Determinantes de la mortalidad neonatal en el municipio de la Zona da Mata Pernambucana

Souza, Bruno Felipe Novaes de; Sousa, Nayara Francisca Cabral de; Sette, Gabriela Cunha Schechtman; Lima, Ana Paula Esmeraldo; Leal, Luciana Pedrosa; Holanda, Eliane Rolim de

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020015003726 copiar

Determinantes de la mortalidad neonatal en el municipio de la Zona da Mata Pernambucana

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Analizar los determinantes asociados a la mortalidad neonatal en un municipio de la Zona da Mata de Pernambuco.

Método:

Estudio transversal y analitico, realizado en Vitoria de Santo Antao, Pernambuco. Todas las muertes infantiles reportadas por el municipio en el Sistema de Informacion de Mortalidad entre 2011 y 2018 fueron analizadas. Los datos fueron categorizados y organizados en tres dimensiones para ser sometidos a estadistica descriptiva, bivariada y regresion de Poisson con varianza robusta. Razones de prevalencia fueron estimadas, considerando como significativas las variables con p <0.05.

Resultados:

Los determinantes asociados a la muerte neonatal fueron: parto por cesarea (RP 0,83; IC 95% 0,75-0,92), nacimiento en la propia ciudad (RP 1,12; IC 95% 1,01-1,25), raza/color del recien nacido parda y negra. (RP 1,13; IC del 95% 1,00-1,29), prematuridad (RP 1,88; IC del 95% 1,79-1,97) y puntuacion de Apgar <7 en el quinto minuto (RP 1,74; IC del 95% 1,67-1,82).

Conclusión:

Caracteristicas biologicas como raza/color parda y negra, prematuridad y puntaje de Apgar <7 en el 5o minuto posparto, asi como el acceso a servicios de salud, como nacer en el propio municipio y no nacer por cesarea fueron determinantes asociados con la mortalidad neonatal.

DESCRIPTORES:
Mortalidad Infantil; Factores de Riesgo; Enfermeria Neonatal; Enfermeria Pediatrica; Sistemas de Informacion

Variables	Neonatal Death		p-Value
Variables	Yes	No	p-Value
Distal Dimension - Socioeconomic factors
Maternal level of education
<8 years	47 (62.7%)	28 (37.3%)	0.683¹ 1 Chi-square test.
≥ 8 years	52 (65.8%)	27 (34.2%)	0.683¹ 1 Chi-square test.
Mother's marital status
No partner	51 (63.8%)	29 (36.3%)	0.660¹ 1 Chi-square test.
With a partner	51 (67.1%)	25 (32.9%)	0.660¹ 1 Chi-square test.
Occupation (outside work)
Yes	39 (67.2%)	19 (32.8%)	0.750¹ 1 Chi-square test.
No	68 (64.8%)	37 (35.2%)	0.750¹ 1 Chi-square test.
Intermediate Dimension - Behavioral factors and use of services
Type of delivery
Caesarean	39 (52.7%)	35 (47.3%)	0.0021
Vaginal	68 (76.4%)	21 (23.6%)	0.0021
Induced labor
Yes	6 (54.5%)	5 (45.5%)	0.518² 2 Fisher's exact test.
No	96 (65.8%)	50 (34.2%)	0.518² 2 Fisher's exact test.
Parity
Primiparous	24 (68.6%)	11 (31.4%)	0.722¹ 1 Chi-square test.
Multiparous	83 (65.4%)	44 (34.6%)	0.722¹ 1 Chi-square test.
Number of prenatal consultations
Inadequate (<7)	78 (69.6%)	34 (30.4%)	0.012 ¹ 1 Chi-square test.
Adequate (≥ 7)	19 (47.5%)	21 (52.5%)	0.012 ¹ 1 Chi-square test.
Beginning of prenatal care in the 1st trimester
Yes	66 (61.1%)	42 (38.9%)	0.157 ¹ 1 Chi-square test.
No	26 (74.3%)	9 (25.7%)	0.157 ¹ 1 Chi-square test.
Place of birth
Vitória de Santo Antão	51 (58.6%)	36 (41.4%)	0.063 ¹ 1 Chi-square test.
Other municipalities	51 (72.9%)	19 (27.1%)	0.063 ¹ 1 Chi-square test.
Proximal Dimension - Biological Factors
Maternal age
<19 years	27 (65.9%)	14 (34.1%)	1.000¹ 1 Chi-square test.
≥ 19 years	81 (65.9%)	42 (34.1%)	1.000¹ 1 Chi-square test.
Maternal race/skin color
Brown/Black	14 (60.9%)	9 (39.1%)	0.622¹ 1 Chi-square test.
White	88 (66.2%)	45 (33.8%)	0.622¹ 1 Chi-square test.
Type of pregnancy
Single	101 (66.0%)	52 (34.0%)	0.737² 2 Fisher's exact test.
Twins	6 (60.0%)	4 (40.0%)	0.737² 2 Fisher's exact test.
Newborn sex
Male	64 (68.1%)	30 (31.9%)	0.485¹ 1 Chi-square test.
Female	44 (62.9%)	26 (37.1%)	0.485¹ 1 Chi-square test.
Newborn race/skin color
White	14 (43.8%)	18 (56.3%)	0.003 ¹ 1 Chi-square test.
Brown/Black	90 (72.0%)	35 (28.0%)	0.003 ¹ 1 Chi-square test.
Congenital anomaly
Yes	17 (73.9%)	6 (26.1%)	0.374¹ 1 Chi-square test.
No	85 (64.4%)	47 (35.6%)	0.374¹ 1 Chi-square test.
Prematurity (<37 weeks)
Yes	77 (74.8%)	26 (25.2%)	0.001 ¹ 1 Chi-square test.
No	29 (49.2%)	30 (50.8%)	0.001 ¹ 1 Chi-square test.
Birth weight
<2,500 grams	84 (77.1%)	25 (22.9%)	<0.001 ¹ 1 Chi-square test.
≥ 2,500 grams	28 (43.6%)	14 (56.4%)	<0.001 ¹ 1 Chi-square test.
Apgar score in the 1st minute
< 7	67 (82.7%)	14 (17.3%)	<0.001 ¹ 1 Chi-square test.
≥ 7	32 (45.1%)	39 (64.9%)	<0.001 ¹ 1 Chi-square test.
Apgar score in the 5th minute
< 7	46 (92.0%)	4 (8.0%)	<0.001 ¹ 1 Chi-square test.
≥ 7	53 (52.0%)	49 (48.0%)	<0.001 ¹ 1 Chi-square test.

Determinants	PR	95%CI	p-Value¹ 1 Wald test.
Intermediate Dimension - Behavioral factors and use of services
Type of delivery			0.001
Caesarean	0.83	0.75-0.92
Vaginal	1	-
Place of birth			0.032
Vitória de Santo Antão	1.12	1.01-1.25
Other municipalities	1	-
Proximal Dimension - Biological Factors
Newborn race/skin color			0.035
Brown/Black	1.13	1.00-1.29
White	1	-
Prematurity (<37 weeks)			0.016
Yes	1.88	1.79-1.97
No	1	-
Apgar score in the 5th minute			<0.001
< 7	1.74	1.67-1.82
≥ 7	1	-

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Bruno Felipe Novaes de Souza Rua Escritor Álvaro Lins, 176, Apto. 103, Afogados, CEP 50830-420 - Recife, PE, Brazil. bruno-novaes@hotmail.com