Parto acidental não-hospitalar como indicador de risco para a mortalidade infantil / Accidental non-hospital birth as an indicator of risk of infant mortality

Analisar diferenças na mortalidade infantil, segundo local do parto, no Estado de São Paulo (2009). Métodos: coorte de 252.201 nascidos vivos (NV) por parto vaginal, vinculados a 3289 óbitos infantis, por técnica determinística, divididos em: nascidos em hospitais (250.850) e em domicílio/outro local (1351). Foram calculadas probabilidades de morte e os riscos relativos (RR) e para avaliar o efeito de covariáveis sobre o óbito, utilizou-se modelo de regressão logística multinomial. Resultados: 0,5 por cento NV ocorreram em domicílio/outro local e apresentaram maior probabilidade de morte (45,2 por mil NV) do que os nascidos em hospitais (12,9). A mortalidade foi maior para os nascimentos fora do hospital em todos os componentes da mortalidade infantil: neonatal precoce (RR=3,9), neonatal tardio (RR=2,6) e pós-neonatal (RR=3,4). A probabilidade de morte diminuiu conforme aumentou o peso ao nascer, porém o risco de morte dos NV ≥2500 g em domicílio/outro local foi duas vezes maior que nos partos hospitalares. Após ajuste, nascer fora do hospital permaneceu como risco apenas para a mortalidade pós-neonatal. Conclusões: embora reduzidos, os partos fora do hospital apresentam maior risco de morte, inclusive no período pós-neonatal, sugerindo que há barreiras de acesso não só durante o pré-natal e parto, mas que estas persistem na atenção à criança no primeiro ano de vida...

To examine diferences in infant mortality rates by place of birth, in the State of São Paulo (2009). Methods: a cohort of all 252,201 live vaginal births, with 3,289 infant deaths, was obtained from a deterministic linkage and divided into those born in hospital (250,850) and those born at home or else-where (1351). The probability of death and relative risk (RR) were calculated and a multinomial logistic regression model was used to assess the effect of co-variables on mortality. Results: 0.5 percent live births occurred in the home or elsewhere outside the hospital and presented a greater likelihood of mortality (45.2 per thousand live births) compared with those born in hospital (12.9). Mortality was higher for births outside of hospital for all types of infant mortality: early neonatal (RR=3.9), late neonatal (RR=2.6) and post-neonatal (RR=3.4). The likelihood of death diminished as birth weight increased, although the risk of death for live births ≥2500 g in the home or elsewhere was twice as high as for hospital births. After adjustment, being born outside of hospital continued to be a risk factor for post-neonatal mortality. Conclusions: although few in number, births outside of hospital present a greater risk of death, including post-neonatal mortality, suggesting that there are barriers to access not only during the prenatal period and delivery, but also throughout the first year of life...

Factores que influyen en la decisión de tener partos domiciliarios en la localidad de Ironcollo - Cochabamba, gestión 2011 / Factors influencing the decision to have home births in the town of Ironcollo - Cochabamba, management 2011

El alto índice de morbimortalidad materno-infantil es un problema importante de salud pública en los países en los que el parto domiciliario continúa siendo habitual como en Bolivia, motivo por el que el presente estudio pretende identificar los factores influyentes en la decisión de tener partos domiciliarios en la localidad de Ironcollo. El enfoque que encamina la investigación es el enfoque mixto cuali-cuantitativo basada en obtener resultados visibles y puntuales.Los resultados obtenidos muestran que los factores de mayor influencia para decidir tener un parto domiciliario son varios, entre los cuales están las barreas sociales (idioma, grado de instrucción), culturales (malas experiencias y temores de las mujeres a las instituciones y personal de salud, vergüenza, costumbre y la satisfacción de dar a luz en casa); además, la incapacidad de pago por atenciones prestadas en instituciones hospitalarias; factores que llevan a las mujeres a optar por la atención de partos domiciliarios a pesar de que los servicios de salud se están volviendo cada vez más accesibles, no sólo por el aspecto cultural, sino por el presupuesto económico disminuido gracias a las prestaciones del Seguro Universal Materno Infantil (SUMI)

[Risk factors associated with maternal mortality in the State of Morelos, Mexico]. / Factores de riesgo asociados con mortalidad materna en el estado de Morelos, México.

INTRODUCTION: Maternal mortality is a public health issue. The causes of maternal mortality are directly related to accessibility, opportunity, costs and quality of obstetric and perinatal services. OBJECTIVE: To describe the characteristics of maternal deaths and analyze the risk factors associated with these deaths in the State of Morelos (Mexico). MATERIAL AND METHOD: a cross-sectional epidemiological, observational, descriptive, retrospective study of 94 cases of maternal deaths registered in the Morelos health services, from 2000 to 2004. Hospitalized and non-hospitalized maternal deaths characteristics were compared. RESULTS: Of 94 maternal deaths, 81.9% were classified as hospitalized (66.7% in public hospitals) and 13.8% as non-hospitalized. 73 (77.6%) deaths occurred during the postpartum period. Most women did not have any medical service (76.7%). There were 77 cases (81.9%) of direct maternal death and 12 (18.1%) indirect. The risk of non-hospitalized maternal death in women 35 to 40 years old was three times higher, with incomplete primary education or none 10.9 and without medical service 3.6 times. CONCLUSIONS: Most deaths were in hospitals, the main causes were hypertensive disorders of pregnancy, childbirth and postpartum and obstetric hemorrhage, events related to the quality of health services. It is necessary to develop more efficient prenatal programs, with focus in maternal and child risk.