RESUMO

Three mechanisms related to household living standards might affect early-age mortality: the absolute level of deprivation, its level relative to the average of the community, and the inequality in the distribution of deprivation within communities. A large body of literature has explored the effect of the absolute level of deprivation, but little research has examined the association between relative deprivation and early-age mortality, and findings related to deprivation inequality are inconsistent. Using 2008 Bolivian Demographic and Health Survey data, this study explores patterns of association between the three factors and mortality occurring in the neonatal and postneonatal periods. Because household-level deprivation might capture some unmeasured characteristics at the community level, such as area-specific investments, this study decomposes household-level deprivation into its between- and within-community components. The results show that after possible confounders are controlled for, community-level absolute deprivation is a significant predictor of neonatal and postneonatal mortality. Relative deprivation and deprivation inequality are not associated with early-age mortality. These findings are specific to a context of widespread deprivation and low inequality within communities; the role of the distribution of deprivation might be more important in countries in which basic needs are met within a bigger proportion of the population. This study helps identify crucial sectors of development related to living standards and deprivation inequality in order to tackle neonatal and postneonatal mortality.

Assuntos

RESUMO

OBJECTIVE: To determine the importance of infant factors, maternal prenatal care use, and demographic characteristics in explaining the racial disparity in infant (age <365 days) mortality due to congenital heart defects (CHD). STUDY DESIGN: In this cross-sectional population-based study, stratified and multivariable logistic regression analyses were performed on the 2003-2004 National Center for Health Statistics linked live birth-infant death cohort files of term infants with non-Hispanic white (n = 3 684 569) and African-American (n = 782 452) US-born mothers. Infant mortality rate, including its neonatal (<28 day) and postneonatal (28-364 day) components, due to CHD was the outcome measured. RESULTS: The infant mortality rate due to CHD for African-American infants (296 deaths; 3.78 per 10 000 live births) exceeded that of white infants (1025 deaths; 2.78 per 10 000 live births) (relative risk [RR], 1.36; 95% CI, 1.20-1.55). The racial disparity was wider in the postneonatal period (2.08 per 10 000 vs 1.42 per 10 000; RR, 1.53; 95% CI, 1.29-1.83) compared with the neonatal period (1.70 per 10 000 vs 1.44 per 10 000; RR, 1.20; 95% CI, 0.99-1.45). Compared with white mothers, African-American mothers had a higher percentage of high-risk characteristics. In multivariable logistic regression models, the adjusted OR of postneonatal and neonatal mortality due to CHD for African-American mothers compared with white mothers was 1.20 (95% CI, 0.98-1.48) and 0.95 (95% CI, 0.77-1.19), respectively. CONCLUSION: The racial disparity in infant mortality rate due to CHD among term infants with US-born mothers is driven predominately by the postneonatal survival disadvantage of African-American infants. Commonly cited individual-level risk factors partly explain this phenomenon. The study is limited by the lack of information on neighborhood factors.

Assuntos

RESUMO

OBJECTIVE: to estimate the association between maternal nutritional extremes and offspring mortality in the Brazilian population. METHODS: this cross-sectional study used secondary data from Brazilian women of reproductive age obtained from the National Demographic and Health Survey 2006. Maternal anthropometric indices were used: height, body mass index (BMI), and waist circumference. Logistic regression modelling was used to evaluate the relationship between obesity and offspring mortality. The data analysis was appropriate for the complex sample design. RESULTS: children of mothers of short stature were at greater risk of death in the postnatal period than children of mothers of normal height, even after adjusting for sociodemographic characteristics [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.31-15.77]. Maternal obesity was associated with mortality, and children whose mothers were abdominally obese were at greater risk of dying in the neonatal period (OR 3.19, 95% CI 1.23-8.27). Children of mothers who were overweight or obese (BMI≥25kg/m(2)) were at greater risk of dying in the neonatal period (OR 2.41, 95% CI 1.12-5.16), and children of malnourished mothers (BMI<18.5kg/m(2)) were at greater risk of dying during the postneonatal period (OR 9.47, 95% CI 2.07-43.41). CONCLUSION: maternal obesity is a risk factor for neonatal death, maternal malnutrition is a risk factor for postneonatal death, and maternal short stature is a risk factor for mortality among Brazilian children.

