Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil

Abstract

OBJECTIVE This study aims to identify the social and demographic determinants, in addition to the determinants of reproductive health and use of health services, associated with infant mortality in small and medium-sized cities of the North, Northeast and Southeast regions of Brazil.METHODS This is a case-control study with 803 cases of death of children under one year and 1,969 live births (controls), whose mothers lived in the selected cities in 2008. The lists of the names of cases and controls were extracted from the Sistema de Informação sobre Mortalidade (SIM – Mortality Information System) and the Sistema de Informação sobre Nascidos Vivos (SINASC – Live Birth Information System) and supplemented by data obtained by the research of “active search of death and birth”. Data was collected in the household using a semi-structured questionnaire, and the analysis was carried out using multiple logistic regression.RESULTS The final model indicates that the following items are positively and significantly associated with infant mortality: family working in agriculture, mother having a history of fetal and infant losses, no prenatal or inadequate prenatal, and not being associated to the maternity hospital during the prenatal period. We have observed significant interactions to explain the occurrence of infant mortality between race and socioeconomic score and between high-risk pregnancy and pilgrimage for childbirth.CONCLUSIONS The excessive number of home deliveries and pilgrimage for childbirth indicates flaws in the line of maternity care and a lack of collaboration between the levels of outpatient and hospital care. The study reinforces the need for an integrated management of the health care networks, leveraging the capabilities of cities in meeting the needs of pregnancy, delivery and birth with quality.

Inequalities in Infant Mortality in Brazil at Subnational Levels in Brazil, 1990 to 2015

“…Despite the marked reduction of inequalities in various indicators of maternal and child health and the remarkable expansion of coverage of prenatal care and hospital delivery after the implementation of the Uni ed Health System [32], additional efforts aimed at improving access to good quality childbirth care are crucial. It is necessary to integrate actions developed in primary care to the services of childbirth care, to potentiate the municipal capacities in providing adequate assistance to maternal and delivery care [33].…”

Intraurban differentials of perinatal mortality: modeling for identifying priority areas

“…19 Similarly, it is possible to signal areas with higher concentrations of deaths and indicate the presence of risk factors in specific localities, similar to the described in the literature. 20 In Recife, the quality of the data on vital information considered reliable accompanied the improvement of the information systems of continuous record in Brazil, enabling to the public management a broad view of the locations with higher risks for mortality and collaborating for its combating and the reduction of inequalities. 21 National and international research that value the use of spatial analysis techniques, signaling urban agglomerates without maps of points or of rates with a need of priority interventions are widely used due to their importance in subsidizing the management of health actions.…”

Infant mortality: surveillance, epidemiological characteristics and spatial distribution pattern in Recife, Brazil

“…The analysis of spatial data of the infant deaths investigated allowed the identification of a heterogeneous pattern of occurrence of mortality in children under one year old, with a higher concentration of cases in 12 out of 94 neighborhood sin Recife, with similar spatial clusters for neonatal and post-neonatal deaths. The detection of these areas reveals particularities in the distribution of deaths that may reflect inequalities in health and social conditions (Rodrigues et al, 2014;Nucci, Souccar, & Castilho, 2016;Faria, 2016;Leal, Bittencourt, Torres, Niquini, & Souza Jr, 2017) and indicates locations with greater need for investment in public policies directed at the health of women and children.…”

“…The punctual analysis of deaths by characterizing the territory in detail reveals areas with a higher concentration of deaths and indicates the presence of risk factors in certain localities (MacQuillan et al, 2017). Studies on the spatial analysis of infant mortality point to the usefulness of these approaches for the elaboration and development of policies aimed at coping with the determinants of these deaths, particularly those related to healthcare (Rodrigues et al, 2014;Faria, 2016;Rodrigues et al, 2016;Venâncio, Tuan, Vaz, & Nascimento, 2016;Leal et al, 2017). Likewise, the characterization of the epidemiological profile of infant deaths is recognized as an important tool for drawing strategies to deal with the problem, in particular, by investigating the events, because it allows a better understanding of the circumstances of their occurrence (Vanderlei & Navarrete, 2013).…”