Mortalidade das crianças menores de cinco anos na Guiné-Bissau entre 2000 e 2023: estimativas do estudo de carga global de doença

Abstract

Under-five mortality constitutes one of the most important indicators of human development and health system performance. This dissertation analyzed temporal trends in under-five mortality in Guinea-Bissau between 2000 and 2023, considering age groups, cause groups, and specific causes. This is an ecological study based on secondary data from the Global Burden of Disease Study 2023 (GBD 2023), using segmented regression modeling (joinpoint regression) to estimate the annual percentage change (APC) and the average annual percentage change (AAPC) in mortality rates. The results showed a consistent reduction in under-five mortality, declining from 146,18 to 71,81 deaths per 1,000 live births (–51%; AAPC –3.06%), indicating a sustained downward trend over the period. The reduction was more pronounced among children aged 1–4 years (–63%; AAPC –4.29%) than among infants under one year of age (–41%; AAPC –2.40%). Regarding major cause groups, communicable diseases accounted for the highest magnitudes throughout the series, declining by 54% (AAPC –3.31%), and remained the leading component of mortality, although with a slowdown in the rate of decline after the first decade. Noncommunicable diseases showed low magnitude and a modest reduction (–12%; AAPC –0.84%), reflecting relative stability. Injuries remained at low levels (–25%; AAPC – 0.57%), indicating a slow decline with minimal temporal variation. Marked reductions were observed in vaccine-preventable diseases, including tetanus (–85%), diphtheria (–99%), pertussis (–75%), and measles (–56%). Neonatal conditions showed more moderate declines, notably perinatal asphyxia (–29%), prematurity (–33%), and neonatal sepsis (–33%), whereas malnutrition presented a more pronounced proportional reduction (–66%). Among other communicable causes, substantial decreases were observed in malaria (–85%), HIV/AIDS (–67%), diarrhea (–64%), and lower respiratory infections (–56%). However, conditions such as lower respiratory infections, HIV/AIDS, measles, pertussis, malaria, and diarrhea showed periods of instability and occasional increases over time. The substantial reduction in under-five mortality in Guinea-Bissau indicates notable progress, yet remains insufficient to achieve SDG target 3.2 of fewer than 25 deaths per 1,000 live births by 2030. Persistent challenges include poverty, shortages of qualified human resources, and limited coverage of maternal and child health services. The study reinforces the need for sustained intersectoral policies grounded in continuous surveillance, strengthened prenatal care, safe delivery, and expanded immunization as strategic pillars for consolidating the progress achieved.