Mortality in children under five years old in Brazil: evolution from 2017 to 2020 and the influence of COVID-19 in 2020

Abstract Objective: To analyse the mortality trends in children under five years old in Brazil from 2017 to 2020 and the influence of COVID-19 in 2020. Methods: A retrospective study employing secondary data from the Brazilian Mortality Information System. Deaths according to cause were extracted and disaggregated into early, late, post-neonatal, and 1 to 4-year-old periods. Corrected mortality rates per 1, 000 live births and relative risk ratio for the cause of death were calculated. Results: There were 34, 070 deaths, being 417 (1.2%) from COVID-19 in 2020. COVID-19 mortality was 0.17 per 1000 live births, reaching 0.006 in the early neonatal period, 0.007 in the late neonatal, 0.09 in the postneonatal, and 0.06 in 1 to 4-year-old. Mortality decreased mostly for some diseases that originated in the perinatal period, congenital anomalies, diseases of the respiratory system and external causes, in this order. In 2020, the highest rate was in the early neonatal period, with a fall from 7.2 to 6.5, followed by the postneonatal (3.9 to 3.4) and late neonatal (2.3 to 2.1). Among children aged 1 to 4-year-old, external causes had the highest proportional rate, and diseases of the respiratory system showed the highest decline. Conclusion: The mortality rate declined from 2017 to 2020, and this variation was higher in the early neonatal period. The risk of death from COVID-19 was 14 times higher in the postneonatal period and 10 times higher in children aged 1 to 4 year-old compared to the early neonatal period.

Mortality in children under five years old in Brazil: evolution from 2017 to 2020 and the influence of COVID-19 in 2020.

OBJECTIVE: To analyse the mortality trends in children under five years old in Brazil from 2017 to 2020 and the influence of COVID-19 in 2020. METHODS: A retrospective study employing secondary data from the Brazilian Mortality Information System. Deaths according to cause were extracted and disaggregated into early, late, postneonatal, and 1 to 4-year-old periods. Corrected mortality rates per 1,000 live births and relative risk ratio for the cause of death were calculated. RESULTS: There were 34,070 deaths, being 417 (1.2%) from COVID-19 in 2020. COVID-19 mortality was 0.17 per 1000 live births, reaching 0.006 in the early neonatal period, 0.007 in the late neonatal, 0.09 in the postneonatal, and 0.06 in 1 to 4-year-old. Mortality decreased mostly for some diseases that originated in the perinatal period, congenital anomalies, diseases of the respiratory system and external causes, in this order. In 2020, the highest rate was in the early neonatal period, with a fall from 7.2 to 6.5, followed by the postneonatal (3.9 to 3.4) and late neonatal (2.3 to 2.1). Among children aged 1 to 4-year-old, external causes had the highest proportional rate, and diseases of the respiratory system showed the highest decline. CONCLUSION: The mortality rate declined from 2017 to 2020, and this variation was higher in the early neonatal period. The risk of death from COVID-19 was 14 times higher in the postneonatal period and 10 times higher in children aged 1 to 4 year-old compared to the early neonatal period.

Ethnic differences in maternal near miss.

PURPOSE: To evaluate the association between ethnic differences and the occurrence of maternal near miss (MNM) in the Amazon and Northeast regions of Brazil. METHODS: This is a secondary analysis of a national cross-sectional study focused on the assessment of care to pregnancy, childbirth, and infants under 1 year of age. Ethnicity was classified as white, black or indigenous. Ethnic distribution by state and region, the proportion of severe maternal complications and related procedures, and the prevalence of MNM and its criteria were calculated for the ethnic groups. Risks for MNM were estimated per sociodemographic characteristics and healthcare received by ethnic group, using prevalence ratios adjusted by all predictors and by the sampling method. RESULTS: 76% of the 16.783 women were black, 20% white and 3.5% indigenous. Around 36% reported any complication related to pregnancy and the most frequent were hemorrhage (27-31%), and infection (7.1-9.0%). The MNM ratio was higher among indigenous (53.1) and black (28.4) than in white women (25.7). For black women, the risks of MNM were lower for private prenatal care and hospital admission for conditions other than hypertension, while higher for cesarean section and peregrination. For indigenous, the risks of MNM were lower for private prenatal care, and higher for a longer time to reach the hospital. For white women, only the low number of prenatal visits increased the risk of MNM. CONCLUSIONS: The occurrence of MNM was higher for indigenous and black than for white women.

