Fatores associados aos óbitos infantis evitáveis nos anos de 2000, 2010 e 2020: estudo brasileiro de base populacional
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2023-02-23
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Universidade Estadual Paulista (Unesp)
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Introdução: A mortalidade infantil caracteriza-se pelos óbitos de crianças menores de um ano de idade. O componente neonatal inclui os óbitos até 27 dias e a pós-neonatal, entre 28 dias e um ano de vida. Apesar de todos os esforços, milhões de crianças ainda morrem por causas evitáveis no mundo. Conceituam-se como evitáveis, os óbitos que poderiam ser prevenidos pela adequada atenção à saúde e garantia de assistência de qualidade no pré-natal, parto e puerpério, especialmente em decorrência de diagnósticos e intervenções efetivas e precoces, com planejamento de ações que visem a sua redução. Objetivo: Conhecer os fatores associados aos óbitos infantis evitáveis no Brasil no início das últimas décadas. Método: Trata-se de estudo epidemiológico e de base populacional, constituído por três coortes históricas, observadas em 2000, 2010 e 2020. Utilizaram-se dados secundários do Sistema de Informações de Mortalidade (SIM), sobre a mortalidade infantil no Brasil. Para a análise da evitabilidade dos óbitos, foi empregada a proposta de evitabilidade da Lista de causas de mortes evitáveis por intervenções dos Sistema Único de Saúde. Resultados: De modo geral, diminuíram os óbitos evitáveis: o componente neonatal diminuiu 21,9%, enquanto o pós-neonatal teve redução de 40,9%. Sobre os critérios de evitabilidade, para os óbitos neonatais, a maior redução ocorreu para os óbitos preveníveis por adequada atenção ao recém-nascido e para os pós-neonatais, destacaram-se os previníveis por ações de diagnóstico e tratamento e por ações de promoção à saúde. Para os óbitos neonatais evitáveis, nos três anos analisados, nascer de cesárea foi fator independente de proteção e a idade gestacional entre 28-36 semanas, constituiu fator de risco, sendo que outras variáveis influenciaram de maneira independente, significativamente, mas de forma esporádica. Para o componente pós-neonatal evitável, dois fatores constituíram fator de risco independente nos três anos do estudo: analfabetismo materno e óbito no domicílio, sendo que de forma esporádica outras variáveis influenciaram significativamente o óbito. Conclusões: O principal fator de risco para o óbito neonatal evitável foi a prematuridade e para o óbito pós-neonatal evitável destacou-se o risco social, representado pelo analfabetismo e pela ocorrência no domicílio. Esse resultado sinaliza a necessidade de esforços constantes na criação de políticas públicas em saúde que englobem acesso adequado e de qualidade, desde a gestação até a primeira infância, ampliando o olhar para essa população e articulando às tecnologias disponíveis no sistema de saúde, com intuito de contribuir para a redução da mortalidade infantil evitável no Brasil.
Introduction: Infant mortality is characterized by the deaths of children under one year of age. The neonatal component includes deaths up to 27 days and post-neonatal, between 28 days and one year of life. Despite all efforts, millions of children still die from preventable causes around the world. Deaths that could be prevented by adequate health care and the guarantee of quality care in prenatal care, childbirth and the puerperium are conceptualized as preventable, especially as a result of effective and early diagnoses and interventions, with planning of actions aimed at its reduction. Objective: To know the factors associated with preventable infant deaths in Brazil at the beginning of the last few decades. Method: This is an epidemiological and population-based study, consisting of three historical cohorts, observed in 2000, 2010 and 2020. Secondary data from the Mortality Information System (SIM) on infant mortality in Brazil were used. For the analysis of the avoidability of deaths, the avoidability proposal of the List of causes of deaths avoidable by interventions of the Unified Health System was used. Results: In general, avoidable deaths decreased: the neonatal component decreased by 21.9%, while the post-neonatal component had a reduction of 40.9%. Regarding the preventability criteria, for neonatal deaths, the greatest reduction occurred for preventable deaths through adequate attention to the newborn and for post-neonatal deaths, those preventable through diagnosis and treatment actions and through actions to promote health stand out. health. For preventable neonatal deaths, in the three years analyzed, being born by cesarean section was an independent protective factor and gestational age between 28-36 weeks was a risk factor, and other variables influenced independently, significantly, but sporadically. For the avoidable post-neonatal component, two factors constituted an independent risk factor in the three years of the study: maternal illiteracy and death at home, and other variables sporadically significantly influenced death. Conclusions: The main risk factor for preventable neonatal death was prematurity and for avoidable post-neonatal death, social risk stood out, represented by illiteracy and occurrence at home. This result signals the need for constant efforts to create public health policies that include adequate and quality access, from pregnancy to early childhood, broadening the focus on this population and articulating the technologies available in the health system, with the aim of contribute to the reduction of preventable infant mortality in Brazil.
Introduction: Infant mortality is characterized by the deaths of children under one year of age. The neonatal component includes deaths up to 27 days and post-neonatal, between 28 days and one year of life. Despite all efforts, millions of children still die from preventable causes around the world. Deaths that could be prevented by adequate health care and the guarantee of quality care in prenatal care, childbirth and the puerperium are conceptualized as preventable, especially as a result of effective and early diagnoses and interventions, with planning of actions aimed at its reduction. Objective: To know the factors associated with preventable infant deaths in Brazil at the beginning of the last few decades. Method: This is an epidemiological and population-based study, consisting of three historical cohorts, observed in 2000, 2010 and 2020. Secondary data from the Mortality Information System (SIM) on infant mortality in Brazil were used. For the analysis of the avoidability of deaths, the avoidability proposal of the List of causes of deaths avoidable by interventions of the Unified Health System was used. Results: In general, avoidable deaths decreased: the neonatal component decreased by 21.9%, while the post-neonatal component had a reduction of 40.9%. Regarding the preventability criteria, for neonatal deaths, the greatest reduction occurred for preventable deaths through adequate attention to the newborn and for post-neonatal deaths, those preventable through diagnosis and treatment actions and through actions to promote health stand out. health. For preventable neonatal deaths, in the three years analyzed, being born by cesarean section was an independent protective factor and gestational age between 28-36 weeks was a risk factor, and other variables influenced independently, significantly, but sporadically. For the avoidable post-neonatal component, two factors constituted an independent risk factor in the three years of the study: maternal illiteracy and death at home, and other variables sporadically significantly influenced death. Conclusions: The main risk factor for preventable neonatal death was prematurity and for avoidable post-neonatal death, social risk stood out, represented by illiteracy and occurrence at home. This result signals the need for constant efforts to create public health policies that include adequate and quality access, from pregnancy to early childhood, broadening the focus on this population and articulating the technologies available in the health system, with the aim of contribute to the reduction of preventable infant mortality in Brazil.
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Mortalidade infantil, Sistemas de informação em saúde, Características da população, Infant mortality, Health information systems, Population characteristics