Made available in DSpace on 2016-08-19T17:47:10Z (GMT). No. of bitstreams: 1 Jaqueline Pimentel Dias Carneiro.pdf: 1257141 bytes, checksum: 90ca601295946d1bfb1647639e8a3d90 (MD5) Previous issue date: 2008-10-28 / The infant mortality indicator in São Luís, historical series from 1999 to 2007. A quantitative study based on collected data from Basic Attention Information System (SIAB). It was developed treatment and correlation statistics from this data, which made possible the analysis of dispersal and the selected sample descriptive studies, including the variables crossing. It shows the scenario of health politics in Brazil, in special the Primary Attention as an important way to be reach to make stronger the health actions, development of life conditions and access to quality of health actions and services. The infant mortality data is important as a major focus from this politics and a key indicator of life conditions. Discussions are presented around the results, as they are national, from the state or local. It points up the fragility of Information Systems, the variable and visible lack of connection between practice and recorded information. Starting from quantitative method of multivariate analysis stepwise, makes part in the evaluation universe of infant mortality data, as a dependent variable from the rest of health data child presents at SIAB, considered don this study independents variables and calculated statistics for validation of a math model the represents this correlation, moment that were used forty six variables. Based on reached results, we could get a model that allows to affirm that the rate of global infant mortality can be explained by statistics in 98,1 %, through the variables: death of children down 28 days by acute respiratory infection (total by year), death of children down 28 days and 11 months/29 days by diarrhea (total by year), death of children down 1 year old by another causes (total by year) and death of children of 28 days and 11 months/29 days by acute respiratory infection (total by year), observing what the method of multiple regression do when the exam of influence and the intensity made by two or more independent variables on a dependent variable. Treating of quantitative analysis model result, stays the space to increase the present research in quantitative analysis and recognizing that the variable components of the model takes direction for the needs as a constant prevention practice and promotion as vectors members of the development infant mortality data. / O indicador mortalidade infantil em São Luís, série histórica de 1999 a 2007. Estudo quantitativo que tem por base dados coletados no Sistema de Informação da Atenção Básica (SIAB). Desenvolveu-se tratamento e correlação estatística deste indicador, o que possibilitou análise de dispersão e estudos descritivos da amostra selecionada, incluindo o cruzamento de variáveis. Mostra-se o cenário das políticas de saúde no Brasil, em especial a Atenção Primária como um importante caminho a ser percorrido para o fortalecimento das ações de saúde, melhoria das condições de vida e do acesso à qualidade das ações e serviços de saúde. Destaca-se o indicador de mortalidade infantil como foco premente dessas políticas e importante indicador das condições de vida. Apresentam-se as discussões em torno dos resultados, seja em âmbito nacional, estadual ou local. Aponta-se a fragilidade dos Sistemas de Informação, a variedade dos mesmos e a falta visível de alinhamento entre a prática e as informações registradas. A partir do método quantitativo de análise multivariada stepwise, adentra-se no universo da avaliação do indicador mortalidade infantil, como variável dependente dos demais indicadores de saúde da criança presentes no SIAB, consideradas neste estudo variáveis independentes e estatisticamente calculadas para validação de um modelo matemático que represente essa correlação, momento em que utilizamos quarenta e nove variáveis. De acordo com os resultados alcançados, chegamos ao modelo que permite afirmar que taxa de mortalidade infantil global pode ser explicada estatisticamente em 98,1% por meio das variáveis: óbitos de menores de 28 dias por infecção respiratória aguda (total anual), óbitos de menores de 28 dias a 11 meses/29 dias por diarréia (total anual), óbitos de menores de 1 ano por outras causas (total anual) e óbitos de 28 dias e 11 meses/29 dias por infecção respiratória aguda (total anual), observando-se o que predispõe o método de regressão múltipla quando do exame da influência e da intensidade exercida por duas ou mais variáveis independentes sobre uma variável dependente. Por se tratar de um modelo resultante de uma análise quantitativa, fica o espaço para o aprofundamento da presente pesquisa em análises qualitativas e o reconhecimento de que as variáveis componentes do modelo apontam para a necessidade da prática constante da prevenção e da promoção como vetores integrantes da melhoria do indicador de mortalidade infantil.

