Mortalidad infantil en la provincia de Santiago de Cuba durante el período 2008-2022

Introducción: La tasa de mortalidad infantil es un indicador importante y sensible del bienestar y la calidad de vida de una población, muy usado para medir su estado de salud. Objetivo: Caracterizar la mortalidad infantil según semestres en la provincia de Santiago de Cuba durante 2008-2022. Métodos: Se realizó un estudio observacional descriptico y transversal sobre la mortalidad infantil en la provincia de Santiago de Cuba durante los años 2008-2022. Para ello se analizó la relación existente entre los semestres de cada año respecto a los nacimientos, las defunciones y su incidencia en la tasa del país. Resultados: Se observó una disminución de los nacimientos y un incremento de las defunciones en cada quinquenio estudiado respecto al anterior. El número de fallecidos menores de un año fluctuó, con una tendencia al aumento a partir del 2019; asimismo, los indicadores de mortalidad infantil fueron inestables, con propensión al incremento, sobre todo en el segundo semestre, y peores resultados en el 2021 y 2022. Existió un descenso mantenido de los nacimientos a partir del 2011, que alcanzó 25,6 % en el 2022. Respecto a los semestres, en el segundo hubo mayor número de nacimientos, defunciones y tasas. Conclusiones: La provincia de Santiago de Cuba influye de forma directa en los resultados de la mortalidad infantil nacional, con una tasa superior a la exhibida por el país. El segundo semestre es el período en el que se incrementan los nacimientos y las defunciones, lo que incide en la elevación de las tasas respectivas.

Introduction: The infant mortality rate is an important and sensitive indicator of the well-being and life quality of a population, very used to measure the health state. Objective: To characterize the infant mortality in Santiago de Cuba province during the period 2008-2022. Methods: An observational descriptive and cross-sectional study about the infant mortality was carried out in Santiago de Cuba during the years 2008-2022. The existent relationship among the semesters of every year regarding births, deaths and their incidence in the country rate was analyzed. Results: A decrease of births and an increment of deaths were observed in each five year period studied regarding the previous one. The number of deceased children under one year fluctuated, with a tendency to the increase starting from 2019; also, the indicators of infant mortality were unstable, with tendency to the increment, mainly in the second semester, and worse results in 2021 and 2022. There was a maintained decrease of births since 2011 that reached 25.6% in 2022. In relation to semesters, in the second one there was a higher number of births, deaths and rates. Conclusions: Santiago de Cuba province influences in a direct way on the results of national infant mortality, with a superior rate to the one exhibited by the country. The second semester is the period in which births and deaths are increased, what impacts in the elevation of the respective rates.

Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil.

BACKGROUND: Ending preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country. METHOD: An ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated. RESULTS: In 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment. CONCLUSIONS: The strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.

Estudo da mortalidade infantil nos estados brasileiros utilizando aplicação de dados em painel / Study of child mortality in brazilian states using panel data application / Estudio de mortalidad infantil en estados brasileños mediante aplicación de datos de panel

Este trabalho tem como objetivo determinar uma relação linear entre a Taxa de Mortalidade Infantil (TMI) e um conjunto de variáveis socioeconômicas observadas por unidades federativas no período de 2005 à 2010 utilizando o modelo de dados em painel de efeitos fixo e aleatório. Metodologia: trata-se de um estudo descritivo com abordagem quantitativa, com utilização dos Sistema de Informação sobre Mortalidade (SIM) e o Sistema de Informações sobre Nascidos Vivos (SINASC) e em seguida utilizou-se o software R para realizar esta análise de dados com a função plm. Resultados: os estudos mostram que o modelo mais adequado é o de efeito fixo com transformação logarítmica nas variáveis independentes e na variável dependente que foram as seguintes: TMI, taxa de analfabetismo, PIB per capita, proporção pessoas com baixa renda, percentual da população servida por rede de abastecimento de água e a proporção da população servida por coleta de lixo. Conclusão: As variáveis independentes que causam impacto significativo na TMI são taxa de analfabetismo, PIB per capita e proporção de pessoas com baixa renda.

This work aims to determine a linear relationship between the Infant Mortality Rate (IMR) and a set of socioeconomic variables observed by federative units in the period from 2005 to 2010 using the fixed and random effects panel data model. Methodology: this is a descriptive study with a quantitative approach, using the Mortality Information System (SIM) and the Live Birth Information System (SINASC) and then using the R software to perform this data analysis with the plm function. Results: studies show that the most appropriate model is the fixed effect model with logarithmic transformation in the independent variables and the dependent variable, which were as follows: IMR, illiteracy rate, GDP per capita, proportion of people with low income, percentage of the population served by water supply network and the proportion of the population served by garbage collection. Conclusion: The independent variables that have a significant impact on IMR are the illiteracy rate, GDP per capita and the proportion of people with low income.

Este trabajo tiene como objetivo determinar una relación lineal entre la Tasa de Mortalidad Infantil (TMI) y un conjunto de variables socioeconómicas observadas por las unidades federativas en el período 2005 a 2010 utilizando el modelo de datos de panel de efectos fijos y aleatorios. Metodología: se trata de un estudio descriptivo con enfoque cuantitativo, utilizando el Sistema de Información de Mortalidad (SIM) y el Sistema de Información de Nacidos Vivos (SINASC) y luego utilizando el software R para realizar este análisis de datos con la función plm. Resultados: los estudios muestran que el modelo más adecuado es el modelo de efectos fijos con transformación logarítmica en las variables independientes y la variable dependiente, las cuales fueron las siguientes: TMI, tasa de analfabetismo, PIB per cápita, proporción de personas con bajos ingresos, porcentaje de la población atendida por red de suministro de agua y la proporción de la población atendida por recolección de basura. Conclusión: Las variables independientes que tienen un impacto significativo en la TMI son la tasa de analfabetismo, el PIB per cápita y la proporción de personas con bajos ingresos.

