Mortalidade infantil nos Municípios do Estado de Pernambuco e a sua relação com os indicadores sociodemográficos, socioeconômicos, socioambientais e de saúde

Abstract

Introduction: Child Mortality is defined as the death that occurs in children before they complete one year of life. Although it presents a decreasing trend, in Brazil, TMI still reaches worrying levels, in some regions of the country. Interrupting the downward trend in recent years, in 2016 there was an increase in this indicator in the country, as a result of the increase in some states, such as Pernambuco. Objective: To analyze the relationship between TMI and post-neonatal TMI with socio-demographic, socioeconomic, socioenvironmental and health indicators in the municipalities of the state of Pernambuco in 2016. Method: This is a mixed ecological study that used secondary data of number of infantile deaths, in minors of one year of age, and post-neonatal in the referred state, through the Mortality Information System; data of applied doses of the vaccines indicated for minors of one year, through the Information System of the National Program of Immunization; number of live births, through the Information System of Live Births; besides the sociodemographic, socioeconomic, socioenvironmental and health indicators, through the Brazilian Institute of Geography and Statistics. Descriptive analysis and logistic regression analysis were performed. It was carried through mapping of the post-neonatal TMI and TMI, using the Software QGIS 3.4. For the other analyses, the SPSS 24.0 software was used, considering the 5% significance level. Results: The TMI, in the state and year surveyed, was considered low (13.93 per 1000 live births), but there is high heterogeneity of this indicator, in the municipalities of the state of Pernambuco. The post-neonatal MRI presents average (4.15) above the national average, also with significant regional differences. The CV of the BCG vaccine was well below (67%) that recommended by the Ministry of Health. The CV of the other vaccines was considered adequate or high. However, the state presented low homogeneity of the CV. More than 80% of the population lives in urban areas. 51.9% of the population are female. Approximately 1/3 of the population with 18 years or more does not have schooling. The state has an HDI considered average (0.599), but with high regional inequality. 69.6% of mothers of live births have had 7 or more prenatal consultations. In the multiple logistic regression analysis, the municipalities with per capita household income between 332 and 1144 presented less chances for the infant mortality rate (OR=0.280) than the municipalities with per capita household income between 155 and 234. The municipalities with the percentage of live births born, in 2016, to mothers who underwent 7 or more prenatal consultations in the percentile 75 (greater than or equal to 76.63%) also showed less risk for the infant mortality rate compared to municipalities with a percentage of live births born to mothers who underwent 7 or more prenatal consultations percentile 75 (below 76.63%). The municipalities with a higher percentage of the illiteracy rate 18 years or more (between 35.06% and 45.40%) presented 5.8 times greater risk for the post-neonatal infant mortality rate (OR=5.842) than the municipalities with a lower percentage of the illiteracy rate 18 years or more (5.10% and 24.64%). Conclusion: Among the social indicators analyzed, the per capita household income and illiteracy rate had a more significant impact on the risk of increasing infant and post-neonatal mortality rates, while among the health indicators, the percentage of 7 or more prenatal consultations in the municipalities of the state of Pernambuco was highlighted. Thus, MI should be faced by all government instances with effective investments in the most varied sectors of society, in order to mitigate the impacts of multiple conditioning factors and determinants of death in this age group.