Activities developed by the committees of prevention of infant and fetal deaths: integrative review

Andriela Backes Ruoff Selma Regina de Andrade Márcia Danieli Schmitt About the authors

RESUMO

Objetivo

Sistematizar o conhecimento sobre as atividades desenvolvidas por comitês que atuam com a prevenção do óbito infantil e fetal.

Método

Revisão integrativa de literatura, realizada no mês de novembro de 2015, nas bases de dados PubMed, CINAHL, Scopus, LILACS, BDEnf e SciELO, utilizando as palavras-chave e descritores mortalidade infantil, óbito infantil, óbitos infantis, óbito fetal, óbitos fetais, mortalidade fetal, mortalidade neonatal, comitê de profissionais, comissão, comissões, comitês consultivos. Os 34 estudos selecionados foram organizados e analisados com auxílio do Microsoft Excel®.

Resultados

Há comitês de âmbito internacional, nacional, regional, estadual e municipal que analisam óbitos e realizam atividades para qualificar a assistência materno-infantil e alimentar os sistemas de informação em saúde.

Conclusão

Os comitês de prevenção do óbito infantil e fetal desenvolvem atividades de coleta, produção, análise e divulgação de informações relacionadas ao óbito com a finalidade de reduzir taxas de mortalidade infantil e fetal.

Comitê de profissionais; Mortalidade infantil; Mortalidade fetal; Gestão em saúde

RESUMEN

Objetivo

Para sistematizar el conocimiento de las actividades desarrolladas por los comités que trabajan con la prevención del trabajo infantil y la muerte fetal.

Método

Revisión integrada de la literatura, que se celebró en noviembre de 2015, de las bases de datos PubMed, CINAHL, Scopus, LILACS, BDEnf y SciELO, usando las palabras clave y descriptores de mortalidad infantil,mortalidad fetal intrauterina, mortinatos, mortalidad fetal, la mortalidad neonatal, del comité profesional, comisiones, comités de asesoramiento. Se organizaron los 34 estudios seleccionados y se los analizó utilizando Microsoft Excel®.

Resultados

Existen internacionalmente comités, nacional, regional, estatal y actividades escénicas locales para calificar los sistemas de información de salud materna e infantil y de los alimentos.

Conclusión

Los comités de prevención de la mortalidad infantil y fetal se desarrollan las actividades de recolección, producción, análisis y difusión de información relacionada con la muerte, a fin de reducir las tasas de mortalidad infantil y fetal.

Comités de profesionales; Mortalidad infantil; Mortalidad fetal; Gestión en salud

ABSTRACT

Objective

To systematize knowledge on the activities developed by the committees involved in the prevention of infant and fetal deaths.

Method

Integrated literature review conducted in November 2015 at PubMed, CINAHL, Scopus, LILACS, BDEnf and SciELO databases using keywords and descriptors of infant mortality, infant death, infant deaths, fetal death, fetal deaths, fetal mortality, neonatal mortality, professional committee, committee, committees, advisory committees. The 34 selected studies were organized and analyzed using Microsoft Excel®.

Results

International, national, regional, state and local committees analyze the deaths and conduct activities aimed to qualify maternal and childcare and feed the health information systems.

Conclusion

The committees for the prevention of infant and fetal mortality collect, produce, analyze and disseminate information related to these deaths in order to reduce infant and fetal mortality rates.

Professional committees; Infant mortality; Fetal mortality; Health management

INTRODUCTION

The Sustainable Development Goals (SDG) include 17 goals and 169 targets to be met by the countries by 2030. Ending preventable deaths of newborns and children under five years old in order to reduce neonatal mortality to less than 12 per 1,000 live births and mortality of children under five years to the less than 25 per 1,000 live births is one of the targets of the third sustainable development goal12. Portal Brasil [Internet]. Brasília (DF); c2015-2017 [citado 2016 abr 5]. ONU: Brasil cumpre meta de redução da mortalidade infantil; [aprox. 4 telas]. Disponível em: http://www.brasil.gov.br/cidadania-e-justica/2015/09/onu-brasil-cumpre-meta-de-reducao-da-mortalidade-infantil.
http://www.brasil.gov.br/cidadania-e-jus...

