Óbitos de crianças menores de um ano e qualidade da atenção primária em saúde : pesquisando municípios da 15ª Regional de Saúde do Paraná

• Autor(a) principal: Fernandes, Claudiane Amaro
• Data de Publicação: 2011
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da Universidade Estadual de Maringá (RI-UEM)
• Texto Completo: http://repositorio.uem.br:8080/jspui/handle/1/2331
• topic: Avaliação em saúde; Atenção primária à saúde; Mortalidade infantil; 15ª Regional de Saúde do Paraná; Paraná (Estado); Brasil.; Child Mortality; Evaluation in Health; Primary Attention to Health; 15ª Regional of Health of Paraná; Paraná; State; Brazil.; Ciências da Saúde; Enfermagem

The first year of life is one of the periods which presents the higher risk of death, so the child mortality has been considered one sensitive indicator to the social onditions and health of the human population. The reduction of the child mortality is one of the main goals of the primary attention to health. Know the causes of death and the factors attached can help to provide subsidies to the health services on reducing the child mortality. Evaluate the quality of the first health care provided to children from the 15ª Regional of Health, through investigating the death of the children under one year old. Descriptive and exploratory research, in the field of evaluative research with qualitative and quantitative approach, performed in fifteen cities of the 15ª Regional of Health - PR, in which 15 (50%), nine of them with less than 20.000 inhabitants, four within 20.000 and 50.000 inhabitants, and two with more than 50.000 inhabitants were selected. The universe of study was formed by 74 children that died in 2008 in the 15a Regional of Health of Maringá. For the data collection, the records of the prevention committee of child and fetal death were used, on which is recorded information of every attendance provided to the pregnant and to the child. The obtained data was identified by city, gathered in Excel, counted through frequency and simple percentage, presented and analyzed in tables, it was used the statistic method of Pearson Correlation to the analysis of the statistic correlation, it was evaluated through the Winbug free software the analysis of the statistic difference amongst the range, which proceed Bayesian estimation. The child mortality correlation rate with population range was low, showing that the CM occurred in all of the population ranges with low general variation. In Bayesian analysis to check the statistic difference amongst the ranges, the cities with 20 to 50 thousand inhabitants presented the highest coefficient of CM, with average of 14, 82% from 1998 to 2008. The CM correlation rate with the population was ative, showing that as the population number rises, the CM decreases. The correlation between the CM rate and the Health strategy of the family was negative (-45%), showing that, as the Health strategy of the family coverage percentage rises, there is a decrease on the child mortality. In the correlation between the child mortality rate and the distance amongst the cities, it was obtained a correlation of 25,80% demonstrating that, as long as the cities are distant from Maringá, the child mortality rate tends to rise. Regarding to the avoidance of the death, it was possible to check that 82% could have been avoided, with higher percentage in cities with more than 50 thousand inhabitants. Amongst the 74 investigated death, 51 (69%) represented neonatal death and 23 (31%) postnatal, highlighting the cities with less than 20 thousand inhabitants where the neonatal mortality occurred in more than 82%. It was predominant thedeath of male children 39 (53%) and regarding to the mother age, the deaths which more occurred were within the age of 20 and 24 years old and, 46 (66%) of the families received until a minimum wage whose range of until 20 thousand presented higher percentage with 92%, most of them had within 8 and 11 year of education and 80% had a stable marital relation. Forty-one children (56%) were born through Caesarean section, it was not presented significant difference amongst the population range, and 27% of the children weighted less than 1000g, highlighting the cities with more than 50 thousand inhabitants, 65% of the mothers had their children assisted by Unique Health System. Regarding to the 54 deaths classified as avoidable, 50 performed the prenatal 23 (47%) attended in at least seven appointments and 24 (48%) of the cases the first prenatal appointment happened in less than three months of pregnancy. It was observed the precarious situation of the medical records,because 36% were without information about the prenatal. In general, the found causes of death were related to the perinatal period and to congenital alformations, without difference amongst the population extracts. According to the avoidably measures, in 30 deaths the most found were related to the attention given to the women during pregnancy. The measures that were most indicated by the committee were the ones which promote health and primary prevention with 84 (34%), highlighting educational action in health, evaluation of the pregnancy risk and familiar planning. The results of the study suggest that the quality of the primary attention provided to the children may have deficiencies; especially on the prenatal assistance and on the cares provided to the newborn, due to the high number of death that could have been reduced with effective actions of the health services. The range differences found on the present work indicate that the deficiencies are not only related to the high technology, like intensive care unit and sophisticated equipments, but also to light technologies like better attendance to pregnancy and to the risky birth and to the care of the newborn in their first days of life.