Impact of the COVID-19 Pandemic on Births, Vaginal Deliveries, Cesarian Sections, and Maternal Mortality in a Brazilian Metropolitan Area: A Time-Series Cohort Study

Dilson Palhares Ferreira,1,* Cláudia Vicari Bolognani,2,3,* Levy Aniceto Santana,2,* Sérgio Eduardo Soares Fernandes,2,3,* Matheus Serwy Fiuza de Moraes,3,* Luana Argollo Souza Fernandes,3,* Camila de Sousa Pereira,3,* Gabriela Billafan Ferreira,3,* Leila Bernarda Donato Göttems,2,3,* Fábio Ferreira Amorim1– 4,* 1Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 2Department of Research and Scientific Communication, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 4Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil*These authors contributed equally to this workCorrespondence: Fábio Ferreira Amorim; Dilson Palhares Ferreira, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, CEP 70701-907, Brazil, Email [email protected]; [email protected]: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in healthcare. The primary objective of the study was to assess the impact of the COVID-19 pandemic on birth, vaginal delivery, and cesarian section (c-section) rates. The secondary objective was to compare the maternal mortality before and after the pandemic.Patients and Methods: Time-series cohort study including data of all women admitted for childbirth (vaginal delivery or c-section) at the maternities in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. Causal impact analysis was used to evaluate the impact of COVID-19 on birth, vaginal delivery, and c-section using the CausalImpact R package, and a propensity score matching was used to evaluate the effect on maternal mortality rate using the Easy R (EZR) software.Results: There were 150,617 births, and considering total births, the effect of the COVID-19 pandemic was not statistically significant (absolute effect per week: 5.5, 95% CI: − 24.0− 33.4). However, there was an increase in c-sections after COVID-19 (absolute effect per week: 18.1; 95% CI: 11.9− 23.9). After propensity score matching, the COVID-19 period was associated with increased maternal mortality (OR: 3.22, 95% CI: 1.53− 6.81). The e-value of the adjusted OR for the association between the post-COVID-19 period and maternal mortality was 5.89, with a 95% CI: 2.43, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: Our study revealed a rise in c-sections and maternal mortality during the COVID-19 pandemic, possibly due to disruptions in maternal care. These findings highlight that implementing effective strategies to protect maternal health in times of crisis and improve outcomes for mothers and newborns is crucial.Keywords: COVID-19, cesarean section, maternal health services, maternal mortalit

Trajetória da política de atenção básica à saúde no Distrito Federal, Brasil (1960 a 2007): análise a partir do marco teórico do neo-institucionalismo histórico A history of primary health care policy in the Federal District, Brazil (1960-2007): an analysis based on the theoretical framework of historical neo-institutionalism

Este artigo analisa a trajetória da política de atenção básica à saúde no Distrito Federal, Brasil, a partir do marco teórico do neo-institucionalismo histórico, identificando as conformações e as tendências predominantes nas gestões da Secretaria de Estado da Saúde (SES-DF) no período de 1960 a 2007. O estudo sinaliza que a política de saúde do Distrito Federal apresenta características de dependência da trajetória dos planos de saúde originais na definição de prioridades e metas, bem como na implementação do sistema de saúde. Essa influência, agregada à centralização dos processos decisórios e à limitada participação política, pode contribuir para situar a atenção básica como acessória ao atendimento hospitalar, destituindo-a do seu potencial de produzir mudança no modelo assistencial.<br>This article analyzes the history of primary health care policy in the Federal District, Brazil, based on the theoretical framework of historical neo-institutionalism, identifying the predominant configurations and trends in the various administrations of the State Health Secretariat (SES-DF) from 1960 to 2007. The study indicates that the characteristics of the Federal District's health policy are dependent on the history of the original health system plans for setting priorities and goals, as well as for the health system's implementation. This influence, in addition to the centralization of decision-making processes and limited political participation, can contribute to making primary care ancillary to hospital care, thus jeopardizing its potential to produce change in the health care model