Made available in DSpace on 2016-08-19T18:32:11Z (GMT). No. of bitstreams: 1 Dissertacao Wedia Duarte Pereira.pdf: 2479909 bytes, checksum: 6b3a13e6605bd65989f6dbab24bbbb15 (MD5) Previous issue date: 2014-03-27 / The actions developed to promote a healthy and safe pregnancy promote a decline in infant mortality in many regions of the country, the adoption of educational practices and investment in improving the quality of services, but is, therefore, being necessary to implement programs improvement to ensure quality care. Thus, the present study aimed to evaluate the actions of prenatal developed before and after the implementation of the Project Caring for the Future, in the municipality of Bacabal, considering the indicators under the dimension Healthy Pregnancy and Safe. This is a descriptive study with a quantitative approach, developed in Bacabal, Maranhao, from data SISPRENATAL, pregnant women who started and finished the prenatal care in the years 2009 and 2011, one year before the implementation of the Project Caring for the Future and one year, respectively, based on the quality indicators proposed by the Project Caring for the Future. To study the indicator of infant mortality, we used data from the Mortality Information System and Information System of Live Birth and analyzed by Statistical Package for the Social Sciences software, using Pearson's correlation to compare the variables under study. It was observed that the number of pregnant women who received seven or more increased from 1.2% to 14.7%, noting an increase in achievement of prenatal care in the first quarter from 11.7% to 66.5%. Regarding laboratory tests, in 2009, 10% of pregnant women underwent all tests, with an increase to 13% in 2011 and the number of pregnant women immunized expanded from 51.6% to 79%. With all of these indicators improved, there was a reduction in infant mortality. We conclude that the Caring Project of the Future had a positive impact on the actions of prenatal care, helping to reduce the infant mortality rate, making it a challenge currently investing more in policies and practices to proper prenatal care, improving increasing the quality indicators and further reducing child mortality. / As ações desenvolvidas para a promoção de uma gestação saudável e segura promovem um declínio da mortalidade infantil em várias regiões do país, sendo necessária a adoção de práticas educativas e investimento na melhoria da qualidade dos serviços, devendo-se, para tanto, implementar programas de melhoramento para garantir um atendimento de qualidade. Assim, a presente pesquisa teve como objetivo avaliar as ações de pré-natal, desenvolvidas antes e depois da implantação do Projeto Cuidando do Futuro, no município de Bacabal, Maranhão, considerando os indicadores previstos na dimensão Gestação Saudável e Segura. Trata-se de um estudo descritivo com abordagem quantitativa, desenvolvida a partir de dados do Sistema de Acompanhamento do Programa de Humanização no Pré-Natal e Nascimento, das gestantes que iniciaram e finalizaram a assistência pré-natal nos anos de 2009 e 2011, um ano antes da implantação do Projeto Cuidando Futuro e um ano após, respectivamente, tendo como base os indicadores de qualidade propostos, pelo Projeto Cuidando do Futuro. Para estudar o indicador de mortalidade infantil utilizaram-se dados do Sistema de Informação de Mortalidade e do Sistema de Informação de Nascido Vivo, sendo analisado pelo programa Statistical Package for the Social Sciences, utilizando a correlação de Pearson para comparação das variáveis em estudo. Observou-se que o número de gestantes que realizaram sete ou mais consultas passou de 1,2% para 14,7%, notando-se um aumento na realização do pré-natal no primeiro trimestre de 11,7% para 66,5%. Em relação aos exames laboratoriais, em 2009, 10% das gestantes realizaram todos os exames, tendo um acréscimo para 13% em 2011 e o número de gestantes imunizadas ampliou-se de 51,6% para 79%. Com todos esses indicadores melhorados, observou-se uma redução da mortalidade infantil. Conclui-se que o Projeto Cuidando do Futuro, gerou impacto positivo nas ações de pré-natal, ajudando a reduzir as taxas de mortalidade infantil, tornando-se atualmente um desafio investir cada vez mais em políticas e práticas para adequada assistência pré-natal, melhorando cada vez mais os indicadores de qualidade e reduzindo mais ainda a mortalidade infantil.

