The aim of this study was to analyze maternal and child health indicators and infant mortality rate (IMR) at the cities located at the 18th Health Division (HD) in Parana State, Brazil. In this ecological study we analyzed all live births and infant deaths which occurred from 2000 to 2009 at the 18th HD, collecting data from the Mortality Information Database and the Live Births Information Database. The variables assessed were grouped into maternal, pregnancy and delivery, and neonatal variables. The analysis was conducted using the mean percentage of each variable and the IMR calculated for both periods: from 2000 to 2004 and from 2005 to 2009. The IMR was reduced considerably, following Brazil's and Paraná State's trend. Maternal indicators went down regarding the mean percentage of teenage mothers and low education, whereas they went up regarding mother with 35？years old or older and mothers without a partner. Pregnancy indicators showed increased prematurity and cesarean birth. Neonatal indicators raised in black/brown skin color and low birth weights percentages. This study provides a better understanding of maternal and child health in the cities located at the 18th HD, supplying grounds to plan actions regarding the real needs of each specific city. 1. Introduction Maternal and child health is a priority in Brazil’s agenda of health programs and actions, as well as in several countries. The concept of maternal and child health has expanded over the years, which also includes a set of knowledge, practices, and attitudes that aim at the promotion of healthy pregnancies, deliveries, and births and also the prevention of maternal and child mortality [1]. Brazil, as many other areas in the world, has been showing a reduction in infant mortality rate (IMR), mainly due to sanitary investments and increased health services accessibility [2]. In 1990, Brazil’s infant mortality rate was 47.1 deaths by a thousand live births. In 2009, it went down to 22.5 by a thousand live births [3]. In Paraná State, infant mortality has also decreased in the last years. In 2001, this rate was 17.4 by a thousand live births, and in 2008, this rate declined to 12.1 by a thousand live births, showing a 30.4% reduction. However, important inequities are observed among the cities located at the 18th Health Division area, which must be highlighted and addressed by health managers while devising prevision and distribution of resources and services, as well as health professionals’ qualification [4]. Studies conducted in Paraná State expose inequities in maternal, pregnancy,
References
[1]
BRASIL, Ministério Da Saúde, Manual Técnico Pré-Natal e Puerpério: Aten？？o Qualificada e Humanizada, Brasília, Brazil, 2006.
[2]
C. G. Victora, M. L. Barreto, M. Do Carmo Leal et al., “Health conditions and health-policy innovations in Brazil: the way forward,” The Lancet, vol. 377, no. 9782, pp. 2042–2053, 2011.
[3]
IBGE—Instituto Brasileiro de Geografia e Estatística. Dados do censo, 2010, http://www.censo2010.ibge.gov.br/dados_divulgados/index.php?uf=41.
[4]
E. C. Melo and T. A. F. Mathias, “Mother's and newborn characteristics in main municipalities of regional health units in the state of Paraná from SINASC's data files,” Cogitare Enfermagem, vol. 15, no. 2, pp. 293–301, 2010.
[5]
K. M. Predebon and T. A. D. F. Mathias, “Inequalities in indicators of women and child's health in Paraná state, Brazil,” Acta Scientiarum, vol. 33, no. 2, pp. 139–145, 2011.
[6]
H. A. C. Ramos and R. K. N. Cuman, “Risk factors for prematurity: document search,” Escola Anna Nery Revista De Enfermagem, vol. 13, no. 2, pp. 297–304, 2009.
[7]
E. V. Mendes, As Redes De Aten？？o à saúde, Organiza？？o Pan-Americana da Saúde, Brasília, Brazil, 2011.
[8]
SESA-Secretaria de Saúde do Paraná, Rede M？e Paranaense, Curitiba, 2012, http://www.sesa.pr.gov.br/arquivos/File/APSUS_-_Ed._Permanente/Oficina_02/Rede_Mae_Paranaense.pdf.
[9]
SESA-Secretaria de Saúde do Paraná, Regionais de Saúde, Curitiba, 2011, http://www.sesa.pr.gov.br/modules/conteudo/conteudo.php?conteudo=2752.
