Mortality among children enrolled in public day care centers in Brazil

Objective To describe the mortality pattern among children enrolled in public day care centers. Methods This was a descriptive study of the mortality pattern among children aged from 0 to 6 years and 11 months who were enrolled in all the public day care centers in the city of Sao Paulo, Brazil, from 1995 to 1999. The variables of interest were sex, age, underlying cause of death, duration of day care attendance and seasonality. Results The average mortality rate for the period was 36.4 per 100,000 children. Of the total number of deaths, 32.7% were among children under 1 year old and 78.4% under 3 years old. The deaths of 54.2% of these children occurred before completing six months in the day care center, with a concentration of 36.3% during the first three months. The majority of the deaths occurred during the winter and autumn seasons: 31.8% and 29.6%, respectively. The main underlying causes of death were infections: pneumonia (29.6%), meningococcal disease (13.0%), non-meningococcal meningitis (8.5%), gastroenteritis (7.6%) and chickenpox (5.4%). External causes were responsible for 13.5% of the deaths and included falls, being run over, drowning, burns and physical aggression. Conclusions The study indicated that younger children (0-3 years) were the most vulnerable group and that the majority of deaths derived from avoidable causes, some of which preventable by vaccination nowadays.