Infant death surveillance as an indicator of health care system effectiveness - a study conducted in northeastern Brazil

Abstract

ResumoObjetivo: avaliar, a partir do óbito infantil, o acesso e a qualidade da atenção à saúde prestada às crianças no município, durante a doença que levou ao óbito.Métodos: estudo descritivo de corte transversal, censitário, de série de casos de óbitos infantis ocorridos em Bom Conselho, Pernambuco, no período de 1/1/1999 a 31/12/1999, identificados através do Sistema de Informação sobre Mortalidade, unidades de saúde, cartórios, cemitérios, agentes de saúde e parteiras. Os dados foram coletados mediante entrevistas domiciliares e revisão de prontuários, em instrumentos específicos.Resultados: foram investigados 71 dos 72 óbitos identificados, com perda de 1,4%. A maioria (69,4%) ocorreu no período pós-neonatal. Do total, 67,6% aconteceram no domicílio, 77,5% procuraram assistência pelo menos uma vez, sendo as emergências as mais procuradas (65,1%), porém 22,5% não foram levados a nenhum serviço de saúde. A maioria dos serviços de saúde (90,9%) estava a menos de uma hora de distância dos domicílios, 78,5%, localizados no município de residência, e 97% dos atendimentos foram realizados por médicos. Das 88 consultas realizadas, 39,8% terminaram com internamento, e 27,3% foram atendidos e dispensados sem marcação da consulta de retorno, e 84% receberam todas as medicações gratuitamente.Conclusões: através da vigilância dos óbitos, foi possível identificar a precariedade do acesso e da qualidade da atenção prestada às crianças no município. A elevada proporção de óbitos domiciliares sugere problemas no acesso, e a peregrinação de parte das mães aos serviços, durante a doença que provocou a morte dos seus filhos, denunciam a precária organização dos serviços.J Pediatr (Rio J) 2002;78(6):509-16: avaliação de serviços de saúde, avaliação da qualidade dos cuidados de saúde, avaliação de processos e resultados, indicadores de qualidade em assistência à saúde, inquérito domiciliar de óbitos infantis. AbstractObjective: to evaluate the access to and quality of health care administered to infants based on postmortem data.Methods a descriptive cross-sectional census-based study was carried out to assess the infant deaths that occurred in the town of Bom Conselho, state of Pernambuco, between January 1st 1999 and December 31st 1999. Home interviews and inspection of medical records were used for data collection. Deaths were identified by consulting the Mortality Information System, health centers, public notary services, cemeteries, health workers, and midwives.Results: seventy-one of 72 deaths were investigated, with a loss of 1.4%. The majority (69.4%) of deaths occurred in the postneonatal period and 67.6% of them occurred at home. In 77.5% of the cases medical help was sought at least once, most frequently at emergency units (65.1%). However, 22.5% of the patients were not taken to any kind of health care service. Most health care services (90.9%) were less than one hour away from the patient's home, 78.5% were located in the town of residence and 97% of the consultations were carried out by doctors. Of 88 consultations...

Mortalidade infantil: tendência temporal e contribuição da vigilância do óbito

“…This has not always contributed to the correction of failures described in vital statistics, although some informative data were produced. (11,18) Studies related to the quality and filling of sociodemographic, reproductive, and care variables, as well as death causes, showed high incompleteness ratios and an insufficient definition level of causes recorded in death certificates. (6,(19)(20)(21)(22) The quality of data recorded in death certificates depends on access to health services, technologies for diagnosis, and physicians' ability to recognize the dynamics of events that participated in the causal chain of deaths, as well as physicians' commitment to the production of reliable statistics.…”

“…(3,9) In addition to collective and individual activities directly related to care, Brazil has been developing health surveillance actions, such as research on deaths, which may contribute to a better understanding of death determinant chains, especially those that are preventable. (10) Although death surveillance is considered a good indicator of healthcare systems' effectiveness, (11) the Brazilian Ministry of Health made it compulsory only in 2010, aiming at improving the quality of vital information and promoting reflections for workers and managers in the care provided to women and children. (2) The objective of the present study was to analyze temporal trends 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.…”

Fatores de risco para mortalidade infantil em municípios do Estado do Paraná, de 1997 a 2008

“…Infant mortality rates are one of the most relevant instruments to assess a community's health status, since they are determined by social, economic and cultural aspects (1) . They also contribute in the analysis of programs, besides providing information for the planning of activities in epidemiological vigilance and actions in health (1)(2)(3) .…”