1
|
Correa HFDS, Domingues RMSM, Pina MDF. [Spatial analysis of maternal morbidity and mortality in users of the Brazilian Unified National Health System in the city of Rio de Janeiro, Brazil, 2014-2016]. CAD SAUDE PUBLICA 2023; 39:e00247322. [PMID: 37729308 PMCID: PMC10513155 DOI: 10.1590/0102-311xpt247322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/25/2023] [Accepted: 06/02/2023] [Indexed: 09/22/2023] Open
Abstract
The objective of this study is to analyze the maternal morbidity and mortality of women treated in hospitals of the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro in the period 2014-2016. An ecological study was conducted using data from the Brazilian Information System on Live Birth (SINASC), the Brazilian Mortality Information System (SIM), and the Brazilian Hospital Information System (SIH/SUS). For the analysis of the maternal mortality ratio (MMR), data from the SIM were used. For the analysis of maternal morbidity, World Health Organization criteria were used to estimate the ratios of maternal near miss and potentially life-threatening conditions. SINASC was used to retrieve data on the number of live births, for demographic characterization, social aspects, and access to prenatal care. To evaluate the spatial association between the indicators MMR, ratios of maternal near miss, and potentially life-threatening conditions and the demographic, social, obstetric, and access indicators, obtained from SINASC, the bivariate Moran Index was estimated with a significance level of 0.05, using the GeoDa program. In the period analyzed, the MMR in the Rio de Janeiro was 94.16/100,000 live births, the ratio of maternal near miss was 28.21/1,000 live births, and the potentially life-threatening conditions was 34.31/1,000 live births. Cases of potentially life-threatening conditions were used for the first time in this study and presented diagnoses and procedures during hospitalization more consistent with the maternal mortality profile in the city of Rio de Janeiro. There was a significant association between MMR and percentage of live births in SUS, potentially life-threatening conditions and percentage of live births in SUS, and potentially life-threatening conditions and being single.
Collapse
Affiliation(s)
- Heloisa Ferreira Dos Santos Correa
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- Prefeitura Municipal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Maria de Fátima Pina
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| |
Collapse
|
2
|
Fernandez M, Fernandes LDMM, Massuda A. atenção Primária à Saúde na pandemia da COVID-19. Rev Bras Med Fam Comunidade 2022. [DOI: 10.5712/rbmfc17(44)3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introdução: A pandemia da COVID-19 afetou o mundo desigualmente. Países com ausência de coordenação nacional e/ou que resistiram a implementar as ações não farmacológicas de saúde pública tiveram suas populações impactadas pelo alto número de casos e pelas mortes por COVID-19, além de grandes impactos socioeconômicos, como o Brasil e os EUA. No caso brasileiro, especial atenção deve ser dada ao papel da Atenção Primária à Saúde (APS), considerando sua função de coordenadora e ordenadora do Sistema Único de Saúde. Objetivo: Este artigo tem como objetivo discutir as ações da APS no primeiro ano da emergência sanitária no Brasil. Métodos: Para realizar a análise proposta, consideramos os planos propostos por diversas organizações: Organização Mundial da Saúde, Conselho Nacional de Secretários de Saúde e Conselho Nacional de Secretarias Municipais de Saúde, Associação Brasileira de Saúde Coletiva e Sociedade Brasileira de Medicina de Família e Comunidade. Os documentos foram contrapostos ao conjunto de documentos publicados pelo Ministério da Saúde relacionados à APS. Resultados: A estratégia de combate à pandemia do Brasil falhou em subestimar o papel da APS. Mesmo diante do apelo e dos parâmetros estabelecidos por entidades nacionais e internacionais, a ação foi descoordenada e pouco do previsto em notas técnicas foi implementado. Conclusões: Entendendo que a pandemia ainda está em curso no Brasil, há a necessidade de retomar a centralidade da APS.
