Este artigo está publicado em acesso aberto (Open Access) sob a licença Creative Commons, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho seja corretamente citado.

Este artigo está publicado em acesso aberto (Open Access) sob a licença Creative Commons, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho seja corretamente citado. Doença de Chagas: serviço de referência e epidemiologiaChagas disease: a reference and epidemiology center Enfermedad de Chagas: servicio de referencia y epidemiologia

Introduction: Tetanus has a worldwide distribution and high lethality. The goal of this study was to characterize the tetanus cases confirmed in Pernambuco and identify factors associated with death in these patients. Methods: Cross-sectional, with internal comparison groups. For data analysis we used the chi-square test and Pearson estimated the odds ratios and their respective confidence intervals at 95%. Multivariate analysis was applied to multiple logistic regression Results: The incidence of tetanus ranged between 0.65 and 2.79 cases per 100,000 inhabitants with higher involvement of adults, male and city population. Only 13.8% had received the vaccine and 23.4% received it as prophylaxis. The average mortality rate was 20.4%. In multivariate analysis, presented neck stiffness as a symptom (p = 0.029), which was associated with increased mortality. Conclusion: There is a need for greater investment in the prevention of the disease, both in immunization coverage and in the application of prophylaxis. Despite the hospitalization guarantee with proper care, there was an increase in tetanus mortality, suggesting that more specific studies should be conducted to investigate what may have influenced this change. Special attention should be offered to cases that presented neck stiffness as a symptom, because these groups have a higher chance of progressing to death.

Objectives: to analyze the risks of deaths in the first 24 hours of life and their preventable causes. Methods: cross-sectional study carried out in Pernambuco, Northeast of Brazil, between 2000-2019, with mortality and live birth data. The avoidability was analyzed through the Brazilian List of Avoidable Causes of Deaths due to Interventions of the Unified Health System. For the statistical analyses, Pearson’s chi-squared test and relative and attributable risks were used. Results: 13,601 deaths were registered, of which 10,497 (77.19%) were from preventable causes. Of the total, 5,513 (40.53%) were reducible through adequate care for women during pregnancy. The lower the gestational age, birth weight and education level, the higher the relative and attributable risk of death in the first 24 hours of life. Conclusions: most of the deaths were considered avoidable and with high relative and attributable risks. These early deaths suggest care failures and the need to reinforce prevention and treatment measures.

RESUMO Objetivos: analisar os riscos de mortes nas primeiras 24 horas de vida e suas causas evitáveis. Métodos: estudo transversal realizado em Pernambuco, Nordeste do Brasil, entre 2000-2019, com dados de mortalidade e nascidos vivos. Analisou-se a evitabilidade pela Lista Brasileira de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde. Para as análises estatísticas, utilizou-se o teste de Qui-quadrado de Pearson e os riscos relativo e atribuível. Resultados: registraram-se 13.601 óbitos, sendo 10.497 (77,19%) por causas evitáveis. Do total, 5.513 (40,53%) eram reduzíveis por adequada atenção à mulher na gestação. Quanto menor a idade gestacional, o peso ao nascer e a escolaridade, maior o risco relativo e atribuível ao óbito nas primeiras 24 horas de vida. Conclusões: a maior parte dos óbitos foram considerados evitáveis e com elevados riscos relativo e atribuível. Esses óbitos precoces sugerem falhas assistenciais e a necessidade de reforçar as medidas de prevenção e tratamento.

I n f l u ê n c i a s s o c i a i s , p o l í t i c a s , i n s t i t u c i o n a i s e i d e o l ó g i c a s 3

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This is an ecological study analysing spatial patterns of the total mortality over the first 24 hours of life and that due to preventable causes using data from the mortality information system (SIM) and live birth information system (SINASC) based on the municipalities of Pernambuco State, Brazil. The total mortality rates over the first 24 hours and that due to preventable causes were calculated for each municipality for the decades of 2000 to 2009 and for 2010 to 2019 to enable a comparison of the spatial patterns with spatial scan statistic used to identify clusters. Over the first 24 hours of life, a total of 13,571 deaths were reported, out of which 10,476 (77.2%) were preventable. The total mortality rate over the first 24 hours of life decreased from 5.5 in the 2000- 2009 period to 3.7 per 1000 live births in the following decade: a reduction of 32.7%, while the mortality rate due to preventable causes decreased from 4.4 to 2.8 per 1000 live births, a reduction of 36.7%. In the first decade, spatial exploratory analysis found three mortality rate clusters encompassing 56 municipalities over the first 24 hours of life. With respect to preventable causes over the first 24 hours of life, two mortality rate clusters were identified encompassing 41 municipalities. Risk areas for mortality over the first 24 hours of life were detected through spatial scan statistic. This method, directed towards uncovering the geographical distribution of deaths of very premature infants, can act as a tool for identifying priority areas to guide healthcare interventions.