Death surveillance and contributions to an improved definition of the underlying cause of neonatal death




Neonatal mortality; Causes of death; Information systems; Vital statistics; Epidemiological surveillance.


Objective: To analyze the improvement of the definition of the underlying cause of neonatal deaths before and after death surveillance in Recife, Pernambuco. Methods: A descriptive study that used data from medical certificates of death, confidential data sheets, summaries of investigations. The profiles and the relocation of the underlying cause of death were compared before and after the investigation through specific chapters and groups of the Tenth Revision of the International Classification of Diseases. The agreement was analyzed using the Kappa index. Results: Of the total 144 deaths investigated, 95 (66.0%) had their underlying cause redefined. During the general analysis of the neonatal component, a reasonable agreement index was identified (0.311; CI95%: 0.272-0.350). All ill-defined causes were clarified after surveillance. There was an increment of the preventability potential for all neonatal deaths, with an emphasis on early deaths, which reached 100% causes registered as preventable. Conclusion: Death surveillance made it possible to improve the specificity of the underlying causes described in the medical certificate of death and may contribute to the reorientation of the strategies to reduce neonatal mortality from the perspective of preventability.


Almeida, W. S., & Szwarcwald, C, L. (2017). Adequacy of mortality data and correction of reported deaths from the Proactive Search of Deaths. Cienc saude colet, 22(10), 3193-3203.

Bensaid, K., Yaroh, A. G., Kalter, H. D., Koffi, A. K., Amouzou, A., Maina, A., & Kazmi, N. (2016). Verbal/Social Autopsy in Niger 2012-2013: A new tool for a better understanding of the neonatal and child mortality situation. J Glob Health, 6(1), Article 010602.

Brasil. (2009). Ministério da saúde. Manual de vigilância do óbito infantil e fetal e do Comitê de Prevenção do Óbito Infantil e Fetal (2nd ed.). Ministério da Saúde.

Brasil. (2010). Ministério da Saúde. Portaria nº 72, de 11 de janeiro de 2010. Estabelece que a Vigilância fetal é obrigatória nos serviços de saúde (públicos e privados) que integram o Sistema Único de Saúde. Diário Oficial da República Federativa do Brasil, Brasília (DF), Seção 1, 29.

Brasil. (2014). Ministério da Saúde. Departamento de Informática do SUS. Informações em Saúde (Tabnet) Demográficas e Socioeconômicas. Retrieved July 14, 2017, from

Cavalcante, K. O., Santos, A. A., Lúcio, I. M., Silva, J. M., Melo, D. S., & Jacintho, K. S. (2016). Routine on prenatal examinations: solution or problem? J Nurs UFPE on line, 10(Supl. 3), 1415-1422.

Dias, B. A., Santos Neto, E. T., Andrade, M. A., & Zandonade, E. (2019). Spatial analysis of avoidable infant deaths in Espírito Santo, Brazil, 2006-2013. Epidemiol Serv Saude, 28(3), Article e2018111.

Dieleman, J. L., Schneider, M. T., Haakenstad, A., Singh, L., Sadat, N., Birger, M., Reynolds, A., Templin, T., Hamavid, H., Chapin, A., & Murray, C. J. (2016). Development assistance for health: past trends, associations, and the future of international financial flows for health. Lancet, 387(10037), 2536-2544.

Dieleman, J. L., Templin, T., Sadat, N., Reidy, P., Chapin, A., Foreman, K., Haakenstad, A., Evans, T., Murray, C. J., & Kurowski, C. (2016). National spending on health by source for 184 countries between 2013 and 2040. Lancet, 387(10037), 2521-2535.

Domingues, C. M., & Teixeira, A. M. (2013). Vaccination coverage and impact on vaccine-preventable diseases in Brazil between 1982 and 2012: National Immunization Program progress and challenges. Epidemiol Serv Saude, 22(1), 9-27.

Grove, J., Claeson, M., Bryce, J., Amouzou, A., Boerma, T., Waiswa, P., Victora, C., & Kirkland Group. (2015). Maternal, newborn, and child health and the Sustainable Development Goals - a call for sustained and improved measurement. Lancet, 386(10003), 1511-1514.

Halim, A., Dewez, J. E., Biswas, A., Rahman, F., White, S., & van den Broek, N. (2016). When, where, and why are babies dying? Neonatal death surveillance and review in Bangladesh. PLoS One, 11(8), Article e0159388.

Helps, A., Leitao S., Greene R., & O’Donoghue K. (2020). Perinatal mortality audits and reviews: Past, present and the way forward. Eur J Obstet Gynecol Reprod Biol, 250, 24-30.

Landis, J. R., & Koch, G. C. (1977). A medida da concordância entre observadores para dados categóricos. Biometrics, 33(1), 159-174.

Lansky, S., Friche, A. A., Silva, A. A., Campos, D., Bittencourt, S. D., Carvalho, M. L., Frias, P. G., Cavalcante, R. S., & Cunha, A. J. (2014). Birth in Brazil survey: neonatal mortality, pregnancy and childbirth quality of care. Cad Saude Publica, 30(Suppl. 1), 192-207.

Leal, M. C., Theme-Filha, M. M., Moura, E. C., Cecatti, J. G., & Santos, L. M. (2015). Prenatal and childbirth care for women using the public health system resident in Amazonia Legal and the Northeast Region of Brazil 2010. Rev Bras Saude Mater Infant, 15(1), 91-104.

