Risk factor for perinatal mortality in Recife - 2003 / Fatores de risco para a mortalidade perinatal no Recife - 2003

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Perinatal mortality results from a close and complex relationship between biological and/or social variables and those of health care, which makes its reduction more difficult and slower than that of infant mortality. The purpose of this study is to identify and analyse the risk factors for perinatal mortality in Recife, in 2003, using a multilevel model. In this case control study the sample consisted of all perinatal deaths which occurred between January 1st and December 31st, 2003.The babies with birthweight equal to or above 500g, with no congenital anomalies, were all from single pregnancies of women residing in Recife. The controls were live births between December 26th 2002 and 31th of December 2003, with the same characteristics as the study group, but who managed to survive up to the age of six days. By using record linkage techniques, 403 cases and 1612 controls were obtained. The identification of the risk factors associated with perinatal mortality was done by unilevel and multilevel analyses (logistic regression). Fetal death accounted for 57.8% of the perinatal deaths; low weight at birth, for 74.2%; and prematurity, for 76.5%. Among the fetal and early neonatal components of perinatal mortality, a statistically significant difference was observed in relation to the duration of pregnancy (p<0.01) and the motherÂs educational level (p<0.01). The multivariate analysis revealed that low birth weight (OR=4.90), prematurity (OR=19.90) and the motherÂs age equal to or over 35 (OR=1.84) were the risk factors for perinatal death related to proximal determinants. The risk factor related to intermediate determinants was delivery at public hospitals (SUS) (OR=2.39), whereas caesarean section was found to be a protective factor (OR=0.43; p<0.001). Related to distal determinants were the following risk factors: a mother with less than 4 years of formal education (OR=2.09) and poor living conditions (OR=1.45). All these variables, when submitted together to multiple logistic regression, showed statistical significance in decreasing order of risk: Prematurity (OR=18.23), low births weight (OR=4.90), motherÂs age equal to or over 35 (OR=1.97), delivery at public hospitals (OR=1.93) and the mothers with less than 4 years of formal education (OR=1.78). The caeserian section was no longer a protective factor and poor living conditions no longer a risk for perinatal death. All in all, the prematurity and low birth weight risk factors were the ones most strongly associated with perinatal mortality in Recife, for they are influenced by the quality of healthcare and by socioeconomic condition

ASSUNTO(S)

Ãbito neonatal precoce saude publica perinatal mortality, fetal death, early neonatal death, risk factor Ãbito fetal fator de risco mortalidade perinatal

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