L'objectiu principal d'aquesta tesi és analitzar les desigualtats socials i econòmiques lligades a la salut maternoinfantil a Bolívia, segons les dues darreres estadístiques oficials: Cens Nacional de Població i Habitatge INE-2001, i l'Enquesta Nacional de Demografia i Salut ENDSA-2003.En el primer estudi es va realitzar un disseny ecològic. La unitat d'anàlisi van ser els municipis de Bolívia, sobre la base de dades del cens 2001. La variable dependent és la taxa de mortalitat infantil (TMI) i les independents són els indicadors socioeconòmics categoritzats en quartils. Es va analitzar la relació entre la TMI i els indicadors socioeconòmics mitjançant correlacions de Spearman i l'ajustament de models de regressió de Poisson. En el segon es va realitzar un disseny transversal amb base individual, amb informació de l'Enquesta Nacional de Demografia i Salut de l'any 2003, que va analitzar 7.238 dones que van donar a llum entre 15 i 49 anys. Es van calcular les prevalences i van ajustar models bivariats i multivariats per tal d'estimar les associacions de les variables dependents i independents, mitjançant raons de prevalença i els intervals de confiança del 95%.La TMI a Bolívia va ser de 67 per 1.000 nascuts vius el 2001. Les taxes van fluctuar entre: <0,1 per 1.000 en un municipi de Tarija i 170 per 1.000 en un altre de Potosí. La mitjana de població analfabeta dels municipis va ser 11,7%; d'habitatges que van tenir accés a l'aigua fora d'elles va ser de 90,4% i d'habitatges que mancaven de sanitaris va ser de 67,6%.El 79.2% de dones que van donar a llum van rebre atenció prenatal, 58.7% almenys quatre controls i 66.2% part institucional. Els percentatges van ser inferiors en La Paz i Potosí per a dones que es van realitzar controls prenatals (66.8%); quatre controls prenatals (46.5%) i el part institucional (48.6%). Els menors percentatges dels indicadors es van donar en dones sense estudis i d'ètnia Aimara.La situació socioeconòmica dispar en els municipis de Bolívia, està estretament associada a la TMI. L'educació, l'absència de sanejament bàsic i la precarietat d'habitabilitat, són factors claus que tripliquen el risc de mort. Respecte a l'accés i utilització dels serveis de salut maternoinfantil, poc més de la meitat de les dones ateses es realitzen quatre controls prenatals i part institucional, sent les sense estudis entre 36 i 49 anys, d'ètnia Aimara i dels Departaments de La Paz i Potosí qui menys ho realitzen. / The main objective of this thesis is to analyze the social and economic inequalities associated to maternal and child health in Bolivia, according of two recent official statistics: National Census of Population and Housing, 2001-INE, National Demographic and Health Survey ENDSA-2003.The first study was an ecological design. The analysis unit was the municipalities of Bolivia, based on 2001 census data. The dependent variable was the infant mortality rate (IMT) and the independent socioeconomic indicators are categorized into quartiles. We analyzed the relationship between socioeconomic indicators and IMT using Spearman correlations and adjustment of Poisson regression models. The second study was conducted with a cross-sectional individual basis, using information from the National Demographic and Health Survey ENDSA-2003, which examined 7,238 women between 15 and 49 years who gave birth. Prevalence was calculated and bivariate and multivariate models were adjusted to estimate the associations between dependent and independent variables, using prevalence ratios and 95% confidence intervals.The IMT in Bolivia was 67 per 1,000 live births in 2001. The rates were ranged from <0.1 per 1,000 in some Beni's municipal and 170 per 1,000 in another of Potosí. The average illiterate population of the municipalities was 11.7% of homes had access to drinking out of them was 90.4% homes which bathrooms were not was 67.6% .The 79.2% of gave birth women received antenatal check-ups at least four antenatal check-ups 58.7% and 66.2% institutional child delivery. The percentages were lower in La Paz and Potosi for women who were attended antenatal check-ups (66.8%), four antenatal check-ups (46.5%) and institutional delivery (48.6%). The smaller indicators percentages were in Aymara women ethnicity with non education.The disparate socioeconomic status in the Bolivian municipalities is closely associated with the IMT. Education, bathrooms were not and scarcities of housing are key factors that triple the risk of death. Regarding access and utilization of maternal health services, just over half the gave birth women attended antenatal checks-ups are made four and institutional side, being non education between 36 and 49 years old from Aymara ethnicity and from Departments of La Paz and Potosi were made less.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2017-12-14T11:36:39Z No. of bitstreams: 1 MAURÍCIO MORAES.pdf: 1939077 bytes, checksum: 5f962c51d7f26c25c9f55cc3a504d5c6 (MD5) / Made available in DSpace on 2017-12-14T11:36:39Z (GMT). No. of bitstreams: 1 MAURÍCIO MORAES.pdf: 1939077 bytes, checksum: 5f962c51d7f26c25c9f55cc3a504d5c6 (MD5) Previous issue date: 2016-07-12 / This research results from an analysis of a group of mothers selected from participants in a cohort that follows the trajectory of pregnant adolescents. It aimed to understand and characterize the singularities expressed by this group, relating them into three categories: medical education, health care and the universe of pregnant women. For this article the themes more incidents and with strong meaning in the categories, were selected. A questionnaire composed of open questions was applied in an interview with 136 mothers and subsequently analyzed using qualitative methodology of thematic analysis. The results show the existing implications and challenges, among others, for the teaching and practice in the prenatal, delivery and postpartum, serving as elements for rethinking of practical proposals. Keywords: teenage pregnancy, medical education, assistance to maternal and child health. / Pesquisa que resulta da análise qualitativa de um grupo de puérperas selecionadas das participantes de uma coorte de acompanhamento da trajetória de gestantes adolescentes. Teve como objetivo compreender e caracterizar as singularidades manifestadas por este grupo, relacionando-as em três categorias: ensino médico, assistência à saúde e o universo das gestantes. Para o presente artigo foram selecionadas as temáticas mais incidentes e com forte significado nas categorias. Um questionário composto de perguntas abertas foi aplicado em entrevista com 136 puérperas e posteriormente analisado, utilizando-se a metodologia qualitativa de análise de temáticas. Os resultados mostram as implicações e desafios existentes, entre outros, para o ensino e a prática de saúde no pré-natal, parto e puerpério de mulheres adolescentes.