O silêncio de vidas não contadas: mortalidade materna tardia no Brasil 2010-2019

Abstract

Introduction: Women’s deaths during the pregnancy-puerperium cycle are associated with unsatisfactory provision of health care and reflect on low quality of care, considered an important indicator of poverty, social inequity, coverage, and quality of care for people’s health needs. Although the numbers point to a large percentage of women who die during pregnancy and puerperium, maternal deaths do not only occur during this period. While there is a continuous increase in late maternal mortality rates.However, the invisibility of these deaths and the shortage of its dimension directly impact the strength of actions to confront it. Objective: To evaluate the temporal trend of late maternal mortality ratio in Brazil and its geographic regions from 2010 to 2019. Method: This is an epidemiological, exploratory ecological time-series study, with data from Mortality Information System (SIM) and Live Birth Information System (SINASC), from 2010 to 2019, from women of child-bearing age who had their deaths declared with ICD-10 O96. Late maternal mortality rate (LMMR) of Brazil and its five geographic regions were calculated. To analyze the trends, Prais-Winsten autoregressive model was used. LMMR trends were analyzed according to age, race; color, marital status, and maternal level education. Annual Percent Change (APC) of LMMR of the country and its regions and their respective 95% confidence intervals (95% CI) were calculated. Results: A total of 1.470 late maternal deaths were declared. LMMR in the study period was 5 deaths per 100.000 live births (LB), with the lowest score in North region(3.5/100.000 LB) and the highest in South region (8.3/100.000 LB). There was significant upward trend in LMMR in the country. There was an increase LMMR in Brazil with an average annual percentage change of 26.06% (95%CI 16.36-36.56), followed by North with 23.50% (13.93–33.88) and Northeast with 14.60% (95%CI 8.50– 21.05). An increase in LMMR was also observed in black/brown women (APC=8.01%;CI95% 2.47 – 13.86); in the age groups from 15 to 19 years old (APC=12.37%; CI95%5.40-19.79), from 20 to 24 (APC=12.35%; CI95% 5.32-19.85), from 25 to 29 years (APC=9.93%; CI95% 4.77-15.34) and from 30 to 34 years (APC=10.44%; CI 95% 4.66-16.54); and in women with no education (APC=21.43%; CI95% 10.87-32.99%), 1 to 3 years of education (APC=31.33%; CI95% 10.08-56.69), from 4 to 7 years of education (APC=13.53%; CI95% 7.31-20.11) and from 8 to 11 years of education (APC=13.79%; CI95% 9.08-18.70). About 83% of late maternal deaths were investigated. The ICD-10 code O96 was not declared as the original underlying cause of death in 65.6% of the cases. Considerations: There is urgent need to improve postnatal care over an extended period, with a focus on detecting and treating known conditions at this stage, in addition to the need to improve statistics on late maternal deaths. A significant amount of data is lost due the depreciation of its declaration, its unreliable notification and the classification limitation of maternal death up to 42 days after the end of pregnancy.