Lourenço, E. C., Guerra, L. M., Tuon, R. A., Silva, S. M., Ambrosano, G. M., Corrente, J. E., Cortelazzi, K. L., Vazquez, F. L., Meneghim, M. C., & Pereira, A. C. (2014). Impact variables on the decline in infant mortality in the state of São Paulo, Brazil: 1998-2008. Cienc saude coletiva, 19(7), 2055-2062.

Maia, L. T., Souza, W. V., & Mendes, A. D. (2020). Individual and contextual determinants of infant mortality in Brazilian state capitals: a multilevel approach. Cad Saude Publica, 36(2), Article e00057519. 2020;36:e00057519.

Maia, L. T., Souza, W. V., Mendes, A. D., & Silva, A. G. (2017). Use of linkage to improve the completeness of the SIM and SINASC in the Brazilian capitals. Rev Saude Publica, 51, 112.

Malta, D. C., Duarte, E. C., Cortez-Escalante, J. J.., Almeida, M. F., Sardinha, L. M., Macário, E. M., Monteiro, R. A., & Morais Neto, O. L. (2010). Avoidable causes of infant mortality in Brazil, 1997-2006: contributions to performance evaluation of the Unified National Health System. Cad Saude Publica, 26(3), 481-491.

Masson, V. L., Farquhar, C. M., & Sadler, L. C. (2016). Validation of local review for the identification of contributory factors and potentially avoidable perinatal deaths. Aust N Z J Obstet Gynaecol, 56(3), 282-288.

Matlow, J. N., Pupco, A., Bozzo, P., & Koren, G. (2013). Tdap vaccination during pregnancy to reduce pertussis infection in young infant. Can Fam Physician, 59(5), 497-498.

Mikkelsen, L., Phillips, D. E., AbouZahr, C., Setel, P. W., Savigny, D., Lozano, R., & Lopez, A. D. (2015). A global assessment of civil registration and vital statistics systems: monitoring data quality and progress. Lancet, 386(10001), 1395-1406.

Oliveira, C. M., Bonfim, C. V., Guimarães, M. J., Frias, P. G., Sposito, V. C., & Medeiros, Z. M. (2017). Infant mortality surveillance in Recife, Pernambuco, Brazil: operationalization, strengths and limitations. Epidemiol Serv Saude, 26(2), 413-419.

Oliveira, R. A., Santos, K. B., Vasconcelos, A. R., Lopes, B. F., Castro, B. T., Saback, J. P., Souza, K. A., Freitas, L. S., Costa, R. F., Lacerda, R. M., Marçal, S. A., & Ramalho, L. T. (2021). Síndromes hipertensivas gestacionais: o impacto do pré-natal na mortalidade materna, Int J Dev Res, 11(03), 45293-45297.

Paris, G. F., Pelloso, S. M., & Martins, P. M. (2013). Quality of prenatal care in public and private services. Rev Bras Ginecol Obstet, 35(10), 447-452.

Pedraza, D. F. (2021). Information system on live births: a quality analysis based on literature. Cad saude colet, 29(1), 143-152.

Rasella, D., Aquino, R., Santos, C. A., Paes-Sousa, R., & Barreto, M. L. (2013). Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet, 382(9886), 57-64.

Rodrigues, P. L., Gama, S. G., & Mattos, I. E. (2019). Completeness and reliability of the National Mortality Information System for perinatal deaths in Brazil, 2011- 2012: a descriptive study. Epidemiol Serv Saude, 28(1), Article e2018093.

Ruiz, J. I., Nuhu, K., McDaniel, J. T., Popoff, F., Izcovich, A., & Criniti, J. M. (2015). Inequality as a Powerful Predictor of Infant and Maternal Mortality around the World. PLoS One, 10(10), Article e0140796.

Sala, A., & Luppi, C. G. (2020). Trend of preventable deaths up to the 6th day of life in the state of São Paulo – 2008 to 2017. Rev Saude Publica, 54, 132.

Santos, S. P, Lansky, S., Ishitani, L. H., & França, E. B. (2015). Avoidable infant deaths in Belo Horizonte: a concordance analysis of basic causes, 2010-2011. Rev Bras Saude Matern Infant, 15(4), 389-399.

Silva, C. M., Gomes, K. R., Rocha, O. A., Almeida, I. M., & Moita Neto, J. M. (2013). Validity and reliability of data and avoidability of the underlying cause of neonatal deaths in the intensive care unit of the North-Northeast Perinatal Care Network. Cad Saude Publica, 29(3), 547-556.

Szwarcwald, C. L., Leal, M. C., Pereira, A. P., Almeida, W. S., Frias, P. G., Damacena, G. N., Souza Junior, P. R., Rocha, N. M., & Mullachery, P. M. (2019). Evaluation of data from the Brazilian Information System on Live Births (SINASC). Cad Saúde Pública, 35(10), Article e00214918.

Teixeira, J. A., Araujo, W. R., Maranhão, A. G., Cortez-Escalante, J. J., Rezende, L. F., & Matijasevich, A. (2019). Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015. Epidemiol Serv Saude, 28(1), Article e2018132.

Vanderlei, L. C, & Navarrete, M. L. (2013). Preventable infant mortality and barriers to access to primary care in Recife, Northeastern Brazil . Rev Saude Publ, 47(2), 379-389.




How to Cite

PIMENTEL, D. da R. .; LIMA, R. A. F. .; CARDOSO, M. D. .; OLIVEIRA, C. M. de .; BONFIM, C. V. do . Death surveillance and contributions to an improved definition of the underlying cause of neonatal death. Research, Society and Development, [S. l.], v. 10, n. 13, p. e571101320391, 2021. DOI: 10.33448/rsd-v10i13.20391. Disponível em: Acesso em: 7 dec. 2021.



Health Sciences