Brazil is one of the 62 countries that achieved the goal of reducing infant mortality, with a rate of decline of 73% in the 1990-2015 period. Such rate is higher than the global average of 53% of decline over the past 25 years 23. Oliveira E, Souto MB, Santos RA, Fonseca RL, Matos FV, Caldeira AP. Mortalidade infantil evitável em montes claros, Minas Gerais, Brasil, 1999-2011. Rev Baiana Saúde Pública. 2015 [citado 2016 jan 25];39(2):397-407. Disponível em: http://inseer.ibict.br/rbsp/index.php/rbsp/article/viewFile/1688/pdf_632.
http://inseer.ibict.br/rbsp/index.php/rb...

Most infant deaths are preventable. Analyzes of preventable mortality allows assessing living and health conditions and support the implementation of interventions tailored to this population group34. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Secretaria de Atenção à Saúde. Manual de vigilância do óbito infantil e fetal e do Comitê de Prevenção do Óbito Infantil e Fetal. Brasília: Ministério da Saúde; 2009 [citado 2015 nov 3]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manual_obito_infantil_fetal_2ed.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe...

Analysis of the preventability of these deaths should highlight the activities of the committees for prevention of infant and fetal deaths, which aim to give visibility, detect and monitor infant and fetal deaths and propose interventions to reduce these deaths. They consist in management tools that allow assessing the quality of care to pregnant women and children during the first year of life, in order to support public policies and intervention actions 45. Ganong LH. Integrative reviews of nursing research. Res Nurs Health. 1987;10(1):1-11.

Given the target of infant mortality reduction established by the SDGs, and since the countries are getting prepared to monitor mortality indicators, it is important to gain insight on the way in which committees for the prevention of infant and fetal mortality and fetal operate, through the systematization of their activities, with the purpose of sharing experiences. Thus, the justification for conducting this review is its purpose to systematize the knowledge of activities developed by committees for the prevention of child and fetal deaths.

METHOD

This is an integrative literature review that allows the synthesis of relevant publications based on the results of these studies, resulting in a broader analysis and visualization of gaps 56. Lalonde AB, Grellier R. FIGO saving mothers and newborns initiative 2006-2011. Int J Gynaecol Obstet. 2012 [cited 2015 Dec 2];119(suppl. 1):18-21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22883921.
http://www.ncbi.nlm.nih.gov/pubmed/22883...
The study design observed the recommendations of the Checklist of PRISMA Statement for Reporting Systematic Reviews And MetaAnalyzes Of Studies and the development of a protocol of six methodological steps, validated by an expert 56. Lalonde AB, Grellier R. FIGO saving mothers and newborns initiative 2006-2011. Int J Gynaecol Obstet. 2012 [cited 2015 Dec 2];119(suppl. 1):18-21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22883921.
http://www.ncbi.nlm.nih.gov/pubmed/22883...

In the first stage of the review, the following question was posed: How does the national and international scientific literature address the activities developed by committees for prevention of infant and fetal death?

The second stage involved literature search and selection of the studies. The descriptors were used in Portuguese, English and Spanish and comprised the 2005-2015 period. Results of studies, reports of experiences, critical reflections, reviews and management reports were included. Editorials, letters to the editor, comments, summaries of annals, essays, duplicate publications, dossiers, official documents, theses, dissertations, epidemiological bulletins and books and articles that did not meet the scope of this review were excluded.

The following electronic bibliographic databases of November 2015 were consulted in this literature review: (PubMed) Cumulative Index to Nursing & Allied Health Literature (CINAHL), Scopus, Latin American and Caribbean Health Sciences (LILACS), Nursing Database (BDEnf) and Scientific Electronic Library Online (SciELO). The following keywords and combined descriptors were selected: infant mortality, infant death, infant deaths, fetal death, fetal deaths, fetal mortality, neonatal mortality, committee of professionals, committee, committees, advisory committees, and their corresponding terms in English and Spanish. In total, 3,890 studies were identified in the six databases searched.