As ações em saúde contribuem para a melhoria das condições de vida e de saúde da criança, com reflexo na redução da mortalidade infantil. O objetivo do presente estudo foi identificar as ações em saúde para redução da mortalidade infantil apontadas pelos profissionais de saúde que atendem gestantes, recém-nascidos e crianças menores de um ano na atenção básica de um município do interior paulista. Trata-se de um estudo transversal, com abordagem quantitativa, inserido no campo da avaliação em saúde, com aproximação ao componente processo. Foram realizadas entrevistas com os profissionais de saúde, através de dois roteiros semiestruturados, autoaplicados, baseados em frases afirmativas, adaptadas de dois documentos técnicos do Ministério da Saúde. Participaram 54 profissionais da saúde, médicos (ginecologistas e pediatras), enfermeiros e Agentes Comunitários de Saúde (ACS), de três unidades básicas de saúde selecionadas para o estudo. A maioria de médicos e enfermeiros afirmou que somente às vezes as gestantes têm início precoce ao pré-natal, e grande parte respondeu que são realizadas seis ou mais consultas; porém, o mesmo número de profissionais confirmou que somente às vezes isso ocorre. ACS, médicos e enfermeiros mostraram que existe busca ativa às gestantes faltosas ao pré-natal, e os ACS afirmaram que realizam visitas domiciliares com esse intuito. De acordo com 44,4% dos médicos e enfermeiros, as puérperas têm consulta até 42 dias após o parto. Grande parte de todos profissionais de saúde participantes do estudo, afirmou desenvolver ações de incentivo ao aleitamento materno no pré-natal, no puerpério e nos 30 dias, seis e 12 meses de vida da criança; 59,3% responderam que as crianças atendidas na unidade de saúde estão com o esquema de vacinação em dia. A maioria dos médicos e enfermeiros confirmou que a criança recebe ao menos uma consulta na sua primeira semana de vida, mas que às vezes é realizado visita domiciliar por parte desses profissionais; somente quando houver necessidade. Os profissionais, médicos, enfermeiros e ACS, reconhecem que existe a educação permanente na unidade de saúde que trabalham; porém, 51,9% afirmam que às vezes há participação da equipe. Foram identificadas várias ações que correspondem ao que é preconizado pelas políticas públicas de atenção à mulher e à criança. Entretanto ainda existem fragilidades que apontam a necessidade de ampliar a visão dos profissionais de saúde para maior planejamento dessas ações, adequando às necessidades da população materno-infantil atendida nas unidades de saúde com vistas à redução de óbitos infantis / Healthcare action plans improve children\'s life conditions and health, thereby reducing child mortality. This study aimed to identify healthcare actions that decreased child mortality on the basis of reports by healthcare professionals assisting expectant mothers, newborns, and children aged less than one year in basic healthcare units in a city in the state of São Paulo, Brazil. This transversal study adopted a quantitative health assessment approach with process approximation. Healthcare professionals were interviewed by means of two semi-structured, self-applied questionnaires based on affirmative statements; the instrument was adapted from two technical documents of the Brazilian Health Ministry. Fifty-four healthcare professionals including physicians (gynecologists and pediatricians), nurses, and Health Community Agents (HCA) working at three basic health units were selected for this study. Most of the physicians and nurses stated that only sometimes do expectant mothers receive pre-natal care at an early stage. The majority of physicians and nurses stated that pre-natal care includes six or more visits, but they rarely occur. HCA, physicians, and nurses showed that they actively search for expectant mothers that skip pre-natal consultations, and HCA affirmed that they conduct home visits aiming to contact these patients. According to 44.4% of the physicians and nurses, mothers have a visit scheduled for up to 42 days after childbirth. Most of the participants confirmed that they develop actions to encourage breastfeeding during the pre- natal and puerperium periods as well as at 30 days, six months, and twelve months after childbirth. Of all the participants, 59.3% stated that the children assisted at the health units follow the recommended vaccination schedule. Most physicians and nurses confirmed that children are seen at the basic healthcare unit within one week after birth, and that these professionals visit the child at home when necessary. All the participants--physicians, nurses, and HCA--confirmed that ongoing professional education takes place at the basic healthcare unit where they work; however, 51.9% stated that the health team sometimes participates in the activities. It was possible to identify several actions that followed the public policy recommendations for woman and child healthcare. Nevertheless, it is important to make healthcare professionals aware of the need to implement more action plans that meet the requirements of mothers and children assisted at healthcare units, aiming to diminish child mortality

