The challenge to reduce infant mortality in Brazil: Perinatal causes of death and health care practices

Neonatal mortality (NM) represents around 70% of infant mortality (IM) with persistent high rates in Brazil; 80% of the deaths are Perinatal Causes. This group of causes is nevertheless unspecific and reunites different causes of death that demand very different measures to its reduction, some of them more effective to prevent these deaths. We used a classification of causes of neonatal deaths based on the International Classification of Diseases (ICD-10), focusing its preventability, to comprehend the determinants of neonatal death in the country.  Six groups of neonatal deaths were used: prematurity, infection, asphyxia, maternal factors related to pregnancy, respiratory problems of the neonate and congenital anomalies. We used traditionally registered codes and related codes.. Prematurity was the main cause of neonatal mortality death in Brazil in 2005 (24,0%), followed by infection (17,0%), congenital anomalies (14,6%) and  asphyxia (14,3%). The neonatal mortality rates for these causes in general are higher at the Northeast and North regions of the country and lower in the South. Rates for congenital anomalies are relatively similar across all regions. The risk of preventable causes of neonatal mortality are excessively high in the country, indicating difficulties in health care process related to prenatal care, during labor and neonatal health care. For instance, the neonatal mortality rate for asphyxia traditional codes (P20-P21) at the USA in 2003 was 0,13/1000, whereas in Brazil this rate was 1,12/1000 in 2005, indicating that Brazilian children have a 8.6 higher relative risk of dying in the neonatal period of asphyxia. Social and economic inequalities are reflected in the higher risk at the less developed regions of the country. The utilization of special classification lists of neonatal causes of deaths based on the ICD-10 are important to transform mortality data into useful information for the health policies and management.