Cristiane B Batista1, Márcia L de Carvalho2, Ana Glória G Vasconcelos2. 1. Universidade Federal do Rio de Janeiro (UFRJ), Maternidade Escola, Rio de Janeiro, RJ, Brazil. Electronic address: cristiane.batist@gmail.com. 2. Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS), Rio de Janeiro, RJ, Brazil.
Abstract
OBJECTIVE: To analyze the factors associated with neonatal mortality related to health services accessibility and use. METHODS: Case-control study of live births in 2008 in small- and medium-sized municipalities in the North, Northeast, and Vale do Jequitinhonha regions, Brazil. A probabilistic sample stratified by region, population size, and information adequacy was generated for the choice of municipalities. Of these, all municipalities with 20,000 inhabitants or less were included in the study (36 municipalities), whereas the remainder were selected according to the probability method proportional to population size, totaling 20 cities with 20,001-50,000 inhabitants and 19 municipalities with 50,001-200,000 inhabitants. All deaths of live births in these cities were included. Controls were randomly sampled, considered as four times the number of cases. The sample size comprised 412 cases and 1772 controls. Hierarchical multiple logistic regression was used for data analysis. RESULTS: The risk factors for neonatal death were socioeconomic class D and E (OR=1.28), history of child death (OR=1.74), high-risk pregnancy (OR=4.03), peregrination in antepartum (OR=1.46), lack of prenatal care (OR=2.81), absence of professional for the monitoring of labor (OR=3.34), excessive time waiting for delivery (OR=1.97), borderline preterm birth (OR=4.09) and malformation (OR=13.66). CONCLUSION: These results suggest multiple causes of neonatal mortality, as well as the need to improve access to good quality maternal-child health care services in the assessed places of study.
OBJECTIVE: To analyze the factors associated with neonatal mortality related to health services accessibility and use. METHODS: Case-control study of live births in 2008 in small- and medium-sized municipalities in the North, Northeast, and Vale do Jequitinhonha regions, Brazil. A probabilistic sample stratified by region, population size, and information adequacy was generated for the choice of municipalities. Of these, all municipalities with 20,000 inhabitants or less were included in the study (36 municipalities), whereas the remainder were selected according to the probability method proportional to population size, totaling 20 cities with 20,001-50,000 inhabitants and 19 municipalities with 50,001-200,000 inhabitants. All deaths of live births in these cities were included. Controls were randomly sampled, considered as four times the number of cases. The sample size comprised 412 cases and 1772 controls. Hierarchical multiple logistic regression was used for data analysis. RESULTS: The risk factors for neonatal death were socioeconomic class D and E (OR=1.28), history of childdeath (OR=1.74), high-risk pregnancy (OR=4.03), peregrination in antepartum (OR=1.46), lack of prenatal care (OR=2.81), absence of professional for the monitoring of labor (OR=3.34), excessive time waiting for delivery (OR=1.97), borderline preterm birth (OR=4.09) and malformation (OR=13.66). CONCLUSION: These results suggest multiple causes of neonatal mortality, as well as the need to improve access to good quality maternal-child health care services in the assessed places of study.
Keywords:
Acesso aos serviços de saúde; Case–control studies; Estudos de casos e controles; Health services accessibility; Mortalidade Neonatal; Neonatal mortality
Authors: Karla Eveline Ximenes de França; Mirella Bezerra Rodrigues Vilela; Paulo Germano de Frias; Silvia Wanick Sarinho Journal: Rev Paul Pediatr Date: 2020-09-25