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Deng J, Song Q, Liu H, Jiang Z, Ge C, Li D. The coupling coordination between health service supply and regional economy in China: spatio-temporal evolution and convergence. Front Public Health 2024; 12:1352141. [PMID: 38774045 PMCID: PMC11106377 DOI: 10.3389/fpubh.2024.1352141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/17/2024] [Indexed: 05/24/2024] Open
Abstract
Background The coordination of health service supply and regional economy is an integral path to promote China's prosperity. Methods Based on the coupling mechanism of health service supply and regional economy, we sampled the data from 30 provinces in China from 2009 to 2021 in this study and constructed the evaluation index system. Additionally, we calculated the coupling coordination degree (HED) of the two through the coupling coordination degree model. We further used the kernel density estimation, Moran's I index, and spatial β convergence model to assess the dynamic evolution trends, spatial aggregation effect, and spatial convergence characteristics of coupling coordination. Conclusion (1) HED in China showed a rising trend during the study period but with large regional differences, forming a gradient distribution pattern of "high in the east and low in the west." (2) The results of Kernel density estimation show that HED has formed a gradient differentiation phenomenon within each region in China. (3) HED has modeled spatial clustering characteristics during the study period, with high-value clusters mainly appearing in the eastern region and low-value clusters appearing in the northwestern region. (4) There are absolute β-convergence and conditional β-convergence trends in HED in China and the three major regions during the study period, but there is an obvious regional heterogeneity in the control factors. The research provides a reference for accurately implementing policies according to different levels of health service supply and economic development, in addition to narrowing the regional differences of the coupling coordination between the regional economy and health service supply.
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Affiliation(s)
- Jing Deng
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Qianwen Song
- Office of Chengdu Shuangliu District Maternal and Child Health Hospital, Chengdu, China
| | - Huan Liu
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Zicheng Jiang
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Chengzhi Ge
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Data Science and Traditional Chinese Medicine Innovation and Development, Anhui University of Chinese Medicine, Hefei, China
| | - Dexun Li
- School of Hospital Economics and Management, Anhui University of Chinese Medicine, Hefei, China
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Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, Thumé E, Facchini LA. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve? PLoS One 2022; 17:e0262217. [PMID: 35041716 PMCID: PMC8765636 DOI: 10.1371/journal.pone.0262217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.
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Affiliation(s)
- Elaine Tomasi
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Denise Silva da Silveira
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Everton Fantinel
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
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Factors related to the incidence of unmet need in couples of reproductive age in the working area of Marawola Health Center. GACETA SANITARIA 2021; 35 Suppl 2:S176-S179. [PMID: 34929805 DOI: 10.1016/j.gaceta.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed at determining factors associated with the incidence of unmet need for family planning among couples of reproductive age in the working area of Marawola Health Center, Sigi Regency. METHOD This research was an analytic observational study with a cross-sectional study design. The variables in this study included age, education, family planning history, husband's support and unmet need. Data were in the form of primary and secondary data. Data were collected using a questionnaire. The data were analyzed using univariate and bivariate analysis utilizing the Chi-Square test. Population in this study were 4715 couples of reproductive age in the working area of Marawola Health Center. By using Lemeshow's calculation technique and simple random sampling, a sample of 90 people was obtained. RESULT The results demonstrated a relationship between age and the incidence of unmet need with p value=0.004 (p-value ≤0.05); education and the incidence of unmet deed with p value=0.005 (p-value ≤0.05); family planning history and the incidence of unmet need with p value=0.002 (p-value ≤0.05); as well as husband's support and the incidence of unmet need with p value=0.001 (p-value ≤0.05). CONCLUSION This study concludes that there is a relationship between age, education, family planning history, and husband's support and the incidence of unmet need for family planning in the working area of Marawola Health Center, Sigi Regency. Therefore, health workers, local governments, and traditional institutions are expected to provide education about family planning to couples of reproductive age (husband and wife) as an attempt to reduce the number of unmet needs in the working area of Marawola Health Center.