In the third stage, the studies were previously selected through the reading of the title, abstract, keywords or descriptors, with exclusion of duplicate publications, as well as publications that did not meet the scope of this review. Forty-five (45) articles were pre-selected. All the studies that met the scope of the review (34 studies) were read in full (Figure 1).

Figure 1
– Flowchart of the collection and selection of studies

In the fourth stage, the data obtained was entered into Microsoft Excel® with and included the following items: database, journal, year, author, title, objective, method, location, type of committee, activities performed.

The fifth stage consisted of analysis and interpretation of the results and discussion, highlighting the activities performed by the committees for the prevention of infant and fetal death. In the last stage, a review and synthesis of the knowledge of the activities carried out by the committees for the prevention of infant and fetal death was prepared.

RESULTS

Of the thirty-four (34) selected studies, 17 were indexed in Scopus, nine in CINAHL, PubMed five No, two in SciELO, one in LILACS. No articles that met the objectives of this review were found in BDENF. Regarding the locations, the studies were originally from Brazil 14 studies; United States, 12; China, Japan, Ghana, Israel and Cuba, one study each. In Brazil, the state with the largest number of studies was Paraná (10) followed by São Paulo (4). Regarding the year of publication, six studies were conducted in 2009, five in 2011, four in 2006, three studies in 2008, 2013, 2014 and 2015, two studies in 2007, 2010 and 2012 and one study in 2005.

Regarding the design, the studies were as follows: descriptive and exploratory approach (19), report of experience (7), cross-sectional and descriptive (2), cross-sectional, descriptive and retrospective (1), retrospective descriptive exploratory (one), retrospective descriptive (1), ecological retrospective (1), analysis of agreement (1) and study with clustering approach (1).

Regarding their area of responsibility of these committees, they operate at the international, national, regional, state and municipal levels. The international committees include representatives of several countries, e.g. the Standing Committee on Perinatal Mortality and Morbidity (FIGO), of 1967, which includes representatives from Haiti, Kenya, Kosovo, Pakistan, Peru, Uruguay, Canada, United Kingdom, Spain and other countries 67. Mohangoo AD, Buitendijk ES, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One. 2011 [cited 2015 Dec 15];6(11):e24727. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024727.
http://journals.plos.org/plosone/article...
-78. Dunn PM. History of the FIGO Standing Committee on perinatal mortality and morbidity 1979-1991. Int J GynaecolObstet. 2007 [cited 2015 May 14];96(2):131-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17239382.
http://www.ncbi.nlm.nih.gov/pubmed/17239...
The Euro-Peristat network was established in 1999 as part of the European Union Health Surveillance Program, and is currently formed by 29 countries 89. Sun B, Liang K, Yi B, Zhang L. Child health in China in the Millennium Development Goal era. Arch Dis Child. 2015 [cited 2016 Jan 10];100(1): 61-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25613973.
http://www.ncbi.nlm.nih.gov/pubmed/25613...
The national committees are the top level in the production of information on mortality where the main goals and policies to be achieved at the national, state and municipal levels are formulated 910. American College of Obstetricians and Gynecologists. Committee Opinion Summary Nº 639: The Importance of Vital Records and Statistics for the Obstetrician-Gynecologist. Obstet Gynecol. 2015 [cited 2016 Jan 20];126(3):e-28-e30. Available from: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/The-Importance-of-Vital-Records-and-Statistics-for-the-Obstetrician-Gynecologist.
http://www.acog.org/Resources-And-Public...

11. Lu MC, Johnson KA. Toward a national strategy on infant mortality [Editorials]. Am J Public Health. 2014 Feb [cited 2015 Nov 30];104(suppl. 1):S13-6. Available from: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301855.
http://ajph.aphapublications.org/doi/pdf...

