Related Experiment Videos
[Neonatal mortality trends in São Luís, Maranhão, Brazil, from 1979 to 1996]
1Departamento de Medicina III, Universidade Federal do Maranhão, São Luís, MA, 65020-070, Brasil. valdinar@elo.com.br.
Insights
Neonatal mortality in São Luís unexpectedly increased due to early deaths, signaling potential issues in obstetric and neonatal care quality. This trend highlights the need for urgent healthcare system restructuring.
Area of Science:
- Public Health
- Neonatal Epidemiology
- Healthcare Quality Assessment
Context:
- Examined neonatal mortality trends in São Luís over 18 years.
- Assessed early and late neonatal mortality components.
- Classified causes based on reducibility and prevention timing.
Purpose:
- To analyze changes in neonatal mortality rates and identify contributing factors.
- To evaluate the quality of obstetric and neonatal services.
- To inform healthcare policy and system restructuring.
Summary:
- An unexpected rise in neonatal mortality, primarily early neonatal deaths, was observed.
- Increases were linked to infections, respiratory causes, preterm births, and low birth weight.
- Post-neonatal mortality decreased, while infant mortality remained stable.
Impact:
- The rising trend suggests a decline in obstetric and neonatal care quality since 1995.
- High cesarean rates and strained neonatal services necessitate urgent healthcare system reform.
- Findings underscore the need to restructure the mother and child health care system.
Abstract:
This study examined neonatal mortality trends in São Luís in the last 18 years. The early and late components were assessed and causes were classified according to SEADE Foundation criteria based on reducibility of deaths and timing of prevention (during prenatal care, childbirth, or neonatal care). Data were derived from official live birth and death records. We detected an unexpected increase in the neonatal mortality rate, due primarily to a steep rise in early neonatal deaths. Causes reducible by early diagnosis and treatment (other specific infections and other neonatal respiratory causes) and those partially reducible by adequate monitoring of pregnancy (preterm births, low birth weight, and respiratory distress syndrome) showed the largest increase. Conversely, the post-neonatal mortality rate fell. The infant mortality rate remained the same, reflecting these antagonistic trends. The important rise in the neonatal mortality rate from 1995 onwards suggests a deterioration in the quality of obstetric and neonatal services. The high cesarean rate and overcrowded neonatal services (i.e., unable to cope with increasing demands foe specialized neonatal care) indicate the urgent need for restructuring the mother and child health care system.