INFANT MORTALITY AND FAMILY HEALTH STRATEGY IN THE 3<sup>RD</sup> HEALTH REGIONAL OF PARANÁ, FROM 2005 TO 2016

Broday, Geovani Allan; Kluthcovsky, Ana Cláudia Garabeli Cavalli

doi:10.1590/1984-0462/2022/40/2020122

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020122 copy

INFANT MORTALITY AND FAMILY HEALTH STRATEGY IN THE 3^RD HEALTH REGIONAL OF PARANÁ, FROM 2005 TO 2016

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the temporal trend in infant mortality and in populational coverage by the Family Health Strategy and associated factors with infant mortality in the municipalities of the 3^rd Health Regional of Paraná, Southern Brazil.

Methods:

Ecological time series study, with data from the Mortality Information System (Sistema de Informação Sobre Mortalidade - SIM), the Live Birth Information System (Sistema de Informação Sobre Nascidos Vivos - SINASC) and the Support Room for Strategic Management (Sala de Apoio à Gestão Estratégica - SAGE), from 2005 to 2016. Trends were calculated using polynomial regression. The associated factors with infant mortality were maternal, perinatal and obstetric variables. The significance level adopted was 5%.

Results:

Between 2005 and 2016, there were 115,796 births and 1,575 deaths of children under 1 year of age. Considering the municipalities together, the populational coverage by the Family Health Strategy went from 43.8% in 2005 to 66.4% in 2016 and the infant mortality from 17.1/1,000 live births in 2005 to 10.7/1,000 live births in 2016. The trend over time of populational coverage by the Family Health Strategy was crescent and of infant mortality was decrescent, for most municipalities. The factors associated with greater chances of death in children under 1 year of age were preterm gestational age (Odds Ratio - OR=15.05; 95% confidence interval - 95CI% 13.54-16.72), low birth weight (OR=15.14; 95%CI 13.61-16.84), multiple gestation (OR=4.51; 95%CI 3.74-5.45) and mother with up to 7 years of study (OR=1.93; 95%CI 1.74-2.14).

Conclusions:

Crescent trend in coverage by the Family Health Strategy was accompanied by a decrescent trend in infant mortality. The results can be a source of information for the strengthening of mother-child health actions, considering local and regional specificities.

Keywords:
Infant mortality; Family Health Strategy; Risk factors

Location	Population coverage by the Family Health Strategy (%)			Infant mortality**
	Initial and final years		Mean annual variation	Initial and final years		Mean annual variation
	2005	2016	Mean annual variation	2005	2016	Mean annual variation
Arapoti	100.0	87.7	-1.0	19.6	11.1	-0.7
Carambeí	19.9*	16.0	-0.3	22.4	5.5	-1.4
Castro	56.8	82.8	2.2	12.4	10.8	-0.1
Ipiranga	50.7	95.3	3.7	52.2	9.9	-3.5
Ivaí	57.1	76.0	1.6	15.3	10.8	-0.4
Jaguariaíva	30.4*	30.0	0.0	21.7	8.6	-1.1
Palmeira	43.7	92.0	4.0	27.5	9.1	-1.5
Piraí do Sul	14.6*	0.0	-1.2	19.4	13.7	-0.5
Ponta Grossa	34.4	79.7	3.8	14.6	10.9	-0.3
Porto Amazonas	100.0	72.2	-2.3	29.0	0.0	-2.4
São João do Triunfo	83.1	93.9	0.9	11.3	11.3	0.0
Sengés	18.6*	71.5	4.4	19.9	20.0	0.0
3^rd Health Regional	43.8	66.4	1.9	17.1	10.7	-0.5
State of Paraná	46.8	63.7	1.4	14.6	10.5	-0.3