12. Ponce VAA, Uría RMA, Rizo MM, Hernández OG, Mederos JMP. Mortalidad infantil en el Hospital Docente Ginecoobstétrico de Guanabacoa (1998-2010). Rev Cubana Med Gen Integr. 2011 Oct [citado 2015 Dic10];27(4): 495-503. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252011000400008.
http://scielo.sld.cu/scielo.php?script=s...

13. Itabashi K, Horiuchi T, Kusuda S, Kabe K, Itani Y, Nakamura T, et al. Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics. 2009 Feb [cited 2015 Dec 15];123(2):445-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19171608.
http://www.ncbi.nlm.nih.gov/pubmed/19171...
-1314. Issah k, Beifubah AN, Opoku CF. Maternal and neonatal survival and mortality in the Upper West Region of Ghana. Int J Gynaecol Obstet. 2011 Jun [cited 2015 Dec 10];113(3):208-10. Available from: http://www.sciencedirect.com/science/article/pii/S0020729211001093.
http://www.sciencedirect.com/science/art...
The regional committees are focused on the areas of greater vulnerability in the country, with specific characteristics and needs 1415. Strulov A. The Western Galilee Experience: reducing infant mortality in the Arab population. IMAJ. 2005 Aug [cited 2015 Dec 10];7:483-6. Available from: https://www.ima.org.il/FilesUpload/IMAJ/0/50/25306.pdf.
https://www.ima.org.il/FilesUpload/IMAJ/...
-1516. Wilson AL, Sideras J. Regional Infant and Child Mortality Review Committee 2013 final report. S D Med. 2015 Feb [cited 2015 Dec 15];68(2):57-9, 57-9, 61, 63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25799635.
http://www.ncbi.nlm.nih.gov/pubmed/25799...
The state and local committees are responsible for producing information through surveillance, investigation and analysis of infant and fetal deaths 1617. Wilson AL, Sideras J. Regional Infant and Child Mortality Review Committee 2012 final report. S D Med. 2013 Oct [cited 2015 Dec 15];66(10):415-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24244981.
http://www.ncbi.nlm.nih.gov/pubmed/24244...

18. Randall B, Wilson A. Regional Infant and Child Mortality Review Committee 2010 final report. S D Med. 2011 Dec [cited 2015 Dec 15]; 64(12):455-63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22312750.
http://www.ncbi.nlm.nih.gov/pubmed/22312...

19. Venâncio SI, Paiva R. O processo de implantação dos comitês de investigação do óbito infantil no Estado de São Paulo. Rev Bras Saúde Matern Infant. 2010 jul [citado 2015 dez 15];10(3):369-75. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292010000300010.
http://www.scielo.br/scielo.php?script=s...

20. Randall B, Wilson A. Regional Infant and Child Mortality Review Committee: 2009 final report. S D Med. 2010 Oct [cited 2015 Dec 10];63(10):343-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20968213.
http://www.ncbi.nlm.nih.gov/pubmed/20968...

21. Randall B, Wilson A. The 2008 annual report of the Regional Infant and Child Mortality Review Committee. S D Med. 2009 Dec [cited 2015 Dec 10];62(12):471-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20369635.
http://www.ncbi.nlm.nih.gov/pubmed/20369...

22. Yao GM, Leone CR, Sadeck L, Vico ER, Taniguchi M. Sistema de investigação dos óbitos perinatais e neonatais por meio de comitês de mortalidade perinatal e infantil na cidade de São Paulo. Saúde Soc. 2009 Jan [citado 2015 dez 11];18(supl. 1):80. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-12902009000500032.
http://www.scielo.br/scielo.php?script=s...