The spatio-temporal dynamics of infant mortality in Ecuador from 2010 to 2019.

The infant mortality rate (IMR) is still a key indicator in a middle-income country such as Ecuador where a slightly increase up to 11.75 deaths per thousand life births has been observed in 2019. The purpose of this study is to propose and apply a prioritization method that combines clusters detection (Local Indicators of Spatial Association, LISA) and a monotonic statistic depicting time trend over 10 years (Mann-Kendall) at municipal level. Annual national databases (2010 to 2019) of live births and general deaths are downloaded from National Institute of Statistics and Censuses (INEC). The results allow identifying a slight increase in the IMR at the national level from 9.85‰ in 2014 to 11.75‰ in 2019, neonatal mortality accounted for 60% of the IMR in the last year. The LISA analysis allowed observing that the high-high clusters are mainly concentrated in the central highlands. At the local level, Piñas, Cuenca, Ibarra and Babahoyo registered the highest growth trends (0.7,1). The combination of techniques made it possible to identify eight priority counties, half of them pertaining to the highlands region, two to the coastal region and two to the Amazon region. To keep infant mortality at a low level is necessary to prioritize critical areas where public allocation of funds should be concentrated and formulation of policies.

Inequalities in infant mortality in Brazil at subnational levels in Brazil, 1990 to 2015.

BACKGROUND: In this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales. METHODS: The Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010. RESULTS: IMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010. CONCLUSION: The results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments.

An assessment of infant mortality rates in Colombia, 1980-2009 / Una evaluación de las tasas de mortalidad infantil en Colombia, 1980-2009

Abstract Purpose: The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. Methods: The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. Results: The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. Conclusions: The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.

Resumen Propósito: La Tasa de Mortalidad Infantil es un indicador clave del bienestar y desarrollo humano. Sin embargo, en Colombia el Departamento Administrativo Nacional de Estadística reporta una tasa de mortalidad infantil registrada para 2009 de 13.69 por cada 1,000 nacidos vivos, mientras que, la tasa estimada es de 20.13 para el mismo año, como en muchas economías de transición, lo que sugiere la presencia de datos inconsistentes. El objetivo fue determinar la tasa de mortalidad infantil de Colombia desde 1980 a 2009, con los datos disponibles y publicados recientemente. Métodos: El estudio analiza 8 636 510 de registros individuales de nacidos vivos (1998-2009) y 443 338 registros individuales de mortalidad (1979-2009). Además, se incluyen todas las fuentes disponibles: nacimientos y defunciones registrados del Departamento Administrativo Nacional de Estadística (DANE), datos censales, y la Encuesta Nacional de Demografía y Salud (ENDS) de Profamilia Colombia. En primer lugar, tras un análisis descriptivo, se utilizó una función exponencial para estimar las tasas de mortalidad infantil en Colombia para 1980-2009 mientras se resuelven las incoherencias internas en los datos de todas las fuentes, con el objetivo de evaluar la tasa de mortalidad infantil en Colombia 1980-2009. Resultados: El análisis mostró que las tasas registradas y estimadas para 2009 eran incompatibles, debido a que la tasa de descenso de los nacimientos y las defunciones a lo largo del tiempo también eran inconsistentes. Si bien la tasa registrada de 13.69, estaba subestimada frente a la situación real, la tasa estimada de 20.13, parecía estar demasiado sobreestimada. Los análisis basados en otras fuentes muestran que la tasa de mortalidad infantil se encuentra entre 15.81 y 17.58 en 2009, con tasas de descenso anual entre un 3.0 y el 5.0 por ciento, para el período 1980-2009. Conclusiones: El estudio concluye que, durante el período 1980-2009 la tasa de mortalidad infantil para Colombia se redujo de 54 a 17 muertes por mil nacidos vivos, lo que sugiere una tasa anual de descenso aproximada para el período de 4.0 por ciento.

An assessment of infant mortality rates in Colombia, 1980-2009.

PURPOSE: The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. METHODS: . The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. RESULTS: The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. CONCLUSIONS: The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.

Relación de la mortalidad infantil con la altura geográfica en el Noroeste Argentino / Relationship between infant mortality and altitude in the Northwest region of Argentina

Introducción. Por su localización sobre los Andes, el Noroeste Argentino presenta una heterogeneidad geográfica, socioeconómica, cultural y biológica reflejada en tasas de mortalidad infantil (TMI) superiores a casi todas las regiones argentinas. Objetivo. Calcular la TMI, tasa de mortalidad neonatal (TMN) y la tasa de mortalidad posneonatal (TMP) para analizar su variación temporal y espacial, a través de la tendencia secular y el riesgo relativo de acuerdo con el nivel altitudinal. Población y método. En un estudio retrospectivo, descriptivo y de correlación basado en datos de nacimientos y defunciones infantiles sucedidos en el Noroeste Argentino (1998-2010), se calcularon por departamentos y nivel altitudinal (departamentos a < 2000metros sobre el nivel del mar, tierras bajas y > 2000 msnm, tierras altas) TMI, TMN y TMP, tendencia secular y riesgo relativo de muerte, realizando un análisis de agrupamiento. Resultados y conclusiones. Las tasas fueron más elevadas en tierras altas, la TMI fue de 29,8%o (en tierras bajas, 15,6%); la TMP en tierras altas fue de 17,7% y 5,2% en tierras bajas. Las tierras altas mostraron un descenso promedio anual del 3,9% para la TMI y del 4,1% para la TMP; en tierras bajas, el descenso fue de 7,0% para la TMI y del 9,3% para la TMP. El riesgo relativo fue significativamente mayor a grandes alturas para TMI y TMP. La TMN, su tendencia secular y riesgo relativo no mostraron diferencias estadísticamente significativas entre niveles de altura.

