Infant mortality rate in Brazil, 2000–10: correction of vital statistics based on a proactive search of deaths and livebirths

Abstract

BackgroundIn the last 20 years, Brazil underwent rapid changes in terms of medical care, with a marked expansion of primary health care and initiatives in child health. The present article addresses how infant mortality was affected by these changes. MethodsA proactive search of livebirths and deaths was carried out in the Amazon and Northeast regions to find vital events not informed to the Ministry of Health in 2008. A probabilistic sample of 133 municipalities stratified by population size and adequacy of vital information was selected. For each municipality, the adequacy analysis was based on the levels of the informed age-standardised mortality rate and of the ratio between informed and estimated number of livebirths. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalised to correct vital statistics in all Brazilian municipalities in the period 2000–10. FindingsIn the proactive search, 36% (2953 of 8312) of non-informed deaths were found within the health system (hospitals and other health establishments), 31% in civil registry offices, but 28% (2328 of 8312) were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and deficiency of vital information, the sample estimate of the coverage of informed infant deaths was only 33%. After correction of vital statistics, the infant mortality rate was estimated as 17·6 per 1000 livebirths in 2008, and decreased from 26·1 per 1000 livebirths in 2000, to 16·0 per 1000 livebirths in 2010. Among Brazilian regions, the Northeast showed the largest decrease, from 38·4 to 20·1 per 1000 livebirths (48%). InterpretationThe proactive search of vital events was shown to be a good strategy both for understanding local irregularities as well as for correcting vital statistics. After correcting death and livebirth data, the results show a large decrease of the infant mortality rate in all Brazilian regions and strongly suggest we are heading in the right direction to achieve the fourth Millennium Development Goal. FundingThis research was funded by the Brazilian Ministry of Health.