Collapse
|
3
|
Villalba JPG, Pereira ALDF, Queiroz ABA, Batista DBDS, Guimarães JCN. Assistance process to women with severe maternal morbidity: a mixed study. Rev Gaucha Enferm 2022; 43:e20210046. [PMID: 35976376 DOI: 10.1590/1983-1447.2022.20210046.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the maternal and obstetric characteristics associated with severe maternal morbidity, and the factors of the assistance process involved in the severe outcomes according to nurses and doctors. METHOD Sequential mixed study at the tertiary maternity in the city of Rio de Janeiro, based on care records and interviews with these professionals, from February to July 2019. Chi-square test, prevalence ratio and thematic content analysis were applied. RESULTS In 66 (100%) women with SMM, severe preeclampsia (77.3%) was more prevalent and there were 12 (18.2%) cases of near miss and one maternal death. Postpartum hemorrhage (PR = 3.21; 95% CI 1.22-8.41) and blood transfusions (PR = 3.60; 95% CI 1.81-7.16) contributed to severe outcomes. There are deficiencies in the health system, access to reproductive health and quality of care. CONCLUSION Improvements in access to health and quality of the care process are imperative to reduce severe maternal outcomes.
Collapse
Affiliation(s)
- Jessica Paola Garcia Villalba
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Enfermagem, Curso de Mestrado. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Adriana Lenho de Figueiredo Pereira
- Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Enfermagem, Departamento de Enfermagem Materno-Infantil. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Beatriz Azevedo Queiroz
- Universidade Federal do Rio de Janeiro (UFRJ), Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil. Rio de Janeiro, Rio de Janeiro, Brasil
| | - Deise Breder Dos Santos Batista
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Enfermagem, Curso de Mestrado. Rio de Janeiro, Rio de Janeiro, Brasil
| | | |
Collapse
|
4
|
Villalba JPG, Pereira ALDF, Queiroz ABA, Batista DBDS, Guimarães JCN. Processo assistencial às mulheres com morbidade materna grave: um estudo misto. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20210046.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Descrever as características maternas e obstétricas associadas à morbidade materna grave e os fatores do processo assistencial envolvidos nesses desfechos graves segundo enfermeiras e médicos. Método: Estudo misto sequencial em maternidade terciária no município do Rio de Janeiro, a partir de registros da assistência e entrevistas com esses profissionais, de fevereiro a julho de 2019. Aplicaram-se teste qui-quadrado, razão de prevalência e análise de conteúdo temática. Resultados: Em 66 (100%) mulheres, a pré-eclâmpsia grave (77,3%) foi mais prevalente e ocorreram 12 (18,2%) casos de near miss e um óbito materno. A hemorragia pós-parto (RP= 3,21; IC 95% 1,22-8,41) e realização de transfusões sanguíneas (RP= 3,60; IC 95% 1,81-7,16) contribuíram nos desfechos graves. Há deficiências no sistema de saúde, acesso à saúde reprodutiva e qualidade da assistência. Conclusão: Melhorias no acesso à saúde e qualidade do processo assistencial são imperiosas para reduzir os desfechos maternos graves.