Introduction. Given its location on the Andes, the Northwest region of Argentina is geographically, socioeconomically, culturally, and biologically heterogeneous, and this is reflected on an infant mortality rate (IMR) that is higher than in any other Argentine region. Objective. To estimate IMR, neonatal mortality rate (NMR), and post-neonatal mortality rate (PNMR), and to analyze their spatial and temporal variations using secular trends and the relative risk based on altitudinal zones. Population and method. This was a retrospective, descriptive, correlational study based on birth and death data recorded in the Northwest region of Argentina (1998-2010); IMR, NMR, PNMR, secular trends, and the relative risk of death were calculated by district and altitudinal zone (districts at < 2000 meters above sea level, lowlands; at > 2000 meters above sea level, highlands) by means of a cluster analysis. Results and conclusions. Rates were higher in the highlands; IMR was 29.8%o (versus 15.6%o in the lowlands); PNMR was 17.7% in the highlands (versus 5.2% in the lowlands). In the highlands, there was an annual average reduction of 3.9% in IMR and of 4.1% in PNMR; in the lowlands, such reduction was of 7.0% in IMR and of 9.3% in PNMR. The relative risk of IMR and PNMR was significantly higher at high-altitude zones. NMR, its secular trend, and the relative risk did not show statistically significant differences between both altitudinal zones.

Relationship between infant mortality and altitude in the Northwest region of Argentina. / Relación de la mortalidad infantil con la altura geográfica en el Noroeste Argentino.

INTRODUCTION: Given its location on the Andes, the Northwest region of Argentina is geographically, socioeconomically, culturally, and biologically heterogeneous, and this is reflected on an infant mortality rate (IMR) that is higher than in any other Argentine region. OBJETIVE: To estimate IMR, neonatal mortality rate (NMR), and post-neonatal mortality rate (PNMR), and to analyze their spatial and temporal variations using secular trends and the relative risk based on altitudinal zones. POPULATION AND METHOD: This was a retrospective, descriptive, correlational study based on birth and death data recorded in the Northwest region of Argentina (1998-2010); IMR, NMR, PNMR, secular trends, and the relative risk of death were calculated by district and altitudinal zone (districts at < 2000 meters above sea level, lowlands; at > 2000 meters above sea level, highlands) by means of a cluster analysis. RESULTS AND CONCLUSIONS: Rates were higher in the highlands; IMR was 29.8%o (versus 15.6%o in the lowlands); PNMR was 17.7% in the highlands (versus 5.2% in the lowlands). In the highlands, there was an annual average reduction of 3.9% in IMR and of 4.1% in PNMR; in the lowlands, such reduction was of 7.0% in IMR and of 9.3% in PNMR. The relative risk of IMR and PNMR was significantly higher at high-altitude zones. NMR, its secular trend, and the relative risk did not show statistically significant differences between both altitudinal zones.

INTRODUCCIÓN: Por su localización sobre los Andes, el Noroeste Argentino presenta una heterogeneidad geográfica, socioeconómica, cultural y biológica reflejada en tasas de mortalidad infantil (TMI) superiores a casi todas las regiones argentinas. OBJETIVO: Calcular la TMI, tasa de mortalidad neonatal (TMN) y la tasa de mortalidad posneonatal (TMP) para analizar su variación temporal y espacial, a través de la tendencia secular y el riesgo relativo de acuerdo con el nivel altitudinal. POBLACIÓN Y MÉTODO: En un estudio retrospectivo, descriptivo y de correlación basado en datos de nacimientos y defunciones infantiles sucedidos en el Noroeste Argentino (1998-2010), se calcularon por departamentos y nivel altitudinal (departamentos a < 2000metros sobre el nivel del mar, tierras bajas y > 2000 msnm, tierras altas) TMI, TMN y TMP, tendencia secular y riesgo relativo de muerte, realizando un análisis de agrupamiento. RESULTADOS Y CONCLUSIONES: Las tasas fueron más elevadas en tierras altas, la TMI fue de 29,8%o (en tierras bajas, 15,6%); la TMP en tierras altas fue de 17,7% y 5,2% en tierras bajas. Las tierras altas mostraron un descenso promedio anual del 3,9% para la TMI y del 4,1% para la TMP; en tierras bajas, el descenso fue de 7,0% para la TMI y del 9,3% para la TMP. El riesgo relativo fue significativamente mayor a grandes alturas para TMI y TMP. La TMN, su tendencia secular y riesgo relativo no mostraron diferencias estadísticamente significativas entre niveles de altura.

