Fatores contextuais, maternos e da criança e óbitos infantis evitáveis no Rio Grande do Sul em 2017

Abstract

Contextual, maternal, and infant factors in preventable infant deaths in Rio Grande do Sul in 2017 This thesis had the objective to 1) evaluate the infant mortality due to avoidable causes in 2017, in the Rio Grande do Sul (RS), according to contextual, maternal, and child characteristics; and 2) compare the mortality rates during the first year of life among twins and singletons born in RS in 2017. The results of the analyses performed for the achievement of each one of those objectives were presented as two scientific papers entitled “Contextual, maternal, and infant factors in preventable infant deaths in the Rio Grande do Sul in 2017” and “Twin infant mortality in the state of Rio Grande do Sul, Brazil, in 2017”. With a cross-sectional design, the studies were descriptive, employing data extracted from the Death Certificates and the Certificates of Live Births from the Mortality Information System – Federal System, of the state of RS. The List of Avoidable Causes of Deaths due to Interventions of the Brazilian Health System was used for the classification of the preventability of deaths. The avoidable rates of infant mortality (AIMR), early neonatal (AENMR), late neonatal (ALNMR), and post neonatal (APNMR), per 1,000 live births (LB), and crude cumulative incidence ratios, according to contextual (Human Development Index – HDI - of the health region and the city; and the city’s Gini index); maternal at the time of birth (age, schooling, skin color, partner presence, number of prenatal appointments, and birth type), and the child characteristics at birth (gestational age, weight, and gestation type) were calculated. In 2017, the number of children who were born alive was 141,568 and there were 1,425 infant deaths, among which 1,119 were avoidable (AIMR=7,9:1000 LB). The AENMR, ALNMR, and APNMR were, respectively, 4.1, 1.5, and 2.3:1000 LB. More than 60% of the deaths over the first week and 57.5% over the late neonatal period could have been reducible through adequate attention to the woman during gestation. The most frequent avoidable neonatal causes were related to prematurity. During the postnatal period, 31.8% of the deaths could have been avoided through adequate diagnosis and treatment actions. In 2017, among the live births, 3,467 were from multiple gestations (3,390 from double gestations and 77 from triple gestations), corresponding to 2.4% of the births. Among the 1,342 deaths during the first year of life with information about the gestation type, 148 (11.0%) were twins. Among the infants from double and triple gestations, the infant mortality rate was, respectively, 4.5 and 27.2 times higher than among those from singleton gestations. During the neonatal period, the mortality rate among twins and triplets was, respectively, 5.6 and 35.2 times higher than among those from singleton gestation, and the post neonatal mortality, respectively, 2.0 and 9.6 times higher than among singletons. The prematurity was present in 97% of the deaths among double gestations and in 100% of the deaths of triplets. Over 80% of the deaths among twins were due to affections originated during the perinatal period. We may conclude from this thesis that: 1) the necessary strategies to reduce the avoidable infant deaths in RS must focus preferentially on the prevention of the prematurity through adequate attention to the woman during gestation and not on its consequences; and 2) although they represented 2.4% of the births in 2017, the twins comprehended 11.0% of all deaths during the first year of life of that year, thus indicating that this group requires special attention through its early identification and appropriate care during the prenatal and the birth, in a way to contribute to the reduction of the infant mortality in the state of RS.