title: Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care.
abstract: This study examined neonatal deaths in the live-births cohort in the Birth in Brazil survey, which interviewed and examined medical records of 23,940 mothers from February 2011 to October 2012. Potential risk factors were analyzed using hierarchical modeling. Neonatal mortality rate was 11.1/1,000, the highest rates occurring in the North and Northeast regions and in lower social classes. Low birth weight, risks during pregnancy and conditions of the newborn were the main factors associated with neonatal death. Inadequate prenatal and childbirth care point to unsatisfactory quality of health care. Difficulty in gaining hospital admission for delivery, and children with birth weight<1,500g born at hospitals without a neonatal intensive care unit, indicate gaps in health system organization. Deaths from intra-partum asphyxia in term babies and late prematurity express preventable neonatal mortality. Better quality health care, especially hospital care during labor and birth, poses the main public policy challenge to progress in reducing mortality and inequalities in Brazil.
authors.affiliation: Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Brasil.
authors.forename: Sônia
authors.initials: S
authors.lastname: Lansky
authors.affiliation: Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
authors.forename: Amélia Augusta de
authors.initials: AA
authors.lastname: Lima Friche
authors.affiliation: Centro de Ciências da Saúde, Universidade Federal do Maranhão, São Luis, Brasil.
authors.forename: Antônio Augusto Moura da
authors.initials: AA
authors.lastname: Silva
authors.affiliation: Gerência de Ensino e Pesquisa, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brasil.
authors.forename: Deise
authors.initials: D
authors.lastname: Campos
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Sonia Duarte de
authors.initials: SD
authors.lastname: Azevedo Bittencourt
authors.affiliation: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Márcia Lazaro de
authors.initials: ML
authors.lastname: Carvalho
authors.affiliation: Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brasil.
authors.forename: Paulo Germano de
authors.initials: PG
authors.lastname: Frias
authors.affiliation: Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brasil.
authors.forename: Rejane Silva
authors.initials: RS
authors.lastname: Cavalcante
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Antonio José Ledo Alves da
authors.initials: AJ
authors.lastname: Cunha
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008427:Maternal Health Services / Q000592:standards; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult