OBJECTIVE:To analyze the risk factors associated with neonatal deaths among children with low birth weight.
METHODS:A cohort study was carried out on live births weighing between 500 g and 2,499 g from single pregnancies without anencephaly in Recife
RESULTS:After adjusting the variables through multivariate logistic regression, the factors from the distal level that remained signifi cantly associated with neonatal death were: cohabitation by the parents, number of live births and type of maternity hospital. At the intermediate level, the factors were: number of prenatal consultations, complexity of the maternity hospital and type of delivery. At the proximal level, the factors were: sex, gestational age, birth weight, Apgar score and presence of congenital malformation.
CONCLUSIONS:The main factors associated with neonatal mortality among low weight live births are related to prenatal and postnatal care. Such factors are reducible through health sector actions.
in Recife, death by cervix cancer are more frequent among adult, black, single, housewives, women living in poor neighborhoods and attended to at national health system hospitals, with differences in death risk among age ranges and living place.
Foi realizado estudo caso-controle com o objetivo de analisar os fatores de risco associados à mortalidade perinatal no Recife, Pernambuco, Brasil, 2003, de acordo com um modelo hierarquizado de determinantes proximais, intermediários e distais. Foram considerados casos os óbitos perinatais com peso ao nascer igual ou superior a 500g, de gravidez única e não portador de anencefalia. Os controles foram os nascidos vivos entre 26 de dezembro de 2002 e 31 de dezembro de 2003, que não evoluíram para o óbito até seis dias completos de vida, com as mesmas características dos casos. Com o linkage entre o banco de dados do Sistema de Informações sobre Nascidos Vivos e o de óbitos perinatais, obtiveram-se 403 casos e 1.612 controles. Após regressão logística múltipla, com a inclusão de variáveis dos três níveis de determinação, constituíram-se fatores de risco para mortalidade perinatal: a prematuridade (OR = 18,23), o baixo peso ao nascer (OR = 4,90), a idade da mãe igual a ou maior que 35 anos (OR = 1,97), o nascimento em hospitais participantes do Sistema Único de Saúde (OR = 1,93) e a escolaridade da mãe inferior a quatro anos de estudo (OR = 1,78).
Objective: To analyze the temporal trend in infant mortality in the city of Recife, state of Pernambuco, Brazil and evaluate the contribution of death surveillance as an instrument for improving vital statistics and action planning. Methods: Infant, neonatal, and post-neonatal mortality rates were calculated from 1980 to 2012. An exponential regression model was used for trend analysis. A study on the variables, the basic and associated causes of death certificates, and avoidability was conducted to evaluate the contribution of infant death surveillance. Results: The trend in infant mortality rate and its age components was shown to be decreasing. After research on infant death surveillance, no death certificate variable remained incomplete, and the underlying cause of death was better determined in 52% of deaths. Almost 80% of deaths were classified as preventable, and 51.3% were classified as reducible by appropriate care provided to women during their pregnancy. Conclusion: Infant mortality presented a decreasing trend, and infant death surveillance contributed to improve vital statistics, which are essential for maternal-infant health planning actions.
ResumoObjetivo: Analisar a tendência temporal da mortalidade infantil na cidade de Recife, Pernambuco, Brasil e avaliar a contribuição da vigilância do óbito como instrumento para aprimoramento das estatísticas vitais e planejamento de ações. Métodos: Foram calculados os coeficientes de mortalidade infantil, neonatal e pós-neonatal para o período de 1980 a 2012. Utilizou-se o modelo de regressão exponencial para análise da tendência. Para avaliar a contribuição da vigilância do óbito infantil foi realizado um estudo sobre as variáveis, causas básicas e associadas da Declaração de Óbito, e da evitabilidade. Resultados: A tendência do coeficiente de mortalidade infantil e seus componentes etários foram decrescentes. Após a investigação da vigilância do óbito infantil nenhuma variável da Declaração de Óbito ficou incompleta e, em 52% dos óbitos, a causa básica foi melhor definida. Quase 80% dos óbitos foram classificados como evitáveis e 51,3% reduzíveis por adequada atenção à mulher na gestação. Conclusão: A mortalidade infantil apresentou tendência decrescente e a vigilância do óbito infantil contribuiu para aprimorar as estatísticas vitais, fundamental para o planejamento das ações de saúde materno-infantil.
The objective of this study was to show infant mortality differentials in different areas of Recife, analyzing the relationship between living conditions and mortality risk. An ecological study design compared infant mortality coefficients in 1995 with living conditions indicators obtained from the 1991 National Demographic Census. Information on the 770 infant deaths and 27,965 live births were collected from death and birth certificates. Information on water supply, sanitation, garbage collection, literacy, schooling, income, and overcrowding were used to establish a compound indicator for living conditions, constructed through factor analysis. The neighborhoods were then ordered according to the level of living conditions and grouped in 4 clusters, through hierarchical cluster analysis. Infant, neonatal, and post-neonatal mortality coefficients were 23.94, 17.66, and 6.28, respectively, for cluster I; and 32.04, 20.24, and 11.80 for cluster IV. In general, an inverse relationship was found between infant mortality and living conditions in clusters from Recife, revealing inequalities that are disguised when coefficients are expressed as averages for the entire city.
In an ecological study based on the 18 microregions that form the city of Recife, the capital of the Brazilian state of Pernambuco, associations between socio-demographic, environmental and reservoir factors and the incidence of leptospirosis in the city were investigated. Incidence over a 5-year period (2001-2005) and 14 variables were analysed, using central trend and dispersion measurements, Pearson's correlation and multiple linear regression. Variables relating to education, income, housing type, sewage system, rubbish collection and hydrographic factors were found to be significantly correlated with leptospirosis incidence (P<0.05 for each). Just two variables - the proportion of heads of households with incomes less than or equal to the legal minimum (U.S.$83.55/month), and the proportion of households from which rubbish was dumped in skips, lakes, rivers or the sea or on vacant land - explained 60% (P=0.017) of the differences in disease risk observed between the various areas of the city.
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