The challenge of reducing neonatal mortality in middle-income countries: findings from three Brazilian birth cohorts in 1982, 1993, and 2004

摘要: Summary Background Middle-income countries will need to drastically reduce neonatal deaths achieve the Millennium Development Goal for child survival. The evolution of antenatal and perinatal care indicators in Brazilian city Pelotas from 1982 2004 provides a useful case study potential challenges. Methods We prospectively studied three birth cohorts representing all urban births 1982, 1993, January July, 2004. same methods were used studies. Findings Despite improvements maternal characteristics, prevalence preterm increased 6·3% (294 4665) 16·2% (342 2112) 2004, corresponding 47 g reduction mean birthweight. Average number visits was 8·3 per woman, but quality still inadequate—97% women had an ultrasound scan, only 1830 (77%) vaginal examination 559 1748 non-immunised did not receive tetanus toxoid. Rate caesarean sections greatly, 28% (1632 5914) 43% (1039 2403) reaching 374 456 (82%) private deliveries rate seemed result largely or inductions. Newborn improved, gestational-age-specific mortality rates fallen by about 50% since 1982. As result, been stable 1990, despite increase deliveries. Interpretation Excessive medicalisation—including labour induction, sections, inaccurate scans—led unregulated sector with spill-over effects public sector, might offset gains resulting improved health newborn These challenges have be faced middle-income striving survival Goal. Published online March 3, 2005 http://image.thelancet.com/extras/04art11026web.pdf