Evolución de la mortalidad infantil en Argentina en el marco de los Objetivos de Desarrollo del Milenio / Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals

Introducción. La tasa de mortalidad infantil (TMI) es un indicador del estado de salud de una población y de accesibilidad y calidad de los servicios de salud. En el año 2000, Argentina asumió, en el marco de los Objetivos de Desarrollo del Milenio, el compromiso de disminuir la TMI para el año 2015 a un tercio del valor del año 1990 y reducir las brechas entre jurisdicciones. El objetivo de este trabajo fue describir la evolución de la mortalidad infantil en Argentina y las brechas entre las jurisdicciones, su magnitud y sus causas, en función del cumplimiento de los Objetivos de Desarrollo del Milenio. Población y métodos. Se realizó un estudio descriptivo de la mortalidad infantil en Argentina en 1990 y de 2000 a 2013 sobre la base de publicaciones de estadísticas vitales de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. Resultados. Se constató un descenso en la TMI de 57,8%, en la tasa de mortalidad neonatal de 52,6% y en la tasa de mortalidad posneonatal de 63,8%. El coeficiente de Gini interprovincial para la TMI disminuyó un 27%. El riesgo atribuible poblacional disminuyó 16,6% para la TMI, 38,8% para la tasa de mortalidad neonatal y 51,5% para la tasa de mortalidad posneonatal en el año 2013 respecto de 1990. Conclusión. Se constató un importante descenso en la mortalidad infantil y sus componentes, aunque insuficiente para alcanzar las metas de los Objetivos de Desarrollo del Milenio. La disminución de labrecha de la TMI alcanzó la meta asumida; sin embargo, aún persisten inequidades.

Introduction. Infant mortality rate (IMR) is an indicator of the health status of a population and of the quality of and access to health care services. In 2000, and within the framework of the Millennium Development Goals, Argentina committed to achieve by 2015 a reduction by two thirds of its 1990 infant mortality rate, and to identify and close inter-jurisdictional gaps. The objective of this article is to describe the trend in infant mortality rate in Argentina and interjurisdictional gaps, infant mortality magnitude and causes, in compliance with the Millennium Development Goals. Population and methods. A descriptive study on infant mortality was conducted in Argentina in 1990 and between 2000 and 2013, based on vital statistics data published by the Health Statistics and Information Department of the Ministry of Health of Argentina. Results. The following reductions were confirmed: 57.8% in IMR, 52.6% in neonatal mortality rate and 63.8% in post-neonatal mortality rate. The inter-provincial Gini coefficient for IMR decreased by 27%. The population attributable risk decreased by 16.6% for IMR, 38.8% for neonatal mortality rate and 51.5% for post-neonatal mortality rate in 2013 versus 1990. Conclusion. A significant reduction in infant mortality and its components has been shown, but not enough to meet the Millennium Development Goals. The reduction in IMR gaps reached the set goal; however, inequalities still persist.

Trend in infant mortality rate in Argentina within the framework of the Millennium Development Goals. / Evolución de la mortalidad infantil en Argentina en el marco de los Objetivos de Desarrollo del Milenio.

INTRODUCTION: Infant mortality rate (IMR) is an indicator of the health status of a population and of the quality of and access to health care services. In 2000, and within the framework of the Millennium Development Goals, Argentina committed to achieve by 2015 a reduction by two thirds of its 1990 infant mortality rate, and to identify and close inter-jurisdictional gaps. The objective of this article is to describe the trend in infant mortality rate in Argentina and interjurisdictional gaps, infant mortality magnitude and causes, in compliance with the Millennium Development Goals. POPULATION AND METHODS: A descriptive study on infant mortality was conducted in Argentina in 1990 and between 2000 and 2013, based on vital statistics data published by the Health Statistics and Information Department of the Ministry of Health of Argentina. RESULTS: The following reductions were confirmed: 57.8% in IMR, 52.6% in neonatal mortality rate and 63.8% in post-neonatal mortality rate. The inter-provincial Gini coefficient for IMR decreased by 27%. The population attributable risk decreased by 16.6% for IMR, 38.8% for neonatal mortality rate and 51.5% for post-neonatal mortality rate in 2013 versus 1990. CONCLUSIONS: A significant reduction in infant mortality and its components has been shown, but not enough to meet the Millennium Development Goals. The reduction in IMR gaps reached the set goal; however, inequalities still persist.

INTRODUCCIÓN: La tasa de mortalidad infantil (TMI) es un indicador del estado de salud de una población y de accesibilidad y calidad de los servicios de salud. En el ano 2000, Argentina asumió, en el marco de los Objetivos de Desarrollo del Milenio, el compromiso de disminuir la TMI para el ano 2015 a un tercio del valor del ano 1990 y reducir las brechas entre jurisdicciones. El objetivo de este trabajo fue describir la evolución de la mortalidad infantil en Argentina y las brechas entre las jurisdicciones, su magnitud y sus causas, en función del cumplimiento de los Objetivos de Desarrollo del Milenio. POBLACIÓN Y MÉTODOS: Se realizó un estudio descriptivo de la mortalidad infantil en Argentina en 1990 y de 2000 a 2013 sobre la base de publicaciones de estadísticas vitales de la Dirección de Estadísticas e Información de Salud del Ministerio de Salud de la Nación. RESULTADOS: Se constató un descenso en la TMI de 57,8%, en la tasa de mortalidad neonatal de 52,6% y en la tasa de mortalidad posneonatal de 63,8%. El coeficiente de Gini interprovincial para la TMI disminuyó un 27%. El riesgo atribuible poblacional disminuyó 16,6% para la TMI, 38,8% para la tasa de mortalidad neonatal y 51,5% para la tasa de mortalidad posneonatal en el ano 2013 respecto de 1990. CONCLUSIONES: Se constató un importante descenso en la mortalidad infantil y sus componentes, aunque insuficiente para alcanzar las metas de los Objetivos de Desarrollo del Milenio. La disminución de labrecha de la TMI alcanzó la meta asumida; sin embargo, aún persisten inequidades. Palabras clave: tasa de mortalidad infantil, Objetivos de Desarrollo del Milenio, disparidades en atención de salud, inequidad.

