Atenção a saude da gestante e mortalidade neonatal

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

The first a coort of 49,310 live bom, in with 327 deaths in the neonatal period. The varaibles regularly registred in the Birth Certficate were analysed to identify the factors associated to neonatal deaths. Cox regression ana1sis in a hierarquical model showed a significant statistic association among live borns from widows or separated mothers, primiparous, mothers with less than 7 prenatal visits, birth at public school-hospital or at private hospital with National Unified Health System (SUS) agreement, male , Apgar score <8 at 5th minute, low birth weight «2500 g.) and preterm (gestational age <37 weeks). It was observed that sociodemographic variables (age and maternal education) had no influence on neonatal mortality. The study reinforced the importance of low birth weight and/or preterm as conditions strongly associated to death in the neonatal period. In the second study, a case-control with 117 neonatal deaths and 234 controls was used to assess factors associated to neonatal mortlity. Data were obtained from household interviews. A multiple logistic regression analysis, in a hierarquical model, identified as factors associated to nenonatal deaths: socioeconomic variables (income, immigration, number of dwellers and no choice of delivery hospital), maternal morbidity (vaginal bleeding, premature delivery related to health problems, time elapsed between hospital admission and delivery), quality of prenatal care (number of orientations received) and newbom health conditions (gestational age, low birth weight and Apgar score at 5th minute). Among term deliveries, less than 5 prenatal visits did not show association with neonatal death when stratified by gestational age, but among preterms « 37 weeks) the association showed a statistical significance (p=0,015). The variable of prenatal assistance "the absence or little number of orientations", that remained associated to neonatal death in final model, may be representing other variables of quality of assistance, that initially showed association with neonatal death in the hierarquical model but did not remain in the final model. The third study, a sample of 248 pregnant women, was drawn to analyse inequlities in health care, comparing two different income extracts. Data were obtained from household interviews. The study showed a predominance of young women, black or mulatto, with low education, with no economic activity and living without a mate, in the group of pregnants with less than 1 minimun wage per capita income. Also among the low income the proportion of pregnants that pregnancy was lower, had fewer number of prenatal visits, began the prenatal later and used public services most1y. No statistically significant difference was oberved between gestational age and birth weight between the two income group. The proportion of cesarean section was higher in the higher income. The evaluation of prenatal use of services was analysed through three referential indexes (Kessner, APNCU and Ministry of Health norms). Ali index pointed out, that the proportion of inadequate prenatal care was higher among pregnants in the lower income group. In the context of this analysis, sociodemografic conditions do not appear quite strong to distinguish neonatal mortality risks. The influence of reprodutive antecedents and health assistance in neonatal period, indicate the importance of improving the quality of prenatal and delivery care, to reduce preterm and low birth weight births. Still, the results indicate that, in some aspects, public health services suceed in promote maternal and children health equity

ASSUNTO(S)

cuidado pre-natal epidemiologia desigualdade social recem-nascidos - mortalidade

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