ORIGINAL ARTICLES Factors associated to maternal and child’s health in Rio Grande do Sul, Brazil Franciele Mattei 1 Ioná Carreno 2 1,2 Centro de Ciências Biológicas e da Saúde. Universidade do Vale do Taquari UNIVATES. Rua Avelino Tallini, 171. Universitário. Lajeado, RS, Brasil. CEP: 95.914-014. E-mail: [email protected] Abstract Objectives: to analyze the factors associated to maternal and child’s health from the Live Births Information System (Sinasc) in Rio Grande do Sul, 2012. Methods: a cross-sectional ecological study with analysis on Sinasc variables from 19 Regional Health Coordinations in Rio Grande do Sul. The variables occurrence frequencies were calculated and analyzed by Spearman correlation. Results: we observed that a higher maternal level of education, the presence of a partner and the adequate number of prenatal consultations reduced the frequency of vaginal delivery, as for the proportion of cesarean section, it was 62%. The frequency of low schooling was associated to prematurity (rho = 0.521, p=0.022) and low birth weight (rho = 0.542, p=0.016). The low prenatal coverage correlated positively with the Apgar score ≤ 7 in the 5th minute (rho = 0.467; p=0.044) and negatively with adequate birth weight (rho = -0.500; p=0.029). Conclusions: this study allows to identify factors associated to maternal and child’s health contributing information to the development of actions that qualifies pregnant women’s healthcare. Palavras-chave Maternal and Child Health, Live birth, Epidemiology http://dx.doi.org/10.1590/1806-93042017000300007 Rev. Bras. Saúde Matern. Infant., Recife, 17 (3): 527-537 jul. / set., 2017 527 Mattei F, Carreno I Introduction live births throughout nation territory. Through this system, it is possible to get information on births that Maternal and child health is a priority for the occurred and the mothers, the characteristics of the Brazilian health system that seeks to promote safe delivery and pregnancy and the newborns’ data, and and free of complications at motherhood which the possibility of doing this is knowing the factors arises during pregnancy. However, despite the associated to maternal and child health.8,9 progress achieved in relation to childbirth health- The objective of this present study was to care, maternal morbimortality and perinatal remain analyze the factors associated to maternal and child high in this country, even being preventable in most health from Sinasc in Rio Grande do Sul State, cases.1 Brazil, 2012. Furthermore, childbirth has ceased to be a natural experience for all social classes in Brazil and Métodos this is due to the occurrence of vaginal delivery that is often painful with excessive medical interventions This is a cross-sectional ecological study whose unit and the high rate of cesarean sections in the country. of analysis was constituted by live births in 2012, Many interventions performed during a normal this was the last available information at the time delivery are at discordance with the Ministry of when this study was developed, and children’s Health recommends and the numerous of cesarean mothers were living in Rio Grande do Sul State, sections that are pre-scheduled and performed according to the administrative division in the State. unnecessarily.2 The situation is not restricted to the Rio Grande do Sul State is administratively divided Brazilian scenario, the cesarean rates have increased into 19 Regional Health Coordinations (CRS) around the world, reaching almost all the countries.3 (Figure 1). The data were obtained from Sinasc data- The absence of physiological mechanisms to base of the Ministry of Health. adapt at childbirth, which occurs through the perfor- Among the Sinasc variables, eight that have mance of cesareans sections, entails risks to the epidemiological significance in relation to the newborns’ adaptation and their worst outcome may mother and the newborn were selected, classified in be evidenced by high rates of prematurity associated sociodemographic, healthcare and results. The to respiratory disorders, such as tachypnea or hyaline sociodemographic variables included the mother's membrane disease and low birth weight.4 age (<20, 20 to 34 and 35 to 49 years), the mother’s Prenatal care is an essential component for schooling level in years (<4, 4 to 11 and ≥12), and women's healthcare and has as the main objective to the mother’s marital status (with and without a reduce maternal and child’s morbimortality. This partner). The healthcare variables were constituted reduction has a close relation to healthcare in which on the number of prenatal consultations (<4, 4 to 6 pregnant women receive during pregnancy and at the and ≥7 consultations) and the type of childbirth moment of the delivery.5 However, in spite of in (vaginal and