23. Fortuna CB, Lima E, Lima MR. Óbitos neonatais: uma experiência de trabalho do Comitê Regional de Vigilância ao Óbito Infantil e Fetal (CRVOIF) no Departamento Regional de Saúde de Campinas (DRS-VII), no ano 2005. Saúde Soc. 2009 jan [citado 2015 dez 11];18(supl. 1):80. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-12902009000500033.
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24. Orlandi MHF. Comitês de prevenção da mortalidade materna e infantil no Paraná: estratégia de sucesso na vigilância da saúde de mulheres e crianças [Editorial]. Cienc Cuid Saude. 2008 Jan [citado 2015 jan 15];7(1):7-8. Disponível em: http://periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/11379/6165.
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25. Randall B, Wilson A. The 2007 annual report of the Regional Infant and Child Mortality Review Committee. S D Med. 2008 Aug [cited 2015 Dec 8];61(8):287-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18819316.
http://www.ncbi.nlm.nih.gov/pubmed/18819...

26. Randall B, Wilson A. The 2006 annual report of the Regional Infant and Child Mortality Review Committee. S D Med. 2007 Sep [cited 2015 Dec 8];60(9):343-51. Available from: http://www.pubpdf.com/pub/17987866/The-2006-annual-report-of-the-Regional-Infant-and-Child-Mortality-Review-Committee.
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27. Brennan G, Rhoades E, Chilton L. Forty years in partnership: The American Academy of Pediatrics and the Indian Health Service. Pediatrics. 2006 Oct [cited 2015 Dec 10];118(4):e1257-63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17015514.
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28. Andrade SM, Soares DA, Matsuo T, Souza RKT, Mathias TAF, Iwakura MLH, et al. Condições de vida e mortalidade infantil no estado do Paraná, Brasil, 1997/2001. Cad Saúde Pública. 2006 jan [citado 2015 dez 10];22(1):181-9. Disponível em: http://www.scielo.br/pdf/csp/v22n1/19.pdf.
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29. Randall B, Wilson A. The 2005 Annual Report of the Regional Infant and Child Mortality Review Committee. S D Med. 2006 Nov [cited 2015 Dec 8];59(11):473-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17180844.
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30. Santos HG, Andrade SM, Silva AMR, Carvalho WO, Mesas AE, González AD. Concordância sobre causas básicas de morte infantil entre registros originais e após investigação: análise de dois biênios nos anos 2000. Rev Bras Epidemiol. 2014 abr-jun [citado 2015 dez 15];17(2):313-22. Disponível em: http://www.scielo.br/pdf/rbepid/v17n2/pt_1415-790X-rbepid-17-02-00313.pdf.
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31. Careti CM, Scarpelini AHP, Furtado MCC. Perfil da mortalidade infantil a partir da investigação de óbitos. Rev Eletr Enf. 2014 jun [citado 2015 jan 10];6(2):352-60. Disponível em: http://revistas.ufg.br/fen/article/view/20321/17252.
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32. Fernandes CA, Vieira VCL, Scoth MS. Mortalidade infantil e classificação de evitabilidade: pesquisando municípios da 15 regional de saúde paraná. Cienc Cuid Saúde. 2013 dez [citado 2015 dez 10];12(4):752-9. Disponível em: http://www.periodicos.uem.br/ojs/index.php/CiencCuidSaude/article/view/16537/pdf_88.
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http://www.scielosp.org/pdf/csp/v30n10/0...
. In Chart 1, the selected studies are grouped by scope, author, title and objective. A summary of the activities developed by the committees according to their level of responsibility is also included.

Chart 1
– Characterization of the studies regarding scope, author/year, title, objective of the study and activities developed by the committees

At all levels, the activities of the committees have a multidisciplinary team composed of nurses, pathologists, epidemiologists, obstetricians, gynecologists and health educators. They have an inter-institutional nature, with representatives of public and private institutions at the primary, secondary and tertiary level.