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Pasklan ANP, Queiroz RCDS, Rocha TAH, Silva NCD, Tonello AS, Vissoci JRN, Tomasi E, Thumé E, Staton C, Thomaz EBAF. [Spatial analysis of the quality of Primary Health Care services in reducing child mortality]. CIENCIA & SAUDE COLETIVA 2021; 26:6247-6258. [PMID: 34910014 DOI: 10.1590/1413-812320212612.24732020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
This study sought to analyze the correlation of the quality of Primary Health Care services in reducing child mortality, via geoprocessing. It involved an ecological study, with a cross-sectional approach, in which secondary data from all 5,565 Brazilian municipalities were used to analyze the infant mortality rate (IMR) and cause of infant death. The data related to IMR was obtained from the Mortality Information System. For the spatial analysis, 5,011 municipalities were included. The clustering analyses were performed using GEODA software and the spatial regression analyses were performed using ARCGIS 10.5 software. In Brazil, there was a 45.07% reduction in IMR between the years 2000 and 2015. The greatest reduction occurred in the northeastern region of the country, although it is still the region with the highest IMR. Of the 749 municipalities analyzed in the differential cluster for infant death, 153 had high IMR. The areas with the greatest increase in IMR were found in the North and Northeast regions. In Brazil, IMR proved to be inversely associated with the accessibility to high complexity services, health management strata and population size, reference for childbirth, live birth rate, per capita income and unemployment rate. A progressive reduction in IMR was recorded between 2000 and 2015.
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Affiliation(s)
- Amanda Namíbia Pereira Pasklan
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | | | | | - Núbia Cristina da Silva
- Centro de Pós-Graduação e Pesquisa em Administração, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| | | | | | | | - Elaine Thumé
- Universidade Federal de Pelotas. Pelotas RS Brasil
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Motta CT, Moreira MR. Will Brazil comply with the SDG 3.1 of the 2030 Agenda? An analysis of maternal mortality, from 1996 to 2018. CIENCIA & SAUDE COLETIVA 2021; 26:4397-4409. [PMID: 34730631 DOI: 10.1590/1413-812320212610.10752021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Abstract
This article aims to analyze if it is possible for Brazil to meet the Sustainable Development Goals (SDG) 3.1, based on a diagnosis of the situation of maternal mortality in the Health Regions (HRs) of Brazil, in 2018, and the main characteristics of this mortality between 1996 and 2018 in the country. The study consists of two articulated phases: (i) bibliographical analysis of maternal mortality in Brazil; (ii) study in the Mortality Information System (SIM, in Portuguese). In 2018, from the 450 HRs, 159 showed a maternal mortality rate (MMR) of above 70 per 100,000 live births (LBs). Between 1996 and 2018, in Brazil, there was a reduction among women 30 to 49 years of age. However, in the age group of 10 to 29 years, there was no change during the time studied. The dissemination of the Maternal Mortality Committees, the PHPN, the PNAISM, and the "Stork Network" have all contributed to improvements in late pregnancies; however, they were inefficient at preventing deaths among young mothers. Compliance with SDG 3.1 requires: prioritization of CIR with MMR greater than 70.0/100,000 LB; qualification of prenatal services, focusing on care among women aged 10 to 29 years and hypertensive complications; and legalization of abortion.
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Affiliation(s)
- Caio Tavares Motta
- Departamento de Ciências Sociais, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1.480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Marcelo Rasga Moreira
- Departamento de Ciências Sociais, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1.480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
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Are Primary Health Care Features Associated with Reduced Late Neonatal Mortality in Brazil? An Ecological Study. Matern Child Health J 2021; 26:1790-1799. [PMID: 34731357 DOI: 10.1007/s10995-021-03269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the effect and efficiency of the characteristics of PHC facilities' structures and the work process of PHC teams on late neonatal mortality (LNM). METHODS This ecological time-series study adopted 3.764 Brazilian municipalities as analysis units. The independent variables were sorted into three hierarchical levels and four blocks. The distal level consisted of economic and demographic variables; the intermediate level comprised health coverage and demand for services; and the proximal level included structure and work process. The dependent variable was LNM. A linear mixed-effects regression analysis with a hierarchical approach was performed, estimating the crude (β) and adjusted (alpha = 5%) regression coefficients. Data involution analysis and municipalities were the decision-making unit according to their strata. RESULTS LNM was directly associated with the number of live births and unemployment rate. LNM was inversely associated with the year, per capita income, the community health worker's strategy coverage, vaginal delivery, household visits, and available vaccines. In the 2002-2014 period, the number of municipalities efficient in reducing LNM dropped from 38 to 27. In 2014, a more significant investment occurred in the number of vaginal deliveries in almost all strata to make inefficient municipalities efficient. CONCLUSION FOR PRACTICE The deaths of children aged 7-28 days are affected by the characteristics of the PHC structure and work process.
