Abstract
Abstract Objectives: to analyze the spatial distribution of fetal deaths before and after implementation of surveillance for this event in the city of Recife, in the Northeast Region of Brazil. Methods: an ecological study whose spatial analysis unit was the 94 neighborhoods. The gross fetal mortality rates were calculated and the local empirical Bayesian estimator was adopted to smooth out random fluctuations of such rates. To analyze the spatial autocorrelation, the Global Moran’s Index was used, and spatial clusters were located by the Local Moran’s Index. Results: during the period before implementation of death surveillance, 1,356 fetal deaths were reported, a coefficient of 9.9 deaths per thousand births. During the second period, 1,325 fetal deaths occurred, a coefficient of 9.6 deaths per thousand births. The Global Moran’s Indexes (I) were I=0.6 and I=0.4 for the first and second periods, respectively, with statistical significance (p<0.05). For both periods analyzed, spatial clusters of high-risk neighborhoods were identified in the northern and eastern regions of the city. Conclusion: the spatial analysis indicated areas that persist as priorities for planning surveillance and health assistance actions to reduce fetal mortality.
Highlights
Fetal mortality is an indicator that reflects the quality of women’s healthcare during pregnancy and labor
Between 2004 and 2009, the period before the implementation of death surveillance, 1,356 fetal deaths were reported, which characterizes a Fetal mortality rates (FMRs) of 9.9 deaths per thousand births in Recife (Table 1)
A reduction in the fetal mortality ratio from 9.9 to 9.6 deaths per thousand births was observed, following the national trend,[15] different from the infant mortality rate, which showed a significant decrease, strongly influenced by improvements in healthcare policies, intersectoral actions, and implementation of strategies such as death surveillance.[16]. This may be a reflex of the low visibility of fetal deaths, which were not contemplated in international agreements, in addition to not being the focus of public policies.[1,6]
Summary
Fetal mortality is an indicator that reflects the quality of women’s healthcare during pregnancy and labor. The Millennium Development Goals (MDGs) contributed to boosting the reduction in maternal mortality and of children under the age of five, during the period from 2003 to 2015, in the world. Fetal mortality rates (FMRs), in their turn, have decreased more slowly, since 2000, compared to the maternal mortality and that of children under the age of five. As of 2015, it was estimated that 2.6 million fetal deaths occur annually in the world, almost all (98%) in low- and medium-income countries.[1]. Fetal deaths have not been incorporated into global mortality estimates and, even with the recent efforts to include them, fetal mortality rate is still underestimated.[2] Social stigma and misclassification, such as miscarriage or early neonatal deaths, are factors that contribute to this fact.[2]
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