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The impact of the COVID-19 pandemic on trends in stillbirths, under-5 and maternal mortality in Brazil: Excess deaths and regional inequalities

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dc.contributor.author Xavier, Mariana Otero
dc.contributor.author Amouzou, Agbessi
dc.contributor.author Maïga, Abdoulaye
dc.contributor.author Akseer, Nadia
dc.contributor.author Huicho Oriundo, Luis
dc.contributor.author Matijasevich, Alicia
dc.date.accessioned 2023-10-12T15:30:07Z
dc.date.available 2023-10-12T15:30:07Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14276
dc.description.abstract 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. en_US
dc.language.iso eng
dc.publisher Edinburgh University Global Health Society
dc.relation.ispartofseries Journal of Global Health
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject COVID-19 en_US
dc.subject Pandemic en_US
dc.subject Stillbirths en_US
dc.subject Maternal mortality en_US
dc.subject Brazil en_US
dc.subject Deaths en_US
dc.subject Regional inequalities en_US
dc.subject.mesh COVID-19
dc.subject.mesh Pandemia
dc.subject.mesh Mortinato
dc.subject.mesh Mortalidad Materna
dc.subject.mesh Brasil
dc.subject.mesh Muerte
dc.subject.mesh Factores Socioeconómicos
dc.title The impact of the COVID-19 pandemic on trends in stillbirths, under-5 and maternal mortality in Brazil: Excess deaths and regional inequalities en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7189/jogh.13.06040
dc.relation.issn 2047-2986


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