Spatial patterns of preventable perinatal mortality in Salvador, Bahia, Brazil

Abstract

OBJECTIVETo identify the spatial distribution patterns and areas of higher risk of preventable perinatal mortality in the city of Salvador, State of Bahia, Brazil.METHODSWe carried out a spatial aggregated study in 2007, considering the weighting areas (census tracts contiguous sets) of Salvador, of which the center and north present low life conditions. Data were obtained from national vital statistics systems and the 2010 Census. Addresses of live births and stillbirths were geocoded by weighting area. The spatial distribution of the perinatal mortality rate was analyzed from thematic maps. Spatial dependence was evaluated by the Global and Local Geary’s and Moran’s Indexes.RESULTSCrude and smoothed perinatal mortality rates were high in areas situated to the north, west, and in center of Salvador. The smoothed rates in weighting areas ranged from 4.9/1,000 to 22.3/1,000 births. Of all perinatal deaths, 92.1% could have been prevented. We identified spatial dependence for preventable perinatal mortality for care in pregnancy, with neighboring areas with high risk in the north of the city.CONCLUSIONSThe preventability potential of perinatal mortality was high in Salvador, in 2007. The spatial distribution pattern with higher rates in disadvantaged areas of the city suggests the existence of social inequalities in health. The characteristics of the process of urban development of Salvador, which has inadequate prenatal care, possibly influenced the magnitude and spatial distribution pattern of this mortality.

Análise espacial dos óbitos infantis evitáveis no Espírito Santo, Brasil, 2006-2013*

“…This fact corroborates with previous studies conducted in other Brazilian states, which pointed to intraregional inequality as evidenced by the large flow of pregnant women to municipalities located in urban areas with better levels of socioeconomic development. 24,25,26 This scenario is worrying, given that in Brazil there is a large proportion of health establishments without the minimum required equipment or specialized professionals for providing emergency care for perinatal women and the newborn. 24 This may further increase infant death rates.…”

“…As such, the infant mortality rate is strongly linked to social inequalities, i.e., it is the most vulnerable populations who have greater difficulty in accessing health services. 1,21,25,29 However, when avoidable death rates Spatial analysis of preventable infant deaths are analyzed, the refined methods used only indicate deaths that could be prevented through intervention.…”

Associações do espaço geográfico com a mortalidade perinatal: revisão integrativa de literatura

“…Nas regiões centro, nordeste e oeste a dependência espacial foi significativa quando considerados os cuidados ao recém-nascido e ao feto, enquanto os cuidados durante a gravidez e parto foram significativos em todas as áreas da cidade. Salvador possui uma das menores coberturas de atenção primária à saúde e esta condição pode ter determinado o padrão de distribuição espacial da mortalidade perinatal evitável por assistência à gestante (Nascimento et al, 2017). Canuto et al (2019) aponta que 66,2% dos óbitos perinatais investigados em seu estudo apresentaram causas evitáveis, segundo a classificação pela Lista brasileira de causas de mortes evitáveis por intervenções do SUS, reduzível principalmente por adequada atenção…”

Análise de mortalidade perinatal na Região Metropolitana da Grande Vitória, Espírito Santo, Brasil

“…Além disso, os óbitos de crianças menores de um ano no estado do ES estão fortemente associados as questões de desigualdade social e a análise espacial da mortalidade infantil revela que condições socioeconômicas e de saneamento se relacionam com os riscos de morte. Assim, classifica-se as populações mais vulneráveis ao óbito, aquelas que possuem dificuldade em receber atendimento à saúde (BOING, BOING, 2008;NASCIMENTO et al, 2017;SANTOS et al, 2011. ).…”

“…A atenção básica e a cobertura do pré-natal aumentaram muito nas áreas remotas, entretanto ainda existe uma distribuição desigual entre os serviços de saúde, mesmo que não seja uma desigualdade tão gritante, faz bastante diferença nos indicadores (DIAS et al, 2019). BITTENCOURT et al, 2014;NASCIMENTO et al, 2017;MARANHÃO et al, 2012).…”