Fetal and Infant Mortality in Botucatu City, São Paulo State, Brazil: Evaluation of Maternal - Infant Health Care

In Brazil, neonatal mortality rate is considered
incompatible with the country development conditions, and has been
a Public Health concern. Reduction in infant mortality rates has also
been part of the Millennium Development Goals, a commitment
made by countries, members of the Organization of United Nations
(OUN), including Brazil. Fetal mortality rate is considered a highly
sensitive indicator of health care quality. Suitable actions, such as
good quality and access to health services may contribute positively
towards reduction in these fetal and neonatal rates. With appropriate
antenatal follow-up and health care during gestation and delivery,
some death causes could be reduced or even prevented by means of
early diagnosis and intervention, as well as changes in risk factors
and interventions. Objectives: To study the quality of maternal and
infant health care based on fetal and neonatal mortality, as well as the
possible actions to prevent those deaths in Botucatu (Brazil).
Methods: Classification of prevention according to the International
Classification of Diseases and the modified Wigglesworth´s
classification. In order to evaluate adequacy, indicators of quality of
antenatal and delivery care were established by the authors. Results:
Considering fetal deaths, 56.7% of them occurred before delivery,
which reveals possible shortcomings in antenatal care, and 38.2% of
them were a result of intra- labor changes, which could be prevented
or reduced by adequate obstetric management. These findings were
different from those in the group of early neonatal deaths which were
also studied. Adequacy of health services showed that antenatal and
childbirth care was appropriate for 24% and 33.3% of pregnant
women, respectively, which corroborates the results of prevention.
These results revealed that shortcomings in obstetric and antenatal
care could be the causes of deaths in the study. Early and late
neonatal deaths have similar characteristics: 76% could be prevented
or reduced mainly by adequate newborn care (52.9%) and adequate
health care for gestational women (11.7%). When adequacy of care
was evaluated, childbirth and newborn care was adequate in 25.8%
and antenatal care was adequate in 16.1%. In conclusion, direct
relationship was found between adequacy and quality of care
rendered to pregnant women and newborns, and fetal and infant
mortality. Moreover, our findings highlight that deaths could be
prevented by an adequate obstetric and neonatal management.

• Noda L. M.
• Salvador I. C
• C. M. L. G. Parada
• Fonseca C. R. B.

• Fetal Mortality
• Infant Mortality
• Maternal-Child Health Services
• Program Evaluation.

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