[10]
IPEA, Instituto de Pesquisa e Econ？mica Aplicada. Dinamica Demográfica da popula？？o Negra Brasileira, Brasília, 2011, http://portal.mte.gov.br/data/files/8A7C816A316B688101318AAF34BF324A/110512_comunicadoipea91.pdf.
[11]
UNICEF, “Fundo das Na？？es Unidas para Infancia,” Situa？？o Mundial da Infancia, Caderno Brasil. Brasília, DF, 2008, http://www.unicef.org/brazil/pt/cadernobrasil2008.pdf.
[12]
J. P. Mackenbach, I. Stirbu, A.-J. R. Roskam et al., “Socioeconomic inequalities in health in 22 European countries,” The New England Journal of Medicine, vol. 358, no. 23, pp. 2468–2481, 2008.
[13]
M. G. Martins, G. H. dos Santos, M. S. Sousa, et al., “Association of pregnancy in adolescence and prematurity,” Revista Brasileira de Ginecologia e Obstetrícia, vol. 33, no. 11, pp. 354–360, 2011.
[14]
F. L. Gabani, F. H. M. Santánna, and S. M. Andrade, “Characterization of live births in Londrina (PR) from Live Birth Information System (LBIS) data, 1994 to 2007,” Ciência, Cuidado e Saúde, vol. 9, no. 2, pp. 205–213, 2010.
[15]
P. C. Andrade, J. J. Linhares, S. Martinelli, et al., “Perinatal results in pregnant women with more than 35 years: a controlled study,” Revista Brasileira de Ginecologia e Obstetrícia, vol. 26, no. 9, pp. 697–702, 2004.
[16]
IBGE, “Instituto brasileiro de geografia e estatística,” Nascimentos no Brasil: o que dizem as informa？？es? 2009, http://www.ibge.gov.br/home/estatistica/populacao/indic_sociosaude/2009/com_nasc.pdf.
[17]
A. Marin and C. A. Piccinini, “One-parent families: single-mother in the literature,” Revista Psico, vol. 40, no. 4, pp. 422–429, 2009.
[18]
A. H. Marin, “Maternity constitution in single pregnant women,” Revista Psico, vol. 42, no. 2, pp. 246–254, 2011.
[19]
M. A. B. Dias, R. M. S. M. Domingues, A. P. E. Pereira et al., “The decision of women for cesarean birth: a case study in two units of the supplementary health care system of the State of Rio de Janeiro,” Ciencia e Saude Coletiva, vol. 13, no. 5, pp. 1521–1534, 2008.
[20]
G. Kac, E. A. Silveira, L. C. De Oliveira, D. M. R. Araújo, and E. B. De Sousa, “Factors associated to cesarean sections and abortions in women selected from a health clinic in the city of Rio de Janeiro, Brazil,” Revista Brasileira de Saude Materno Infantil, vol. 7, no. 3, pp. 271–280, 2007.
[21]
G. P. Barbosa, K. Giffin, A. Angulo-Tuesta et al., “Cesarean sections: who wants them and under what circumstances?” Cadernos de Saude Publica, vol. 19, no. 6, pp. 1611–1620, 2003.
[22]
J. C. De Souza Jr., N. Kunkel, M. D. A. Gomes, and P. F. Freitas, “Inverse equity and inequalities in the use of technology in childbirth, in Santa Catarina, Brazil, 2000 to 2004,” Revista Brasileira de Saude Materno Infantil, vol. 7, no. 4, pp. 397–403, 2007.
[23]
B. Niclasen, “Low birthweight as an indicator of child health in Greenland—use, knowledge and implications,” International journal of circumpolar health, vol. 66, no. 3, pp. 215–225, 2007.
[24]
S. M. A. Donahue, K. P. Kleinman, M. W. Gillman, and E. Oken, “Trends in birth weight and gestational length among singleton term births in the United States: 1990-2005,” Obstetrics and Gynecology, vol. 115, no. 2, pp. 357–364, 2010.
[25]
S. Kilsztajn, A. Rossbach, M. Santos Nunes do Carmo, and G. T. Lopes Sugahara, “Prenatal care, low birth weight and prematurity in Brazil, 2000,” Revista de Saude Publica, vol. 37, no. 3, pp. 303–310, 2003.