DISCUSSION

At the international level, the activities of FIGO 67. Mohangoo AD, Buitendijk ES, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One. 2011 [cited 2015 Dec 15];6(11):e24727. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024727.
http://journals.plos.org/plosone/article...
-78. Dunn PM. History of the FIGO Standing Committee on perinatal mortality and morbidity 1979-1991. Int J GynaecolObstet. 2007 [cited 2015 May 14];96(2):131-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17239382.
http://www.ncbi.nlm.nih.gov/pubmed/17239...
and Euro-Peristat 89. Sun B, Liang K, Yi B, Zhang L. Child health in China in the Millennium Development Goal era. Arch Dis Child. 2015 [cited 2016 Jan 10];100(1): 61-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25613973.
http://www.ncbi.nlm.nih.gov/pubmed/25613...
committees are focused on the production of statistical data on infant and fetal mortality, allowing a thorough analysis of changes in mortality rates between the countries. They are responsible for the establishment of national committees and monitor their perinatal event reports. Based on statistical data and the reports, the international committees prepare projects targeted to the particularities of each country, addressing the clinical training of the professionals and the development of treatment protocols, as well as the implementation of clinical audits and legislative and policy changes. Regional differences in the notification of vital events can reveal the underestimation of fees, precisely in areas of lower socioeconomic level and difficult access to health care. On the other hand, increased coverage of information systems affects the evolution of infant mortality estimates and may lead to underreporting 4041. Santos SPC, Lansky S, Ishitani LH, França EB. Óbitos infantis evitáveis em Belo Horizonte: análise de concordância da causa básica, 2010-2011. Rev Bras Saúde Matern Infant. 2015 out [citado 2016 abr 10]; 5(4):389-99. Disponível em: http://www.scielo.br/pdf/rbsmi/v15n4/1519-3829-rbsmi-15-04-0389.pdf.
http://www.scielo.br/pdf/rbsmi/v15n4/151...
In Brazil, the vital signs are consistent with the recommendations of international bodies, being suitable for the construction of development indicators and to the assessment of health policies 4041. Santos SPC, Lansky S, Ishitani LH, França EB. Óbitos infantis evitáveis em Belo Horizonte: análise de concordância da causa básica, 2010-2011. Rev Bras Saúde Matern Infant. 2015 out [citado 2016 abr 10]; 5(4):389-99. Disponível em: http://www.scielo.br/pdf/rbsmi/v15n4/1519-3829-rbsmi-15-04-0389.pdf.
http://www.scielo.br/pdf/rbsmi/v15n4/151...

At the national level, the committees of Cuba 1213. Itabashi K, Horiuchi T, Kusuda S, Kabe K, Itani Y, Nakamura T, et al. Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics. 2009 Feb [cited 2015 Dec 15];123(2):445-50. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19171608.
http://www.ncbi.nlm.nih.gov/pubmed/19171...
and Japan 1314. Issah k, Beifubah AN, Opoku CF. Maternal and neonatal survival and mortality in the Upper West Region of Ghana. Int J Gynaecol Obstet. 2011 Jun [cited 2015 Dec 10];113(3):208-10. Available from: http://www.sciencedirect.com/science/article/pii/S0020729211001093.
http://www.sciencedirect.com/science/art...
are concerned with the investigation of infant mortality rates, and attempt to elucidate the influence of biological, psychological, social, cultural, economic and environmental factors on these rates. In China 910. American College of Obstetricians and Gynecologists. Committee Opinion Summary Nº 639: The Importance of Vital Records and Statistics for the Obstetrician-Gynecologist. Obstet Gynecol. 2015 [cited 2016 Jan 20];126(3):e-28-e30. Available from: http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/The-Importance-of-Vital-Records-and-Statistics-for-the-Obstetrician-Gynecologist.
http://www.acog.org/Resources-And-Public...
the committee also seeks to mitigate the gaps between rural and urban areas to reduce infant mortality. In the United States 1011. Lu MC, Johnson KA. Toward a national strategy on infant mortality [Editorials]. Am J Public Health. 2014 Feb [cited 2015 Nov 30];104(suppl. 1):S13-6. Available from: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301855.
http://ajph.aphapublications.org/doi/pdf...
-1112. Ponce VAA, Uría RMA, Rizo MM, Hernández OG, Mederos JMP. Mortalidad infantil en el Hospital Docente Ginecoobstétrico de Guanabacoa (1998-2010). Rev Cubana Med Gen Integr. 2011 Oct [citado 2015 Dic10];27(4): 495-503. Available from: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252011000400008.
http://scielo.sld.cu/scielo.php?script=s...
the national committee seeks to optimize care during pregnancy and childbirth, focusing primary prevention, and makes recommendations to the gynecology and obstetrics service on the relevance of statistics and the quality of vital records.

