Trend in mortality from preventable causes in children: contributions to the evaluation of the performance of public health services in the Southeast Region of Brazil

ABSTRACT: Objective: 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”. Method: 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. Results: 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. Conclusion: 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.

摘要：研究目的为借助《巴西可预防死亡原因清单》，分析巴西东南部地区及其所辖各州5岁以下儿童的死亡率变化趋势。
方法：本研究为生态学时间序列研究，针对2000年至2013年间的可预防与不可预防死亡原因展开分析，并对死因不明病例及死亡漏报情况进行校正。
结果：巴西东南部地区及其各州由可预防原因（年均下降4.4%）与不可预防原因（年均下降1.9%）导致的儿童死亡率均呈下降趋势，但疫苗可预防的死亡原因除外，该类死因在研究期间保持稳定。本研究同时关注到，通过为孕妇提供充足照护可预防的死亡原因降幅仅为1.7%，降幅较小；与此同时，因影响胎儿或新生儿的母体相关基础死因导致的死亡率有所上升，与短期妊娠及低出生体重相关的疾病死亡率则保持稳定，这一现象可能源于产前照护质量欠佳。与其他联邦单位（FUs）相比，米纳斯吉拉斯州的可预防死亡原因年度降幅最大（5.5%），但在2010年前其儿童死亡率仍居各地区之首；而里约热内卢州则在2010年至2013年间位居首位。
结论：近十年间儿童死亡率下降符合预期，这得益于医疗保健系统应对能力的提升，以及健康状况与关键社会条件的改善。但与其他国家相比，当前儿童死亡率仍处于较高水平，说明仍存在较大的改进空间。