DETERMINANTS OF NEONATAL MORTALITY IN THE LARGEST INTERNATIONAL BORDER OF BRAZIL: A CASE CONTROL STUDY

Abstract BACKGROUND: Neonatal deaths correspond to 44% of the deaths in children under five globally. The most populous international border of Brazil includes Foz do Iguassu (Brazil), Puerto Iguazu (Argentina) and Ciudad del Este (Paraguay). Similarly to any other Brazilian city, the public health services located in Foz do Iguassu provide medical care to foreigners, including pregnant women who go to Brazil to deliver. Although the international importance of Foz do Iguassu in terms of healthcare, neonatal mortality in the city (15.3/1,000 live births) is higher than Brazil’s average (13.8/1,000 live births) and corresponds to 61% of all deaths in children under five. Unfortunately, the causes of the neonatal deaths in Foz do Iguassu remain unclear, which make it more difficult to manage the problem. The current study aimed to identify the determinants of neonatal mortality in Foz do Iguassu. METHODS: In this case-control study, we analyzed all neonatal deaths occurred in Foz do Iguassu from 2012 to 2016. Birth and mortality data were extracted from two national governmental databases (SINASC and SIM). We extracted data on (i) maternal sociodemographic characteristics, (ii) pregnancy care, and (iii) newborn characteristics. Multiple logistic regression with the conceptual framework was applied to examine the factors associated with neonatal mortality. RESULTS: Most of the deaths occurred in the early neonatal period (65.9%). The factors associated with neonatal death were fetal congenital anomaly (OR 22.4; CI 95% 7.41-67.76; p = <0.001); low birth weight (OR 17.4; CI 95% 8.70-35.17; p = <0.001), first minute Apgar score under 7 (OR 15.4; CI 95% 8.11- 29.24; p = <0.001); zero to 3 prenatal appointments (OR 3.3; CI 95% 1.28-8.70; p = 0.014) and prematurity (OR 3.5; CI 95% 1.79 6.92; p = <0.001). CONCLUSION: The high rate of neonatal death in Foz do Iguassu is strongly associated with newborn characteristics and not associated with maternal sociodemographic characteristics. Thus, the health services in the Brazilian side of this international borders should be aware of the quality of the prenatal care and childbirth attention provided.