Análise da relação entre gasto público per capita em saúde e a taxa de mortalidade infantil nas 4 macrorregiões do estado de Pernambuco no período de 2008 a 2012 / Analysis of the relationship between public expenditure per capita in health and the infant mortality rate in the four macroregions of the state of Pernambuco in the period from 2008 to 2012

Um dos principais desafios em pauta para o SUS é o seu financiamento, que envolve tanto a insuficiência dos recursos disponíveis frente às necessidades da população, como a precária qualidade da gestão e ineficiência do gasto em saúde. Este trabalho objetivou analisar a relação entre a despesa per capita em saúde e o impacto na Taxa de Mortalidade Infantil-TMI nas quatro Macrorregiões do Estado Pernambuco no período de 2008 a 2012. Estudo quantitativo, descritivo com dados secundários. Foram analisados as informações referentes aos 184 municípios de PE, sendo esses agrupados em 4 Macrorregionais de Saúde, de acordo com a divisão política administrativa de saúde do Estado de PE. Os dados foram analisados através do método de Pearson e do modelo econométrico de regressão múltipla, utilizando o método de dados em painel. Verificou-se que a despesa com saúde per capita nas quatro Macrorregiões de Pernambuco mostrou tendência ascendente no período de 2008 a 2012. Observou-se também que a Taxa de Mortalidade InfantilTMI nas quatro Macrorregiões, assim como no Estado de Pernambuco e no Brasil, apresentaram uma tendência de redução. Contudo, há importantes diferenças na redução da TMI entre as Macrorregiões. Na análise da correlação bivariada entre a despesa per capita em saúde e a TMI nas quatro Macrorregiões de saúde, os dados mostraram que as variáveis estão correlacionadas em todas as quatro Macrorregiões, com destaque para a Macrorregião II (p = 0,011 e de r2 = 0,91) , que apresentou a correlação mais significante entre as Macrorregionais de saúde. Na montagem do modelo econométrico, os resultados mostraram que mesmo com a introdução de outras variáveis que também influenciam a TMI, o efeito da despesa per capita/ano na TMI continua significativo, conferindo a despesa per capita com saúde um grau de robustez.(AU)

One of the major challenges on the agenda for the NHS is its funding, which involves both the inadequacy of available resources across the population's needs, as the poor quality of management and inefficiency of spending on health. This study aimed to analyze the relationship between per capita health expenditure and the impact on Mortality Rate Child-TMI in the four Macroregions of Pernambuco State in the period 2008 to 2012. quantitative, descriptive study using secondary data. We analyzed the information regarding the 184 municipalities of PE, these being grouped into 4 macro-regional Health, according to the administrative political division of health PE status. Data were analyzed using the method of Pearson and econometric multiple regression model using panel data method. It was found that expenditure on health per capita in the four Macroregions of Pernambuco showed upward trend in the period 2008 to 2012. It was also observed that the mortality rate Child-TMI in the four Macroregions, as well as in the state of Pernambuco and Brazil , showed a downward trend. However, there are important differences in the reduction of IMR between Macroregions. In the analysis of the bivariate correlation between the per capita expenditure on health and IMR in four health Macroregions, the data showed that the variables are correlated in all four Macroregions, with emphasis on the macroregion II (p = 0.011 and r2 = 0 , 91), which had the most significant correlation between health macro-regional. In the assembly of the econometric model, the results showed that even with the introduction of other variables also influence the IMR, the effect of expenditure per capita / year in IMR remains significant, giving the per capita expenditure on health a degree of robustness.(AU)

Correction of vital statistics based on a proactive search of deaths and live births: evidence from a study of the North and Northeast regions of Brazil.

BACKGROUND: In the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000-2010 by macro-geographical region. METHODS: A proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000-2010. RESULTS: In the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births. CONCLUSIONS: The proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies.

Brechas regionales de la mortalidad infantil en Colombia / Regional disparities in infant mortality in Colombia

Objetivos. Estudiar las variaciones de la tasa de mortalidad infantil (TMI) en los departamentos de Colombia durante el período 2003-2009, examinar la persistencia de las variaciones entre los departamentos sobre el tiempo y relacionarlas con el impacto de las condiciones socioeconómicas y la disponibilidad de servicios de salud, sobre la mortalidad infantil. Materiales y métodos. Utilizando estadísticas vitales y relacionando datos socioeconómicos y de servicios de salud, se analizaron tres aspectos: la variación de la TMI departamental (2003-2009), la relación entre la TMI departamental y determinantes claves en el tiempo, y las líneas de causalidad e impacto relativo de los diferentes factores. Se emplearan ecuaciones estructurales. Resultados. Se encontró una razón de 4,7 entre la mayor y menor TMI departamental (2009), esta podría estar subestimada principalmente por el subregistros en departamentos de bajos ingresos. Hay una relación negativa entre la TMI departamental con el tiempo y variables altamente correlacionadas, como educación de la madre, ingreso per cápita, cobertura de aseguramiento y acceso a servicios. Conclusiones. El efecto del aseguramiento, disponibilidad de camas privadas y atención médica, es superior al impacto de mejores condiciones socioeconómicas sobre la TMI. La oferta de servicios no parece estar influenciada por una política racional, los recursos no se asignan de acuerdo con las necesidades, sino con el desarrollo general. Las camas privadas se hacen disponibles donde hay mejor aseguramiento en salud y menor TMI.

