Abstract
The aim of this study was to analyze the trend in mortality of children under 5 years old living in the Southeast Region of Brazil and states using the "Brazilian List of Causes of Preventable Deaths". We conducted an ecological time-series study of mortality from preventable and non-preventable causes, with corrections for ill-defined causes and underreporting of deaths, from 2000 to 2013. There was a decline in the rate of childhood mortality due to preventable (4.4% per year) and non-preventable (1.9% per year) causes in the Southeast Region and its states, except for those reducible by vaccine prevention, which remained stable in the period. The study called attention to the smaller decrease in causes of preventable deaths by providing adequate care to women during pregnancy (1.7%), with an increase in mortality rates due to basic causes of death due to maternal conditions affecting the fetus or newborn and stability in disorders related to short-term pregnancy and low birth weight, a fact that possibly occurred due to inadequate quality of prenatal care. Minas Gerais showed the greatest reduction in annual percentage of deaths from preventable causes (5.5%), compared to other FUs, but it led in mortality rates up to 2010, while Rio de Janeiro led between 2010 and 2013. The decline in childhood mortality was expected in the last decade, due to progress in the response of health care systems, and to improvements in health and determinant social conditions as well. However, the rate is still high compared to other countries, showing that there is still much room for improvement.
Highlights
Various studies have prompted debates on the concept of avoidable death, as well as the definition of better methods for the classification of causes of avoidable deaths[1,2,3,4,5,6,7]
In the year 2013, 51,344 deaths were reported in Brazil, for all causes, in children under 5 years old, of which 16,612 (32.96%) occurred in the Southeast Region
Our study showed a decline in mortality rate for the population aged 0 to 4 years due to preventable causes that was twice as much as for non-preventable causes in the period 2000-2013 in the Southeast Region and in all states, and a decrease in all groups of preventable causes of death, except for those reducible by immunoprevention, which remained stable in the period and whose occurrence was low
Summary
Various studies have prompted debates on the concept of avoidable death, as well as the definition of better methods for the classification of causes of avoidable deaths[1,2,3,4,5,6,7]. Rutstein et al.[1] are considered pioneers in research on this theme, proposing that preventable deaths are those that could have been prevented (in whole or in part) by the presence of effective health services[1] Based on these initial studies, several lists of preventability were proposed in developed countries[1,2,3,4,5], but modifications and adaptations were necessary in view of different regional, economic, social, epidemiological and technological advances in the health area. International and national scientific publications on the preventability of causes of death, including review articles[5,8,9], evaluation of health service performance[10,11] and studies of mortality trends in specific groups are growing[11,12,13,14]
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