Distribuição temporal da mortalidade infantil em uma capital do Nordeste do Brasil, 2003-2016: reflexões sobre a qualidade da assistência na atenção primária à saúde

Abstract

The objective of this study was to analyze the temporal distribution of infant deaths, biossociodemographic factors related to infant mortality, the main causes, type of avoidance of death and factors related to the quality of maternal and child health care in Primary Health Care in Natal / RN, a capital of Northeastern Brazil, between 2003 and 2016. Ecological study, of a time series, carried out with data from the Mortality Information System. Infant mortality rates (IMR), neonatal (TMN) and post-neonatal (MTP), and IMR due to death and type of avoidance of death were calculated for each year evaluated. The joinpoint method was used to calculate the Annual Percentage Change (APC). The biossociodemographic variables were analyzed: sex, race, type of gestation, type of delivery, gestational age, and birth weight. To assess the association of these variables and the occurrence of infant death in the neonatal and post-neonatal period, the prevalence ratio (PR) and the 95% confidence interval were calculated. To evaluate the quality of care in Primary Care (AB), data from the Program for Improving Access and Quality of Primary Care (PMAQ-AB) 2014 were used. IMR significantly reduced -12.74% (95% CI -23.9 %, -0.8%) per year, between 2007 and 2011. Of the causes of death, there was a significant reduction only in deaths due to respiratory diseases and in endocrine and nutritional diseases. From the biosociodemographic variables analyzed, gender, type of gestation, type of delivery, gestational age at birth and birth weight were associated with neonatal mortality, with a higher probability of death in the neonatal period; of twin gestation; vaginal delivery; preterm infants with very low birth weight. Regarding maternal and child care, the number of pregnant women who performed more than 7 prenatal visits and the number of neonatal ICU beds significantly increased. Of the infant deaths, 71.7% were considered avoidable, with a significant reduction in avoidable deaths due to adequate attention to the woman in childbirth and to the newborn, and by health promotion actions. Regarding the quality of prenatal care, some indicators were found that may have a negative impact on the infant mortality rate: against maternity leave (7.4%); existence of a system that alerts to the probable date of birth (10.2%); consultation during special hours any day of the week (34.7%) and the early collection of pregnant women and intercurrences during pregnancy (45.3%). It was concluded that a significant reduction in IMR in Natal / RN was achieved, but IMR increased again in later years, which showed that efforts, were insufficient to keep infant mortality in decline. There is still a high occurrence of death due to preventable causes and failures in care in Primary Care observed by the low supply of some maternal and child health indicators agreed upon.