Abstract
OBJECTIVE: The aim of this study was to identify spatial patterns of distribution of overall, early, and late neonatal mortality rates in São Paulo state.METHODS: An ecological and exploratory study was carried in micro-regions of São Paulo sate. Mortality rates per 1,000 live births (LB) were calculated using data on overall, early, and late neonatal mortality in São Paulo between 2006 and 2010; these data were obtained from Information System and Information Technology Department of the Brazilian National Healthcare System (DATASUS). The global Moran's indices (I) were calculated for rates and thematic maps were built with these rates. Micro-regions with a high priority for intervention were identified by the box map. The software TerraView 4.2.1 was used for spatial analysis.RESULTS: The rates of early and late neonatal mortality were 6.2 per thousand LB and 2.5 per thousand LB, respectively. The global Moran's indexes (I) were I=0.13, I=0.15, and I=0.26 for overall, early, and late neonatal mortality rates, respectively; all global Moran's indices showed p-values <0.05. Thematic maps showed clusters of micro-regions with high rates located in the southwest and east of the state.CONCLUSION: The results presented in this study allow the implementation of policies by health managers, aiming to reduce neonatal mortality.
Highlights
Neonatal mortality is an important health indicator of a population and accounts for approximately two-thirds of infant deaths
A database was created, which included all cases of neonatal death, and the overall neonatal mortality rate was calculated per 1,000 live births, as well as the early neonatal mortality rate and late, by micro-region of the state of São Paulo
In the period from 2006 to 2010 a total of 3,000,158 live births were recorded in the state of São Paulo; there were 18,448 early neonatal deaths (6.2/1,000 LB) and 7,510 late neonatal deaths (2.5/1,000 LB)
Summary
Neonatal mortality (deaths between 0 and 27 days of life) is an important health indicator of a population and accounts for approximately two-thirds of infant deaths. The neonatal mortality rate consists of early and late neonatal mortality rates, with the first representing the main component that reflects the health care provided to pregnant women in the antepartum period, at delivery, and the care given to the newborn soon after birth and in neonatal units.[1,2]. Neonatal death is the main component of infant mortality in Brazil and was 9.7/1,000 LB in 2010, higher than in other countries such as the U.S (4/1,000 LB), Chile (5/1,000 LB), and Canada (4/1,000 LB), among others, as reported by the World Health Organization.[3,4] In the period between 2001 and 2010, the decrease in neonatal mortality was approximately 25%.4. Neonatal mortality rate can be determined by several factors, such as low and extremely low birth weight, prematurity, complex congenital malformations, and neonatal asphyxia, as well as by poor-quality prenatal care, in addition to sociodemographic factors and regional inequities.[1,2,5,6,7,8] the maternal causes, the most preventable, are the most frequent underlying causes and the main triggers of neonatal mortality in developing countries.[9,10] It is known that most neonatal deaths occur in regions with low income, and that children born in poor regions have a higher risk of death.[10,11]
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