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The Determinants of Infant Mortality in Brazil, 2010-2020: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126464. [PMID: 34203770 PMCID: PMC8296299 DOI: 10.3390/ijerph18126464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022]
Abstract
Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a slower decline of infant mortality. After an economic and political crisis, Brazil witnessed increases in infant mortality that raised questions about what are the determinants of infant mortality after the implementation of such policies. We conducted a scoping review to identify and summarize those determinants with searches in three databases: LILACS, MEDLINE, and SCIELO. We included studies published between 2010 and 2020. We selected 23 papers: 83% associated infant mortality with public policies; 78% related infant mortality with the use of the health system and socioeconomic and living conditions; and 27% related to individual characteristics to infant mortality. Inequalities in the access to healthcare seem to have important implications in reducing infant mortality. Socioeconomic conditions and health-related factors such as income, education, fertility, housing, and the Bolsa Família. Program coverage was pointed out as the main determinants of infant mortality. Likewise, recent changes in infant mortality in Brazil are likely related to these factors. We also identified a gap in terms of studies on a possible association between employment and infant mortality.
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Bugelli A, Borgès Da Silva R, Dowbor L, Sicotte C. Health capabilities and the determinants of infant mortality in Brazil, 2004-2015: an innovative methodological framework. BMC Public Health 2021; 21:831. [PMID: 33931073 PMCID: PMC8086285 DOI: 10.1186/s12889-021-10903-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies. METHOD A series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates. RESULTS The results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths. CONCLUSION The results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.
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Affiliation(s)
- Alexandre Bugelli
- École de Santé Publique de l'Université de Montréal, student affiliated to the Centre de Recherche en Santé Publique (CReSP), 7101, Park Avenue, 3rd floor, Montreal (Québec) H3N, 1X9, Canada.
- CAPES Foundation scholar (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Ministry of Education of Brazil, Science without Borders Program, proc. 12940/13-5), Brasilia, DF, 700040-020, Brazil.
| | - Roxane Borgès Da Silva
- Ecole de Santé Publique de l'Université de Montréal (ESPUM), Centre de Recherche en Santé Publique (CReSP), 7101, Park Avenue, 3rd floor, Montreal (Québec) H3N 1X9, Canada
| | - Ladislau Dowbor
- Pontifícia Universidade Católica de São Paulo (PUC-SP), School of Economics and Business Administration Graduate Program, Rua Monte Alegre, 984, Perdizes, São Paulo, CEP 05014-901, Brazil
| | - Claude Sicotte
- École de Santé Publique de l'Université de Montréal (ESPUM), 7101, Park Avenue, 3rd floor, Montreal (Québec) H3N 1X9, Canada
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Queiroz BL, Lima EEC, Freire FHMA, Gonzaga MR. Temporal and spatial trends of adult mortality in small areas of Brazil, 1980–2010. GENUS 2020. [DOI: 10.1186/s41118-020-00105-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
To determine the variations and spatial patterns of adult mortality across regions, over time, and by sex for 137 small areas in Brazil, we first apply TOPALS to estimate and smooth mortality rates and then use death distribution methods to evaluate the quality of the mortality data. Lastly, we employ spatial autocorrelation statistics and cluster analysis to identify the adult mortality trends and variations in these areas between 1980 and 2010. We find not only that regions in Brazil’s South and Southeast already had complete death registration systems prior to the study period, but that the completeness of death count coverage improved over time across the entire nation—most especially in lesser developed regions—probably because of public investment in health data collection. By also comparing adult mortality by sex and by region, we document a mortality sex differential in favor of women that remains high over the entire study period, most probably as a result of increased morbidity from external causes, especially among males. This increase also explains the concentration of high male mortality levels in some areas.