Considering the context of the death means reflecting on the reduction of inequalities and social injustices, including, in the actions proposed by the committee, the biological, socioeconomic services, recognized as determinants of infant and fetal mortality (4142. Bernardino LCS, Costa SM, Lima CM, Brito MFSF, Dias OV, Freitas DM. Mortalidade infantil e desigualdade social: análise fundamentada na bioética de intervenção. Rev Norte Min Enferm. 2015 [citado 2016 fev 15];4(2):42-60. Disponível em: http://www.renome.unimontes.br/index.php/renome/article/view/95/136.
http://www.renome.unimontes.br/index.php...
In Brazil, a study showed that increase in mortality is related to lower human development index, lower per capita income and insufficient health facilities. Thus, increase in mortality correlates with the worst socioeconomic and health investment indicators, suggesting a direct relationship of social determination and the influence of the context in which the deaths occurred 4243. Barros GA, Lima PCM, Mata MS. Análise dos determinantes sociais dos anos potenciais de vida perdidos no estado do Rio Grande do Norte. Rev Ciênc Plural. 2015 dez [citado 2016 mai 19];1(3):14-25. Disponível em: http://www.periodicos.ufrn.br/rcp/article/view/8579/6180.
http://www.periodicos.ufrn.br/rcp/articl...
-4344. Ferreira AIG, Soares V, Nitschke RG, Tholl AD, Munoz MAGC, Michelin SR. The daily life of pregnant women: nursing promoting being healthy. Texto Contexto Enferm. 2014 Oct [cited 2016 Apr 10];23(4):987-94. Available from: http://www.scielo.br/pdf/tce/v23n4/0104-0707-tce-23-04-00987.pdf.
http://www.scielo.br/pdf/tce/v23n4/0104-...

The actions of the regional committees are focused on the specific circumstances of a particular geographic region, such as in Ghana 1415. Strulov A. The Western Galilee Experience: reducing infant mortality in the Arab population. IMAJ. 2005 Aug [cited 2015 Dec 10];7:483-6. Available from: https://www.ima.org.il/FilesUpload/IMAJ/0/50/25306.pdf.
https://www.ima.org.il/FilesUpload/IMAJ/...
and Israel 1516. Wilson AL, Sideras J. Regional Infant and Child Mortality Review Committee 2013 final report. S D Med. 2015 Feb [cited 2015 Dec 15];68(2):57-9, 57-9, 61, 63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25799635.
http://www.ncbi.nlm.nih.gov/pubmed/25799...
The committee of the western region of Ghana 1415. Strulov A. The Western Galilee Experience: reducing infant mortality in the Arab population. IMAJ. 2005 Aug [cited 2015 Dec 10];7:483-6. Available from: https://www.ima.org.il/FilesUpload/IMAJ/0/50/25306.pdf.
https://www.ima.org.il/FilesUpload/IMAJ/...
provides tools to improve the work process in health services, and also documents the deaths and analyzes the related factors in each case. In the region of Galilee in Israel 1516. Wilson AL, Sideras J. Regional Infant and Child Mortality Review Committee 2013 final report. S D Med. 2015 Feb [cited 2015 Dec 15];68(2):57-9, 57-9, 61, 63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25799635.
http://www.ncbi.nlm.nih.gov/pubmed/25799...
the committee introduced an online real-time computer system for monitoring and analyzing information. It also implemented a program for health prevention and education, aimed to reduce mortality by seasonal infections.

