Surveillance of Fetal and Child Mortality in Brazil

Session: Innovative and Collaborative Regional Response to Improved Newborn Surveillance in Latin America and the Caribbean

Presenter: Juan José Cortez-Escalante, Pan-American Health Organization, World Health Organization

Background: In recent years, Brazil has strengthened the Surveillance of Fetal and Child Mortality (SFCM) as part of an effort to reduce infant mortality. IMR was 14.9 per 1000 live births (2012).Three objectives were established for this initiative: i) increase in case notification; ii) improvement in establishing correctly the underlying cause of death; and iii) identification of possible factors that may have led to the death.

Methodology: Since 2009, SFCM has been implemented nationally. This process was coordinated by the MoH Secretariat of Health Surveillance, and included: establishment of guidelines, decentralization at the local level, setting up of procedures at all levels (state, municipality and special districts of indigenous health), priority setting for physical, human, and financial resources, and timely reporting. The following actions were carried out: 1) improved Information System Regulation 2) implementation of a Mortality Research Subsystem; 3) provision of information “dashboard” to facilitate monitoring of individual cases; 4) development of Mortality Surveillance guidelines; 5) technical/ financial support; 6) periodic assessment workshops; 7) training of health professionals; and 8) partnership with health authorities (Secretariat of Health Care and Special Secretariat for Indigenous Health).

Results: In the decade prior to the implementation of SFCM, fewer than 2000 infant deaths were recorded annually. Following, the number of recorded infant deaths increased (also approximately 2000 annually) as both deaths declined and identification of deaths improved. An impressive increase in the investigation of fetal and child deaths has resulted, rising from 12% (8751/74475) in 2009 to 72% (51106/71029) in 2013. Also the time taken for the investigation to occur has been reduced: from 570 days on average in 2009, to 128 days in 2013.

Conclusion: SFCM has been very effective in strengthening surveillance, providing strong support for the development of better health actions at local and federal levels.