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Lima SSD, Braga MC, Vanderlei LCDM, Luna CF, Frias PG. [Assessment of the impact of prenatal, childbirth, and neonatal care on avoidable neonatal deaths in Pernambuco State, Brazil: an adequacy study]. CAD SAUDE PUBLICA 2020; 36:e00039719. [PMID: 32130315 DOI: 10.1590/0102-311x00039719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess the impact of programs for prenatal, childbirth, and neonatal care (Mother Owl and Stork Network) on avoidable neonatal mortality in Pernambuco State, Brazil, using the adequacy approach. We analyzed the trend in avoidable neonatal mortality and the impact of these programs on avoidable neonatal mortality in four health regions in the state from 2000 to 2016. The Mortality Information System (SIM) and the Information System on Live Births (SINASC) and official documents were used as the data sources. Deaths were classified according to the Brazilian List of Avoidable Causes of Deaths Via Interventions by the Unified National Health System. Linear regression and joinpoint methods were used to analyze tendencies and identifying turning points in the neonatal mortality curves. There was a sharp drop in avoidable neonatal mortality in the state, especially in early neonatal mortality. Except for the I-Recife region, where there was a downturn in the mortality curves after implementation of the Stork Network, there was no association between the turning points in the curves and the periods with the programs' implementation in the regions. Other factors appear to have led to the improvement of these indicators, such as the expansion of the high-risk network. Strengthening this network can thus help reduce avoidable neonatal deaths, especially early deaths.
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Vale ÉDL, Cunha de Menezes LC, Bezerra INM, Frutuoso ES, Silva Gama ZAD, Wanderley VB, Piuvezam G. Melhoria da qualidade do cuidado à hipertensão gestacional em terapia intensiva. AVANCES EN ENFERMERÍA 2020. [DOI: 10.15446/av.enferm.v38n1.81081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: avaliar o efeito de um ciclo de melhoria da qualidade na implementação de práticas baseadas em evidências no tratamento de mulheres com doenças hipertensivas gestacionais admitidas em Unidade de Terapia Intensiva Materna (UTIM).Métodos: estudo quase-experimental, sem grupo de controle, realizado numa UTIM de um hospital universitário que seguiu as etapas de um ciclo de melhoria da qualidade. Avaliaram-se nove critérios de processo em todas as mulheres admitidas com diagnóstico de doenças hipertensivas gestacionais nos períodos anterior (n = 50) e posterior à intervenção (n = 50) em 2015. Estimou-se a conformidade com intervalo de confiança de 95 %, as não conformidades com gráficos de Pareto e a significância da melhoria com teste do valor Z unilateral (α = 5 %).Resultados: o nível de qualidade inicial foi alto em seis dos nove critérios (amplitude: 94-100 %), as práticas com menor adesão foram a “manutenção de sulfato de magnésio” (54 %), “solicitação de ultrassom fetal” (72 %) e “restrição hídrica intravenosa” (78 %). Houve melhoria absoluta em cinco dos nove critérios (amplitude: 2-16 %), que foi significativa para a solicitação de ultrassom fetal (melhoria absoluta: 16 %; p = 0,023) e para o total de critérios (4 %; p = 0,01).Conclusão: a intervenção de melhoria da qualidade proposta aumentou a adesão às recomendações baseadas em evidência para o tratamento de pacientes com doenças hipertensivas gestacionais admitidas em uma UTIM.
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Veloso FCS, Kassar LDML, Oliveira MJC, Lima THBD, Bueno NB, Gurgel RQ, Kassar SB. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta‐analysis of observational studies. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Veloso FCS, Kassar LDML, Oliveira MJC, Lima THBD, Bueno NB, Gurgel RQ, Kassar SB. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies. J Pediatr (Rio J) 2019; 95:519-530. [PMID: 31028747 DOI: 10.1016/j.jped.2018.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. SOURCES This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. SUMMARY OF FINDINGS The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar<7 at the fifth minute, low and very low birth weight, gestational age≤37 weeks, and caesarean delivery. CONCLUSION The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.