cesarean section). The result variables Brazil, the prenatal healthcare coverage has become considered the gestation length (<37 weeks and 37 almost a universal practice, its adequacy is low in to 42 weeks), birth weight (<2,500g, 2,500 to 3,999g our country.6 Yet, it appears that health professionals and ≥4,000 g), and the Apgar score at the 5th minute have a certain hurry to promote the delivery, and in (≤ 7 and 8 to 10). the process to accelerate the delivery disrespecting For each variable and its categories was the pregnant women’s autonomy, imposing their performed to collect data from the Sinasc database, practices and the excess of interventions making the database was built in the Excel Software 2010. labor healthcare in focusing only on medical deci- The variables frequency of occurrence by the CRS sion.7 was calculated and the Spearman correlation coeffi- In this context, the vital statistics which cover cient was used to evaluate the existence of associa- births and deaths data are fundamental elements to tion between the relative frequencies (fr) of the vari- understand the epidemiological profile and to plan ables in this study. The Statistical Package for Social and evaluate maternal and child health, especially in Sciences Software (SPSS) version 18.0 was used in countries with large socioeconomic inequality, as in the statistical analysis of the data. The level of Brazil.8 significance was at p≤0.05. The category on infor- In the 1990’s, the Ministry of Health had imple- mation ignored was deleted from all the variables. mented in Brazil, Live Births Information System This study was conducted within the ethical prin- (Sinasc). The Sinasc database was developed to ciples contained in the Declaration of Helsinki and collect and provide epidemiological information on in accordance to the Resolution Number 466 in 2012 528 Rev. Bras. Saúde Matern. Infant., Recife, 17 (3): 527-537 jul. / set., 2017 Factors associated to maternal and child’s health in Rio Grande do Sul, Brazil Figure 1 Regional Health Coordinations (CRS) and Macro Regions of the State. Rio Grande do Sul, Brazil, 2012. Macro Regions: 19 South 11 Midwest 14 15 Valleys Mountains 17 12 6 Metropolitan North 9 5 Missionary 16 CRS: 4 13 1 1 Porto Alegre - 01 10 18 2 Porto Alegre - 02 2 3 Pelotas 8 4 Santa Maria 2 5 Caxias do Sul 6 Passo Fundo 7 7 Bagé 8 Cachoeira do Sul 3 9 Cruz Alta Brazil 10 Alegrete 11 Erechim 12 Santo Ângelo 13 Santa Cruz do Sul 14 Santa Rosa 15 Palmeira das Missões 16 Lajeado 17 Ijuí 18 Osório 19 Frederico Westphalen Fonte: Santos DM, Mattei F 2015, adapted to Regional Coordinations, Health Secretary of State / RS. of the Ministry of Health. As this is a study partner. The CRS in Lajeado was pointed out with performing secondary data, accessible to the public the smallest number of teenage mothers (10.7%), and without identifying the individuals’ names, there low schooling levels (1.6%) and mothers without a has been an exempted in submitting to the Ethics partner (22.2%). Research Committee at the University of Vale do In relation to the healthcare variables, 71.7% of Taquari - Univates. the mothers had seven or more prenatal visits in the State. The lowest coverage proportions on prenatal Results healthcare (<4 consultations) were found in the CRS in Pelotas (16%) and Alegrete (11.3%). The cesarean The total number of live births registered in the sections occurred in 62% of the total live births in Sinasc in Rio Grande do Sul, in 2012, was 138;941, 2012, with a higher percentage in the CRS in of which the percentage of information ignored Palmeira das Missões (81.6%) and the lowest of the ranged between 0.01% to the maternal age variable CRS in Porto Alegre-02 (50.7%) (Table 2). and 2.5% for the length of pregnancy variable. As for the result variables, the majority of the As for the sociodemographic characteristics pregnancies lasted from 37 to 42 weeks (87.6%). (Table 1), it was observed a predominance of The high proportions of prematurity (gestational mothers aged 20 to 34 years (69.2%), with 4 to 11 length <37 weeks) were observed in the State years of schooling (78%) and the same proportion of (12.4%), pointing out for the CRS in Santa Maria mothers with and without a partner (50%). The CRS (15.3%) and Cachoeira do Sul (14%). Regarding the in Alegrete, Bagé and Palmeira das Missões Apgar score at the 5th minute, most newborns presented a greater proportion of one or more of the showed good vitality (Apgar score 8-10), totaling worst socio-demographic indicators, although there 97.7% of live births. The low vitality of the newborn are other CRS with higher percentages of teenage at the 5th minute (Apgar ≤7) concentrated higher mothers, low schooling levels and mothers without a values of the CRS in Pelotas (3.7%), Alegrete (3.0%) Rev.