Spatial patterns of the total mortality over the first 24 hours of life and that due to preventable causes.

This is an ecological study analysing spatial patterns of the total mortality over the first 24 hours of life and that due to preventable causes using data from the mortality information system (SIM) and live birth information system (SINASC) based on the municipalities of Pernambuco State, Brazil. The total mortality rates over the first 24 hours and that due to preventable causes were calculated for each municipality for the decades of 2000 to 2009 and for 2010 to 2019 to enable a comparison of the spatial patterns with spatial scan statistic used to identify clusters. Over the first 24 hours of life, a total of 13,571 deaths were reported, out of which 10,476 (77.2%) were preventable. The total mortality rate over the first 24 hours of life decreased from 5.5 in the 2000- 2009 period to 3.7 per 1000 live births in the following decade: a reduction of 32.7%, while the mortality rate due to preventable causes decreased from 4.4 to 2.8 per 1000 live births, a reduction of 36.7%. In the first decade, spatial exploratory analysis found three mortality rate clusters encompassing 56 municipalities over the first 24 hours of life. With respect to preventable causes over the first 24 hours of life, two mortality rate clusters were identified encompassing 41 municipalities. Risk areas for mortality over the first 24 hours of life were detected through spatial scan statistic. This method, directed towards uncovering the geographical distribution of deaths of very premature infants, can act as a tool for identifying priority areas to guide healthcare interventions.

Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil.

BACKGROUND: Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015-2016), which is in Northeast Brazil, and its association with the living conditions in this city. METHODS: This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of -2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. RESULTS: During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. CONCLUSION: This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.