Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: mothers' health care-seeking behaviors during their infants' fatal illness
Circumstances of post-neonatal deaths in Ceara, Northeast Brazil: mothers' health care-seeking behaviors during their infants' fatal illness
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DOI：
10.1016/s0277-9536(00)00100-3
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发表时间：
2000-12-01
影响因子：
5.4
通讯作者：
Ascherio, A
中科院分区：
文献类型：
--
作者：
de Souza, ACT;Peterson, KE;Ascherio, A
推广口服体液补充疗法以治疗呼吸道疾病和卫生组织的急性呼吸道感染病例管理战略（API），大大降低了婴儿死亡率，但这两种情况仍然是大多数发展中国家婴儿死亡的主要原因。查明造成这些死亡的因素可能有助于减少可预防原因造成的婴儿死亡率。为了深入了解可能导致婴儿死亡的情况以及产妇和保健服务因素，我们采用了死因推断的方法，对巴西东北部塞阿拉州11个城市在过去12个月（1995年6月至1996年5月）内死亡的所有婴儿的母亲进行了访谈。我们的研究结果显示，三分之一的死亡发生在医院，三分之二发生在家中。然而，几乎所有在家中死亡的婴儿都接受过医生的一次或多次检查，其中36%的婴儿在导致死亡的疾病发作期间住院。对于这些儿童中的大多数（85%）来说，死亡原因是腹泻或急性呼吸道感染，如果及时采取适当的治疗，死亡很可能是可以避免的。单独或结合起来似乎造成大多数死亡的三大类因素是：代表父母寻求医疗护理的延误、母亲报告的医疗干预无效以及向当天到达医院太晚而无法安排就诊的儿童提供医疗护理的延误。我们的研究结果表明，政府进一步降低塞阿拉婴儿死亡率的努力应侧重于健康教育干预措施，解决家庭护理质量，认识到严重性和危险的迹象以及寻求及时医疗护理的重要性;并提高社区卫生中心和医院提供的护理质量。可能提高婴儿存活机会的措施包括：确保被送到保健中心或医院的幼儿在感染后有可能危及生命的症状时能及时得到医疗咨询，向母亲提供健康教育，使其了解出院后需要继续接受家庭护理，如果儿童没有康复，应返回医疗机构，并且他们可以获得医院医生开的药。利用社区卫生工作者（现已纳入家庭医疗方案卫生小组）提供卫生教育、监督家庭护理、将母亲转诊到保健中心并便利她们就医，可以获得进一步的好处。(C)2000爱思唯尔科技有限公司版权所有。
Promotion of oral rehydration therapy (ORT) for the treatment of diarrheal diseases and the WHO case management strategy for acute respiratory infections (API) have contributed to significant reductions in infant mortality, but these two conditions remain the leading causes of infant deaths in most developing countries. Identification of the factors contributing to these deaths may contribute to reduce infant mortality from preventable causes. To gain insight into the circumstances and maternal and health services factors that may contribute to infant deaths we used a verbal autopsy method to interview mothers of all infants who died during the previous 12 months (June 1995-May 1996) in 11 municipalities in the State of Ceara, Northeast Brazil. Our results revealed that one-third of the deaths occurred in a hospital and two-thirds at home. Almost all the infants who died at home, however, had been examined one or more times by a doctor, and 36% of them had been hospitalized during the disease episode that resulted in death. For most (85%) of these children the causes of death were diarrhea or acute respiratory infection, and it is likely that death could have been averted if appropriate treatment had been initiated promptly. Three major groups of factors that alone or in combination appeared to contribute to most deaths were delays in seeking medical care on behalf of the parents, medical interventions reported as ineffective by mothers and delays in providing medical care to children who arrived at the hospital too late in the day to be scheduled for consultation. Our findings suggest that government efforts to further reduce infant mortality in Ceara should focus on health education interventions that address quality of home care, recognition of signs of severity and danger and importance of seeking timely medical care; and on improving the quality of care provided at community health centers and hospitals. Measures likely to improve infants' chance of survival include: ensuring prompt access to medical consultation for young children brought to health centers or hospitals with potentially life-threatening symptoms related to infections, health education to mothers on the need for continued home care after discharge and to return to the medical care facility if the child does not recover, and that they have access to medicine prescribed by hospital physicians. Further benefits could be obtained by using community health workers, now integrated into the Family Medicine Program (PSF) health teams, to provide health education, supervise home care, refer mothers to health centers and facilitate their access to hospitals. (C) 2000 Elsevier Science Ltd. All rights reserved.