Caracterização e predição da mortalidade infantil em municípios de uma regional de saúde do Brasil

Abstract

Child mortality rate (CMR) is considered an indicator of human development. Lately, CMR within the municipalities belonging to the 8th health regional of Francisco Beltrão - which had a decline trend - started to grow again, without any plausible explanation. Thus, the aim of the study was to analyze the risk factors for CMR in these region and to explore the evitability of these deaths. The 8th health regional comprises towns with a range of inhabitants between 10 to 100 thousand. This is a retrospective, cohort observational study of live births that occurred between January 1 2017 to December 31 2017. Children from mothers living in municipalities of the 8th health regional who have come to die under the first year were studied. Secondary data were used from the National Live Birth Information System and the Mortality Information System. The studied variables were those that allowed a description of the CMR (outcome variable) and possible risk factors associated with children’s death: Distal (socioeconomic variables), medial (variables related to health care and the mother's biological characteristics) and proximal variables (i.e., those related to the characteristics of the child). Results for CMR indicated 10.4 deaths per thousand live births. Higher CMR were observed among women living with a partner (p = 0.013), with fewer than four prenatal consultations (p <0.001), in hospitals with neonatal ICU (p <0.001), in double (or more) pregnancies (p < 0.001), low birth weight (p <0.001), low Apgar scores at the first and fifth minutes (p <0.001), preterm (p = 0.006), and congenital anomaly (p <0.001). Factors associated with CMR included the case of children born in hospitals with neonatal ICU (OR 2.94; 95% CI: 1.25 - 6.90; p = 0.013), born with low weight (OR: 3.24 ; 1.24-8.47; p = 0.017), preterm (OR: 4.33; 95% CI: 1.85-10.17; p = 0.001), low Apgar score during the first minute (OR : 6.57; 95% CI 2.58-16.75; p> 0.001), fifth minute (OR: 4.20; 95% CI 1.53-11.57; p = 0.006) and the presence of congenital anomaly (OR: 81.88; 95% CI 31.90-210.21; p> 0.001). This research could be of assistance in designing public health policies to improve both mother and child care, thus reducing the incidence deaths in the first year of children’s life in this region.