Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil
Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil
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DOI：
10.1590/s1518-8787.2017051006391
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发表时间：
2017-01-01
期刊：
影响因子：
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通讯作者：
Souza Jr, Paulo Roberto Borges de
中科院分区：
文献类型：
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作者：
Leal, Maria do Carmo;Bittencourt, Sonia Duarte de Azevedo;Souza Jr, Paulo Roberto Borges de
目的：本研究的目的是确定社会和人口的决定因素，除了生殖健康和使用卫生服务的决定因素，与婴儿死亡率在巴西北部，东北部和东南部地区的中小城市。这是一项病例对照研究，其中有803例一岁以下儿童死亡病例和1 969例活产婴儿（对照），其母亲在2008年居住在选定的城市。病例和对照名单摘自Sistema de Informacao sobre Mortalidade（SIM-死亡信息系统）和Sistema de Informacao sobre Nascidos Vivos（SINASC-活产信息系统），并补充了“死亡和出生主动搜索”研究获得的数据。数据收集在家庭使用半结构式问卷，并进行了分析，使用多元logistic regression.RESULTS：最终模型表明，以下项目是积极的，显着相关的婴儿死亡率：从事农业的家庭，母亲有胎儿和婴儿丢失史，没有产前检查或产前检查不足，在产前期间与妇产医院无关。我们已经观察到显着的相互作用，以解释发生的婴儿死亡率之间的种族和社会经济评分和高风险怀孕和朝圣分娩之间的结论：过多的家庭分娩和朝圣分娩表明缺陷的产妇保健和缺乏门诊和医院护理水平之间的合作。这项研究强调，需要对保健网络进行综合管理，利用城市的能力，高质量地满足怀孕、分娩和生育的需要。
OBJECTIVE: This study aims to identify the social and demographic determinants, in addition to the determinants of reproductive health and use of health services, associated with infant mortality in small and medium-sized cities of the North, Northeast and Southeast regions of Brazil.METHODS: This is a case-control study with 803 cases of death of children under one year and 1,969 live births (controls), whose mothers lived in the selected cities in 2008. The lists of the names of cases and controls were extracted from the Sistema de Informacao sobre Mortalidade (SIM-Mortality Information System) and the Sistema de Informacao sobre Nascidos Vivos (SINASC-Live Birth Information System) and supplemented by data obtained by the research of "active search of death and birth". Data was collected in the household using a semi-structured questionnaire, and the analysis was carried out using multiple logistic regression.RESULTS: The final model indicates that the following items are positively and significantly associated with infant mortality: family working in agriculture, mother having a history of fetal and infant losses, no prenatal or inadequate prenatal, and not being associated to the maternity hospital during the prenatal period. We have observed significant interactions to explain the occurrence of infant mortality between race and socioeconomic score and between high-risk pregnancy and pilgrimage for childbirth.CONCLUSIONS: The excessive number of home deliveries and pilgrimage for childbirth indicates flaws in the line of maternity care and a lack of collaboration between the levels of outpatient and hospital care. The study reinforces the need for an integrated management of the health care networks, leveraging the capabilities of cities in meeting the needs of pregnancy, delivery and birth with quality.