Due to the significant differences in the profiles of the regional populations, and considering the maternal circumstances of infant death, it is necessary to understand the distribution of social risk factors, the regional variation of these factors and the profile of perinatal morbidity and mortality closely related to the quality of care. Thus, mortality monitoring makes it possible to assess health care quality 4445. Gaiva MAM, Bittencourt RM, Fujimori E. Early and late neonatal death: characteristics of mothers and newborn. Rev. Gaúcha Enferm. 2013 [cited 2016 Mar 14];34 (4):91-7. Available from: http://www.scielo.br/pdf/rgenf/v34n4/en_12.pdf.
http://www.scielo.br/pdf/rgenf/v34n4/en_...
- 4546. Areco KCN, Konstantyner T, Taddei JAAC. Tendência secular da mortalidade infantil, componentes etários e evitabilidade no Estado de São Paulo - 1996 a 2012. Rev Paul Pediatr. 2016 mar [citado 2016 mai 15];34(3):263-70. Disponível em: http://ac.els-cdn.com/S0103058216000228/1-s2.0-S0103058216000228-main.pdf?_tid=5c9c35cc-2e58-11e6-aa59-00000aab0f6b&acdnat=1465486952_b9c349a9f120b044a8470e03564ec657.
http://ac.els-cdn.com/S0103058216000228/...
A study conducted in Brazil 45. Ganong LH. Integrative reviews of nursing research. Res Nurs Health. 1987;10(1):1-11.67. Mohangoo AD, Buitendijk ES, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One. 2011 [cited 2015 Dec 15];6(11):e24727. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024727.
http://journals.plos.org/plosone/article...
revealed the importance of regional analysis for the organization of services and the establishment of care networks targeted to mothers and newborns. The study also demonstrated the importance of mapping the current health care status and its evolution, to assist the managers 45. Ganong LH. Integrative reviews of nursing research. Res Nurs Health. 1987;10(1):1-11.67. Mohangoo AD, Buitendijk ES, Szamotulska K, Chalmers J, Irgens LM, Bolumar F, et al. Gestational age patterns of fetal and neonatal mortality in Europe: results from the Euro-Peristat project. PLoS One. 2011 [cited 2015 Dec 15];6(11):e24727. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0024727.
http://journals.plos.org/plosone/article...

The actions of state and municipal (local) committees are focused on the monitoring and analysis of preventability of infant and fetal deaths, with direct participation in the process of surveillance, investigation and analysis of deaths and the living conditions and health status of families, by issuing reports on the number of deaths and making recommendations for the community.

There are similarities and specificities regarding the activities carried out by the different committees. At the international level, the committees monitor statistical data and develop targets to be met by countries. The main responsibility of the national committees is to support the state committees. These, in turn, support the municipal committees. The municipal level is a central axis, as it is the basis of the collection, production and analysis of the data that feeds the information systems of the other levels.

At all levels, the committees are composed of multidisciplinary teams that contribute to the development strategies to prevent new deaths 45. Ganong LH. Integrative reviews of nursing research. Res Nurs Health. 1987;10(1):1-11.

CONCLUSION

Some studies showed that the activities developed by all the committees are complementary, and involve collection, production, analysis and dissemination of information. Regardless of its level, the committees ultimately aim to reduce infant mortality.

The present study contributes to the systematization of knowledge of the activities developed by the committees, allowing the sharing of experiences, which is in accordance with the targets set by the SDG. Furthermore, it provides a reflection on the organizational strategies and actions for the prevention of infant and fetal mortality and qualification of care. However, this integrative review failed to obtain a high level of evidence, which is one limitation. Thus, given the technical, scientific and social relevance of the referred committees for the prevention of infant mortality, further studies on this topic are needed.

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Publication Dates

  • Publication in this collection
    2017

History

  • Received
    26 Aug 2016
  • Accepted
    14 Feb 2017
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