[Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba]

Spatio-temporal analysis of infant mortality in the city of Rio de Janeiro, 2010-2019

OBJECTIVE

To describe the spatio-temporal distribution of infant mortality and its components in the city of Rio de Janeiro, Brazil, in 2010 and 2019.

METHODS

Infant mortality rate and the neonatal and postneonatal components were estimated. The standardized mortality rate was calculated to detect excess child mortality in the planning areas. Poisson regression was performed to estimate the effect of these planning areas on the years 2010 and 2019. Spatial analysis per neighborhoods was performed to identify the spatial autocorrelation rates, using the Moran's Index and local indicator of spatial association (LISA).

RESULTS

The planning areas are very heterogeneous, depending on the history and evolution of occupation. There is an excess of mortality in planning areas with greater social vulnerability. In the Poisson model, it was observed that in all components, the planning area (PA) of residence was statistically significant as well as the year. Moran's index did not show global spatial autocorrelation. However, when applying the LISA method, autocorrelation was observed at the local level and spatial clusters in the municipality of Rio de Janeiro.

CONCLUSIONS

The spatial heterogeneity of the infant mortality rate in Rio de Janeiro suggests that local health policy strategies of each region consist in an efficient measure for reducing this rate.

Análise espaço-temporal da mortalidade infantil no município do Rio de Janeiro, 2010–2019

RESUMO Objetivo: Descrever a distribuição espaçotemporal da mortalidade infantil eseus componentes no município do Rio de Janeiro nos anos de 2010 e 2019. Métodos: Estimamos a taxa de mortalidade infantil e os componentes neonatal e pós-neonatal. Calculamos a taxa de mortalidade padronizada para detectar excesso de mortalidade infantil nas áreas de planejamento e realizamos regressão de Poisson para estimar o efeito dessas áreas nos anos de 2010 e 2019. Efetuamos análise espacial por bairros para detectar autocorrelação espacial das taxas, com uso do índice de Moran e do indicador local de associação espacial (LISA). Resultados: As áreas de planejamento são muito heterogêneas em função da história e da evolução da ocupação. Há excesso de mortalidade nas áreas de planejamento com maior vulnerabilidade social. No modelo de Poisson, observamos que em todos os componentes a área de planejamento de residência teve significância estatística, assim como o ano. O índice de Moran não mostrou autocorrelação espacial global. Contudo, ao aplicarmos o método LISA, observou-se autocorrelação em nível local e aglomerados espaciais no município do Rio de Janeiro. Conclusões: A heterogeneidade espacial da taxa de mortalidade infantil no Rio de Janeiro sugere que estratégias locais de políticas de saúde para cada região são uma medida eficiente para sua redução.

Under five and infant mortality in Chile (1990-2016): Trends, disparities, and causes of death

Background

Child health has been a health policy priority for more than a century in Chile. Since 2000, new health and intersectoral interventions have been implemented. However, no recent analyses have explored child mortality and equity in Chile, an indispensable input to guide policies towards the achievement of the Sustainable Development Goals, specially, in the context of a deeply unequal country such as many other Latin American countries. Thus, the objectives of this study are to analyze the variations in the risk and the causes of death among Chilean children aged <5 years, to identify the determinants, and to measure inequality of infant mortality from 1990 to 2016.

Materials and methods

An observational study was conducted to analyze the Chilean children's mortality from 1990 to 2016 using under five deaths and live births data from the Vital Statistics System. To describe the variation in the risk of death, a time series analysis was performed for each of the under five mortality rate components. A comparative cause of death analysis was developed for Neonatal and 1–59 months’ age groups. The determinants of infant mortality were studied with a descriptive analysis of yearly rates according to mother’s and child factors and bivariate logistic regression models at the individual level. Finally, simple and complex measures of inequality at individual level were estimated considering three-year periods.

Results

Regarding under 5 mortality: (i) Child survival has improved substantially in the last three decades, with a rapid decline in under five mortality rate between 1990 and 2001, followed by a slower reduction; (ii) early neonatal mortality has become the main component of the under five mortality rate (50.6%); (iii) congenital abnormalities have positioned as the leading cause of death; (iv) an important increase in live births below 1,000 grs. Regarding infant mortality: (i) birth weight and gestational age are the two most relevant risk factors in the neonatal period, while social variables are more significant for post-neonatal mortality and, (ii) the inequality according to mother’s education has shown a steady decline, with persistent inequalities in post-neonatal period.

Conclusions

The Chilean experience illustrates child health achievements and challenges in a country that transitioned from middle-to high-income in recent decades. Although inequity is one of the main challenges for the country, the health sector by granting universal access was able to reduce disparities. However, closing the gap in post-neonatal mortality is still challenging. To overcome stagnation in neonatal mortality, new and specific strategies must address current priorities, emphasizing the access of vulnerable groups.