Distribuição espacial da mortalidade infantil em municípios da região metropolitana de Maringá

Abstract

Infant mortality, thus as defined as deaths of children under one year of age, is an indicator of quality of life and the organization and quality of health services. The reduction in infant mortality appears as a major goal in health care and shows the impact of services and the outcome of improving the life welfare. According to the geographic field, studying aspects of health could provide information for decisions on prevention and health protection. The aim of this study was to analyze the spatial distribution of infant mortality in three municipalities in the metropolitan region of Maringá, PR. A descriptive, ecological and exploratory study was performed with all infant deaths registered in three counties, which occurred from January 1st, 2004 to December 31st, 2008. The deaths data were obtained from the Mortality Information System (MIS), the births of Information System (SINASC) and information about Preventability Research System of Infant Mortality (SIMI). The infant mortality rate and its components, and the percentage of preventability were geo-referenced in 19 Areas of Population Expansion (AED). Thematic maps and the statistical Moran I, and LISA were used to assess the global autocorrelation and local infant mortality rate, as well as the number of avoidable deaths. The infant mortality rate decreased during this period in the three municipalities, and in 2008 the general coefficient reached 8.7 deaths per thousand live births. The spatial distribution of infant mortality and the number of avoidable deaths resulted in a spatial pattern concentration in the peripheral AED, especially in the city of Sarandi. Differences were observed between the AED with the lowest infant mortality rate found at AED 9 Maringá (6.5 deaths per thousand live births) and higher at AED 14, also in Maringá (18.2 deaths per thousand live births). There was a significant spatial autocorrelation of the "high-high" type between AED 18 and 19, both in Sarandi; such as the "low-low" type among the AED 7, 3 and 6, corresponding to the central region of Maringa and correlation of the "low-high" type at AED 16 in Sarandi. In all the analyzed cases, 67.9% were considered preventable by the Regional Committee for the Prevention of Infant Mortality. The percentage of avoidable deaths was also higher in the city of Paiçandu (73.1%); (9, 10, 11, 13 and 14 in the peripheral AED in Maringa and (16, 18 and 19) in Sarandi, with percentage of preventability between 63.6 and 84.6%. The study results suggest that a slightly deficiency in health care may exist, specifically in prenatal and newborn care, since these were the main criteria of preventability found. It was verified that the EDA core in Maringá has shown more favorable to child health, while in peripheral AED, results are indicative of the worst socioeconomic and health care. These observations allow to propose future assessments, such as how to analyze the coverage of programs, determining priorities and set goals.