Objectives. To study the variations in infant mortality rate (IMR) across Colombia’s 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003-2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.

Viral infections: contributions to late fetal death, stillbirth, and infant death.

OBJECTIVE: To determine the role of viral infections in causing fetal and infant death. STUDY DESIGN: We assessed a well-validated population database of fetal (≥20 weeks gestation) and infant death for infective deaths and deaths from viruses over a 21-year period (1988-2008). We analyzed by specific viral cause, timing (late fetal loss [20-23 weeks], stillbirth [≥24 weeks], neonatal death [0-27 days], and post-neonatal infant death [28-364 days]) and across time. RESULTS: Of the 989 total infective deaths, 108 were attributable to viral causes (6.5% of late fetal losses, 14.5% of stillbirths, 6.5% of neonatal deaths, and 19.4% of postneonatal infant deaths). Global loss (combined fetal and infant losses per 100,000 registerable births) was 139.6 (95% CI, 130.9-148.3) for any infective cause and 15.2 (95% CI, 12.3-18.1) for viral infections. More than one-third (37%) of viral-attributed deaths were before live birth, from parvovirus (63%) or cytomegalovirus (33%). Parvovirus accounted for 26% (28 of 108) of all viral deaths. Cytomegalovirus was associated with a global loss rate of 3.1 (95% CI, 1.8-4.4) and an infant mortality rate of 1.3 (95% CI, 0.4-2.1) per 100,000 live births; 91% of cases were congenital infections. Herpes simplex virus caused death only after live births (infant mortality rate, 1.4; 95% CI, 0.5-2.3). No changes in rates were seen over time. CONCLUSION: We have identified a substantial contribution of viral infections to global fetal and infant losses. More than one-third of these losses occurred before live births. Considering our methodology, our estimates represent the minimum contribution of viral illness. Strategies to reduce this burden are needed.

Inequalities in infant mortality among municipalities in Brazil according to the Family Development Index, 2006-2008 / Desigualdades en la mortalidad de menores de un año entre los municipios del Brasil, según el índice de desarrollo familiar de 2006 a 2008

OBJECTIVE: To describe inequalities in the infant mortality rate (IMR) according to socioeconomic indicators among geographic areas and municipalities in Brazil. METHODS: This was an exploratory ecological study of space aggregates that described IMR in 2006-2008 according to municipalities, states, and the Family Development Index (FDI), a socioeconomic indicator that ranges from 0 to 1. All the municipalities in Brazil were categorized according to four strata as defined by FDI quartiles, where stratum 4 included those with better FDI conditions, and stratum 1, worse conditions. The selected inequality measures were: Concentration Index, Attributable Risk Percent, Population Attributable Risk Percent, Rate Ratio, and number of avoidable events (number of infant deaths). RESULTS: The average IMR (per 1 000 live births) according to the FDI strata were: stratum 1 (FDI = 0.41-0.52) = 18.8; stratum 2 (FDI = 0.53-0.55) = 17.9; stratum 3 (FDI = 0.56-0.58) = 15.0; and stratum 4 (FDI = 0.59-0.73) = 13.4. Overall, the Concentration Index was 0.02. Moreover, stratum 1, with a proportion of 17% of all live births in the population, had a concentration of 20% of infant deaths. Additionally, the profile of causes and ages of infant mortality also differed qualitatively when stratum 1 was compared to stratum 4. CONCLUSIONS: The results suggest an association between the socioeconomic indicators, specifically the FDI, and the risk of infant death. These results call attention to the specific population groups in Brazil that are most vulnerable to infant mortality and demonstrate that the FDI can be used to identify these populations.

OBJETIVO: Describir las desigualdades en la tasa de mortalidad de menores de un año entre las zonas geográficas y los municipios del Brasil según los indicadores socioeconómicos. MÉTODOS: Se realizó un estudio exploratorio y ecológico de los grupos de espacios que definieron la tasa de mortalidad de menores de un año en el período de 2006 a 2008 según los municipios, los estados y el índice de desarrollo familiar (IDF), un indicador socioeconómico que va del 0 al 1. Todos los municipios del Brasil se clasificaron según 4 estratos, de conformidad con lo definido por los cuartiles del IDF; el estrato 4 incluyó a aquellas personas con mejores condiciones de IDF y el estrato 1 a aquellas con peores condiciones. Se eligieron las siguientes medidas de la desigualdad: el índice de concentración, el porcentaje de riesgo atribuible a la población, la razón de la tasa y el número de sucesos evitables (número de defunciones de menores de un año). RESULTADOS: La tasa promedio de mortalidad de menores de un año (por 1 000 nacidos vivos) según los estratos del IDF fueron: estrato 1 (IDF = 0,41-0,52) = 18,8; estrato 2 (IDF = 0,53-0,55) = 17,9; estrato 3 (IDF = 0,56-0,58) = 15,0; y estrato 4 (IDF = 0,59-0,73) = 13,4. En términos generales, el índice de concentración fue 0,02. Al estrato 1, que tuvo una proporción de 17% de todos los nacidos vivos en la población, correspondió una concentración de 20% de defunciones de menores de un año. Además, el perfil de las causas y las edades de la mortalidad de menores de un año también difirió cualitativamente cuando se compararon los estratos 1 y 4. CONCLUSIONES: Los resultados indican que hay una asociación entre los indicadores socioeconómicos, en concreto el IDF, y el riesgo de mortalidad de menores de un año. Estos resultados destacan los grupos de población específicos en el Brasil que son más vulnerables a la mortalidad de menores de un año y demuestran que el IDF puede utilizarse para identificarlos.

