Abstract
BackgroundDifferential 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.MethodsWe 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.ResultsAt 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.ConclusionsThis 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.
Highlights
While impressive improvements have been seen during the Millennium Development Goal (MDG) era in maternal and child health, improvements in stillbirths have been more limited; there were still an estimated 2.6 million stillbirths worldwide in 2015 [1], which is almost the same as the estimated number of neonatal death in the same year [2]
7.9 per 1000 pregnancies ended in stillbirth, but this varied from 0.0 to 28.4 per 1000 across municipalities. 7.9 per 1000 live births 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 (
While some studies have reviewed the literature on stillbirths in Brazil [10, 11] or presented results at the region- or state-level [12, 13], as of yet, no analyses of stillbirths in Brazil have been conducted at more granular geographic levels
Summary
While impressive improvements have been seen during the Millennium Development Goal (MDG) era in maternal and child health, improvements in stillbirths have been more limited; there were still an estimated 2.6 million stillbirths worldwide in 2015 [1], which is almost the same as the estimated number of neonatal death in the same year [2]. Despite calls to improve data collection and reporting [3, 5], reliable and consistent data on stillbirths are scarce [6,7,8]. This is partially driven by challenges in defining and identifying stillbirths consistently worldwide, and may contribute to the remarkable variation in stillbirth rates around the world [6]. 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
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