Mortalidad materna en la población indígena y no indígena en Pará: contribución para el control de óbitos

Santos, Deivid Ramos dos; Nogueira, Laura Maria Vidal; Paiva, Bárbara Lopes; Rodrigues, Ivaneide Leal Ataide; Oliveira, Lívia Félix de; Caldas, Samantha Pereira

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RESEARCH • Esc. Anna Nery 21 (4) • 2017 • https://doi.org/10.1590/2177-9465-EAN-2017-0161 copiar

Mortalidad materna en la población indígena y no indígena en Pará: contribución para el control de óbitos

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivo:

Analizar los casos de Mortalidad Materna en la población general e indígena del estado de Pará.

Método:

Estudio con abordaje cuantitativo, analítico, retrospectivo, que abarca un historial de 2005 a 2014. Para analizar los resultados, se utilizaron pruebas estadísticas no-paramétricas, el Chi-Cuadrado y la prueba G, procesados en el programa BioStat 5.0.

Resultados:

Se pudo comprobar 884 óbitos maternos, correspondientes a la Razón de Mortalidad Materna 60,7 por 100 mil nacidos vivos de no indígenas y 135,8 de 100 mil nacidos vivos de indígenas. El edema, la proteinuria y los trastornos de hipertensión en el embarazo, parto y puerperio corresponden a 30,5% (n = 270).

Conclusión e implicaciones para la práctica:

La mortalidad materna es aún un grave problema de salud pública en el estado, demostrando claramente que las indígenas requieren de una mayor atención, ya que presentaron índices más elevados de mortalidad materna si lo compara con no indígenas.

Palabras clave:
Mortalidad Materna; Población Indígena; Control en Salud Pública

Year	N	%	LB	MMR^* * p < 0.05 (χ2 test = 1277.6; p = 0.0001);	95%CI¹ 1 Confidence Interval for indigenous MMR.		N	%	LB	MMR^* * p < 0.05 (χ2 test = 1277.6; p = 0.0001);	95%CI² 2 Confidence Interval for non-indigenous MMR.		N	LB	N	%	LB	MMR^ p > 0.05 (χ2 test of adherence between MMRs = 296,606; p < 0.0001); (G test = 387.9024; p < 0.0001; G test (Williams) = 386.3852; p < 0.0001). Annual mean (non-indigenous: 86.5 deaths per year; indigenous: 1.3 deaths per year: total population: 88.4 deaths per year).	95%CI
	Indigenous						Non-indigenous						Ignored		Total population				95%CI
2005	1	7.7	791	126.4	124.7	128.1	86	10.0	144.469	59.5	58.3	60.7	1	280	88	10.0	145.540	60.5	124.7	128.10
2006	0	0.0	749	0	0.0	0.0	83	9.5	149.112	55.7	54.6	56.8	0	341	83	9.4	150.202	55.3	0.0	0.00
2007	1	7.7	795	125.8	124.2	127.4	82	9.4	149.045	55	53.9	56.1	0	307	83	9.4	150.147	55.3	124.2	127.43
2008	1	7.7	793	126.1	124.5	127.7	80	9.2	150.142	53.3	52.3	54.3	0	327	81	9.2	151.262	53.5	124.5	127.71
2009	1	7.7	798	125.3	123.7	126.9	73	8.4	141.997	51.4	50.4	52.4	0	345	74	8.4	143.140	51.7	123.7	126.87
2010	1	7.7	834	119.9	118.3	121.5	75	8.6	139.013	54	52.9	55.1	0	840	76	8.6	140.687	54	118.3	121.48
2011	0	0.0	1.124	0	0.0	0.0	87	10.0	139.839	62.2	61.0	63.4	0	1011	87	9.8	141.974	61.3	0.0	0.00
2012	3	23.1	1.205	249	246.5	251.5	84	10.0	135.616	61.9	60.7	63.1	3	1016	90	10.2	137.837	65.3	246.6	251.43
2013	3	23.1	1.206	248.8	246.0	251.6	110	12.9	136.792	80.4	78.8	82.0	2	1418	115	13.0	139.416	82.5	246.0	251.57
2014	2	15.4	1.280	156.3	154.2	158.4	105	12.1	139.733	75.1	73.6	76.6	0	2055	107	12.1	143.068	74.8	154.2	158.42
Total	13	100.0	9.575	135.8	134.0	137.6	865	100.0	1.425.758	60.7	59.5	61.9	6	7940	884	100.0	1.443.273	61.2	134.0	137.58