The effect of maternal near miss on adverse infant nutritional outcomes.

OBJECTIVES:: To evaluate the association between self-reported maternal near miss and adverse nutritional status in children under one year of age. METHODS:: This study is a secondary analysis of a study in which women who took their children under one year of age to the national vaccine campaign were interviewed. The self-reported condition of maternal near miss used the criteria of Intensive Care Unit admission; eclampsia; blood transfusion and hysterectomy; and their potential associations with any type of nutritional disorder in children, including deficits in weight-for-age, deficits in height-for-age, obesity and breastfeeding. The rates of near miss for the country, regions and states were initially estimated. The relative risks of infant adverse nutritional status according to near miss and maternal/childbirth characteristics were estimated with their 95% CIs using bivariate and multiple analyses. RESULTS:: The overall prevalence of near miss was 2.9% and was slightly higher for the Legal Amazon than for other regions. No significant associations were found with nutritional disorders in children. Only a 12% decrease in overall maternal breastfeeding was associated with near miss. Living in the countryside and child over 6 months of age increased the risk of altered nutritional status by approximately 15%, while female child gender decreased this risk by 30%. Maternal near miss was not associated with an increased risk of any alteration in infant nutritional status. CONCLUSIONS:: There was no association between maternal near miss and altered nutritional status in children up to one year of age. The risk of infant adverse nutritional status was greater in women living in the countryside, for children over 6 months of age and for male gender.

The effect of maternal near miss on adverse infant nutritional outcomes

OBJECTIVES: To evaluate the association between self-reported maternal near miss and adverse nutritional status in children under one year of age. METHODS: This study is a secondary analysis of a study in which women who took their children under one year of age to the national vaccine campaign were interviewed. The self-reported condition of maternal near miss used the criteria of Intensive Care Unit admission; eclampsia; blood transfusion and hysterectomy; and their potential associations with any type of nutritional disorder in children, including deficits in weight-for-age, deficits in height-for-age, obesity and breastfeeding. The rates of near miss for the country, regions and states were initially estimated. The relative risks of infant adverse nutritional status according to near miss and maternal/childbirth characteristics were estimated with their 95% CIs using bivariate and multiple analyses. RESULTS: The overall prevalence of near miss was 2.9% and was slightly higher for the Legal Amazon than for other regions. No significant associations were found with nutritional disorders in children. Only a 12% decrease in overall maternal breastfeeding was associated with near miss. Living in the countryside and child over 6 months of age increased the risk of altered nutritional status by approximately 15%, while female child gender decreased this risk by 30%. Maternal near miss was not associated with an increased risk of any alteration in infant nutritional status. CONCLUSIONS: There was no association between maternal near miss and altered nutritional status in children up to one year of age. The risk of infant adverse nutritional status was greater in women living in the countryside, for children over 6 months of age and for male gender.

Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil.

OBJECTIVE: To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil. METHODS: A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI). RESULTS: A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61). CONCLUSIONS: Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country.

Maternal near miss among women using the public health system in the Amazon and Northeast regions of Brazil / Morbilidad materna extremadamente grave entre las usuarias del sistema de salud pública en las regiones amazónica y noreste del Brasil

OBJECTIVE: To assess the prevalence of pregnancy complications identified as maternal near miss (MNM) and associated factors among women using the public health care system in the Amazon and Northeast regions of Brazil. METHODS: A secondary analysis of a population-based survey conducted in 2010 was performed focusing on women self-reporting maternal complications. The main outcome was MNM, pragmatically defined as intensive care unit admission, eclampsia, hysterectomy, or blood transfusion. In addition, the risk of MNM was estimated for certain sociodemographics and characteristics of care received. Poisson regression was performed, generating adjusted prevalence ratios (PRadj) with 95% confidence intervals (95%CI). RESULTS: A total of 13 044 women (77%) who had given birth during the prior year using the public health system were interviewed. At least one complication was reported by 37.5%, with hemorrhage (28.4%) and infection (8.3%) being the most frequent. The overall MNM ratio was 31.5 per 1 000 live births, higher for the Amazon region than for the Northeast. Factors with a higher risk for developing MNM were: indigenous ethnicity (PRadj 2.77; 95% CI: 1.50-5.14), more than one hour to reach the hospital (PRadj 1.55; 95%CI: 1.06-2.25), being refused by a full hospital and having to find another one (PRadj 1.49; 95%CI: 1.03-2.16), cesarean section (PRadj 2.56; 95%CI: 1.90-3.44), and public prenatal care (PRadj 1.95; 95%CI: 1.06-3.61). CONCLUSIONS: Users of public health system in the Amazon and Northeast regions of Brazil have high MNM rates. Some characteristics of the women and of the care they received represent inequalities associated with higher risk for MNM. Specific actions are required to improve maternal health programs in these expansive areas of the country.

