Abstract
Aim: To identify the association between access to obstetric and neonatal hospital service and neonatal death rates. Method: Quantitative and retrospective research retrieved from Declaration of Live Newly-born Children; Declaration of Death; Investigation Chart on Municipal Child Mortality, between 2000 and 2009, at the Nucleus of Information on Mortality Rates. The population studied comprised 537 neonatal deaths and mothers with residence in the municipality, and investigated by the work team of the Committee for the Investigation of Mother-Child Deaths. Data were analyzed in Epi Info 2002 ® computer program and the Statistical Package for the Social Sciences ® was used. Chi-square Test and Fischer’s Exact Test were applied at p < 0.05. Results: 63.7% of 537 neonates were born in hospitals with maternities and neonatal intensive therapy unit; 60.7% weighed ≤1.500 grams; 76.7% had a pregnancy age of ≤36 weeks; 73% died of asphyxia in the 1st minute and 73.5% died during the perinatal period. Throughout the ten years of analysis, access to hospital obstetric service without NITU reduced death rate from 25% in 2000 to 6.8% in 2009. There was a significant statistical association between place of delivery and maternal socio-demographic variables (maternal age bracket p = 0.028; schooling p = 0.000; family income p = 0.000); occupation p = 0.000) and neonatal variables (race/skin color p = 0.007; type of delivery p = 0.000; weight at birth p = 0.000; pregnancy age p = 0.000 and Apgar Score 1st minute p = 0.000 and Apgar Score 5 th minute p = 0.007). Conclusion: Although the municipal government provides obstetric services and specialized neonatal care, this right is not extensive to all; gaps at different * Corresponding author.
Highlights
In its section on health, the Brazilian Federal Constitution underscores that access to services provided by the Brazilian Health Service (SUS in Portuguese; BHS) should be available to all, together with preventive and curative actions, individual and collective, necessary for each case, at all levels of complexity
Data showed that 342 (63.7%) out of 537 neonatal births occurred in hospitals with maternity and Neonatal Intensive Therapy Unit (NITU); 36.3% (176) of births were delivered in institutions without NITU and 3.5% (19) at home or in transit
37.1% of women with family income >1 minimum wage were attended in hospitals with NITU, whereas 17.4% gave birth in obstetric hospitals without NITU
Summary
In its section on health, the Brazilian Federal Constitution underscores that access to services provided by the Brazilian Health Service (SUS in Portuguese; BHS) should be available to all, together with preventive and curative actions, individual and collective, necessary for each case, at all levels of complexity. Throughout several decades, public policies were deployed, with great improvements in mother-child assistance; an increase in income and a decrease in social disparities and differences, greater availability to basic sanitation, more schooling years, reduction of fertility rates and decrease in child mortality rates [1] [2]-[4]. In spite of such progress, neonatal mortality still persists. These activities comprise family planning, pre-natal assistance, follow-up during delivery, humanized birth, assistance to the newly born in the birth room and in the neonatal unit, puerperal follow-up and a support network of mother-child reference and counter-reference services [1] [5]-[9]
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