<p>By the late nineteenth century childbirth was firmly established in the domestic sphere. However, in the early years of the twentieth century different forms of maternity clinics were established where normal, as well as complicated, deliveries could take place. The aim of this dissertation is to analyse the institutionalisation of maternity care in a local urban context, the role of women in confinement in this process, and its impact on infant mortality. The geographical setting of the thesis is Sundsvall, a town in northern Sweden. The study concentrates on the period spanning from 1900 to 1930, when local communities, rather than federal agencies, were charged with creating and implementing community standards for maternity care.</p><p>In order to lower the mortality rate of illegitimate infants, and to improve delivery conditions for unmarried women, a maternity home was opened in Sundsvall in 1913. Moreover, a maternity ward was established at the local hospital in 1920. In this study it is clear, that when institutional maternity care became available, the transition was rapid and unhesitating. When analysing the local practices it is possible to highlight the central role women played as part of this process. Initially indigent women and women bearing children out of wedlock accepted the institutional alternative, but shortly thereafter married women of means turned to the newly created wards. As a result of this early acceptance, these institutions were soon filled to capacity. </p><p>During the period in question a significant reduction in infant mortality rates can be noticed in the Swedish towns. A reasonable assumption is that the institutionalisation of maternity care improved infants chances of survival. In the study it is suggested that the institutionalised maternity care made an impact on neonatal mortality, as well as on post-neonatal mortality. The study shows that local practices of care played a key role in infant survival.</p><p>This dissertation reveals the value of examining local practices in order to understand the rapid changes of maternity care. Childbirth changed from being a private matter, taking place in one’s home, to be a public concern, taking place in the institutional setting. At the 1937 Parliament (Riksdag) the responsibility for institutionalised maternity care became a public and a State concern, and maternity care became a part of the Swedish welfare system.</p>

The dissertation deals with the infant mortality decline in Iceland during the 19th and early 20th Century. It shows that despite its low degree of urbanization, pre-transitional Iceland displayed higher infant mortality rates than most other European countries. Levels are only comparable with a few areas in Europe, all of whom were known for a tradition of artificial feeding of newborns. In the Icelandic case, infants were either not breastfed at all or were weaned at a very young age. Another characteristic of infant mortality in Iceland were huge fluctuations during epidemics. Because of the isolation of the country, several diseases that had become endemie in other societies, such as measles, became dangerous epidemics in Iceland and affected all age groups. After 1850 the effects of epidemics declined and 20 years later there was a steep decline in infant mortality. By the beginning of the 20th Century infant mortality in Iceland was lower than in most other societies. Although epidemics often had important temporary consequences upon infant mortality level in pretransitional Iceland, being breastfed or not was without doubt the most important determinant of infant survival. There were huge differences in infant mortality levels between areas where breastfeeding was common and those where newborns were artificially fed. Towards the turn of the 20th Century significant changes occurred. Even though there were still differences in infant mortality between those babies who were breastfed and those who were not, infant survival had improved greatly and survival chances of Icelandic newborns that were fed artificially became in an international perspective relatively good. Midwives played a central role in the infant mortality decline in Iceland. Growing secularization during the second part of the 19th Century improved educational opportunities for women and also changed the content of education. Improved educational opportunities were reflected in changes in the education of midwives. At the same time there was growth in the publication of books that directly dealt with the issue of infant health. The increase in the number of educated midwives was a factor of central importance. The interaction between midwives and a literate population was most likely the key to infant survival in the Nordic countries. This study shows that that the custom to breastfeed spread earlier in areas with higher literacy. Not only is it plausible that the interest in changing prevailing traditions was directly related to literaey levels of individuai mothers, it is also shown that midwives had the best education in areas where literacy rates were high. On the other hand, the remarkable improvements in infant survival obtained towards the end of the 19th Century were scarcely linked to changes in the economic structure. Those factors only started to play an important role in the 20th Century. In its initial stages, changes in infant feeding and improvements in personal hygiene were more important / digitalisering@umu

