Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies

Rebouças, Poliana; Góes, Emanuelle Freitas; Pescarini, Júlia Moreira; Ramos, Dandara de Oliveira; Ichihara, Maria Yury; Sena, Samila; Veiga, Rafael Valente; Rodrigues, Laura C.; Barreto, Maurício Lima; Paixão, Enny S.

doi:10.1016/s2214-109x(22)00333-3

Cited by 15 publications

(8 citation statements)

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“…A nationwide population-based, retrospective cohort study found substantial ethnoracial inequalities in child mortality in Brazil, especially among the Indigenous and Black populations [37]. Thus, our finding reflects more the higher number of births to women that declared white skin color, as well as the lack of adjustment for confounders, than the risk of dying according to maternal skin color.…”

Section: Discussionmentioning

confidence: 61%

“…The white population is the majority in Rio Grande do Sul State [ 11 ], and white women have better education level and less pregnant adolescents than black mothers, two factors related to lower rates of infant mortality [ 36 ]. A nationwide population-based, retrospective cohort study found substantial ethnoracial inequalities in child mortality in Brazil, especially among the Indigenous and Black populations [ 37 ]. Thus, our finding reflects more the higher number of births to women that declared white skin color, as well as the lack of adjustment for confounders, than the risk of dying according to maternal skin color.…”

Section: Discussionmentioning

confidence: 99%

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Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

Kreutz

Santos

2023

BMC Public Health

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Background Ending preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country. Method An ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated. Results In 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment. Conclusions The strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

Kreutz

Santos

2023

BMC Public Health

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“…For example, P&I MR over the 2002-2011 period in São Paulo state was in the range of 0-8 per million among <5 years old and not exceeding one per million among 5-19-years old 45 , overlapping with influenza A only MR of 0-2 over the 2009-2011 period in the present study (Figure 2). However, a five-year follow-up of Brazilian birth cohorts over the 2012-2018 period found the P&I MR of 132 (126-137) per million for the subsequent five-year period 46 .…”

Section: Discussionmentioning

confidence: 99%

Mortality Time Trend for Major Viral Pathogens Causing Acute Respiratory Failure in Brazilian Children and Adolescents Before and During the SARS-Cov-2 Pandemic

Kupek

Mariano

2023

MRAJ

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Background – Little is known about the time trend in mortality rates due to respiratory viruses other than SARS-CoV-2 and seasonal influenza among Brazilian children and adolescents. Methods – Study outcomes were mortality rates due to influenza A, influenza B, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, for age groups <5, 5-9, and 10-19 years of age, in Brazil, over the 2009-2022 period. Secondary data from the Brazilian Ministry of Health were analyzed by interval regression, bounded between reported deaths and estimated upper limit of this number, which took into account the underestimation of deaths, the error in attributing its causes in official records, and the variation due to Poisson distribution. Results - For all viruses, mortality varied little among the children under five years of age, and increased gradually among the 5-10 and 11-19-years old. The highest average mortality rates per million inhabitants over the 2009-2022 period were estimated for respiratory syncytial virus (1.04), with the lowest values for parainfluenza (0.54) and influenza B (0.55), and intermediate values in the range of 0.90 to 0.95 for influenza A, bocavirus, metapneumovirus, rhinovirus, adenovirus, and other respiratory viruses except SARS-Cov-2. Age groups of 5-9 and 10-19 years of age had similar mortality rates and were by far the largest contributors to the overall mortality rates for all viruses analyzed. Conclusion - Schoolchildren mortality due to respiratory viruses in Brazil has been rising for at least five years before the COVID-19 pandemic, and remained elevated during the pandemic. In addition to SARS-CoV-2 and seasonal influenza, respiratory syncytial virus, metapneumovirus, rhinovirus, parainfluenza, adenovirus, and bocavirus, all showed a non-ignorable impact on mortality in this age group.

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“…Infant mortality rates for Indigenous infants are more than twice of those observed for non-Indigenous populations in Brazil, Colombia, Peru, and Venezuela (4). Disparities were also noted for stunting among the <5-year-olds and low birth weight in some countries; poverty, poor education levels, employment status, and access to health services contributed to the health disparities (5). Suicide rates in Indigenous populations vary globally, and the disparities between Indigenous and non-Indigenous populations are substantial (6).…”

Section: Introductionmentioning

confidence: 96%

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study

Grande,

Dias,

Jardim

et al. 2023

Front. Psychiatry

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BackgroundThe alarming increase in annual deforestation rates has had devastating consequences in climate change, and it is affecting Indigenous people, who depend entirely on the land for survival and has also weakened the rainforest's crucial role in stabilizing the global climate. Recognizing and respecting Indigenous people's needs and social, economic, and historical conditions influence health and healthcare. This study aimed to conduct online concept mapping workshops with university students to identify perceived important and feasible actions for improving the mental health of Indigenous people living in their territory in association with climate change.MethodsConcept mapping, a participatory mixed methodology, was conducted virtually with 20 Indigenous students at two universities in Brazil. A focus prompt was developed from consultations with Indigenous stakeholders and read—“To improve the mental health of Indigenous peoples in their territory during climate change crises, it is necessary to….”ResultsUniversity students organized 42 unique statements in 6 clusters that cover a wide range of topics: family support, 0.68 (SD 0.19); respect and understanding, 0.37 (SD 0.08); improvement actions, 0.52 (SD 0.07); public policies in favor of Indigenous people's mental health, 0.24 (0.09); health actions, 0.15 (SD 0.08); Indigenous training in health and its importance in improving mental health 0.32 (SD 0.07).ConclusionThese clusters range from community initiatives, public policies, health actions, and strengthening professional services in Indigenous communities. These all provide numerous concrete ideas for developing interventions designed to address mental health challenges associated with climate change.

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Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies

Cited by 15 publications

References 38 publications

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil

Mortality Time Trend for Major Viral Pathogens Causing Acute Respiratory Failure in Brazilian Children and Adolescents Before and During the SARS-Cov-2 Pandemic

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study

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