Abstract
To develop a social need index for stratification of municipalities and identification of priority areas for reducing fetal mortality. ecological study, carried out in the state of Pernambuco, between 2010 and 2017. The technique of factor analysis by main components was used for the elaboration of the social need index. In the spatial analysis, the local empirical Bayesian estimator was applied and Moran's spatial autocorrelation was verified. The social deprivation index selected two factors that, together, explained 77.63% of the total variance. The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births (low deprivation), 8.1 per thousand (medium deprivation), 8.8 per thousand (high deprivation), and 10.7 per thousand (very high social deprivation). Some municipalities in the São Francisco and Sertão Mesoregions had both high fetal and preventable fetal mortality, in addition to a very high social deprivation rate. Conclusion: The spatial analysis identified areas with the highest risk for fetal mortality. The social deprivation index listed some determinants of fetal deaths in areas with worse living conditions. Priority areas for intervention in public policies to reduce fetal mortality and its determinants were detected.
Highlights
Geographic areas with great social needs are responsible for a significant number of preventable fetal deaths in the world, in Africa and Latin America[1]
The preventable fetal mortality rate increased among strata of social need, with rates of 8.0 per thousand births, 8.1 per thousand, 8.8 per thousand, and 10.7 per thousand
Considering that composite indices are useful instruments to investigate health care inequalities and socioeconomic conditions[8], this study aimed to develop an ICS for the stratification of municipalities and the identification of priority areas for the reduction of fetal mortality
Summary
Geographic areas with great social needs are responsible for a significant number of preventable fetal deaths in the world, in Africa and Latin America[1]. It is estimated that 2.6 million fetal deaths occur annually, mostly due to preventable causes[2]. The Brazilian fetal mortality rate was 10.8 deaths per thousand births in 20153. The Northeast had the highest rate among the regions of the country, with 13.2, while the state of Pernambuco had a rate of 12.08 per thousand births[3]. Fetal death is defined as the product of pregnancy that shows no sign of life after the expulsion or complete extraction from the maternal organism[4]. Avoidable deaths are sentinel events, unnecessary and preventable events due to the proper functioning of health services with access to effective medical technologies[5]
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