By the late nineteenth century childbirth was firmly established in the domestic sphere. However, in the early years of the twentieth century different forms of maternity clinics were established where normal, as well as complicated, deliveries could take place. The aim of this dissertation is to analyse the institutionalisation of maternity care in a local urban context, the role of women in confinement in this process, and its impact on infant mortality. The geographical setting of the thesis is Sundsvall, a town in northern Sweden. The study concentrates on the period spanning from 1900 to 1930, when local communities, rather than federal agencies, were charged with creating and implementing community standards for maternity care. In order to lower the mortality rate of illegitimate infants, and to improve delivery conditions for unmarried women, a maternity home was opened in Sundsvall in 1913. Moreover, a maternity ward was established at the local hospital in 1920. In this study it is clear, that when institutional maternity care became available, the transition was rapid and unhesitating. When analysing the local practices it is possible to highlight the central role women played as part of this process. Initially indigent women and women bearing children out of wedlock accepted the institutional alternative, but shortly thereafter married women of means turned to the newly created wards. As a result of this early acceptance, these institutions were soon filled to capacity. During the period in question a significant reduction in infant mortality rates can be noticed in the Swedish towns. A reasonable assumption is that the institutionalisation of maternity care improved infants chances of survival. In the study it is suggested that the institutionalised maternity care made an impact on neonatal mortality, as well as on post-neonatal mortality. The study shows that local practices of care played a key role in infant survival. This dissertation reveals the value of examining local practices in order to understand the rapid changes of maternity care. Childbirth changed from being a private matter, taking place in one’s home, to be a public concern, taking place in the institutional setting. At the 1937 Parliament (Riksdag) the responsibility for institutionalised maternity care became a public and a State concern, and maternity care became a part of the Swedish welfare system.

The aim of this thesis was to analyse possible effects of prenatal arsenic exposure on foetal and infant health. The setting is Bangladesh, where two cohorts were studied, both part of a health and demographic surveillance system in Matlab. A historical cohort 1991-2000 included 29,134 pregnant women with information on drinking water sources and arsenic testing of tube well water. A prospective cohort study included pregnant women 2002 - 2003 where urinary arsenic concentrations were assessed twice during pregnancy; 2,924 women and their pregnancy outcomes were evaluated for foetal loss, perinatal and infant mortality; 1,578 mother-infant pairs were analysed for size at birth; and 1,552 were analysed for morbidity during infancy. Women exposed to arsenic levels ≥ 50 µg/L in water had an increased risk of foetal loss and infant death in comparison with women exposed to arsenic levels &lt; 50 µg/L. These findings were confirmed in the prospective cohort study. Women with urine arsenic concentrations at the 5th quintile had 62% increased risk of spontaneous abortion (OR 1.62, 95% CI 1.04 - 2.55) in comparison with women who had arsenic concentrations at the 1st quintile level. Increased risks of perinatal morality (RR 3.01, 95% CI 1.07 - 8.45) and infant mortality (RR 5.01; 95% CI: 1.41 - 17.84) were also observed at the 5th quintile of exposure. Significant negative dose-effect associations were found between arsenic exposure and birth weight, head and chest circumferences at a relatively low level of exposure (&lt;100 µg/L in urine). In this range of exposure birth weight decreased by 1.68 g (SE 0.62) for each 1 µg/L increase of arsenic in urine. In comparison with exposure at the 1st quintile level the risk of lower respiratory tract infection was significantly increased (RR 1.68, 95% CI 1.35-2.07) for women who had urinary arsenic concentrations at the 5th quintile level. The risk was also increased for diarrhoeal diseases. The study findings highlight the negative effects of arsenic exposures on pregnancy outcomes and infant health. Mitigation programs need to be strengthened and women of reproductive ages should be prioritized in arsenic affected regions worldwide.

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

Doctoral dissertation. / Format: PDF. Bibl.