Journal Article Epublish 3 citations
PubMed: 38564620 DOI: 10.1371/journal.pone.0298822
Impact of the COVID-19 pandemic on excess maternal deaths in Brazil: A two-year assessment.
PLoS One 19(4):e0298822
Authors: Jesem Douglas Yamall Orellana, Daniel Gray Paschoal Leventhal, María Del Pilar Flores-Quispe, Lihsieh Marrero, Nadège Jacques, Lina Sofía Morón-Duarte, Cynthia Boschi-Pinto
Affiliations
- Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil.
- VCU School of Medicine Medical Class of 2027, Richmond, Virginia, United States of America.
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
- Department of Nursing, Amazonas State University, Manaus, Amazonas, Brazil.
- Center for Haitian Studies, Miami, Florida, United States of America.
- Global Institute of Clinical Excellence, Keralty, Bogotá, Distrito Capital, Colombia.
- Translational Research Group, Sanitas University Foundation, Bogotá, Distrito Capital, Colombia.
- Department of Epidemiology and Biostatistics, Postgraduate Program in Collective Health, Institute of Collective Health, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
Abstract
BACKGROUND
Accurate estimates of the COVID-19 pandemic's indirect impacts are crucial, especially in low- and middle-income countries. This study aims to update estimates of excess maternal deaths in Brazil during the first two years of the COVID-19 pandemic.
METHODS
This was an exploratory mixed ecological study using the counterfactual approach. The observed maternal deaths were gathered from the Mortality Information System (SIM) for the period between March 2015 and February 2022. Expected deaths from March 2020 to February 2022 were estimated using quasipoisson generalized additive models, considering quadrimester, age group, and their interaction as predictor variables. Analyses were performed in R version 4.1.2, RStudio, version 2023.03.1+446 and carried out with support from the "mgcv" and "plot_model" libraries.
RESULTS
A total of 5,040 maternal deaths were reported, with varying excess mortality across regions and age groups, resulting in 69% excess maternal mortality throughout Brazil during the first two years of the pandemic. The Southeast region had 50% excess mortality throughout the first two years and 76% excess in the second year. The North region had 69% excess mortality, increasing in the second year, particularly among women aged 20-34. The Northeast region showed 80% excess mortality, with a significant increase in the second year, especially among women aged 35-49. The Central-West region had 75% excess mortality, higher in the second year and statistically significant among women aged 35-49. The South region showed 117% excess mortality, reaching 203% in the second year among women aged 20-34, but no excess mortality in the 10-19 age category.
CONCLUSIONS
Over two years, Brazil saw a significant impact on maternal excess deaths, regardless of region and pandemic year. The highest peak occurred between March and June 2021, emphasizing the importance of timely and effective epidemic responses to prevent avoidable deaths and prepare for new crises.
MeSH
Mortality, Aged, Covid-19, Maternal Death, Pandemics