Classificações de evitabilidade dos óbitos infantis : diferentes métodos, diferentes repercussões?

• Ano de defesa: 2016
• Autor(a) principal: Dias, Barbara Almeida Soares
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Espírito Santo; BR; Mestrado em Saúde Coletiva; Centro de Ciências da Saúde; UFES; Programa de Pós-Graduação em Saúde Coletiva
• Palavras-chave em Português: Infant mortality; Maternal and child health; Cause of death; Epidemiologic factors; Saúde materno-infantil; Causas de morte; Fatores epidemiológicos; Mortalidade infantil; Serviços de saúde infantil; Morte - Causas; Epidemiologia; Saúde Coletiva; 614
• Link de acesso: http://repositorio.ufes.br/handle/10/5572

This study aims at analyzing the occurrence of preventable and non-preventable infant mortality and its related factors, according to the preventability methods applied to deaths of under one year-old infants in Espírito Santo State, between 2006 and 2013. The data used come from the Sistema de Informação sobre Mortalidade (Mortality Information System), been the information taken from the Ficha de Notificação de Óbito Fetal e Neonatal (Fetal and Neonatal Mortality Report), digitalized and allowed by Secretaria Estadual de Saúde do Espírito Santo (Espírito Santo State Health Department). 5.316 deaths were reported between 2006 and 2013. Initially, the infant deaths were classified as preventable and non-preventable according to the existing classification methods: Taucher. Wigglesworth; International Collaborative Effort on Infant Mortality; Fundação de Sistema Estadual de Análise de Dados (SEADE); e a Lista Brasileira de Evitabilidade do Óbito Infantil. After that, the level of agreement between the classification methods through Kappa Index; McNemar and Kappa adjusted according to prevalence. Finally, the processing of the data from infant mortality reports was carried out, followed by the Logistic Regression, in which ICE and SEADE were used as dependable variables, and as undependable variables those which presented p-value lower than 0,10 in the ChiSquare. The results demonstrated that most deaths occurred because of preventable causes (34,9% - 76,5%), mainly those related to the quality of prenatal care, birth and puerperium, no matter preventability method used. However, when considering the level of agreement amongst the methods, a major agreement occurred between ICE and SEADE (Kappa adjusted=0,88). Amongst the factors related to the preventability of infant mortality, the post-neonatal death (OR=2,12:IC95%=1,48- 3,03, week pregnancy between 28 and 31 weeks (OR= 1,66:IC95%=1,11-2,47), the adequate weight at birth (OR= 1,94:IC95%= 1,16-3,23), and the surgical intervention (OR= 2,05:IC95%=1,6-2,62) presented meaningful association to the occurrence of the preventable deaths, when considering the ICE method. Nevertheless, when considering SEADE method, it was identified that the post-neonatal death (OR=3,95:IC95%=2,42-6,45), color brown or mixed race children (pardas) (OR=1,48: IC95%=1,10-2,0), private facilities (OR= 1,59: IC95%= 1,05-2,42), adequate weight at birth (OR=2,13: IC95%= 1,34-3,38), and surgical intervention (OR=1,86: IC95%= 1,43-2,42) constituted in risk factors to the occurrence of preventable deaths. It is recommended the use of the methods of classification in the health services, once they can understand the several causes of the deaths, and initiate different repercussions to avoid them, however, periodic actualization of these methods are necessary due to the constant insertion of new technologies and knowledge in the health environment. Besides, it is important to highlight the need of investment in training and qualification of the health professionals, as well as the empowerment of a perinatal net, to qualify the maternal and infant assistance, making the reduction of infant mortality due to preventable causes