Infant death surveillance as an indicator of health care system effectiveness - a study conducted in northeastern Brazil

Objective: to evaluate the access to and quality of health care administered to infants based on postmortem data. Methods: a descriptive cross-sectional census-based study was carried out to assess the infant deaths that occurred in the town of Bom Conselho, state of Pernambuco, between January 1st 1999 and December 31st 1999. Home interviews and inspection of medical records were used for data collection. Deaths were identified by consulting the Mortality Information System, health centers, public notary services, cemeteries, health workers, and midwives. Results: seventy-one of 72 deaths were investigated, with a loss of 1.4%. The majority (69.4%) of deaths occurred in the postneonatal period and 67.6% of them occurred at home. In 77.5% of the cases medical help was sought at least once, most frequently at emergency units (65.1%). However, 22.5% of the patients were not taken to any kind of health care service. Most health care services (90.9%) were less than one hour away from the patient's home, 78.5% were located in the town of residence and 97% of the consultations were carried out by doctors. Of 88 consultations, 39.8% resulted in hospitalization and 27.3% in discharge without arrangement of a follow-up appointment. In 84% of the cases the medication was provided free of charge. Conclusions: death surveillance revealed restricted access to medical care and poor quality of health care administered to infants living in the referred town. The high rate of home deaths is related to access, whilst the journeys made by some of the mothers to health care units, during the illness that caused the death of their infants, points to the precarious organization of those services.

evaluation of health services; evaluation of health care quality; evaluation of processes and results; health care quality indicators; home surveys of infant deaths