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Affiliation(s)
| | | | - Michelle Jacintha Cavalcante Oliveira
- Universidade Federal de Alagoas (UFAL), Faculdade de Medicina, Maceió, AL, Brazil; Centro Universitário Tiradentes, Curso de Medicina, Maceió, AL, Brazil
| | - Telmo Henrique Barbosa de Lima
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Curso de Medicina, Maceió, AL, Brazil; Centro Universitário Tiradentes, Curso de Medicina, Maceió, AL, Brazil
| | - Nassib Bezerra Bueno
- Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Maceió, AL, Brazil
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Menezes AMB, Barros FC, Horta BL, Matijasevich A, Bertoldi AD, Oliveira PD, Victora CG. Stillbirth, newborn and infant mortality: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982-2015. Int J Epidemiol 2019; 48:i54-i62. [PMID: 30883653 PMCID: PMC6422061 DOI: 10.1093/ije/dyy129] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Infant-mortality rates have been declining in many low- and middle-income countries, including Brazil. Information on causes of death and on socio-economic inequalities is scarce. METHODS Four birth cohorts were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, each including all hospital births in the calendar year. Surveillance in hospitals and vital registries, accompanied by interviews with doctors and families, detected fetal and infant deaths and ascertained their causes. Late-fetal (stillbirth)-, neonatal- and post-neonatal-death rates were calculated. RESULTS All-cause and cause-specific death rates were reduced. During the study period, stillbirths fell by 47.8% (from 16.1 to 8.4 per 1000), neonatal mortality by 57.0% (from 20.1 to 8.7) and infant mortality by 62.0% (from 36.4 to 13.8). Perinatal causes were the leading causes of death in the four cohorts; deaths due to infectious diseases showed the largest reductions, with diarrhoea causing 25 deaths in 1982 and none in 2015. Late-fetal-, neonatal- and infant-mortality rates were higher for children born to Brown or Black women and to low-income women. Absolute socio-economic inequalities based on income-expressed in deaths per 1000 births-were reduced over time but relative inequalities-expressed as ratios of mortality rates-tended to remain stable. CONCLUSION The observed improvements are likely due to progress in social determinants of health and expansion of health care. In spite of progress, current levels remain substantially greater than those observed in high-income countries, and social and ethnic inequalities persist.
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Affiliation(s)
- Ana M B Menezes
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Barros
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Bernardo L Horta
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Alicia Matijasevich
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.,Department of Preventive Medicine, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | | | - Paula D Oliveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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15
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Bezerra FD, Menezes MADS, Mendes RB, Santos JMDJ, Leite DCF, Kassar SB, Gurgel RQ. PERINATAL CARE IN A NORTHEASTERN BRAZILIAN STATE: STRUCTURE, WORK PROCESSES, AND EVALUATION OF THE COMPONENTS OF ESSENTIAL NEWBORN CARE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 37:140-148. [PMID: 30810691 PMCID: PMC6651313 DOI: 10.1590/1984-0462/;2019;37;2;00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. METHODS A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. RESULTS Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. CONCLUSIONS The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.
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16
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Carvalho BADS, Andrade AGBF, Dantas AS, Figueiredo IMD, Silva JAD, Rosendo TS, Roncalli AG. Temporal trends of maternal near miss in Brazil between 2000 and 2012. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to identify the temporal trends and regional variations in maternal near miss in Brazil. Methods: ecological study of temporal trends. The units of analysis are in the States, the regions and Brazil, between 2000 and 2012, the dependent variable being the maternal near miss rate (MNMR), calculated from the records of the Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) (National Health Hospital Information System).Regression analysis using Joinpoint regression software, version 4.1.0. was applied to analyze morbidity trends. Results: the main result of this study was a finding on an increase rate trend in maternal near miss in Brazil, between 2000 and 2012. This trend behaves differently depending on the development level of the region studied, presenting a positively higher increase in less developed regions and states. Conclusions: there is an increasing trend in maternal near miss rates in Brazil. The SIH-SUS may be an important instrument in identifying and monitoring maternal morbidity. Furthermore, investments in more effective public policies are needed to reduce inequalities and improve human development, both of which have influenced the chain of events related to maternal health.
