution of maternal and neonatal mortality rates in Brazil, 1997-2012. J Pediatr (Rio J). 2016;92:567-73.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Maternal and neonatal mortality are important public health issues in low-income countries. This study evaluated spatial and temporal maternal and neonatal mortality trends in Brazil between 1997 and 2012.

Methods:

This study employed spatial analysis techniques using death records from the mortality information system. Maternal mortality rates per 100,000 and neonatal mortality rates (early and late) per 1000 live births were calculated by state, region, and period (1997-2000, 2001-2004, 2005-2008, and 2009-2012). Multivariate negative binomial models were used to explain the risk of death.

Results:

The mean Brazilian maternal mortality rate was 55.63/100,000 for the entire 1997-2012 period. The rate fell 10% from 1997-2000 (58.92/100,000) to 2001-2004 (52.77/100,000), but later increased 11% during 2009-2012 (58.69/100,000). Early and late neonatal mortality rates fell 33% (to 7.36/1000) and 21% (to 2.29/1000), respectively, during the 1997-2012 period. Every Brazilian region witnessed a drop in neonatal mortality rates. However, maternal mortality increased in the Northeast, North, and Southeast regions.

Conclusion:

Brazil's neonatal mortality rate has improved in recent times, but maternal mortality rates have stagnated, failing to meet the Millennium Development Goals. Public policies and intersectoral efforts may contribute to improvements in these health indicators.

KEYWORDS
Maternal mortality; Infant mortality; Trends; Maternal health; Ecological studies; Mortality

	Maternal mortality ratio/100,000 live births				Neonatal mortality rate (0-6 days)/1000 live births				Neonatal mortality rate (7-28 days)/1000 live births
	1997-2000	2001-2004	2005-2008	2009-2012	1997-2000	2001-2004	2005-2008	2009-2012	1997-2000	2001-2004	2005-2008	2009-2012
North	58.86	53.24	59.95	63.88	12.66	11.06	9.69	8.87	3.17	2.94	2.57	2.48
Northeast	56.27	61.36	65.93	69.63	11.50	11.51	10.14	8.85	2.98	2.87	2.53	2.27
Southeast	59.59	44.24	45.5	52.22	11.09	8.53	7.16	6.38	3.06	2.80	2.54	2.28
South	65.79	55.17	54.78	49.86	8.69	7.80	6.73	5.85	2.32	2.52	2.29	2.12
Midwest	51.06	57.46	55.45	57.83	9.79	8.95	7.66	7.14	2.78	2.93	2.59	2.44
Total	58.92	52.77	55.19	58.69	10.89	9.62	8.32	7.36	2.92	2.81	2.51	2.29

	Maternal mortality rate		Early neonatal mortality rate		Late neonatal mortality rate
	RR	p-v	RR	p-v	RR	p-v
Period
1997-2000^a a Reference category.	1.00		1.00		1.00
2001-2004	0.80	0.0001	0.83	0.0001	1.01	0.56
2005-2008	0.79	0.0001	0.70	0.0001	0.91	0.002
2009-2012	0.82	0.0002	0.62	0.0001	0.84	0.0001

Area
Midwest^a a Reference category.	1.00		1.00		1.00
North	1.25	0.13	1.45	0.0001	1.10	0.27
Northeast	1.31	0.0002	1.38	0.0001	0.99	0.86
South	0.88	0.001	0.96	0.07	1.00	0.94
Southeast	1.00	0.98	0.86	0.0001	0.86	0.0001

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:nadia@lampada.uerj.br (N.C.P. Rodrigues).