Análise da qualidade da investigação dos óbitos infantis e fetais no município de Caicó/RN

Abstract

The Infant Mortality Rate (IMR) is one of the most common factors used to analyze the health situation of a population. Therefore, the mortality investigation has been used as an instrument to identify the risk factors related to it in order to assist in the action planning which aims to restructure and improve child and maternal assistance, with the objective to reduce deaths and contribute to the qualification of health information. In light of this, the present study which has a descriptive nature and used a quantitative approach, aims, in a general way, to analyze the quality of infant and fetal mortality investigations in the city of Caicó/RN and as a specific objective, to identify the proportion of investigated and notified infant and fetal death, on the Mortality Information System (SIM) from the Municipal Health Office of Caicó/RN; calculate the average number of days until the conclusion of the process of investigation of infant and fetal death; analyze the completeness and consistency of the data found on infant and fetal death certificates (DO) as well as on the investigation files; classify infant and fetal deaths according to the Brazilian Evitability List; and compare, taking into account the evitability potential, the classification of infant and fetal deaths according to the Brazilian Evitability List and the results obtained after the investigation carried out by the municipality. As participants of the study, it was included all infant and fetal deaths (N=55) from residents of the city concerned, which were notified and investigated on the Mortality Information System (SIM) in the period between 2010 and 2015. It was used secondary data about infant and fetal deaths which came from the death surveillance sector of the city and of the SIM. In order to achieve a better analysis of the investigations, the study followed some dimensions: Completeness, Consistency, Evitability Classification and Time of Investigation, each one of these with its corresponding variables. The data was analyzed through absolute and relative frequencies using the program Statistical Package for the Social Sciences (SPSS) in the 22.0 version. The results showed a low percentage of the investigation (45, 3%), with the predominance of the investigations occurring after 120 days (82,7%). Concerning the completeness of the data of the instruments which were used in the investigations, the worst ones, for the stillbirth, refer to out-patient files (78,2%) and home interview (78,4%), whilst for the deaths of children under one year old, they are represented for hospital files (70,1%). 75,7% of the fetal cases and 92% of infant cases which were analyzed, showed factors which compromised the consistency of the investigation. Considering the total of infant and fetal deaths, it was predominant in this study (64, 8%) the causes which are evitable by the health care services and only 13, 7% were in accordance when compared to the results based on the classification of the Brazilian Evitability List and the ones obtained in the investigation carried out by the city in question. In general, the study highlighted the fragility of death surveillance in the city of Caicó, in special at the end of the investigations. Therefore, it is important to acknowledge the fact of the relevance of the investigation to be aware of infant and fetal mortality, this way being an important tool for the management of decision making and monitoring infant death with the objective to transform this reality. It is necessary to reinforce the role of the investigation committee and mobilize the managers and health teams to overcome the problems which were found.