Data Analysis and Related Applications, Volume 2

21The Impact of Cesarean Section on Neonatal Mortality in Rural–Urban Divisions in a Region of Brazil

Neonatal mortality represents, in the first seven days of life, about 70% of infant deaths and is mainly responsible for maintaining the levels of the infant mortality rate, both in Brazil and in the world, where these levels are below 18 deaths per 100,000 live births. One of the important factors associated with neonatal infant mortality is cesarean section, which in Brazil reaches levels around 57%, one of the highest in the world. This study aimed to investigate the impact of cesarean section on neonatal mortality in rural–urban divisions in the State of Paraíba, in northeastern Brazil, from 2009 to 2017. A set of maternal–infant variables was selected, commonly found in the microdata of the Ministry of Health’s Mortality and Birth Information System: gender and race/child color, mother’s age, mother’s level of education, number of children born alive, number of children born dead, type of pregnancy and type of childbirth. After using the database linkage technique and the imputation of missing data of the variables, the multilevel logistic model was applied, which considered two levels: each neonatal death (level 1) and rural–urban municipal characterization (level 2). In light of the microdata of 5,149 neonatal deaths that occurred in Paraíba from 2009 to 2017, the highest proportions of neonatal deaths in children born via cesarean delivery were found in urban municipalities. ...