Abstract
Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.
Highlights
The targets of the Sustainable Development Goals (SDGs) include the reduction of mortality in underfive children to less than 25 per 1,000 live births, reduction of neonatal mortality to less than 12 deaths per 1,000 live births, and elimination of avoidable deaths in newborns and under-five children, from 2016 to 2030 1,2
Brazil reached the target of the Millennium Development Goals (MDGs) to reduce mortality in under-five children by two-thirds by 2015 3
The same pattern was true in the city of Rio de Janeiro, Brazil
Summary
The targets of the Sustainable Development Goals (SDGs) include the reduction of mortality in underfive children to less than 25 per 1,000 live births, reduction of neonatal mortality to less than 12 deaths per 1,000 live births, and elimination of avoidable deaths in newborns and under-five children, from 2016 to 2030 1,2. The same pattern was true in the city of Rio de Janeiro, Brazil The under-five and neonatal mortality rates in the city of Rio de Janeiro were already below the targeted levels by 2016 (14.9 and 8.3 per thousand live births, respectively), the causes of death are still mostly avoidable (http://tabnet.rio.rj.gov.br/, accessed on 30/Jun/2018). The fact that other Latin American countries like Cuba and Costa Rica had under-five mortality rates in 2016 of 5.3 and 10.6 per thousand live births, respectively, reinforces the potential for further reduction of under-five mortality in Brazil [1,2]
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