ALFARO GOMEZ emma laura
Spatial and temporal analysis of infant mortality from congenital malformations in Brazil (1996-2010).
BRONBERG R, SCHULER-FACCINI L, RAMALLO V, ALFARO E, DIPIERRI J
Journal of Community Genetics
While there are a number of studies on infant mortality in general and its risk factors, the contribution of congenital malformations and the mortality rates of children due to them has been less explored. Although individually rare, congenital malformations taken together have contributed significantly to infant mortality in populations where infectious diseases have been controlled and nutritional deficiencies have been corrected (Jenkins 1977). Over the last decades, in countries at different stages of development, there has been a trend of decrease in total infant mortality accompanied by a reduction in the rate of infant mortality from congenital malformations (IMR-CM), that is, the number of deaths from malformations per 1,000 births. The proportion of congenital malformation deaths (CMD%) has also been increasing, that is, the number of deaths from malformations per 100 deaths, for children less than 1 year of age (Rosano et al. 2000; Copeland and Russell 2006). The previously described trend of deaths in children under 1 year of age was confirmed in Chile in the period from 1985 to 2001 (Szot 2004) and in Argentina in the period from 2002 to 2006 (Bronberg et al. 2009). According to Rosano et al. (2000), the IMR-CM tends to be higher in the poorest countries, while the CMD% is higher in richer ones. In most Latin American countries, congenital malformations as the cause of death for children less than 1 year of age has tended to increase, and it has occupied between second and fifth places as the cause of death, contributing between 2 % and 27 % to total infant mortality. According to Victora et al. (2011), in Brazil over the last three decades, there has been a persistent and substantial decrease in infant mortality?it decreased 5.5 % a year between 1980 and 1990, and it has decreased 4.4 % a year since 2000, attaining a rate of 20 deaths per 1,000 live births in 2008. According to these same authors, in the period between 1990 and 2007, there was no significant change in the IMR-CM throughout Brazil. Similar findings were reported by Victora and Celso (2001) when analyzing the behavior of infant mortality due to congenital malformations in Brazil between 1985 and 1987 and 1995 and 1997, thus demonstrating that, while the IMR-CM remained stable in both periods, the CMD% increased from 7.1 % for 1985?1987 to 11.5 % for 1995?1997. The same trend occurred at the regional level but with disparities between regions, particularly for the CMD%. However, Siedersberger Neto et al. (2012) found an increase in both the IMR-CM and the CMD% throughout Brazil in the period between 1996 and 2008. This paper intends to broaden the analysis of the IMR-CM and CMD% trends in Brazil for 1996?2010 as well as their spatial variation at different levels of political?administrative structures (regions, Federative Units/States, and municipalities).