Collapse
|
5
|
de Carvalho-Sauer RDCO, Costa MDCN, Teixeira MG, do Nascimento EMR, Silva EMF, Barbosa MLA, da Silva GR, Santos TP, Paixao ES. Impact of COVID-19 pandemic on time series of maternal mortality ratio in Bahia, Brazil: analysis of period 2011-2020. BMC Pregnancy Childbirth 2021; 21:423. [PMID: 34112099 PMCID: PMC8190975 DOI: 10.1186/s12884-021-03899-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/23/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Most studies on the effects of SARS-CoV-2 infection have been conducted with adults and non-pregnant women. Thus, its impacts on maternal health are not yet fully established. This study aimed to verify the relationship between the maternal mortality ratio and the incidence of COVID-19 in the State of Bahia, Brazil, 2020. METHODS This time-series study used publicly available information in Brazil, to obtain data on maternal deaths and live births in Bahia, State, from January 1, 2011, to December 31, 2020. The time trend of Maternal Mortality Ratio (MMR) was analysed through polynomial regression, of order 6. Expected MMR, monthly (Jan-Dec) and annual values for 2020, were predicted by the additive Holt-Winters exponential smoothing algorithm, with 95% confidence interval, based on the time series of the MMR from 2011 to 2019, and the accuracy of the forecasts for 2020 was assessed by checking the smoothing coefficients and the mean errors. According to the statistical forecast, the MMR values recorded in the year 2020 were compared to those expected. RESULTS In 2020, the annual MMR in Bahia, Brazil, was 78.23/100,000 live births, 59.46% higher than the expected ratio (49.06 [95% CI 38.70-59.90]). The increase in maternal mortality ratio relative to expected values was observed throughout the 2020 months; however, only after May, when the COVID-19 epidemic rose sharply, it exceeded the upper limit of the 95% CI of the monthly prediction. Of the 144 registered maternal deaths in 2020, 19 (13.19%) had COVID-19 mentioned as the cause of death. CONCLUSIONS Our study revealed the increase in maternal mortality, and its temporal relationship with the incidence of COVID-19, in Bahia, Brazil, in 2020. The COVID-19 pandemic may be directly and indirectly related to this increase, which needs to be investigated. An urgent public health action is needed to prevent and reduce maternal deaths during this pandemic, in Brazil.
Collapse
Affiliation(s)
- Rita de Cássia Oliveira de Carvalho-Sauer
- Núcleo Regional de Saúde Leste, Bahia State Health Secretariat, Santo Antônio de Jesus, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria da Conceição N Costa
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Maria Gloria Teixeira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | | | | | | | | | | | - Enny S Paixao
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
- London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
6
|
Magalhães DMDS, Bernardes JM, Ruiz-Frutos C, Gómez-Salgado J, Calderon IDMP, Dias A. Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study. Healthcare (Basel) 2021; 9:healthcare9030335. [PMID: 33809643 PMCID: PMC8002207 DOI: 10.3390/healthcare9030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022] Open
Abstract
The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.
Collapse
Affiliation(s)
- Daniela Mendes dos Santos Magalhães
- Gynecology, Obstetrics and Mastology Posgraduate Programme, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Sao Paulo 18618-687, Brazil; (D.M.d.S.M.); (I.d.M.P.C.)
- Secretary of State for Health of the Federal District, Brasilia 70390-150, Brazil
| | - João Marcos Bernardes
- Public (Collective) Health Grade Programme, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Sao Paulo 18618-687, Brazil; (J.M.B.); (A.D.)
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Posgraduate Programme, Universidad Espíritu Santo, Samborondón, Guayaquil 092301, Ecuador
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain;
- Safety and Health Posgraduate Programme, Universidad Espíritu Santo, Samborondón, Guayaquil 092301, Ecuador
- Correspondence: ; Tel.: +34-959219700
| | - Iracema de Mattos Paranhos Calderon
- Gynecology, Obstetrics and Mastology Posgraduate Programme, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Sao Paulo 18618-687, Brazil; (D.M.d.S.M.); (I.d.M.P.C.)
| | - Adriano Dias
- Public (Collective) Health Grade Programme, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Sao Paulo 18618-687, Brazil; (J.M.B.); (A.D.)
| |
Collapse
|
7
|
Fernandez M, Lotta G, Corrêa M. Desafios para a Atenção Primária à Saúde no Brasil: uma análise do trabalho das agentes comunitárias de saúde durante a pandemia de Covid-19. Trab educ saúde 2021. [DOI: 10.1590/1981-7746-sol00321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo As fragilidades da Atenção Primária à Saúde podem ser reconhecidas por meio da análise do trabalho das agentes comunitárias de saúde. Uma vez que a situação enfrentada por essas profissionais representa desafios estruturais do sistema de saúde, este artigo tem como objetivo analisar a situação das profissionais em questão no enfrentamento à pandemia de Covid-19 no Brasil. Analisamos seus desafios com base nos dados coletados em um inquérito online e em netnografia. Para a realização da análise dos dados, optamos pela análise de conteúdo, inspirada na grounded-theory. Observamos três dimensões que representam como as agentes comunitárias de saúde experienciam a pandemia: mudanças nas práticas de trabalho, bem como nas interações entre trabalhadores e usuários e a expectativa do futuro no trabalho pós-pandemia. As análises mostram que para resguardar essas profissionais e garantir o funcionamento da Atenção Primária à Saúde é necessário contar com novas estratégias para viabilizar as dinâmicas locais de trabalho.