Location	Population coverage by the Family Health Strategy (%)				Infant mortality
Location	Model*	R²	p-value	Trend	Model*	R²	p-value	Trend
Carambeí	Cubic	0.92	<0.001	Increasing	Cubic	0.90	<0.001	Decreasing
Ipiranga	Cubic	0.79	<0.01	Increasing	Cubic	0.81	<0.01	Decreasing
Ivaí	Cubic	0.81	<0.01	Increasing	Quadratic	0.79	0.001	Decreasing
Jaguariaíva	Quadratic	0.93	<0.001	Increasing	Quadratic	0.87	<0.001	Decreasing
Palmeira	Quadratic	0.93	<0.001	Increasing	Cubic	0.87	0.001	Decreasing
Ponta Grossa	Cubic	0.97	<0.001	Increasing	Cubic	0.89	<0.001	Decreasing
Sengés	Quadratic	0.94	<0.001	Increasing	Cubic	0.72	0.01	Decreasing
Castro	Quadratic	0.93	<0.001	Increasing	Cubic	0.35	0.30	Stable
Piraí do Sul	Cubic	0.75	<0.01	Increasing	Cubic	0.32	0.35	Stable
Porto Amazonas	Cubic	0.81	<0.01	Decreasing	Cubic	0.96	<0.001	Decreasing
São João do Triunfo	Quadratic	0.68	<0.01	Decreasing	Cubic	0.76	<0.01	Decreasing
Arapoti	Cubic	0.84	0.001	Decreasing	Cubic	0.32	0.34	Stable
3^rd Health Regional	Cubic	0.89	<0.001	Increasing	Quadratic	0.95	<0.001	Decreasing
Paraná	Cubic	0.99	<0.001	Increasing	Quadratic	0.99	<0.001	Decreasing

	Infant deaths n (%)	Live births n (%)	p-value	Odds Ratio (95%CI)
Age of the mother (years)**
Up to 19	395 (26.6)	24,835 (21.4)	<0.001	1.33 (1.18-1.49)
20 or more	1,088 (73.4)	90,961 (78.6)	<0.001	1.33 (1.18-1.49)
Education of the mother (years)**
Up to 7	663 (45.5)	34,814 (30.2)	<0.001	1.93 (1.74-2.14)
8 or more	793 (54.5)	80,445 (69.8)	<0.001	1.93 (1.74-2.14)
Type of pregnancy **
Multiple	124 (8.2)	2,249 (1.9)	<0.001	4.51 (3.74-5.45)
Single	1,386 (91.8)	113,467 (98.1)	<0.001	4.51 (3.74-5.45)
Type of delivery**
Vaginal	770 (51.8)	57,269 (49.5)	0.07	1.10 (0.99-1.22)
Cesarean	716 (48.2)	58,452 (50.5)	0.07	1.10 (0.99-1.22)
Gender**
Male	851 (54.1)	59,279 (51.2)	0.02	1.12 (1.02-1.24)
Female	723 (45.9)	56,512 (48.8)	0.02	1.12 (1.02-1.24)
Gestational age 1**
Preterm	824 (56.2)	8,943 (7.9)	<0.001	15.05 (13.54-16.72)
Term	642 (43.8)	104,859 (92.1)	<0.001	15.05 (13.54-16.72)
Gestational age 2**
Post-term	16 (2.4)	1,570 (1.5)	0.04	1.66 (1.01-2.74)
Term	642 (97.6)	104,859 (98.5)	0.04	1.66 (1.01-2.74)
Weight at birth 1**
Low	893 (60.6)	10,221 (9.2)	<0.001	15.14 (13.61-16.84)
Normal	581 (39.4)	100,662 (90.8)	<0.001	15.14 (13.61-16.84)
Weight at birth 2**
Normal	581 (95.9)	100,662 (95.3)	0.53	1.13 (0.76-1.69)
High	25 (4.1)	4,911 (4.7)	0.53	1.13 (0.76-1.69)

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[1] *Corresponding author. E-mail: geovanibroday@gmail.com (G.A. Broday).

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INFANT MORTALITY AND FAMILY HEALTH STRATEGY IN THE 3RD HEALTH REGIONAL OF PARANÁ, FROM 2005 TO 2016

ABSTRACT

Objective:

Methods:

Results:

Conclusions:

INFANT MORTALITY AND FAMILY HEALTH STRATEGY IN THE 3^RD HEALTH REGIONAL OF PARANÁ, FROM 2005 TO 2016