Fetal and Infant Mortality in Botucatu City, São Paulo State, Brazil: Evaluation of Maternal - Infant Health Care
In Brazil, neonatal mortality rate is considered incompatible with the country development conditions, and has been a Public Health concern. Reduction in infant mortality rates has also been part of the Millennium Development Goals, a commitment made by countries, members of the Organization of United Nations (OUN), including Brazil. Fetal mortality rate is considered a highly sensitive indicator of health care quality. Suitable actions, such as good quality and access to health services may contribute positively towards reduction in these fetal and neonatal rates. With appropriate antenatal follow-up and health care during gestation and delivery, some death causes could be reduced or even prevented by means of early diagnosis and intervention, as well as changes in risk factors and interventions. Objectives: To study the quality of maternal and infant health care based on fetal and neonatal mortality, as well as the possible actions to prevent those deaths in Botucatu (Brazil). Methods: Classification of prevention according to the International Classification of Diseases and the modified Wigglesworth´s classification. In order to evaluate adequacy, indicators of quality of antenatal and delivery care were established by the authors. Results: Considering fetal deaths, 56.7% of them occurred before delivery, which reveals possible shortcomings in antenatal care, and 38.2% of them were a result of intra- labor changes, which could be prevented or reduced by adequate obstetric management. These findings were different from those in the group of early neonatal deaths which were also studied. Adequacy of health services showed that antenatal and childbirth care was appropriate for 24% and 33.3% of pregnant women, respectively, which corroborates the results of prevention. These results revealed that shortcomings in obstetric and antenatal care could be the causes of deaths in the study. Early and late neonatal deaths have similar characteristics: 76% could be prevented or reduced mainly by adequate newborn care (52.9%) and adequate health care for gestational women (11.7%). When adequacy of care was evaluated, childbirth and newborn care was adequate in 25.8% and antenatal care was adequate in 16.1%. In conclusion, direct relationship was found between adequacy and quality of care rendered to pregnant women and newborns, and fetal and infant mortality. Moreover, our findings highlight that deaths could be prevented by an adequate obstetric and neonatal management.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1099134Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 4773
 UNICEF. Committing to child survival: A promise renewed. United Nations Children’s Fund; New York, NY: 2013. Progress report 2013.
 WHO (accessed Jan 31, 2014); Monitoring maternal, newborn and child health: understanding key progress indicators. 2011 http://www.who.int/ healthmetrics/news/monitoring_maternal_newborn_child_health.pdf.
 Ministry of Health of Brazil. “The National Maternal and Neonatal Mortality Reduction Pact,” Brasília, 2004, 14p.
 Department of Informatics in the SUS - Datasus. Fetal Deaths. http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sim/cnv/fet10uf.def (accessed March 7, 2014).
 C.G. Victora, E.M.L. Aquino, M.C. Leal, C.A. Monteiro, F.C. Barros, C.L. Szwarcwald. “Maternal and child health in Brazil: progress and challenges,” Lancet, 2011; 377(9780):1863–1876.
 D.C. Malta, E.C. Duarte. “Causes of avoidable mortality through effective healthcare services: a review of the literature,” Ciênc Saude Coletiva, 2007;12:765-76.
 A.L.G.S. Gastaud, M.R. Honer, R.V Cunha. “Infant mortality and preventability in Mato Grosso do Sul State, Brazil, 2000-2002,” Cad. Saude Publica, 2008;24(7):1631-40.
 R. Rocha, C. Oliveira, D.K.F. Silva, C. Bonfim. “Neonatal mortality and avoidability: an epidemiological profile analisys,” Rev Enferm UERJ, 2011;19(1):114-20.
 Ministry of Health of Brazil. Pan-American Health Organization, Oswaldo Cruz Foundation. “ Information System of Health,” in The brazilian experience em Health Information System. Brasília: Ministry of Health, 2009:8–9.
 L.D. Fisher. “Biostatistics: a methodology for the Health Sciences,” in 1993 New York: Wiley-interscience, 991p.
 United Nations World Health Organization. “ICD-10. International Statistical Classification of Diseases and Related Health Problems,” 10a rev. São Paulo: Universidade de São Paulo, 1997, v.1.
 J.W. Keeling, Y.I. Mac Gillivra, J. Golding, J. Wigglesworth, J. Berry, P.M. Dunn.“Classification of perinatal death,” Archives of Disease in Childhood, 1989; 64:1345-1351.
 Ministry of Health of Brazil.”Program for Prenatal and Birth Care Humanization.” Brasilia, Ministry of Health of Brazil, 2000.
 V.S. Ribeiro, A.A.M. Silva. “Neonatal mortality trends in São Luis, Maranhão, Brazil, from 1979 to 1996,” Cad. Saude Publica, 2000; 16(2):429-438.
 L.F.C. Nascimento, G.T. Batista, N.W. Dias, C.S. Catelani, D. Becker, L. Rodrigues. “Spatial analysis of neonatal mortality in Paraiba Valley, Southeastern Brazil, 1999 to 2001,” Rev Saude Publica, 2007;41(1):94- 100.
 WHO, UNICEF, UNFPA, The World Bank, United Nations Population Division. Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: World Health Organization, 2014.
 J.B. Lawn, S. Cousens, J. Zupan. “ 4 million neonatal deaths: when? Where? Why?,” Lancet 2005; 365:891–900.
 A.H. Baqui, G.L. Darmstadt, E.K.Williams, V. Kumar, T.U. Kiran, et AL. “Rates, timings and causes of neonatal deaths in rural India: implications for neonatal health programmes,” Bull World Health Organ 2006; 84:706–713.