OBJETIVO: Evaluar la prevalencia de las complicaciones del embarazo establecidas como morbilidad materna extremadamente grave (MMEG), y los factores asociados, entre las usuarias del sistema de atención de salud pública en las zonas amazónica y noreste del Brasil. MÉTODOS:Se realizó un análisis secundario de una encuesta poblacional llevada a cabo en el 2010 y centrado en las mujeres que autonotificaban complicaciones obstétricas. El principal resultado fue la MMEG, definida a efectos prácticos como ingreso en una unidad de cuidados intensivos, eclampsia, histerectomía o transfusión de sangre. Se calculó además el riesgo de MMEG para determinadas características sociodemográficas y de la atención recibida. Se llevó a cabo una regresión de Poisson y se generaron las razones de prevalencia ajustadas (RPa) con intervalos de confianza de 95% (IC 95%). RESULTADOS:Se entrevistó a un total de 13 044 mujeres (77%) que habían dado a luz durante el año previo en el sistema de salud pública. Un 37,5% notificó como mínimo una complicación; la hemorragia (28,4%) y la infección (8,3%) fueron las más frecuentes. El índice general de MMEG fue de 31,5 por 1 000 nacidos vivos, más elevado en la región amazónica que en la noreste. Los factores que comportaron un riesgo mayor de MMEG fueron la etnicidad autóctona (RPa 2,77; IC 95% = 1,50-5,14), precisar más de una hora para llegar al hospital (RPa 1,55; IC 95% = 1,06-2,25), no ser admitida en un hospital por estar completo y tener que encontrar otro (RPa 1,49; IC 95% = 1,03-2,16), la cesárea (RPa 2,56; IC 95% = 1,90-3,44), y la asistencia prenatal pública (RPa 1,95; IC 95% = 1,06-3,61). CONCLUSIONES: Las usuarias del sistema de salud pública en las regiones amazónica y noreste del Brasil muestran tasas elevadas de morbilidad materna extremadamente grave. Algunas características de las mujeres y de la atención recibida comportan desigualdades asociadas con un riesgo mayor de morbilidad materna extremadamente grave. Se requieren acciones específicas que mejoren los programas de salud materna en estas amplias zonas del país.

Research on chronic noncommunicable diseases in Brazil: meeting the challenges of epidemiologic transition.

In Brazil, chronic noncommunicable diseases (CNCDs) are the leading cause of death and a major contributor to the national disease burden. This article describes CNCD research funded by the Ministry of Health Department of Science and Technology (DECIT) to support the production and dissemination of scientific evidence for the national health system, in accordance with the National Agenda of Priorities in Health Research, and within the context of Brazil's epidemiologic transition. Data were obtained from Ministry of Health database management systems. CNCD-related projects financed by DECIT from 2002 to 2009 were analyzed by research theme (cancer, obesity, hypertension, diabetes, cardiovascular diseases, CNCDs in general, and CNCD risk factors) and geographic region. In terms of funding and number of projects, the most-supported research theme was cancer, and the most-supported region was the Southeast. Project type varied widely, ranging from basic scientific studies to highly technological research and development. Results obtained included epidemiologic profiles and surveillance, cost, and quality-of-life data.

Research on chronic noncommunicable diseases in Brazil: meeting the challenges of epidemiologic transition / Investigación sobre las enfermedades crónicas no transmisibles en el Brasil: responder a los retos de la transición epidemiológica

In Brazil, chronic noncommunicable diseases (CNCDs) are the leading cause of death and a major contributor to the national disease burden. This article describes CNCD research funded by the Ministry of Health Department of Science and Technology (DECIT) to support the production and dissemination of scientific evidence for the national health system, in accordance with the National Agenda of Priorities in Health Research, and within the context of Brazil's epidemiologic transition. Data were obtained from Ministry of Health database management systems. CNCD-related projects financed by DECIT from 2002 to 2009 were analyzed by research theme (cancer, obesity, hypertension, diabetes, cardiovascular diseases, CNCDs in general, and CNCD risk factors) and geographic region. In terms of funding and number of projects, the most-supported research theme was cancer, and the most-supported region was the Southeast. Project type varied widely, ranging from basic scientific studies to highly technological research and development. Results obtained included epidemiologic profiles and surveillance, cost, and quality-of-life data.

