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Kreutz IM, Santos IS. Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil. BMC Public Health 2023; 23:87. [PMID: 36631798 PMCID: PMC9835378 DOI: 10.1186/s12889-022-14913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Ending preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country. METHOD An ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated. RESULTS In 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment. CONCLUSIONS The strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.
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Affiliation(s)
- Ivete Maria Kreutz
- grid.412519.a0000 0001 2166 9094Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS Brazil
| | - Iná S. Santos
- grid.412519.a0000 0001 2166 9094Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS Brazil ,grid.411221.50000 0001 2134 6519Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS Brazil
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Vieira CL, Silva VBD, Parmejiani EP, Cavalcante DFB, Souza MHDN, Stipp MAC. Community Health Agents and child health care: implications for continuing education. Rev Esc Enferm USP 2022; 56:e20210544. [PMID: 35421210 PMCID: PMC10081662 DOI: 10.1590/1980-220x-reeusp-2021-0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/09/2022] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To understand the main situations faced by community health agents in relation to children’s health in the light of permanent education actions. Method: This is a research of qualitative approach, which used the Arc of Maguerez. Ten community health agents from a Primary Health Care Unit participated in the study. The following steps were addressed: observation of reality; identification of key points, and theorization. The speeches were recorded, transcribed, and their textual content was processed in the IRAMUTEQ software, using the Descending Hierarchical Classification. Results: Five classes were formed, which composed three thematic blocks named as follows: child’s social vulnerability in the territory; handling the child’s health record, and vaccination schedule. Conclusion: Unveiling situations that influence the work of community health agents is essential for continuing education, as this favors assumptions applicable to daily work with resoluteness in child health.
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Silva ABDS, Araújo ACDM, Frias PGD, Vilela MBR, Bonfim CVD. Auto-Regressive Integrated Moving Average Model (ARIMA): conceptual and methodological aspects and applicability in infant mortality. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract This reflective theoretical article, aims to discuss conceptual and methodological aspects about the applications of time series modeling, in particular, the Integrated Auto-regressive Moving Average model and its applicability in infant mortality. This modeling makes it possible to predict future values using past data, outlining and estimating possible scenarios of the health event, highlighting its magnitude. Due to the persistence of infant mortality as a public health problem, the applicability of this method is useful in the timely and systematic management of child health indicators, in addition to being a method with low operating cost, which in contexts of cost reduction in public healthcare services, becomes a potential management tool. However, there are still gaps in the use of statistical methods in the decision-making and policy-making process in public healthcare, such as the modeling in question. These are methodological (robust statistics), institutional (outdated information systems) and cultural obstacles (devaluation of the data produced, mainly at the local level).
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Broday GA, Kluthcovsky ACGC. INFANT MORTALITY AND FAMILY HEALTH STRATEGY IN THE 3RD HEALTH REGIONAL OF PARANÁ, FROM 2005 TO 2016. ACTA ACUST UNITED AC 2021; 40:e2020122. [PMID: 34008793 PMCID: PMC8240620 DOI: 10.1590/1984-0462/2022/40/2020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/06/2020] [Indexed: 08/19/2023]
Abstract
Objective: To analyze the temporal trend in infant mortality and in populational coverage by the Family Health Strategy and associated factors with infant mortality in the municipalities of the 3rd Health Regional of Paraná, Southern Brazil. Methods: Ecological time series study, with data from the Mortality Information System (Sistema de Informação Sobre Mortalidade - SIM), the Live Birth Information System (Sistema de Informação Sobre Nascidos Vivos - SINASC) and the Support Room for Strategic Management (Sala de Apoio à Gestão Estratégica - SAGE), from 2005 to 2016. Trends were calculated using polynomial regression. The associated factors with infant mortality were maternal, perinatal and obstetric variables. The significance level adopted was 5%. Results: Between 2005 and 2016, there were 115,796 births and 1,575 deaths of children under 1 year of age. Considering the municipalities together, the populational coverage by the Family Health Strategy went from 43.8% in 2005 to 66.4% in 2016 and the infant mortality from 17.1/1,000 live births in 2005 to 10.7/1,000 live births in 2016. The trend over time of populational coverage by the Family Health Strategy was crescent and of infant mortality was decrescent, for most municipalities. The factors associated with greater chances of death in children under 1 year of age were preterm gestational age (Odds Ratio - OR=15.05; 95% confidence interval - 95CI% 13.54-16.72), low birth weight (OR=15.14; 95%CI 13.61-16.84), multiple gestation (OR=4.51; 95%CI 3.74-5.45) and mother with up to 7 years of study (OR=1.93; 95%CI 1.74-2.14). Conclusions: Crescent trend in coverage by the Family Health Strategy was accompanied by a decrescent trend in infant mortality. The results can be a source of information for the strengthening of mother-child health actions, considering local and regional specificities.