Assuntos

RESUMO

O presente trabalho trata-se de revisão sistemática, referente ao período de 2004 a 2009, sobre o tema mortalidade pós-neonatal. Teve o objetivo de identificar como se colocam na literatura, as causas da morte e a relação com as condições socioeconômicas. Foram selecionados 27 artigos, 74,4% publicados em periódicos da área da Saúde Pública e 66,7%, de desenho do tipo ecológico. Quase a totalidade versava sobre grupos de causas e seus componentes (66,7%), seguidos pelo terço restante, sobre a identificação dos fatores determinantes dos óbitos. A região Sudeste produziu mais de 37% dos estudos. Na maioria dos municípios e estados brasileiros, a redução superou 50% no final da década de 1990. Dentre os grupos de causas de óbitos, predominou o grupamento diarreia-pneumonia, seguido pelas malformações congênitas. As condições de vida segundo indicadores socioeconômicos - moradia, saneamento básico, educação e acesso à saúde - foram determinantes para os maiores índices de mortalidade pós-neonatal por causas passíveis de redução.

This is a systematic review regarding postnatal mortality, covering the period between 2004 and 2009. The objective was to identify how the causes of death and the relationship with socioeconomic conditions are stated in the literature. Twenty-seven articles were selected, 74.4% of which were published in public health journals, with 66.7% having an ecological study design. Nearly all articles addressed cause groups and their components (66.7%), followed by the remaining third, which addressed the identification of the determinant factors of the deaths. The Southeast region produced over 37% of the studies. In most Brazilians cities and states, there was a reduction of deaths by more than 50% by the end of the 1900s. Among the cause of death groups, the diarrhea-pneumonia group was predominant, followed by congenital abnormalities. The basic life conditions according to socioeconomic indicators - housing, basic sanitation, education, and accessibility to health - were determinants for the highest postnatal death rates due to reducible causes.

Revisión sistemática referida al período entre 2004 y 2009 acerca del tema mortalidad post-neonatal. Objetivó identificar cómo se expresan en la literatura las causas de muerte y la relación con las condiciones socioeconómicas. Se seleccionaron 27 artículos, 74,4% publicados en revistas del área de Salud Pública y 66,7% de diseño de tipo ecológico. Casi la totalidad versaba sobre grupos de causas y sus componentes (66,7%), seguidos por el tercio restante, atendiendo identificación de factores determinantes de decesos. La región Sudeste produjo más del 37% de los estudios. En la mayoría de los municipios y estados brasileños, la reducción superó el 50% a fines de los '90. Entre los grupos de causas de muerte, predominó el agrupamiento diarrea-neumonía, seguido de malformaciones congénitas. Las condiciones de vida según indicadores socioeconómicos, residencia, sanidad básica, educación y acceso a la salud, fueron determinantes para mayores índices de mortalidad post-neonatal por causas pasibles de reductibilidad.

Assuntos

RESUMO

O principal objetivo deste trabalho foi comparar os diferenciais de mortalidade neonatal precoce e pós-neonatal em grupos etários maternos (10 a 49 anos). Utilizou-se a base de dados da Pesquisa Nacional de Demografia e Saúde da Mulher de 2006, e foram analisados 6.028 casos de nascidos vivos únicos entre 2001 e 2007, para todo o Brasil. Para análise estatística, foram empregados modelos de regressão de Poisson. Os resultados indicaram associação entre parturição igual a 3 ou mais com o óbito neonatal precoce (RP=3,69; p=0,016) e pós-neonatal (RP=7,98; p=0,024). O intervalo intergenésico de 10 a 14 meses apresentou associação com o óbito neonatal precoce (RP=7,12; p=0,025), assim como a prematuridade tardia (RP=5,61; p=0,002) e o contato do recém-nascido com a pele da mãe após o parto (RP=0,08; p=0,000). O óbito pós-neonatal também se associou com o pagamento por alguma consulta pré-natal (RP=0,12; p=0,000).