Mortalidade infantil, segundo critérios de evitabilidade e componentes - Viçosa - MG, 1998-2010 / Infant mortality according to preventable causes and components - Viçosa - MG, 1998-2010

Objetivo: Analisar a evolução dos indicadores da mortalidade infantil, segundo seus componentes e por causas evitáveis, no município de Viçosa, Minas Gerais, comparando-os com o Estado de Minas Gerais e o Brasil. Métodos: Estudo ecológico e descritivo de séries temporais, realizado com dados secundários relativos à mortalidade infantil, segundo grupos de causas e componentes, no município de Viçosa, no período de 1998 a 2010. Os dados de óbitos infantis ocorridos no município de Viçosa, no período de estudo, foram categorizados de acordo com a Classificação Internacional de Doenças, 10ª revisão ou CID-10, nas categorias de dois dígitos, seus componentes ? neonatal precoce, neonatal tardio e pós-neonatal ? e também de acordo com os critérios de evitabilidade, por meio da Classificação de Óbitos Evitáveis da Fundação Sistema Estadual de Análise de Dados (Fundação SEADE) do governo do Estado de São Paulo ou Classificação de Ortiz (2000). Resultados: Apesar de um declínio ao longo dos anos do coeficiente de mortalidade infantil, mantém-se um predomínio do componente neonatal à custa dos óbitos neonatais precoces, sem redução das causas evitáveis (ou reduzíveis) de óbitos nos períodos neonatal e pós-neonatal, as quais vêm mantendo-se em percentuais superiores às causas de óbitos não evitáveis ou maldefinidas. Conclusões: Grande parte da mortalidade infantil poderia ser evitada ou reduzida por meio de adequado controle da gravidez, adequada atenção ao parto e por ações de prevenção, diagnóstico e tratamento precoces e parcerias com outros setores. Por outro lado, as causas maldefinidas ainda estão em valores bem elevados, ressaltando-se a necessidade de registros de óbitos de melhor qualidade.

Defunciones en niños a principios de los siglos XX y XXI en Boyacá-Colombia / Deaths in children during the early twentieth and twenty-first century in Boyacá, Colombia

Objetivo Comparar y analizar las Tasas Brutas de Mortalidad (TBM), la Mortalidad en Menores (MN) de 5 años por mil Nacidos Vivos (NV) y la Mortalidad Infantil (MI) en el departamento de Boyacá-Colombia, a comienzos de los siglos XX y XXI. Métodos Estudio descriptivo comparativo con enfoque histórico epidemiológico. Se utilizaron dos fuentes de datos, para las defunciones: registros parroquiales de 1912-1927 y el Boletín epidemiológico de Boyacá 2007; para la población los censos DANE 1912-1918-1927 y 2005. Se almacenaron y analizaron en Mysql®. Se calcularon tasas brutas, específicas por edad e infantil, proporciones de mortalidad y mortalidad por causas. Resultados Entre 1912-1927 se registra una media de 7 958 muertes, en comparación con 5 813 en el siglo XXI; la TBM pasó de 150 muertes a 42 por 10 mil habitantes; la TMI se redujo considerablemente pasando de 231 a 17 por cada 1 000 NV; aunque se pueden comparar las tasas especificas en menores de 8 años con las de menores de 5, existe variabilidad en el rango y en la construcción de la TM especifica y la definida por OMS- UNICEF. Conclusiones Existe un impacto en la reducción de mortalidad, mayor en el siglo XXI, debido a las políticas nacionales e internacionales de control de enfermedades inmunoprevenibles y muerte materna. La pandemia de gripa de 1918-19 afectó considerablemente la mortalidad en todos los grupos de población; las causas violentas ocupan lugares importantes en la mortalidad infantil en el siglo XXI.

Objective Comparing and analysing crude death (CDR), child mortality (CMR) 5-year per thousand live births (LBR) and infant mortality rates (IMR) in the Boyacá department, Colombia, during the early 20th and 21st centuries. Methods A descriptive epidemiological comparative historical approach was adopted. Two data sources were used for deaths: parish registers 1912-1927 and the Boyacá Epidemiological Bulletin 2007 population census for 1912-1918-1927 and 2005 (Colombian Statistics Bureau - DANE); data was stored and analysed in Mysql. Crude rates, age-specific and child mortality ratios and mortality were calculated by cause. Results 7,958 deaths were recorded from 1912-1927 compared to 5,813 in the 21st century. CDR dropped from 150 to 42 deaths per 10,000 inhabitants; the IMR became significantly reduced from 231 to 17 for every 1,000 LB. Although specific rates for children under 8 years of age could be compared to children under 5, there was variability in the range and construction of the specific MR and that defined by WHO-UNICEF. Conclusions There was a higher reduction in mortality in the 21st century due to national and international policies for controlling preventable diseases and maternal death. The 1918-19 flu pandemic significantly affected mortality in all population groups; violent causes were prominent in infant mortality in the 21st century.