En el Brasil, las enfermedades crónicas no transmisibles (ECNT) son la principal causa de mortalidad y un factor contribuyente muy importante a la carga de morbilidad nacional. En este artículo se describe la investigación en ECNT financiada por el Departamento de Ciencia y Tecnología del Ministerio de Salud (DECIT) para apoyar la producción y la difusión de información científica destinada al sistema nacional de salud, en conformidad con el Programa Nacional de Prioridades en Investigación de Salud y dentro del contexto de la transición epidemiológica del Brasil. Los datos se obtuvieron a partir de los sistemas de manejo de bases de datos del Ministerio de Salud. Los proyectos relacionados con las ECNT financiados por el DECIT entre el 2002 y el 2009 fueron analizados por tema de investigación (cáncer, obesidad, hipertensión, diabetes, enfermedades cardiovasculares, ECNT en general y factores de riesgo de ECNT) y por región geográfica. En cuanto al financiamiento y el número de proyectos, el tema de investigación más apoyado fue el cáncer, y la región más apoyada fue el sudeste del país. El tipo de proyecto varió ampliamente, e incluyó desde estudios científicos básicos hasta estudios de investigación y desarrollo muy técnicos. Los resultados obtenidos incluyeron perfiles epidemiológicos y datos de vigilancia, costos y calidad de vida.

Socioeconomic status and obesity in adult populations of developing countries: a review.

A landmark review of studies published prior to 1989 on socioeconomic status (SES) and obesity supported the view that obesity in the developing world would be essentially a disease of the socioeconomic elite. The present review, on studies conducted in adult populations from developing countries, published between 1989 and 2003, shows a different scenario for the relationship between SES and obesity. Although more studies are necessary to clarify the exact nature of this relationship, particularly among men, three main conclusions emerge from the studies reviewed: 1. Obesity in the developing world can no longer be considered solely a disease of groups with higher SES. 2. The burden of obesity in each developing country tends to shift towards the groups with lower SES as the country's gross national product (GNP) increases. 3. The shift of obesity towards women with low SES apparently occurs at an earlier stage of economic development than it does for men. The crossover to higher rates of obesity among women of low SES is found at a GNP per capita of about US$ 2500, the mid-point value for lower-middle-income economies. The results of this review reinforce the urgent need to: include obesity prevention as a relevant topic on the public health agenda in developing countries; improve the access of all social classes in these countries to reliable information on the determinants and consequences of obesity; and design and implement consistent public actions on the physical, economic, and sociocultural environment that make healthier choices concerning diet and physical activity feasible for all. A significant step in this direction was taken with the approval of the Global Strategy on Diet, Physical Activity and Health by the World Health Assembly in May 2004.

Concentraçäo de hemoglobina e hematocrito em escolares da primeira serie de uma escola publica de Campinas, Sao Paulo, Brasil / Concentration of hemoglobin and hematocrit in schoolchildren, Campinas, Sao Paulo, Brazil

Objetivo: Este estudo teve como objetivo descrever a distribuiçäo da concentraçäo de hemoglobina e hematócrito em escolares, correlacionando os níveis de hemoglobina com idade, sexo, renda per capita, anos de estudo materno e paterno e presença de parasitose intestinal. Métodos: Foram estudadeas 146 crianças, 48,5 por cento do sexo feminino e 51,5 por cento do masculino, com idade de 7,3+-0,6 anos, com renda per capita de 1,1+-1,8 salários mínimos, cujas mäes cursaram 5,2+-3,0 anos de escola e os pais 5,6+-3,4. Essas crianças apresentavam parasitose intestinal em 30,8 por cento dos casos. A hemoglobina foi dosada pelo método da cianometaemoglobina e o hematócrito por técnica do microematócrito. Considerou-se, para anemia, o limite crítico de 11/gdl para a concentraçäo de hemoglobina, propostoo pela Organizaçäo Mundial da Saúde (OMS)...