The aim of this study was to compare the differentials of early neonatal and post-neonatal mortality in maternal age groups from 10 to 49 years old. We used the database of the National Demographic and Women Health Survey, 2006; 6,028 cases of single newborn infants between 2001 and 2007 in Brazil were analyzed. Regarding statistical analysis, we used Poisson regression models. The results revealed that parity equal to three or higher was associated with early neonatal death (PR=3.69; p=0.016) and post-neonatal death (PR=7.98; p=0.024). Early neonatal death was associated with the interval between births equal to 10 up to 14 months (PR=7.12; p=0.025), late preterm births (PR=5.61; p=0.002) and newborn in contact with mother?s skin after birth (PR=0.08; p=0.000). The post-neonatal death was also associated with payment for a prenatal visit (PR=0.12; p=0.000).

RESUMO

OBJETIVO: Verificar, dentre os critérios do Programa do Recém-Nascido de Risco da Secretaria de Saúde de Santos, São Paulo, os fatores de risco para a mortalidade pós-neonatal. MÉTODOS: Estudo retrospectivo de dados secundários de 22.452 fichas coletadas ao nascimento, de janeiro de 1998 a dezembro de 2001. A variável dependente foi o óbito pós-neonatal. As variáveis independentes foram: peso ao nascer <2.500g, malformação ao nascer, necessidade de internação do recém-nascido após a alta materna, gravidez indesejada, chefe de família desempregado, irmão <2 anos e mãe sem companheiro. A análise estatística foi feita por regressão logística. RESULTADOS: Durante o período do estudo, dentre as 22.452 crianças incluídas no estudo, 97 faleceram entre 29 dias e um ano de idade. Na análise bivariada, foram indicadores de óbito: "peso <2.500g", "malformação ao nascer", "internação ao nascer", "chefe familiar desempregado", "irmão <2 anos" e "mãe sem companheiro". Na análise multivariada por regressão logística, as variáveis "peso ao nascer <2.500g", "malformação ao nascer", "necessidade de internação do recém-nascido após a alta materna" e "irmão menor de dois anos no domicílio" se associaram significantemente ao óbito infantil pós-neonatal. CONCLUSÕES: Os critérios utilizados pelo Programa do Recém-Nascido de Risco foram capazes de identificar crianças de risco para óbito pós-neonatal.

OBJECTIVE: To assess, among the criteria adopted by the Program of Neonates at Risk of the Health Department of the Municipality of Santos, São Paulo, Brazil, the risk factors for post-neonatal infant mortality. METHODS: In a retrospective study, data from 22,452 newborn charts, from 1998 to 2001, were retrieved. Logistic regression was applied to detect risk factors for the dependent variable: death between 29 days and one year old. The independent variables were: birth weight <2,500g, congenital malformation, unwanted pregnancy, need of hospitalization after mother's discharge, unemployed house chief, siblings <2 years old and single mother. RESULTS: During the studied period, among the 22,452 children, there were 97 deaths of children between 29 days and one year old. In the bivariate analysis, the variables "birth weight <2,500g", "congenital malformations", "need of hospitalization after mother's discharge", "unemployed house chief", "siblings <2 years" and "single mother" were significantly associated to post-neonatal death. By logistic regression analysis, "birth weight <2.500g", "congenital malformations", "need of hospitalization after mother's discharge" and "siblings <2 years old" were significantly associated to post-neonatal mortality. CONCLUSIONS: The criteria adopted by the Program of Neonates at Risk were useful to identify infants at risk for death from 29 days to one year of life.

