Determinants of neonatal mortality in a municipality of the Zona da Mata in Pernambuco

Souza, Bruno Felipe Novaes de; Sousa, Nayara Francisca Cabral de; Sette, Gabriela Cunha Schechtman; Lima, Ana Paula Esmeraldo; Leal, Luciana Pedrosa; Holanda, Eliane Rolim de

doi:10.1590/S1980-220X2020015003726

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2020015003726 copy

Determinants of neonatal mortality in a municipality of the Zona da Mata in Pernambuco^* * Extracted from the dissertation: “Determinantes socioespaciais da mortalidade infantil em um município da Mata Pernambucana”, Programa de Pós- Graduação em Enfermagem, Universidade Federal de Pernambuco, 2020.

Determinantes de la mortalidad neonatal en el municipio de la Zona da Mata Pernambucana

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the determinants associated with neonatal mortality in a municipality in the Zona da Mata of Pernambuco state.

Method:

Cross-sectional and analytical study, carried out in the city of Vitória de Santo Antão, Pernambuco. All child deaths reported by the municipality to the Brazilian Mortality Information System between 2011 and 2018 were analyzed. Data were categorized and organized in three dimensions to be subjected to descriptive, bivariate statistics and hierarchical Poisson regression with robust variance. Prevalence ratios were estimated, considering variables with p <0.05 as significant.

Results:

The determinants associated with neonatal death were: caesarean delivery (PR 0.83; 95% CI 0.75-0.92), birth in the city itself (PR 1.12; 95% CI 1.01-1.25), newborn brown and black race/skin color (PR 1.13; 95% CI 1.001.29), prematurity (PR 1.88; 95% CI 1.79-1.97), and Apgar score <7 in the fifth minute (PR 1.74; 95% CI 1.67-1.82).

Conclusion:

Biological characteristics such as brown and black race/skin color, prematurity, and Apgar score <7 in the 5th minute after birth, as well as access to health services, such as being born in the municipality itself and not being born by caesarean delivery, were determinants associated with neonatal mortality.

DESCRIPTORS:
Infant Mortality; Risk Factors; Neonatal Nursing; Pediatric Nursing; Information Systems

Variables	Neonatal Death		p-Value
Variables	Yes	No	p-Value
Distal Dimension - Socioeconomic factors
Maternal level of education
<8 years	47 (62.7%)	28 (37.3%)	0.683¹ 1 Chi-square test.
≥ 8 years	52 (65.8%)	27 (34.2%)	0.683¹ 1 Chi-square test.
Mother's marital status
No partner	51 (63.8%)	29 (36.3%)	0.660¹ 1 Chi-square test.
With a partner	51 (67.1%)	25 (32.9%)	0.660¹ 1 Chi-square test.
Occupation (outside work)
Yes	39 (67.2%)	19 (32.8%)	0.750¹ 1 Chi-square test.
No	68 (64.8%)	37 (35.2%)	0.750¹ 1 Chi-square test.
Intermediate Dimension - Behavioral factors and use of services
Type of delivery
Caesarean	39 (52.7%)	35 (47.3%)	0.0021
Vaginal	68 (76.4%)	21 (23.6%)	0.0021
Induced labor
Yes	6 (54.5%)	5 (45.5%)	0.518² 2 Fisher's exact test.
No	96 (65.8%)	50 (34.2%)	0.518² 2 Fisher's exact test.
Parity
Primiparous	24 (68.6%)	11 (31.4%)	0.722¹ 1 Chi-square test.
Multiparous	83 (65.4%)	44 (34.6%)	0.722¹ 1 Chi-square test.
Number of prenatal consultations
Inadequate (<7)	78 (69.6%)	34 (30.4%)	0.012 ¹ 1 Chi-square test.
Adequate (≥ 7)	19 (47.5%)	21 (52.5%)	0.012 ¹ 1 Chi-square test.
Beginning of prenatal care in the 1st trimester
Yes	66 (61.1%)	42 (38.9%)	0.157 ¹ 1 Chi-square test.
No	26 (74.3%)	9 (25.7%)	0.157 ¹ 1 Chi-square test.
Place of birth
Vitória de Santo Antão	51 (58.6%)	36 (41.4%)	0.063 ¹ 1 Chi-square test.
Other municipalities	51 (72.9%)	19 (27.1%)	0.063 ¹ 1 Chi-square test.
Proximal Dimension - Biological Factors
Maternal age
<19 years	27 (65.9%)	14 (34.1%)	1.000¹ 1 Chi-square test.
≥ 19 years	81 (65.9%)	42 (34.1%)	1.000¹ 1 Chi-square test.
Maternal race/skin color
Brown/Black	14 (60.9%)	9 (39.1%)	0.622¹ 1 Chi-square test.
White	88 (66.2%)	45 (33.8%)	0.622¹ 1 Chi-square test.
Type of pregnancy
Single	101 (66.0%)	52 (34.0%)	0.737² 2 Fisher's exact test.
Twins	6 (60.0%)	4 (40.0%)	0.737² 2 Fisher's exact test.
Newborn sex
Male	64 (68.1%)	30 (31.9%)	0.485¹ 1 Chi-square test.
Female	44 (62.9%)	26 (37.1%)	0.485¹ 1 Chi-square test.
Newborn race/skin color
White	14 (43.8%)	18 (56.3%)	0.003 ¹ 1 Chi-square test.
Brown/Black	90 (72.0%)	35 (28.0%)	0.003 ¹ 1 Chi-square test.
Congenital anomaly
Yes	17 (73.9%)	6 (26.1%)	0.374¹ 1 Chi-square test.
No	85 (64.4%)	47 (35.6%)	0.374¹ 1 Chi-square test.
Prematurity (<37 weeks)
Yes	77 (74.8%)	26 (25.2%)	0.001 ¹ 1 Chi-square test.
No	29 (49.2%)	30 (50.8%)	0.001 ¹ 1 Chi-square test.
Birth weight
<2,500 grams	84 (77.1%)	25 (22.9%)	<0.001 ¹ 1 Chi-square test.
≥ 2,500 grams	28 (43.6%)	14 (56.4%)	<0.001 ¹ 1 Chi-square test.
Apgar score in the 1st minute
< 7	67 (82.7%)	14 (17.3%)	<0.001 ¹ 1 Chi-square test.
≥ 7	32 (45.1%)	39 (64.9%)	<0.001 ¹ 1 Chi-square test.
Apgar score in the 5th minute
< 7	46 (92.0%)	4 (8.0%)	<0.001 ¹ 1 Chi-square test.
≥ 7	53 (52.0%)	49 (48.0%)	<0.001 ¹ 1 Chi-square test.

Determinants	PR	95%CI	p-Value¹ 1 Wald test.
Intermediate Dimension - Behavioral factors and use of services
Type of delivery			0.001
Caesarean	0.83	0.75-0.92
Vaginal	1	-
Place of birth			0.032
Vitória de Santo Antão	1.12	1.01-1.25
Other municipalities	1	-
Proximal Dimension - Biological Factors
Newborn race/skin color			0.035
Brown/Black	1.13	1.00-1.29
White	1	-
Prematurity (<37 weeks)			0.016
Yes	1.88	1.79-1.97
No	1	-
Apgar score in the 5th minute			<0.001
< 7	1.74	1.67-1.82
≥ 7	1	-

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Bruno Felipe Novaes de Souza Rua Escritor Álvaro Lins, 176, Apto. 103, Afogados, CEP 50830-420 - Recife, PE, Brazil. bruno-novaes@hotmail.com