ICD-10 cause	N	%	SMMR¹ 1 p < 0.05 (χ2 test = 207.574; p < 0.0001);	N	%	SMMR² 2 p < 0.05 (χ2 test = 23.084; p = 0.0008);	N	N	%	SMMR³ 3 p < 0.05 (χ2 test = 23.688; p = 0.0006); (G test = 39.8016; p < 0.0001; G test (Williams) = 37.1242; p < 0.0002);	95%CI⁴ 4 Confidence Interval between MMRs.
ICD-10 cause	Indigenous			Non-indigenous			Ignored	Total Population			95%CI⁴ 4 Confidence Interval between MMRs.
Pregnancy that ends in an abortion	1	7.7	10.4	82	9.5	5.8	1	84	9.5	5.8	0.82	1.18
Oedema, proteinuria and hypertensive disorders during pregnancy, childbirth and the puerperium	7	53.8	73.1	261	30.2	18.3	2	270	30.5	18.7	6.15	7.85
Other maternal disorders predominantly related to pregnancy	0	0	0	22	2.5	1.5	0	22	2.5	1.5	0.00	0.00
Maternal care related to the fetus and amniotic cavity and possible delivery problems	1	7.7	10.4	58	6.7	4.1	1	60	6.8	4.2	0.85	1.15
Labor and childbirth complications	3	23.1	31.3	191	22.1	13.4	0	194	21.9	13.4	2.53	3.47
Complications predominantly related to the puerperium.	1	7.7	10.4	147	17	10.3	1	149	16.9	10.3	0.76	1.24
Other obstetric conditions not elsewhere classified	0	0	0	104	12	7.3	1	105	11.9	7.3	0.00	0.00
Total	13	100	135.8	865	100	60.7	6	884	100	61.2	10.90	15.10

Variables	Indigenous		Non-indigenous		Ignored		Total population		95%CI¹ 1 Confidence interval between proportions.
Variables	n	%	n	%	n	%	n	%	95%CI¹ 1 Confidence interval between proportions.
Place of occurrence
Hospital	12	92.3	794	91.8	6	100	812	91.9	10.09	13.91
Other than hospital	1	7.7	70	8.1	0	0	71	8.0	0.84	1.16
Ignored	0	0	1	0.1	0	0	1	0.1	0.00	0.00
Obstetric cause
Direct obstetric maternal death	13	100.0	746	86.2	4	66.7	762	86.2	11.07	14.93
Indirect obstetric maternal death	0	0	110	12.8	2	33.3	113	12.8	0.00	0.00
Unspecified obstetric maternal death	0	0	9	1.0	0	0	9	1.0	0.00	0.00
Investigated death
Investigated death with an informed death report file	7	53.8	360	41.6	3	50.0	370	41.9	6.02	7.98
Investigated death without a death report file	1	7.7	70	8.1	0	0	71	8.0	0.84	1.16
Death not investigated	4	30.8	352	40.7	2	33.3	358	40.5	3.26	4.74
Not applicable	1	7.7	83	9.6	1	16.7	85	9.6	0.82	1.18
Total	13	100.0	865	100.0	6	100	884	100.0	10.92	15.08

Health regions	N	%	LB	MMR^ p < 0.05 (χ2 test = 4557.105; p = 0.0001); p < 0.0001, applied to regions with MMR values > 0); p < 0.05 (χ2 test = 1810.930; p < 0.0001); p < 0.005 (χ2 test = 1410.905; p < 0.0001);	N	%	LB	MMR^* * p < 0.05 (χ2 test = 57.148; p < 0.0001);	N	LB	N	%	LB	%	95%CI¹ 1 Confidence Interval between MMRs.
Health regions	Indigenous				Non-indigenous				Ignored		Total Population				95%CI¹ 1 Confidence Interval between MMRs.
Metropolitan 1	0	0	261	0	184	21.3	348.652	52.8	1	879	185	20.9	349.792	52.9	0.00	0.00
Metropolitan 2	0	0	121	0	37	4.3	57.996	63.8	0	579	37	4.2	58.696	63.0	0.00	0.00
Metropolitan 3	0	0	394	0	90	10.4	147.438	61.0	0	545	90	10.2	148.377	60.7	0.00	0.00
Marajó 1	0	0	48	0	31	3.6	33.317	93.0	0	310	31	3.5	33.675	92.1	0.00	0.00
Marajó 2	0	0	44	0	58	6.7	63.390	91.5	0	1.012	58	6.6	64.446	90.0	0.00	0.00
Lago de Tucuruí	0	0	390	0	39	4.5	78.811	49.5	0	481	39	4.4	79.682	48.9	0.00	0.00
Carajás	1	7.7	596	167.8	109	12.6	156.778	69.5	1	446	111	12.6	157.820	70.3	0.80	1.20
Araguaia	3	23.1	1.221	245.7	36	4.2	73.923	48.7	0	458	39	4.4	75.602	51.6	2.80	3.20
Baixo Amazonas	0	0	1.127	0	82	9.5	150.286	54.6	3	1.194	85	9.6	152.607	55.7	0.00	0.00
Rio Caetes	0	0	91	0	70	8.1	95.686	73.2	0	376	70	7.9	96.153	72.8	0.00	0.00
Tapajós	3	23.1	3.857	77.8	22	2.5	38.200	57.6	0	101	25	2.8	42.158	59.3	2.84	3.16
Tocantins	1	7.1	81	1234.6	78	9.0	121.464	64.2	0	1.154	79	8.9	122.699	64.4	0.83	1.17
Xingu	5	38.5	1.344	372.0	28	3.2	59.787	46.8	1	404	34	3.8	61.535	55.3	4.77	5.23
Ignored	0	0	0	0	1	0.1	30	0	0	1	1	0.1	31	0	0.00	0.00
Total	13	100	9.575	135.8	865	100	1.425.758	60.7	6	7.940	884	100.0	1.443.273	61.2	10.92	15.08

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[1] Corresponding author: Bárbara Lopes Paiva. E-mail: barbaralopespaiva@gmail.com