Óbitos neonatais precoces relacionados às causas de mortes evitáveis numa perspectiva étnico-racial no município de São Paulo
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Data
2021-08-30
Autores
Rodrigues, Vandréa Nunes Cordeiro Garcia
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Universidade Estadual Paulista (Unesp)
Resumo
De acordo com o censo de 2018, 50,7% da população brasileira é composta por pretos e pardos. No município de São Paulo, este percentual pode variar de 35,3% a 60,1%, dependendo da região. A literatura mostra uma extrema desigualdade relacionada à raça/cor/etnia, no que diz respeito à saúde, provável reflexo de diferenças no acesso e/ou na qualidade da assistência e com impacto sobre a morbimortalidade. Pretende-se assim, analisar o coeficiente de mortalidade neonatal precoce por causas evitáveis, no município de São Paulo, numa perspectiva étnico-racial. Este estudo se trata de um estudo ecológico, com abordagem quantitativa, no qual serão analisados dados secundários, obtidos no sistema de informações de mortalidade e nascidos vivos da prefeitura de São Paulo - DATASUS. Os dados foram extraídos e inseridos em planilha eletrônica Excel e submetidos à análise estatística e cálculo de coeficiente de mortalidade neonatal precoce por causas evitáveis, segundo cor/raça, gerando uma série temporal de coeficiente de mortalidade neonatal precoce por causas evitáveis (CMNPCE), no período de 2017 e 2018. Ocorreram 1691 óbitos neonatais precoces por causas evitáveis, sendo 56,47% brancos, 0,23% amarelos, 32,17% pardos, 3,19% pretos, 0,059% indígenas e em 7,86% os registros estavam incompletos, não informando a cor/raça/etnia. A série evidenciou, em todo período, um CMNPCE em brancos maior que em negros (pretos + pardos), com períodos de aumento do CMNPCE nos dois grupos e períodos de comportamentos opostos com aumento em um dos grupos e queda no outro. Ressalta-se que esse comportamento do coeficiente de mortalidade pode ser reflexo da má qualidade dos dados quanto ao preenchimento do quesito cor/raça, dada a técnica utilizada e fatores socioculturais relacionados ao racismo. Eles podem também relacionar-se à qualidade da assistência pré-natal, ao parto e ao recém-nascido. Nesse aspecto, conforme demonstrado na literatura, apesar de mulheres negras terem uma qualidade de pré-natal e condições socioeconômicas piores que as brancas, foram encontrados, diferentemente do que se esperava, um maior coeficiente de mortalidade neonatal precoce por causas evitáveis em recém-nascidos brancos. Isso ocorre, possivelmente, devido ao aumento das taxas de cesáreas e recém-nascidos pré-termo. Diante do exposto, tais resultados reforçam a necessidade de mais estudos, tanto em relação à coleta e qualidade dos dados, principalmente, no quesito cor/raça, quanto nas análises mais aprofundadas, como o cálculo e análise de coeficiente de mortalidade neonatal precoce por causasevitáveis em partos cesáreos e em partos pré-termo com recorte de cor/raça. Para além dos resultados encontrados nesse estudo, reforça-se que é fundamental que seja ofertada a todas as mulheres assistência pré- natal, ao parto e ao recém-nascido de qualidade e em rede, de forma equânime, a fim de diminuir às disparidades, respeitando a diversidade, combatendo o racismo em todos os seus níveis, principalmente o racismo institucional e a misoginia. Palavras-chave: Mortalidade neonatal precoce. Causas de morte. Iniquidade étnica. Disparidades nos Níveis de Saúde. Saúde da população negra.
