Time series analysis: trend in late maternal mortality in Brazil, 2010-2019

Area of Science:

• Public Health
• Epidemiology
• Maternal Health

Background:

• Late maternal mortality ratio (LMMR) is a critical but often overlooked indicator of maternal health.
• Understanding temporal trends and regional variations in LMMR is essential for targeted interventions in Brazil.
• Previous data may not fully capture the extent of late maternal deaths due to reporting challenges.

Purpose of the Study:

• To analyze the temporal trends of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions from 2010 to 2019.
• To identify regional disparities in LMMR within Brazil.
• To investigate factors contributing to the observed trends in LMMR.

Main Methods:

• An ecological time series study design was employed.
• Data on late maternal mortality were obtained from Brazilian Ministry of Health information systems.
• Statistical analysis utilized Prais-Winsten autoregressive models.

Main Results:

• A total of 1,470 late maternal deaths were reported, yielding an overall LMMR of 5 deaths per 100,000 live births.
• Significant regional disparities were observed, with the South region having the highest LMMR (8.3/100,000) and the North the lowest (3.5/100,000).
• The LMMR showed a significant increasing trend nationally (9.79% annual variation), particularly in the Central-West (26.06%), North (23.5%), and Northeast regions.

Conclusions:

• The observed increase in LMMR is attributed to improved death registration quality and enhanced investigation by Maternal Mortality Committees.
• Persistent regional disparities in reporting and investigation highlight the need for a more equitable approach to maternal healthcare.
• Strengthening reporting systems and implementing comprehensive strategies are crucial for preventing avoidable late maternal mortality and promoting health equity.