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Guinsburg R, Sanudo A, Kiffer CRV, Marinonio ASS, Costa-Nobre DT, Areco KN, Kawakami MD, Miyoshi MH, Bandiera-Paiva P, Balda RDCX, Konstantyner T, Morais LC, Freitas RM, Teixeira ML, Waldvogel B, Almeida MFB. Annual trend of neonatal mortality and its underlying causes: population-based study - São Paulo State, Brazil, 2004-2013. BMC Pediatr 2021; 21:54. [PMID: 33499817 PMCID: PMC7836582 DOI: 10.1186/s12887-021-02511-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Population-based studies analyzing neonatal deaths in middle-income countries may contribute to design interventions to achieve the Sustainable Development Goals, established by United Nations. This study goal is to analyze the annual trend of neonatal mortality in São Paulo State, Brazil, over a 10-year period and its underlying causes and to identify maternal and neonatal characteristics at birth associated with neonatal mortality. METHOD A population-based study of births and deaths from 0 to 27 days between 2004 and 2013 in São Paulo State, Brazil, was performed. The annual trend of neonatal mortality rate according to gestational age was analyzed by Poisson or by Negative Binomial Regression models. Basic causes of neonatal death were classified according to ICD-10. Association of maternal demographic variables (block 1), prenatal and delivery care variables (block 2), and neonatal characteristics at birth (block 3) with neonatal mortality was evaluated by Poisson regression analysis adjusted by year of birth. RESULTS Among 6,056,883 live births in São Paulo State during the study period, 48,309 died from 0 to 27 days (neonatal mortality rate: 8.0/1,000 live births). For the whole group and for infants with gestational age 22-27, 28-31, 32-36, 37-41 and ≥ 42 weeks, reduction of neonatal mortality rate was, respectively, 18 %, 15 %, 38 %, 53 %, 31 %, and 58 %. Median time until 50 % of deaths occurred was 3 days. Main basic causes of death were respiratory disorders (25 %), malformations (20 %), infections (17 %), and perinatal asphyxia (7 %). Variables independently associated with neonatal deaths were maternal schooling, prenatal care, parity, newborn sex, 1st minute Apgar, and malformations. Cesarean delivery, compared to vaginal, was protective against neonatal mortality for infants at 22-31 weeks, but it was a risk factor for those with 32-41 weeks. CONCLUSIONS Despite the significant decrease in neonatal mortality rate over the 10-year period in São Paulo State, improved access to qualified health care is needed in order to avoid preventable neonatal deaths and increase survival of infants that need more complex levels of assistance.
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Affiliation(s)
- Ruth Guinsburg
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil.
| | - Adriana Sanudo
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Carlos Roberto V Kiffer
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Ana Sílvia S Marinonio
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Daniela T Costa-Nobre
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Kelsy N Areco
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Mandira D Kawakami
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Milton H Miyoshi
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Paulo Bandiera-Paiva
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Rita de Cássia X Balda
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Tulio Konstantyner
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
| | - Liliam Cc Morais
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | - Rosa Mv Freitas
- Fundação Sistema Estadual de Análise de Dados, São Paulo, Brazil
| | | | | | - Maria Fernanda B Almeida
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Rua Vicente Felix 77 apto 09, CEP 01410-020, São Paulo, SP, Brazil
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