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Canuto IMDB, Alves FAP, Oliveira CMD, Frias PGD, Macêdo VCD, Bonfim CVD. Intraurban differentials of perinatal mortality: modeling for identifying priority areas. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To analyze the intraurban spatial distribution of perinatal mortality, its avoidability, and relationship with socioeconomic indicators in Recife, Pernambuco, Brazil, in the period from 2013 to 2015. Method: An ecological study with data from the Information Systems on Mortality and Live Births and the Brazilian Institute of Geography and Statistics, using neighborhoods as the analysis unit. We elaborated an indicator of social deprivation formed by variables from the demographic census. We estimated the Kernel density of the deaths and calculated the Moran index of the perinatal mortality coefficients in the spatial analysis. We elaborated thematic maps of avoidable perinatal mortality and social deprivation. Results: The global statistical analysis of the mortality distribution indicated evidence of spatial aggregation. Moran's index was 0.18. We found clusters of perinatal mortality in neighborhoods of the Central, North, Northwest, and South Regions. In the North, Northwest, Southwest, and South Regions we identified neighborhoods with greater social deprivation and avoidable mortality coefficients. The primary cause of death was of fetuses and newborns affected by hypertensive maternal disorders. Conclusion: We demonstrated intraurban differentials in perinatal mortality among neighborhoods. The stratification of the urban space according to the social deprivation indicator presented a relation with the perinatal mortality and its avoidability.
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Affiliation(s)
| | | | | | - Paulo Germano de Frias
- Secretaria de Saúde do Recife, Brasil; Instituto de Medicina Integral Professor Fernando Figueira, Brasil
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18
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Quaresma ME, Almeida AC, Méio MDB, Lopes JMA, Peixoto MVM. Factors associated with hospitalization during neonatal period. J Pediatr (Rio J) 2018; 94:390-398. [PMID: 28945986 DOI: 10.1016/j.jped.2017.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/26/2017] [Accepted: 05/17/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Neonatal mortality rate remains high in Brazil. The aim of the study was to evaluate the factors associated with hospitalization during the neonatal period. METHODS Cross-sectional study conducted in ten randomly-selected Brazilian municipalities. Mothers of children under the age of 6 who were carrying the child's health booklet were interviewed in basic health units. Hierarchical modeling of sociodemographic factors (distal level), maternal variables (intermediate level), and features of the newborns (proximal level) was performed. The variables that presented a value of p≤0.20 in the univariate analysis were included in the multivariate hierarchical modeling process, with block input according to their hierarchical level. The variables with a value of p≤0.05 were considered statistically significant. RESULTS 2022 mothers were included, allowing 258 (12.8%) cases of hospitalization during the neonatal period to be identified, of which 49.7% were male, 8.9% were premature, and 8.4% had low birth weight (<2500g). After analysis by hierarchical approach, factors associated with neonatal hospitalization (prevalence ratio [95% CI]) included: history of prematurity (2.03 [1.25-3.30], p=0.004), gestational risk (2.02 [1.46-2.79], p<0.001); intrapartum risk (3.73 [2.33-5.99], p<0.001); gestational age (32-37 weeks: 13.83 [1.74-110.09], p=0.01; and<32 weeks: 25.03 [3.03-207.12], p=0.003); low birth weight (3.95 [2.56-6.09], p<0.001), and male gender (1.44 [1.09-1.98], p=0.01). CONCLUSION Factors associated with maternal and neonatal history are associated with neonatal hospitalization.
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Affiliation(s)
- Maria Emília Quaresma
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Laboratório de Pesquisa em Métodos Quantitativos, Rio de Janeiro, RJ, Brazil.
| | - Ana Claudia Almeida
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Laboratório de Pesquisa em Métodos Quantitativos, Rio de Janeiro, RJ, Brazil
| | - Maria Dalva B Méio
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Pós-Graduação em Pesquisa Clínica Aplicada, Rio de Janeiro, RJ, Brazil
| | - José Maria A Lopes
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Pós-Graduação em Pesquisa Clínica Aplicada, Rio de Janeiro, RJ, Brazil
| | - Maria Virgínia M Peixoto
- Fundação Oswaldo Cruz (FIOCRUZ), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Laboratório de Pesquisa em Métodos Quantitativos, Rio de Janeiro, RJ, Brazil
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Quaresma ME, Almeida AC, Méio MDB, Lopes JMA, Peixoto MVM. Factors associated with hospitalization during neonatal period. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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20
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Affiliation(s)
- Waldemar A Carlo
- University of Alabama at Birmingham, Division of Neonatology, Birmingham, United States.
| | - Colm P Travers
- University of Alabama at Birmingham, Division of Neonatology, Birmingham, United States
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Carlo WA, Travers CP. Maternal and neonatal mortality: time to act. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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