Guerra Alexandre Bergo, Guerra Luciane Miranda, Probst Livia Fernandes, Gondinho Brunna Verna Castro, Ambrosano Gláucia Maria Bovi, Melo Estêvão Azevedo, Brizon Valéria Silva Cândido, Bulgareli Jaqueline Vilela, Cortellazzi Karine Laura, Pereira Antonio Carlos
Department of Community Dentistry - Piracicaba Dental School, UNICAMP, Caixa postal 52, 13414-903, Piracicaba, São Paulo, Brazil.
BMC Health Serv Res. 2019 Feb 26;19(1):133. doi: 10.1186/s12913-019-3953-0.
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 in the state of São Paulo, Brazil.
In this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted "p" at 5%.
The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates.
It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population.
1990年至2013年期间，巴西圣保罗州的婴儿死亡率显著下降，但孕产妇死亡率并未实现预期的降低。了解影响这些指标的因素将有助于制定公共政策。本研究的目的是评估社会经济和人口因素、医疗保健模式与巴西圣保罗州婴儿死亡率（考虑新生儿和新生儿后期维度）和孕产妇死亡率之间的关系。
在这项生态学研究中，使用来自国家官方公开来源的数据进行基于人群的研究。分析的单位是巴西圣保罗州的645个市。对于每个市，计算了2013年每1000例活产的婴儿死亡率（新生儿和新生儿后期维度）和孕产妇死亡率。随后，验证了这些比率、社会经济变量、人口模型与该市初级保健组织模式之间的关联。进行统计分析时，我们使用了零膨胀负二项式模型。进行了总体分析，然后估计了多元回归模型。对于关联性，我们采用5%的“p”值。
城市人类发展指数（HDI）的提高和家庭健康护理策略实施比例的增加与婴儿死亡率（新生儿+新生儿后期）和孕产妇死亡率的降低显著相关。反过来，出生率和剖宫产率的增加与婴儿和孕产妇死亡率的增加相关。
得出的结论是，家庭健康护理策略是一种初级保健组织模式，有助于降低婴儿（新生儿+新生儿后期）和孕产妇死亡率，人类发展指数和剖宫产等因素也有同样作用。因此，公共卫生管理人员在为人群规划初级保健服务的组织时应优先选择这种模式。
