Tendências de mortalidade infantil em Governador Valadares, Minas Gerais e Brasil (2009–2023): fatores associados e estratégias na APS

Abstract

Introduction: Infant mortality is a sensitive indicator of the quality of maternal and child health care and of a population's well-being, reflecting the impact of the social determinants of health. Although Brazil has achieved a substantial decline in this indicator over recent decades, significant regional inequities persist. Governador Valadares, the hub municipality of the second most affected macro-region of Minas Gerais, remains a territory with a scarcity of studies on the subject. This study aimed to analyze the temporal trends of infant mortality in Governador Valadares, Minas Gerais, and Brazil, between 2009 and 2023, according to the social determinants of health and maternal and child factors, comparing the neonatal and post-neonatal components across regions and proposing management strategies centered on Primary Health Care (PHC). Methods: This is an exploratory, spatio-temporal ecological study of infant mortality rates (IMR), based on secondary data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC), in Governador Valadares, Minas Gerais and Brasil, between 2009 and 2023. Rates were stratified by neonatal and post-neonatal components and by associated factors — birth weight, sex, race/skin color, maternal age and education, gestational duration and type, and type of delivery. Prais-Winsten or simple regression models were applied to calculate annual rate changes, adopting a statistical significance level of 5%. Results and Discussion: The results revealed a divergence among the analyzed levels. While Minas Gerais and Brazil showed a downward trend in IMR, Governador Valadares followed an upward trajectory, particularly in the neonatal component and in mortality by preventable causes. In all regions, neonatal mortality exceeded post-neonatal mortality, and the outcome was associated with low birth weight, prematurity, maternal age under 20 or over 35 years, low maternal education, multiple pregnancy, and vaginal delivery. The findings indicate that national advances in maternal and child care have not been equitably reflected in the local reality, with a persistently high risk of death from potentially preventable causes during the first days of life in the municipality, avoidable also by strategies in the PHS setting, such as prenatal care and childcare. Conclusions: The study reinforces the relevance of PHC in the early enrollment of pregnant women, in the qualification of prenatal and child care, and in care directed toward the most vulnerable groups. As a practical contribution, technical-technological products were developed - intelligent virtual spreadsheets for prenatal and child care and a conclusive technical report - aimed at supporting Family Health teams and municipal management. It also offers an theoretical-epidemiological framework to underpin local public policies and the continuous monitoring of the indicator, especially in Governador Valadares, whose alarming data call for further research, particularly qualitative studies, on the quality of care across the health care network.