RESUMO
The relationship between cesarean delivery and neonatal mortality is presented with information from 292 early neonatal deaths (cases) and 3098 survivors (controls) born in 25 hospitals in Mexico City during the summer of 1984. The overall rate of cesarean delivery was 27%. Variations between health agencies and different social groups were not related to obstetric risk, suggesting that a sizable proportion of the operations were probably unjustified. Babies of normal birth weight (greater than or equal to 2500 gm) delivered by cesarean section were 2.5 times more likely to die in the early neonatal period compared with vaginally delivered babies of the same weight. The excess of mortality could not be explained by the effect of maternal characteristics or complications or by differences in birth weight or gestational age. It is suggested that the conditions under which the operation was performed probably explain the increased risk of early neonatal death. It is likely that poor quality of resuscitation and respiratory care are implicated in the link between "unnecessary" cesarean section and early neonatal mortality.
Assuntos
Cesárea , Mortalidade Infantil , Recém-Nascido , Peso ao Nascer , Feminino , Humanos , Recém-Nascido de Baixo Peso , México , Gravidez , Valores de Referência , Fatores de RiscoRESUMO
Multiple sources were used to identify maternal deaths and their causes in a study carried out in Jamaica. These sources of information included a review of all deaths of women aged 12 to 49 years and included those occurring in hospitals (on maternity, surgical and medical wards and in casualty departments); reported to coroners' offices and the police; on whom post-mortems were carried out at hospitals, public morgues and for the Ministry of National Security; obtained from interviews with public health staff in all parishes and which were registered with the Registrar General's Department. Some 193 maternal deaths were identified giving a maternal mortality rate of 10 per 10,000 live births. No one source independently identified all maternal deaths. Hospital in-patient records yielded 133 deaths (69%), death certificates 74 (38%). Deaths due to certain causes were far more likely to be identified from particular sources eg those due to clinical mismanagement (complications of anaesthesia and blood transfusion) from hospital in-patient records; while deaths from ruptured ectopic pregnancy were more likely to come from coroners', police and morgue records. It is concluded that using multiple sources to identify maternal deaths in developing countries is an effective method to identify all maternal deaths.
Assuntos
Países em Desenvolvimento , Mortalidade Materna , Adolescente , Adulto , Causas de Morte , Criança , Atestado de Óbito , Feminino , Humanos , Jamaica , Prontuários Médicos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/mortalidadeRESUMO
The quality of care of random samples of about 40 infants admitted with acute gastroenteritis to each of five hospitals in Jamaica was assessed. Low levels of adherence to consensus care criteria appeared to be correlated with high levels of hospital-specific severity standardized mortality ratios X100 (SSMRs); poor adherence, SSMR 127-230; intermediate adherence, SSMR 95; good adherence, SSMR 14. The main deficiencies in care at certain hospitals were: non-weighing of infants, incomplete physical examination, inadequate estimation of fluid requirements, and irregular recording of fluid intake. To improve the effective care of infants with gastroenteritis, a quality assurance program is required.
Assuntos
Gastroenterite/mortalidade , Qualidade da Assistência à Saúde , Doença Aguda , Pré-Escolar , Desidratação/mortalidade , Desidratação/terapia , Gastroenterite/terapia , Humanos , Lactente , JamaicaRESUMO
Health services in Brazil are characterized by a multiplicity of providers. While many are ultimately funded from public sources, notably the National Social Security Scheme, a large proportion are provided by the private sector. This variety of providers of health care has hindered the development of comprehensive care and the coverage of those in greatest need. In recent years increasing attention has been given to ways of reducing the undesirable aspects of this situation. The Federal and State Governments have established committees to improve coordination between services and set up several pilot programmes. One concerned with improving the effective coverage of maternal and child services has been established in Sorocaba. Sorocaba is a medium-sized city which is typical of the many urban centres in the state of São Paulo. This paper describes a study which has provided information from a representative sample of women, who had recently had a baby, on their eligibility for care from the various health services available in the city and on their actual use of those services. This information has been used in the implementation of a pilot programme. Most mothers attended some service for antenatal care. Almost 20% used several services because their entitlement varied from scheme to scheme and some services provided only specific components of care. This applied also to preventive and curative infant care.
PIP: A survey of 296 mothers, with children born in March 1979, was conducted in Sorocaba, Sao Paulo State, Brazil, to describe the use and payment of health care, for baseline data for a maternal-child health program. Sorocaba, 96 km northwest of Sao Paulo, has 260,000 people and an infant mortality of 70/1000. Health care is dominated by private physicians and hospitals, and is largely reimbursed by public sources through the INAMPS social security payroll taxes, federal, state and municipal funds. There are also organized physician co-ops, and prepaid health plans. Because of diversity funding and services, there is an emphasis on curative medicine, duplication, and inequity of care. Extensive information is included in tables on socioeconomic, education, medical, insurance coverage, type of care received and residence characteristics of the subjects, expressed as percentages. Most (83%) mothers belonged to the Federal Social Security plan, and a third also belonged to a private insurance plan, usually through the husband's employment. Only 4% were not covered, except State and Municipal providers. Only 1.7% had no prenatal care. Any drugs needed were paid in part, although 17% had to go to more than one provider to get them. 98% were delivered in hospitals, 30% by Cesarean section, for which doctors receive higher fees. Many (62%) took their children for care by 2 months of age. Equal numbers used private or state health centers, while 14% used several sources. For infants' curative services 56% used private physicians or hospitals, 17% paid for care and 86% paid for drugs. Women in lower socioeconomic groups or with less education began prenatal care later and made significantly fewer visits for prenatal or infant care (p.001). The study has prompted discussions on coordination of outpatient services and identification of high risk patients.
Assuntos
Serviços de Saúde da Criança/provisão & distribuição , Serviços de Saúde Materna/provisão & distribuição , Brasil , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , População UrbanaRESUMO
A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10 000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive diseases of pregnancy (26%), haemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.
PIP: This article reports the results of a review of all maternal deaths occurring in Jamaica in 1981-83. A total of 192 maternal deaths were identified, yielding a maternal mortality rate of 10.8/10,000 live births, which was considerably higher than the official rate of 4.8. 15% of these deaths were associated with abortion or ectopic pregnancy. The most common causes of death were hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. Lowest rates were noted among women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. Avoidable factors were judged to be present in 68% of the deaths. The largest categories of avoidable factors were: nonuse of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of high-risk women; and delays in taking action when signs of complications developed before, during, and after delivery. In response to these findings, the Ministry of Health's Maternal Mortality Committee has called for the following actions: measures to encourage women to seek antenatal care early in pregnancy; improvements in antenatal monitoring; the referral of high-risk women for hospital delivery; the definition of standard procedures for dealing with specific complications of pregnancy, e.g., eclampsia and hemorrhage; regionalization of obstetric services and criteria for referring patients to hospital; and review of provision of blood and plasma for emergency transfusions.