Collapse
|
8
|
Costa JC, Maia MFS, Victora CG. Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies. Cien Saude Colet 2020; 25:4813-4830. [PMID: 33295503 DOI: 10.1590/1413-812320202512.21642020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022] Open
Abstract
We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.
Collapse
Affiliation(s)
- Janaína Calu Costa
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | - Maria Fatima Santos Maia
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| | - Cesar Gomes Victora
- Centro Internacional de Equidade em Saúde, Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. R. Marechal Deodoro 1160, Centro. 96020-220 Pelotas RS Brasil.
| |
Collapse
|
9
|
Oliveira TDC, Lucena TSD, Silva JMDOE, Nagliate PDC, Veríssimo RCSS, Sales MLDH. Adverse outcomes of childbirth in high-risk maternity hospitals. Rev Bras Saude Mater Infant 2020. [DOI: 10.1590/1806-93042020000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract Objectives: to analyze adverse outcomes in teaching maternity hospitals in Maceió, Alagoas, Brazil. Methods: a cross-sectional, retrospective and analytical study was carried out with a random sample of 480 medical records of postpartum women in 2016 using the Adverse Outcome Index: in-hospital maternal death, neonatal in-hospital death> 2500g and> 37 weeks, uterine rupture, unplanned maternal admission to intensive care unit, delivery trauma to the newborn, return to the operating room, admission to an intensive neonatal unit with >2500g and > 37 weeks for more than one day, Apgar <7 at the fifth minute, maternal hemotransfusion and fourth-degree perineal laceration. The data were analyzed using the Statistical Package for Social Sciences software version 22.0. Results: the results showed a 21% rate of adverse outcomes, at a rate of 26.4 for every 1,000 births, with a greater occurrence of neonatal intensive care admission with>2500g and>37 weeks for more than one day (52. 5%), maternal blood transfusion (20.8%) and unplanned maternal admission in intensive care (17.8%). Conclusions: the evaluation of adverse outcomes evidenced a high proportion of births with undesirable results, which allowed the analysis of the outlook of unfavorable outcomes related to safety in maternity wards through the use of indicators.
Collapse
|
10
|
Silva JMDPD, Fonseca SC, Dias MAB, Izzo AS, Teixeira GP, Belfort PP. Concepts, prevalence and characteristics of severe maternal morbidity and near miss in Brazil: a systematic review. Rev Bras Saude Mater Infant 2018. [DOI: 10.1590/1806-93042018000100002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to analyze frequency, characteristics and causes of severe maternal morbidity (maternal near miss) in Brazil. Methods: a systematic review on quantitative studies about characteristics, causes, and associated factors on severe maternal morbidity (maternal near miss). The search was done through MEDLINE (maternal near miss or severe maternal morbidity and Brazil) and LILACS (maternal near miss, maternal morbidity). Data were extracted from methodological characteristics of the article, criteria for maternal morbidity and main results. Near miss ratios and indicators were described and estimated. Results: we identified 48 studies: 37 were on hospital based; six were based on health surveys and five were based on information systems. Different definitions were adopted. Maternal near miss ratio ranged from 2.4/1000 LB to 188.4/1000 LB, depending on the criteria and epidemiological scenario. The mortality rate for maternal near miss varied between 3.3% and 32.2%. Hypertensive diseases and hemorrhage were the most common morbidities, but indirect causes have been increasing. Flaws in the healthcare were associated to near miss and also sociodemographic factors (non-white skin color, adolescence/ age ≥ 35 years old, low schooling level). Conclusions: the frequency of maternal near miss in Brazil is high, with a profile of similar causes to maternal mortality. Inequities and delays in the healthcare were identified as association.
Collapse
|