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

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...

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Autores principales: Andrews, Kathryn, Bourroul, Maria Lúcia Moraes, Fink, Günther, Grisi, Sandra, Scoleze Ferrer, Ana Paula, Diniz, Edna Maria de Albuquerque, Brentani, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741246/
https://www.ncbi.nlm.nih.gov/pubmed/29272295
http://dx.doi.org/10.1371/journal.pone.0190060
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author Andrews, Kathryn
Bourroul, Maria Lúcia Moraes
Fink, Günther
Grisi, Sandra
Scoleze Ferrer, Ana Paula
Diniz, Edna Maria de Albuquerque
Brentani, Alexandra
author_facet Andrews, Kathryn
Bourroul, Maria Lúcia Moraes
Fink, Günther
Grisi, Sandra
Scoleze Ferrer, Ana Paula
Diniz, Edna Maria de Albuquerque
Brentani, Alexandra
author_sort Andrews, Kathryn
collection PubMed
description 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.
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spelling pubmed-57412462018-01-09 Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil Andrews, Kathryn Bourroul, Maria Lúcia Moraes Fink, Günther Grisi, Sandra Scoleze Ferrer, Ana Paula Diniz, Edna Maria de Albuquerque Brentani, Alexandra PLoS One Research Article 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. Public Library of Science 2017-12-22 /pmc/articles/PMC5741246/ /pubmed/29272295 http://dx.doi.org/10.1371/journal.pone.0190060 Text en © 2017 Andrews et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Andrews, Kathryn
Bourroul, Maria Lúcia Moraes
Fink, Günther
Grisi, Sandra
Scoleze Ferrer, Ana Paula
Diniz, Edna Maria de Albuquerque
Brentani, Alexandra
Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title_full Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title_fullStr Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title_full_unstemmed Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title_short Time to change focus? Transitioning from higher neonatal to higher stillbirth mortality in São Paulo State, Brazil
title_sort time to change focus? transitioning from higher neonatal to higher stillbirth mortality in são paulo state, brazil
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741246/
https://www.ncbi.nlm.nih.gov/pubmed/29272295
http://dx.doi.org/10.1371/journal.pone.0190060
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