Mortalidade neonatal no município de Fortaleza Ceará : evolução e fatores de risco entre 2004 e 2008

Abstract

Infant mortality and its components continue to be an important parameter in order to assess the improvement of children health. Objective: a) Determine the evolution of neonatal and infant mortality and predictor variables associated with neonatal deaths and births in the city of Fortaleza in the period 2004-2008; b) examine the relationship between type of childbirth, newborn child weight and gestational age births of children occurring in the same period. Methodology: time series study. All births of living children that occurred in the city of Fortaleza registered in the Information System of Liveborn and all neonatal deaths from Mortality Information System during the period of 2004 to 2008. The data were obtained through electronic access to the Tab Net, on the official website of the Secretary of Health of the city of Fortaleza. Deaths of children under one year old were also studied. Absolute values and its predictor variables proportions for births and deaths for each year of study were calculated. Chi square test-trend was calculated based on the program Epi-info 6.04d. The variation of proportions between the years 2004 and 2008 for all of the studied variables was determined. To analyze the variations of the proportions of these variables the tool comparison of proportions, qui-quadrado trend, was used. It was calculated in the Stat Calc command of the program Epi info 6.04d. Results: the decrease of Child Mortality in Fortaleza was of approximately 17% (3.4% per annum). The reduction of Neonatal Mortality was 15%, remaining at 17.8%O, reduction that did not reach statistical significance (p = 0.18). The greatest reduction was verified in the late neonatal component (30% vs 9.1%). Neonatal mortality's contribution to the infant mortality rate reached 68% on the last year of studies. The predictor variable group for births with best performance in the period was: under seven Apgar score in the fifth minute, maternal schooling and occurrence of teenage pregnancy, for mothers living in Fortaleza. For non-resident mothers, the improvement was smaller and expressed in maternal schooling, Apgar score in the fifth minute and occurrence of teenage pregnancy. Regards to adolescent mothers, positive changes occurred in the following indicators: Apgar score in the fifth minute, maternal schooling, low birthweight and reduction on incomplete or absent prenatal. Cesarean delivery increased by 15% for the whole sample, and in the private area such rate reached 89.8%. Conclusion: in the studied period a decrease of infant mortality rate of 17% ocurried; the early neonatal component practically remained unchanged. Significant improvement occurred on the following predictor variables of births and deaths: maternal schooling, reduction in deliveries in teenagers, in the fifth minute Apgar score less than seven.