Fatores associados aos óbitos neonatais e pós-neonatais em Moçambique / Factores asociados a los óbitos neonatales e postneonatales en Mozambique / Factors related to neonatal and post-neonatal mortality in Mozambique

Este trabalho procura descrever e analisar os fatores associados aos óbitos neonatais e pós-neonatais em Moçambique, entre 1998 e 2003, com base nas informações da Demographic and Health Survey (DHS). Foram utilizadas as distribuições de frequência das características selecionadas, segundo os segmentos neonatal e pós-neonatal. Empregou-se, também, a regressão logística de resposta binária, múltipla, com entrada sequencial das variáveis, de forma a verificar a mudança na magnitude e a significância dos coeficientes. Entre alguns resultados obtidos, destacam-se os fatores que se relacionaram de forma inequívoca ao aumento da chance de mortalidade neonatal e pós-neonatal: ser o primeiro filho; tamanho pequeno ao nascimento; e residência na região Norte. A idade da mãe entre 30 e 34 anos revelou-se elemento protetor do óbito infantil nos dois segmentos, enquanto a faixa de 10 a 19 anos apresentou-se como fator de aumento da chance do óbito pós-neonatal. O tamanho grande ao nascimento mostrou-se protetor no caso do segmento pós-neonatal, assim como a residência na região Sul. Finalmente, o parto domiciliar revelou-se deletério ao óbito pósneonatal.

Este trabajo procura describir y analizar los factores asociados a los óbitos neonatales y postneonatales en Mozambique, entre 1998 y 2003, en base a la información de Demographic and Health Survey (DHS). Se utilizaron las distribuciones de frecuencia de las características seleccionadas, conforme el segmento neonatal y postneonatal. Se empleó, también, la regresión logística de respuesta binaria, múltiple, con entrada secuencial de las variables, de forma que se pudiese verificar el cambio en la magnitud y la relevancia de los coeficientes. Entre algunos de los resultados obtenidos, se destacan los factores que se relacionaron de forma inequívoca con el aumento de la probabilidad de mortalidad neonatal y postneonatal: ser el primer hijo; tamaño pequeño al nacer; y residir en la región Norte. La edad de la madre entre 30 y 34 años se reveló como un elemento protector del óbito infantil en los dos segmentos, mientras que para la franja de los 10 a 19 años se presentó como un factor de aumento de la probabilidad de óbito postneonatal. El tamaño grande en el nacimiento se mostró como protector en el caso del segmento postneonatal, así como residir en la región Sur. Finalmente, el parto en el domicilio se reveló deletéreo para el óbito postneonatal.

This article describes and analyzes factors related to neonatal and post-neonatal deaths in Mozambique between 1998 and 2003, based on information from the Demographic and Health Survey (DHS). Distributions in the frequency of the selected characteristics for the neonatal and post-neonatal segments were studied. Multiple logistic regression with binary responses, and sequential entrance of the variables were used in order to verify changes in the levels and significance of the coefficients. The most important findings are related to the unequivocal associated factors in the odds of neonatal and post-neonatal deaths, such as being the first child, small size at birth, and residence in the northern region of the country. Mothers' being between the ages of 30 and 34 was seen as a protective element against infant mortality in both segments. In contrast, mothers being in the age group between 10 and 19 was shown to be a factor that increased odds of post-neonatal death. Size at birth was also seen as a factor of protection for the post-neonatal segment, as was residence in the southern region of Mozambique. Finally, the death rate was lower among post-neonatal newborns who were given birth at home.

Mortalidade infantil em Cuiabá, Mato Grosso, Brasil, 2005: comparação entre o cálculo direto e após o linkage entre bancos de dados de nascidos vivos e óbitos infantis / Infant mortality rate in Cuiabá, Mato Grosso State, Brazil, 2005: a comparison between direct calculation and linkage between the live birth and infant mortality databases

O objetivo deste estudo foi avaliar a Taxa de Mortalidade Infantil (TMI) pela utilização do método de linkage entre o banco de dados do Sistema de Informação sobre Nascidos Vivos (SINASC) e sobre mortalidade (SIM) e compará-la com a encontrada nos dados brutos fornecidos pelas mesmas bases de dados. Foi utilizado o SINASC contendo 9.590 Declarações de Nascidos Vivos (DNV) entre 1º de janeiro e 31 de dezembro de 2005 e o SIM com 156 Declarações de Óbitos (DO) relativas à população estudada. Dos 156 óbitos relativos ao ano de 2005 foram pareados pelo método direto 126 (80,8 por cento) e pelo método de busca manual 11 (7 por cento), totalizando um total de 137 óbitos (87,8 por cento). As taxas encontradas com o método de linkage permitiram estimar a real TMI (14,2 óbitos/1.000 nascidos vivos) e a de seus componentes. A TMI encontrada pelo uso do método de linkage foi 17,3 por cento menor que a calculada peça utilização dos registros brutos do SIM, permanecendo o componente neonatal precoce (7,2 óbitos/1.000 nascidos vivos) como o principal responsável pelos óbitos no primeiro ano de vida (50,4 por cento).

This study aimed to analyze the infant mortality rate (IMR) by linking the Live Birth Information System (SINASC) and the Mortality Information System (SIM) and comparing the result to direct calculation using crude data provided by the same databases. The systems used were SINASC, containing 9,590 certificates of live birth from January 1 to December 31, 2005, and SIM, containing 156 death certificates from the reference population (2005). Of the 156 deaths in the year 2005, 126 (80.8 percent) were paired by the direct method and 11 (7 percent) by manual search, totaling 137 deaths (87.8 percent). The rates found with the linkage method allowed calculating the real IMR (14.2 deaths/1,000 live births) and its components. The IMR using linkage was 17.3 percent lower than as calculated using crude SIM data. The early neonatal component (7.2 deaths/1,000 live births) accounted for half of the deaths in the first year of life (50.4 percent).