Acurácia dos indicadores de risco do Programa de Defesa da Vida dos Lactentes em região do Estado de São Paulo, Brasil

Abstract

O Programa de Desfesa da Vida dos Lactentes da Secretaria de Higiene e Saúde do Munícipio de Bauru tem um critério diagnóstico para a inclusão de recém-nascidos dentro do programa. Este critério é formado pela combinação de 11 indicadores clínicos e sociais de risco à mortalidade infantil de fácil obtenção no momento do parto. Decidiu-se propor um critério diagnóstico alternativo, a partir dos mesmos indicadores clínicos e sociais, com maior sensibilidade para a mesma proporção de crianças matriculadas no Programa. Os dados hospitalares foram coletados no período de 11 de maio de 1986 a 10 de novembro de 1987. A mortalidade compreende o período entre 7 dias e 6 meses, que é o período de seguimento das crianças pelo Programa. Calculou-se para cada indicador o risco relativo bruto numa análise univariada e o risco relativo ajustado pela técnica de regressão logística. Criou-se um sistema de pontuação baseado na somatória dos excessos de risco de cada indicador.

Infant mortality due to perinatal causes in Brazil: trends, regional patterns and possible interventions

“…These data were not adjusted for socioeconomic factors, and such adjustment is important because many teenage mothers come from poor families and poverty may confound the results. Results of four studies that took into account socioeconomic confounders 13,16,17,47 showed no evidence that children of teenage mothers have an increased risk of mortality, a finding which is in agreement with a recent international review. 48 Infants born to very young mothers (say, under 15 years) may be at higher risk but they are relatively few compared to those of mothers aged 18-20 years, who show no greater risk than women from other age groups.…”

“…[13][14][15][16][17] Such adjustment is essential since mothers with fewer attendances also tend to present other social and biological risk factors. Most studies investigated early neonatal mortality -rather than mortality due to perinatal causes -but these are largely overlapping.…”

Mineração de dados e características da mortalidade infantil

“…Os estudos sobre fatores de risco associados à mortalidade fetal e infantil no Brasil, em áreas da Região Metropolitana de São Paulo, bem como em outras localidades, com suas propostas de instrumentos preditivos e recomendações sobre assistência materno-infantil já relatavam características semelhantes aos encontrados pelo DM 4,24,25,26,27,28,29,30 .…”

The relationship between the use of primary health care and infant health status at 12 months in a Brazilian community

“…Then, to determine whether the relationship between these two variables persisted after adjusting for other predictors, a logistic regression model was examined in which receiving continuous or fragmented primary health care was forced in. All variables that were related to health status (p≤0.30) and which have shown a relationship with health status in previous studies [9][10][11][12][13][14] , including persons per room, mother's age, mother's employment, duration of the appointment and hospitalization during the first year were considered for this model. Finally, the predictors of continuous/fragmented care were identified in a separate regression model using the variables related to health care or health status, which were persons per room, income per capita, urbanizedslum residence site, mother's age, mother's education, mother's employment status, public-private setting for care, length of appointments, and hospitalization during the first year of life.…”