The impact of the COVID-19 pandemic on trends in stillbirths, under-5 and maternal mortality in Brazil: Excess deaths and regional inequalities
Nenhuma Miniatura disponível
Citações na Scopus
0
Tipo de produção
article
Data de publicação
2023
Título da Revista
ISSN da Revista
Título do Volume
Editora
INT SOC GLOBAL HEALTH
Autores
AMOUZOU, Agbessi
MAIGA, Abdoulaye
AKSEER, Nadia
HUICHO, Luis
Citação
JOURNAL OF GLOBAL HEALTH, v.13, article ID 6040, 12p, 2023
Resumo
Background Despite the proliferation of studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic, there is less evidence on the indirect death toll compared to the health system and service provision disruptions. We assessed the impact of the COVID-19 pandemic on national and regional trends and differences in stillbirths, under-5 and maternal deaths in Brazil. Methods We used the nationwide routine health information system data from January 2017 to December 2021, to which we applied descriptive and advanced mixed effects ordinary least squared regression models to measure the percent change in mortality levels during the COVID-19 pandemic (March 2020 to December 2021). We carried out counterfactual analyses comparing the observed and expected mortality levels for each type of mortality at national and regional levels. Results Stillbirths increased 4.8% (3.1% in 2020 and 6.2% in 2021) and most noticeably maternal deaths increased 71.6% (35.3% in 2020 and 103.3% in 2021) over the COVID-19 period. An opposite pattern was observed in under-5 mortality, which dropped -10.2% (-12.5% in 2020 and -8.1% in 2021). We identified regional disparities, with a higher percent increase in stillbirths observed in the Central-West region and in maternal deaths in the South region. Discussion Based on pre-pandemic trends and expected number of deaths in the absence of the COVID-19, we observed increases in stillbirths and maternal deaths and reductions in under-5 deaths during the pandemic. The months with the highest number of deaths (stillbirths and maternal deaths) coincided with the months with the highest mortality from COVID-19. The increase in deaths may also have resulted from indirect effects of the pandemic, such as unavailability of health services or even reluctance to go to the hospital when necessary due to fear of contagion. Conclusions In Brazil, the COVID-19 outbreak and subsequent restrictions had a detrimental impact on stillbirths and maternal deaths. Even before the pandemic, mortality trends highlighted pre-existing regional inequalities in the country's health care system. Although there were some variations, increases were observed in all regions, indicating potential weaknesses in the health system and inadequate management during the pandemic, particularly concerning pregnant and postpartum women.
Palavras-chave
Referências
- Ahmed T, 2022, PLOS MED, V19, DOI 10.1371/journal.pmed.1004070
- Amouzou A, 2022, BMJ GLOB HEALTH, V7, DOI 10.1136/bmjgh-2021-008069
- Appel C, Data on COVID-19 (coronavirus) by Our World in Data
- Aquino EML, 2020, CIENC SAUDE COLETIVA, V25, P2423, DOI 10.1590/1413-81232020256.1.10502020
- Bigoni A, 2022, LANCET REG HEALTH-AM, V10, DOI 10.1016/j.lana.2022.100222
- Blencowe H, 2016, LANCET GLOB HEALTH, V4, pE98, DOI 10.1016/S2214-109X(15)00275-2
- Brasil. Ministerio da Saude, 2019, Obitos de mulheres em idade fertil e obitos maternos
- Brasil. Ministerio da Saude, Indicadores de mortalidade que utilizam a metodologia do Busca Ativa
- Brasil. Ministerio da Saude, 2010, Portaria N 72
- Brasil. Ministerio da Saude Departamento de Informatica do SUS., SIM-Sistema de Informacoes sobre Mortalidade
- Brendolin M, 2023, IJID REG, V6, P1, DOI 10.1016/j.ijregi.2022.11.004
- Chmielewska B, 2021, LANCET GLOB HEALTH, V9, pE759, DOI 10.1016/S2214-109X(21)00079-6
- Bittencourt SDD, 2016, REPROD HEALTH, V13, DOI 10.1186/s12978-016-0229-6
- de Frias PG, 2014, CAD SAUDE PUBLICA, V30, P2068, DOI 10.1590/0102-311X00196113
- De La Torre A, 2018, INT J EQUITY HEALTH, V17, DOI 10.1186/s12939-018-0752-x
- DeSisto CL, 2021, MMWR-MORBID MORTAL W, V70, P1640, DOI 10.15585/mmwr.mm7047e1
- França Elisabeth Barboza, 2017, Rev. bras. epidemiol., V20, P46, DOI 10.1590/1980-5497201700050005
- Hale T, 2021, NAT HUM BEHAV, V5, P529, DOI 10.1038/s41562-021-01079-8
- Instituto Brasileiro de Geografia e Estatitica (IBGE), Projecoes da Populacao
- Khalil A, 2020, JAMA-J AM MED ASSOC, V324, P705, DOI 10.1001/jama.2020.12746
- Leal LF, 2022, REV SOC BRAS MED TRO, V55, DOI 10.1590/0037-8682-0279-2021
- Machado DB, 2020, POPUL HEALTH METR, V18, DOI 10.1186/s12963-020-00207-2
- Vieira MSM, 2016, MATERN CHILD HLTH J, V20, P1634, DOI 10.1007/s10995-016-1962-8
- Michailidou Despoina, 2021, EMBnet J, V26, DOI 10.14806/ej.26.1.969
- Ministerio da Saude, 2018, Saude Brasil 2017: uma analise da situacao de saude e os desafios para o alcance dos objetivos de desenvolvimento sustentavel
- Orellana J, 2022, PLOS ONE, V17, DOI 10.1371/journal.pone.0275333
- Paim J, 2011, LANCET, V377, P1778, DOI 10.1016/S0140-6736(11)60054-8
- Richtmann Rosana, 2020, Case Rep Womens Health, V27, pe00243, DOI 10.1016/j.crwh.2020.e00243
- Rocha R, 2021, LANCET GLOB HEALTH, V9, pE782, DOI 10.1016/S2214-109X(21)00081-4
- Siqueira TS, 2021, LANCET REG HEALTH-AM, V3, DOI 10.1016/j.lana.2021.100076
- Smith ER, 2023, AM J OBSTET GYNECOL, V228, P161, DOI 10.1016/j.ajog.2022.08.038
- Stopa SR, 2017, REV SAUDE PUBL, V51, DOI [10.1590/S1518-8787.2017051000074, 10.1590/s1518-8787.2017051000074]
- Szwarcwald CL, 2022, ARCH PUBLIC HEALTH, V80, DOI 10.1186/s13690-022-01012-z
- Tenorio DS, 2022, LANCET REG HEALTH-AM, V14, DOI 10.1016/j.lana.2022.100343
- Townsend R, 2021, ECLINICALMEDICINE, V37, DOI 10.1016/j.eclinm.2021.100947
- United Nations Inter-agency Group for Child Mortality Estimation (UNIGME), 2023, Levels trends in child mortality: report 2022, estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation
- Vaccaro C, 2021, BMC PREGNANCY CHILDB, V21, DOI 10.1186/s12884-021-04156-y
- Wang HD, 2022, LANCET, V399, P1513, DOI 10.1016/S0140-6736(21)02796-3
- World Health Organization, 2022, World Health Statistics 2022: Monitoring Health for the SDGs, Sustainable Development Goals
- World Health Organization (WHO), 1993, The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research, V2
- Zeiser FA, 2022, LANCET REG HEALTH-AM, V6, DOI 10.1016/j.lana.2021.100107
- Zhu YL, 2021, BMC PEDIATR, V21, DOI 10.1186/s12887-021-02654-8