Effect Of Quality of Care on Preventable Perinatal Mortality

Abstract

This study assessed and quantified the effect of quality of care on death preventability, independent of social and biological variables. One hundred and eighty-one avoidable perinatal deaths (cases) were compared to 341 non-avoidable ones (controls). Judgement criteria on death preventability were based predominantly on compliance with explicit hospital medical care standards, determined by peer review. The overall perinatal mortality rate was 24.8 per 1000 births and could be reduced by 35% if all avoidable perinatal deaths were prevented. Sixteen per cent of the deaths presented structural and 31.2% process deficiencies; both predominated among avoidable perinatal deaths (35.4% vs 5.3%, p < 0.000; and 79.3% vs 5.9%, p < 0.000, respectively). Structural deficiencies increased the risk of an avoidable perinatal death eleven-fold (95% confidence interval (CI) 4.1, 26.9; p < 0.001) and process deficiencies eighty-eightfold (95% CI 37.2, 204.5, p < 0.001), after controlling for confounders. The strength of the association between quality of care and preventable perinatal mortality was estimated.

Medical risk factors in perinatal mortality in Kuwait: a case-controlled study from Al-jahra district

“…Those`defaulters' had a three-fold increased risk compared with`non-defaulters'. This ® nding is similar to others from elsewhere (Ward et al, 1995;Salinas et al, 1997). When comparing women who had one to three visits with those who had more than three visits, the latter group had a higher risk for PNM than the former group.…”

Mortalidade neonatal no Município de São Paulo: influência do peso ao nascer e de fatores sócio-demográficos e assistenciais

“…entre condições de vida e de saúde, e acesso e qualidade da atenção nos serviços de saú-de, têm sido consideradas particularmente importantes na determinação dos níveis de mortalidade neonatal em muitos países [7][8][9][10] . Os principais fatores de risco para mortalidade neonatal em São Paulo são semelhantes àqueles encontrados nos mais diversos contextos e podem ser classificados em quatro categorias principais: condições biológicas do recém-nascido, características maternas, condições socioeconômicas e qualidade da atenção.…”

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“…La fragilidad de los servicios de salud en diferenciar la gravedad de las enfermedades, las dificultades de acceso para obtener los cuidados necesarios y las responsabilidades obstétrica y pediátrica son generalmente identificados como factores que contribuyen a las muertes infantiles en el período (28)(29)(30) neonatal . Ya en 1982, UNICEF propuso un modelo denominado GOBI (Growth monitoring of young children, Oral rehydration therapy, promotion of Breast feeding, and Immunization), de bajo costo, de tecnología simple y accesible, modelo apropiado y prioritario para ser implantado en los países pobres.…”