Evitabilidade e desigualdades regionais da mortalidade infantil em Mato Grosso

Abstract

Infant mortality reflects the population's living conditions and the quality of health services. When avoidable, it is considered a sentinel event, constituting an important indicator for health surveillance. This study aimed to analyze the evolution of infant mortality, its distribution according to the health regions and the factors associated with preventable neonatal death in Mato Grosso, from 2007 to 2016. It is a mixed study, with a trend study approach and control case, both related to ten live birth cohorts (NV) with data from the information systems on live births (SINASC) and mortality (SIM). The parameter of avoidability of causes of death was the List of Causes of Death Avoidable by Interventions under the Unified Health System of Brazil for children under five years of age. In the first approach, presented in this dissertation as the first manuscript, we analyzed the trend of infant mortality rate and proportional mortality according to the group of causes and health regions of Mato Grosso. We used polynomial regression models to estimate the time trend of infant mortality avoidance in the study period. In the control case study, birth and neonatal death records of children of women residing in Mato Grosso, matched by the linkage method, were considered, and neonatal deaths were avoided and controls, live births that survived in the first year of life. Association analysis was performed by means of hierarchical logistic regression, the OR (odds ratio) and their respective confidence intervals were calculated, being considered in the distal level the sociodemographic characteristics, at the intermediate level the previous history and the current and proximal level the conditions of labor and birth. Remaining in the final model were those that presented statistical significance at the 5% level. Statistical analyzes were performed using SPSS software. The infant mortality rate showed a decreasing trend in the state, but individually, only four of the 16 health regions followed this tendency, remaining stationary in most regions. The highest proportion of infant deaths occurred in the first week of life and 65.1% of all deaths were considered preventable, with more than half of them being reduced with adequate health care during pregnancy, delivery and the newborn. In addition, there was a growing trend of proportional mortality due to causes not clearly avoidable, especially congenital malformations. In the process of determination of avoidable neonatal death, all variables distributed at the distal, intermediate and proximal levels were influenced. The results show the importance of prioritizing the access and quality of health services during pregnancy, delivery and the newborn, especially in the first week of life. In addition, there is a need for measures to prevent child deaths through public policies that consider regional inequalities in the distribution of causes of death and their evolution over the years in order to reduce high child mortality rates in Mato Grosso.