Death surveillance as an instrument to reduce invisibility from social and assistance exclusion of women and children

Maternal and infant deaths constitute a public health problem in most of countries, despite being predominantly evitable. Understanding the denial of life as a suppression of the most elementary human right, the United Nations Organization have encouraged countries to make commitments towards its challenging since the year 2000, by the Millennium Development Goals (MDG), updated in new goals to be achieved until 2030 with the Sustainable Development Goals (SDG).¹

However, fetal deaths equally relevant, besides not being contemplated in the MDG and SDG, are neglected and imperceptible to society and public Power for not being the aim of particular care. The visibility conceded to maternal and child death by monitoring the MDG supported the reduction of the problem, yet not evenly in all countries which, even in those who had advanced the most, still indebted with specific populations such as indigenous, quilombolas, gipsy, riverside and homeless.^2,3

In order to develop effective public policies directed to women and children, the adequate knowledge re-garding the relevance of problems, its determinants and circumstances of its occurring is indispensable. Coun-tries which own complete continuous registry information systems can measure safely the mortality range, although sometimes information are insufficient to apprehend facts related to death, as well as identifying so-cially marginalized groups.⁴

In Brazil and other countries who own these systems, besides the improvement of count of maternal, fetal and child deaths and the quality of information, it is necessary to comprehend the event in depth and in multi-ple perspectives, in order to identify groups which is most affected by the inequity of access conditions of ser-vices and assets and intervene towards them.^5,6

For decades the maternal and infant deaths are utilized as sentinel events for their capability of assess the quality of health care in several countries which adopt different organizational arrangements in surveying cases, conditioned by epidemiologic and assistance profile and operational capacity. Only recently the fetal deaths were incorporated in the agenda of events passible of surveillance.⁷

The surveillance of death, when informs the interested ones about the network of contingences which end-ed up with a potentially evitable death, recognizes this strategy as management tool, supports critical reflection of the ones involved in the case and broads the possibility of improvement in access to actions and services during gestation, delivery, birth, puerperium and childcare.⁸ In the same way, the planning of interventions aiming obstacles to quality care contributes to the reduction of evitable deaths and social inequity, being an in-strument to denaturalize deaths which is consented by society.

Evidently, the propagation of information and clarification about this theme to professionals, managers and agencies of maternal and infant health is highly necessary, therefore the contribution of scientific journals with epidemiologic scope involving women health and specially infant health is not irrelevant.

References

• ¹
  Grove J, Claeson M, Bryce J, Amouzou A, Boerma T, Waiswa P, Victora C, Kirkland Group. Maternal, newborn, and child health and the Sustainable Development Goals-a call for sustained and improved measurement. Lancet. 2015; 386 (10003): 1511-4.
• ²
  Merali HS, Lipsitz S, Hevelone N, Gawande AA, Lashoher A, Agrawal P, Spector J. Audit-identified avoidable factors in maternal and perinatal deaths in low resource settings: a systematic review. BMC Pregnancy Childbirth. 2014; 14 (280): 1-12.
• ³
  WHO (World Health Organization). Death reviews: maternal, perinatal and child. WHO 2013. [cited 2016 Jan 24]. Available from: http://www.who.int/pmnch/knowledge/publications/summaries/ks27/en/
  » http://www.who.int/pmnch/knowledge/publications/summaries/ks27/en/
• ⁴
  Frias PG, Szwarcwald CL, Lira PIC. Avaliação dos sistemas de informações sobre nascidos vivos e óbitos no Brasil na década de 2000. Cad SaúdePública. 2014; 30 (10): 2068-280.
• ⁵
  Stratulat P, Curteanu A, Caraus T, Petrov V, Gardosib J. The experience of the implementation of perinatal audit in Moldova. BJOG. 2014; 121 (Suppl. 4): 167-71.
• ⁶
  Vanderlei LCM, Navarrete MLV. Mortalidade infantil evitável e barreiras de acesso a atenção básica no Recife, Brasil. Rev Saúde Pública. 2013; 47 (2): 379-89.
• ⁷
  GOV.UK. Department for Education. Child death reviews: forms for reporting child deaths. [cited 2017 Jan 09]. Available from: http://www.nrhmhp.gov.in/sites/default/files/files/Child%20death%20Review%20guidelines.pdf
  » http://www.nrhmhp.gov.in/sites/default/files/files/Child%20death%20Review%20guidelines.pdf
• ⁸
  Bensaïd K, Yaroh AG, Kalter HD, Koffi AK, Amouzou A, Maina A, Kazmi N. Verbal/Social Autopsy in Niger 2012-2013: A new tool for a better understanding of the neonatal and child mortality situation. J Glob Health. 2016; 6 (1): 010602.

Publication Dates

• Publication in this collection
  Oct-Dec 2017