Abstract:Background
The state of São Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality … Show more
“…The BPHS project was designed to achieve the full cycle of health monitoring and healthcare for newborns from pregnancy to neonatal, which could be key to its effectiveness. The evidences in India, 28 Brazil 30 and many LMICs showed that they had achieved significant decrease in NMR through maternal and neonatal health services, at least three times of antenatal care and postpartum care 31 were provided during the whole pregnancy, which confirmed the potential effect of maternal and neonatal health services in reducing NMR.…”
ObjectiveTo analyse the trend change and level change of neonatal health services and neonatal mortality before and after the introduction of the Basic Public Health Service (BPHS) project in 2009.Design and settingA national longitudinal study on neonatal mortality from 1991 to 2017 and neonatal health services from 2000 to 2017 was conducted based on data extracted from the National Neonatal Mortality Surveillance System and National Health Statistic Yearbook. The segmented linear regression model was used to assess the level changes and trend changes of the outcome variables before and after the introduction of BPHS project. Pearson correlation analysis as conducted to measure association between neonatal mortality rates (NMRs) and maternal health management rates (MMRs), neonatal visit rates, respectively.Primary and secondary outcome measuresThe outcome variables were national NMR, the gap of NMR between urban and rural areas, maternal health management rate and neonatal visit rate.ResultsThe annual trend change coefficient of national NMR and the gap of NMR between urban and rural areas were −0.57 (p<0.01) and −0.49 (p<0.01) after the introduction of BPHS project, while the annual trend coefficient of the MMR and the neonatal visit rate were 1.21 (p<0.01) and 0.85 (p<0.01), respectively. The negative correlations were found between NMR and MMR (r=−0.79, p<0.01) and neonatal visit rate (r=−0.76, p<0.01).ConclusionThe BPHS project was found to be associated with increased volume of neonatal health services and reduced NMR. The design and implementation of this project may provide references to other low-income and middle-income countries.
“…The BPHS project was designed to achieve the full cycle of health monitoring and healthcare for newborns from pregnancy to neonatal, which could be key to its effectiveness. The evidences in India, 28 Brazil 30 and many LMICs showed that they had achieved significant decrease in NMR through maternal and neonatal health services, at least three times of antenatal care and postpartum care 31 were provided during the whole pregnancy, which confirmed the potential effect of maternal and neonatal health services in reducing NMR.…”
ObjectiveTo analyse the trend change and level change of neonatal health services and neonatal mortality before and after the introduction of the Basic Public Health Service (BPHS) project in 2009.Design and settingA national longitudinal study on neonatal mortality from 1991 to 2017 and neonatal health services from 2000 to 2017 was conducted based on data extracted from the National Neonatal Mortality Surveillance System and National Health Statistic Yearbook. The segmented linear regression model was used to assess the level changes and trend changes of the outcome variables before and after the introduction of BPHS project. Pearson correlation analysis as conducted to measure association between neonatal mortality rates (NMRs) and maternal health management rates (MMRs), neonatal visit rates, respectively.Primary and secondary outcome measuresThe outcome variables were national NMR, the gap of NMR between urban and rural areas, maternal health management rate and neonatal visit rate.ResultsThe annual trend change coefficient of national NMR and the gap of NMR between urban and rural areas were −0.57 (p<0.01) and −0.49 (p<0.01) after the introduction of BPHS project, while the annual trend coefficient of the MMR and the neonatal visit rate were 1.21 (p<0.01) and 0.85 (p<0.01), respectively. The negative correlations were found between NMR and MMR (r=−0.79, p<0.01) and neonatal visit rate (r=−0.76, p<0.01).ConclusionThe BPHS project was found to be associated with increased volume of neonatal health services and reduced NMR. The design and implementation of this project may provide references to other low-income and middle-income countries.
“…The intervening factors in the current situation of gestational and congenital syphilis probably derive from the access to and capacity of prenatal care 7 , as well as the coverage of primary health care in the Brazilian state capitals. Maternal and infant mortalities are associated with the inadequacy of prenatal care 8,9 .…”
To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.
“…Although São Paulo has the best quality and best levels of neonatal rate when compared to the rest of Brazil, as depicted in Fig. 3 , these events occurred in heterogeneous ways with smaller or even lower reductions in the most vulnerable populations, as the reflection of unfavorable life conditions of the population, health care and socioeconomic inequalities [ 9 ]. Fig.…”
Section: Dataset Construction and Explorationmentioning
Infant mortality is an important health measure in a population as a crude indicator of the poverty and socioeconomic level. It also shows the availability and quality of health services and medical technology in a specific region. Although improvements have been observed in the last decades, the implementation of actions to reduce infant mortality is still a concern in many countries. To address such an important problem, this paper proposes a new support decision approach to classify newborns according to their neonatal mortality risk. Using features related to mother, newborn, and socio-demographic, we model the problem using a data-driven classification model able to provide the probability of a newborn dying until
days of life. More than a theoretical study, decision support tools as the one proposed here is relevant in countries in development as Brazil, because it aims at identifying risky neonates that may die to raise the attention of medical practitioners so that they can work harder to reduce the overall neonatal mortality. Overcoming an AUC of 96%, the proposed method is able to provide not just the probability of death risk but also an explicable interpretation of most important features for model decision, which is paramount in public health applications. Furthermore, we provide an extensive analysis across different rounds of experiments, including an analysis of pre and post partum features influence over data-driven model. Finally, different from previously conducted studies which rely on databases with less than 100,000 samples, our model takes advantage from a new proposed database, constructed using more than 1,400,000 samples comprising births and deaths extracted from public records in São Paulo-Brazil from 2012 to 2018.
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