According to the 2018 census, 50.7% of the Brazilian population is composed of blacks and browns (“pardos”). In the city of São Paulo, this percentage can vary from 35.3% to 60.1%, depending on the region. Research shows extreme inequality related to race/color/ethnicity regarding health, a likely reflection of differences in access and/or quality of care, and with an impact on morbidity and mortality.To analyze the coefficient of early neonatal mortality from preventable causes, in the city of São Paulo, from an ethnic-racial perspective. This is a ecological study with a quantitative approach in which secondary data, obtained from the information system on mortality and live births from the city of São Paulo – DATASUS, will be analyzed. The data was extracted and entered into an Excel spreadsheet and submitted to statistical analysis and calculation of the coefficient of early neonatal mortality from preventable causes according to color/race, generating a time series of said coefficient (CMNPCE) in the period of 2017 and 2018. There were 1691 early neonatal deaths from preventable causes, with the victims being 56.47% white, 0.23% yellow, 32.17% brown, 3.19% black, 0.059% indigenous and in 7.86% the records were incomplete, not informing the color/race/ethnicity. The series showed throughout the period a higher CMNPCE in whites than in blacks (blacks + browns), with periods of increase in CMNPCE in both groups and periods of opposite behavior with an increase in one of the groups and a fall in the other. It is noteworthy that these showings on the mortality coefficient may reflect the poor quality of data, regarding the filling out of the color/race item in the forms, given the technique used and sociocultural factors related to racism. They can also be related to the quality of prenatal care, during the delivery and directed to the newborn. In this aspect, as shown in researchs, although black women have a worse quality of prenatal care and socioeconomic conditions than white women, we found, differently from what was expected, a higher coefficient of early neonatal mortality from preventable causes in white newborns. Possibly due to increased rates of cesarean sections and preterm newborns. These results reinforce the need for more studies both in relation to the collection and quality of data, especially in terms of color/race, as well as more in-depth analysis such as the calculation and analysis of the coefficient of early neonatal mortality from preventable causes in cesarean deliveries and in pre. Term delivery, with a color/race highlight. Last, but not least, it is essential that all women receive quality prenatal care, delivery and networked care, in an equitablemanner, in order to reduce disparities, respecting diversity, fighting racism at all levels, especially institutional racism and misogyny.
According to the 2018 census, 50.7% of the Brazilian population is composed of blacks and browns (“pardos”). In the city of São Paulo, this percentage can vary from 35.3% to 60.1%, depending on the region. Research shows extreme inequality related to race/color/ethnicity regarding health, a likely reflection of differences in access and/or quality of care, and with an impact on morbidity and mortality.To analyze the coefficient of early neonatal mortality from preventable causes, in the city of São Paulo, from an ethnic-racial perspective. This is a ecological study with a quantitative approach in which secondary data, obtained from the information system on mortality and live births from the city of São Paulo – DATASUS, will be analyzed. The data was extracted and entered into an Excel spreadsheet and submitted to statistical analysis and calculation of the coefficient of early neonatal mortality from preventable causes according to color/race, generating a time series of said coefficient (CMNPCE) in the period of 2017 and 2018. There were 1691 early neonatal deaths from preventable causes, with the victims being 56.47% white, 0.23% yellow, 32.17% brown, 3.19% black, 0.059% indigenous and in 7.86% the records were incomplete, not informing the color/race/ethnicity. The series showed throughout the period a higher CMNPCE in whites than in blacks (blacks + browns), with periods of increase in CMNPCE in both groups and periods of opposite behavior with an increase in one of the groups and a fall in the other. It is noteworthy that these showings on the mortality coefficient may reflect the poor quality of data, regarding the filling out of the color/race item in the forms, given the technique used and sociocultural factors related to racism. They can also be related to the quality of prenatal care, during the delivery and directed to the newborn. In this aspect, as shown in researchs, although black women have a worse quality of prenatal care and socioeconomic conditions than white women, we found, differently from what was expected, a higher coefficient of early neonatal mortality from preventable causes in white newborns. Possibly due to increased rates of cesarean sections and preterm newborns. These results reinforce the need for more studies both in relation to the collection and quality of data, especially in terms of color/race, as well as more in-depth analysis such as the calculation and analysis of the coefficient of early neonatal mortality from preventable causes in cesarean deliveries and in pre. Term delivery, with a color/race highlight. Last, but not least, it is essential that all women receive quality prenatal care, delivery and networked care, in an equitablemanner, in order to reduce disparities, respecting diversity, fighting racism at all levels, especially institutional racism and misogyny.
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Palavras-chave
Mortalidade neonatal precoce, Causas de morte, Iniquidade étnica, Disparidades nos níveis de caúde, Saúde da população negra, Mortalidade infantil