O trabalho avalia a qualidade da informação do Sistema de Informações sobre Nascidos Vivos (SINASC) quanto à clareza metodológica da documentação, completitude do preenchimento e consistência para o país, grandes regiões e Unidades da Federação no ano 2002. Adicionalmente, correlaciona-se a completitude com indicadores de pobreza, desigualdade e recursos humanos. As variáveis analisadas são: raça/cor do recém-nascido, instrução materna, estado civil materno, ocupação materna, idade materna, consulta pré-natal, filhos nascidos vivos, filhos nascidos mortos e peso do bebê ao nascer. Mostrou-se que o SINASC possui boa completitude de preenchimento e consistência da informação na maioria das variáveis; porém, observaram-se sérios problemas de qualidade nas variáveis sobre filhos anteriores e ocupação. Quanto à raça, encontraram-se tanto problemas metodológicos de definição da variável como incompletitude do preenchimento no Distrito Federal, São Paulo, Bahia e Sergipe, Brasil. Por intermédio da análise estatística, confirmou-se a relação significativa entre completitude e indicadores de pobreza e desigualdade. Espera-se que melhorias da qualidade da informação do SINASC possam contribuir para que esse sistema seja uma robusta fonte de dados epidemiológicos que permita identificar fatores de risco e condicionantes sócio-econômicos.

ObjectiveTo analyze social inequalities and inequalities in access to and utilization of health care services according to skin color in a representative sample of postpartum women receiving hospital childbirth care. Methods A cross-sectional study was carried out in a sample of 9,633 postpartum women, of whom 5,002 were white (51.9%), 2,796 mulatto (29.0%), and 1,835 black skin color (19.0%), seen in public maternity hospitals, hospitals contracted out by the Unified National Health System, and private hospitals in the period 1999-2001. Data were collected from medical records and through interviews with the mothers in the immediate postpartum period using standardized questionnaires. Statistical analyses were performed using χ² tests to assess homogeneity of proportions and Student's t-test for comparison of measures. The analysis was stratified by maternal schooling. Results A persistent unfavorable situation was seen for mulatto and black women as compared to white women. Mulatto and black women had the highest rates of adolescent mothers, low schooling, unpaid occupation, and not having a partner. History of physical violence, smoking, attempts to interrupt pregnancy, and visits to several hospitals before being admitted were more frequent among black women, followed by mulatto and then white women of low schooling. High schooling group of women showed better indicators but the same pattern was seen. This variability is also seen in the opposite direction in terms of the level of satisfaction with prenatal and childbirth care. Conclusions It was distinguished two forms of discrimination, by educational level and skin color, in care delivered by health services to postpartum women in Rio de Janeiro.

Este estudo tem como objetivo avaliar a qualidade da informação sócio-econômica e demográfica, por Unidade Federada (UF) do Sistema de Informações sobre Mortalidade (SIM). A finalidade é reconhecer sua potencialidade no monitoramento da desigualdade da mortalidade infantil no Brasil. Utilizaram-se como indicadores de qualidade a acessibilidade, oportunidade, claridade metodológica, incompletitude e consistência. Selecionaram-se as variáveis: raça da criança, peso ao nascer, semanas de gestação, assistência médica, parturição, escolaridade, idade e ocupação materna. Foram revisadas a documentação do SIM e a literatura sobre indicadores associados com a mortalidade infantil, estimaram-se proporções de incompletitude, por região e UF, e identificaram-se fatores que a influenciam a partir de regressões logísticas. Constatou-se que, apesar da acessibilidade da base de dados e da relevância de suas variáveis, o SIM possui sérios problemas de qualidade que incluem instruções confusas no manual para informação ignorada, má classificação da ocupação materna, ausência de identificação sobre a raça do informante e elevada proporção de incompletitude da informação. Conclui-se que o SIM não é uma fonte de dados adequada para monitorar, avaliar e planejar ações sobre desigualdade em saúde infantil.

The Kotelchuck index (KI) was modified and used to evaluate prenatal care provided in the City of Rio de Janeiro, Brazil, in a sample of 9,920 post-partum women following singleton deliveries. Ordinal logistic regression (OLR) and multivariate linear regression (LMR) were used to estimate the importance of demographic, psychosocial, and obstetric factors for modified KI and the effects on birth weight (BW), respectively. Only 38.5% of the sample was classified as having received adequate or intensive prenatal care. After adjusting for other predictors, the explanatory variables for KI were: mother's schooling, living with the newborn's father, attempted abortion, diabetes mellitus, satisfaction with pregnancy, skin color, parity, age, and place of residence. BW was associated with the modified KI, even after controlling for socio-demographic, behavioral, and biological variables. Adequate utilization of prenatal care in the City of Rio de Janeiro contributed to the prevention of low BW, and the mothers who used prenatal services less presented worse conditions in terms of socioeconomic status, schooling, family support, and obstetric risk.

Background and Purpose-We describe the trends in stroke mortality in Brazil during 3 decades and investigate their differences according to regional disparities, sex, and age distributions. Methods-Official data on mortality and population estimates were retrieved to calculate standardized mortality rates (with the 1980 Brazilian population as a reference) in 6 age strata and in the 5 political regions for the initial period (3 first years) of the 1980, 1990, and 2000 decades. Data were corrected for undefined causes of death. The Poisson model was used to estimate risk reduction during the 3 decades and to study the interaction between those rates and sex, age strata, and regions. Results-The stroke standardized mortality rate decreased consistently in the last 20 years, from 68.2 to 40.9 per 100 000 habitants. This reduction paralleled a decrease in total cardiovascular mortality rates in the same period, from 208.2 to 126.1 per 100 000 habitants. The reduction in stroke standardized mortality rate was detected in men and women and in all age strata. The reduction was evident in all geopolitical regions of the country, with the wealthiest regions' exhibiting higher initial rates and more marked standardized mortality rate reductions.

To evaluate the occurrence of birth defects in the city of Rio de Janeiro, Brazil, using the Live Birth Information System (SINASC), we performed a cross-sectional study on all live newborns with birth defects from January 1, 2000, to December 31, 2004. The variables referred to birth defects (presence and system affected), type of health service, mothers, gestations, live births, and deliveries. Prevalence of birth defects was 83/10,000 live births. The most frequent birth defects involved the musculoskeletal system, central nervous system, cleft lip and palate, and chromosomal anomalies. The majority of cases were born in public (municipal) and private maternity hospitals, with the highest prevalence in the Fernandes Figueira Insitute, Oswaldo Cruz Foundation. Older women and those with less schooling had more live born infants with birth defects. The proportion of reports with missing information was high, reaching 21% in some institutions. Wider dissemination of SINASC data on birth defects should be encouraged. Reliability studies are recommended for better use of these reports.

Abstract

Cardiovascular disease standardized mortality rates consistently decreased in Brazil during the study period. The reduction is apparently related to indices of increasing social development. Despite these encouraging findings, a gradual increase in the deaths from cardiovascular disease is expected in the next decades, and additional efforts in prevention are needed.