Assuntos

RESUMO

De 1959 a 1999, con los datos estadísticos disponibles, la mortalidad infantil en Cuba disminuyó en 81,3 %, la mortalidad neonatal precoz se redujo el 73,4 %, la mortalidad neonatal tardía el 83,6 % y la posneonatal en 86,0 %. Las reducciones obtenidas en el período se distribuyeron uniformemente entre todas las provincias, aunque la mayor disminución se produjo en las provincias centrales y occidentales. Los rubros que más disminuyeron sus tasas fueron: enteritis y otras enfermedades diarreicas, infecciones respiratorias agudas, afecciones perinatales en general y las meningitis, aunque todas las causas reducen la mortalidad en el período. La natalidad descendió el 51,3 %, la fecundidad lo hizo en 30 %, el crecimiento demográfico bruto de la población disminuyó el 59,8 %, el parto institucional aumentó en 65,9 %, el bajo peso al nacer descendió el 36,9 %, la mortalidad perinatal se redujo el 67,2 %, los nacidos vivos disminuyeron el 21,1 % y la supervivencia infantil a los 5 años aumentó el 3,8 %. Esto ha sido posible debido principalmente a la decisión política de priorizar el sector de la salud y muy especialmente la salud maternoinfantil adoptada por nuestro Estado a principios de la década de los 60, lo que permitió alcanzar avances en la organización, calidad de la atención y una amplia cobertura de los servicios de salud. También fueron elementos importantes, el mejoramiento del nivel de vida y de la educación alcanzados por la población, las mejoras logradas en la situación sanitaria y epidemiológica, la distribución equitativa de los alimentos que prioriza a la madre y al niño. Un elemento fundamental en la última década ha sido el desarrollo del "médico de la familia" en la atención primaria y el mejoramiento de la atención hospitalaria. Por otra parte han contribuido de manera notable el establecimiento del Programa Nacional de Atención Maternoinfantil, que abarca las inmunizaciones, el control de las enfermedades diarreicas y de las infecciones respiratorias agudas, la lactancia materna, el control de la sepsis y los síndromes neurológicos infecciosos, así como la tecnología avanzada y el desarrollo de las unidades de terapia intermedia e intensiva neonatales y pediátricas. No puede olvidarse tampoco el arduo trabajo desarrollado por nuestros médicos, enfermeras y técnicos que en todo momento han dado lo mejor de su trabajo en aras de reducir con sus modestos esfuerzos, la mortalidad infantil en toda Cuba.

According to the available statistical data, from 1959 to 1999, infant mortality rate in Cuba decreased 81.3 %; early neonatal mortality, 73.4 %; late neonatal mortality, 83.6 %; and postneonatal mortality, 86.0 %. The reductions obtained during this period were uniformly distributed among all the provinces, although the most significant decrease took place in the central and western provinces. Enteritis and other diarrheal diseases, acute respiratory infections, perinatal affections in general and meningitis showed the greatest reductions, even though all the causes of death were reduced in this period. Natality decreased 51.3 %; fecundity, 30 %; and the gross demographic growth of the population, 59.8 %. The institutional delivery increased 65.9 %, low birth weight descended 36.9 %, perinatal mortality decreased 67.2 %, live births decreased 21.1 % and infant survival at 5 rose 3.8 %. This has been possible due mainly to the political decision made by our State of giving priority to the health sector and, specially, to maternal and child health at the beginning of the 1960s, which allowed to attain advances in the organizaton and quality of health care and a wide health services coverage. The improvement of the living standard, of education and of the health and epidemiological situation achieved by the population, as well as the equitative distribution of food, prioritizing mothers and children, were also important elements. A fundamental factor in the last decade has been the development of the family physician plan at the primary health care level and the improvement of hospital care. The establishment of the National Maternal and Infant Care Program, including immunization, the control of diarreal diseases and acute respiratory infections, breast feeding, and the control of sepsis and of infectious neurological syndromes, together with the advanced technology and the development of the neonatal and pediatric intensive and intermediate care units have played an important role, too. We can’t forget the hard work of our doctors, nurses and technicians, who have done their best to reduce with their modest effort the infant mortality rate in Cuba.