Mortalidade evitável em menores de cinco anos : evento sentinela da qualidade dos cuidados primários em Maringá-PR

Abstract

The Infant mortality constitutes an important health indicator, because it contains important information about certain attributes and dimensions of health status, just like the performance of the health system. Added to her death by intestinal infections, pneumonia in children under four years old, among other causes, considered by Rutstein as a sentinel events. Objective: To evaluate, in primary care, the care provided to children under five years old who died in the city of Maringá in 2008. Materials and methods: evaluation, descriptive and systematic research. The study population consisted of 41 deaths under five years old, residing in the city of Maringá, PR, in 2008. For investigation of death in children under one year old were used the records of the Committee for Prevention of Fetal and Infant Death. In children older than one year old and less than five years old, the identification happened by an active search for death certificates at Municipal Secretariat of Health. It was used the same criteria and resources for assessing the condition of death that the Child Death Committee, including the family interview. To the informative form, presented in the Handbook of Committees for Prevention of Fetal and infant death were added vaccine data and items for evaluation of psychomotor development. It was defined set as criteria for evaluating the gold standard for children care. In order to check if there is geographical concentration of deaths in the city, it was used the Google Maps application from the mother's address obtained in the certificate. The trajectories Relief Therapeutic Itineraries were used for the evaluation to the route of care. The data were organized in simple frequency tables and figures. Results: Of the 41 cases investigated, 27 (65.9%) represented neonatal deaths, 10 (24.4%) post-neonatal deaths and 4 (9.7%) higher than one year old. According to the Rutstein's concept about avoidable, 37 (90.2%) deaths were considered sentinel events, 24 (64.9%) neonatal, 10 (27.0%) post-neonatal and 3 (8.1%) above one year old. In general, the causes of death in children under five years old were related to perinatal diseases, congenital malformations, respiratory system diseases and neoplasms. According to the measures of avoidable, it was observed that prevention activities are the most found among the possibilities of reduction of death, staying 22 (59.5%), followed by the diagnosis and treatment actions with 13 (35.1% ) and 2 (5.4%) related to other causes. Twenty-eight cases were analyzed based on established criteria of prenatal, being identified that only 10 (38.5%) of the pregnant women had their first prenatal consultation in the first quarter, 13 (50.0%) mothers made more than six pre-natal consultations, 19 (73.1%) of them were evaluated concerning a gestational risk; 9 (34.6%) promptuary had records about the laboratory tests of prenatal and vaccination against tetanus, 14 (50.0%) births happened by cesarean. For situations of children (8 cases), whose death occurred after hospital discharge, for reasons unrelated to the condition of birth, were used as criteria for evaluating programmatic activities. Of the nine cases, one was excluded, because death couldn't be avoided by health services, being analyzed 8 of them. It was observed in 7 (87.5%) of the promptuary records of growth attendance; 7 (87.5%) had no records of neuromotor development; 4 (50.0%) had complete records of vaccination, 7 (87.5%) had records of risk assessment on the newborn and the inclusion or not in special programs, 6 (75.0%) received home visits from the family health teams. In relation to childcare, all considered low-risk children had at least three consultations, however, only a high-risk newborns reached at least seven medical visits, as required by municipal protocol. The precariousness of the records concerning to prenatal care must make salient, since for some criteria the information was missing in promptuary. The difficulty of access to the private healthcare promptuary was a complicating factor for analysis the process of care. Distributing geographically the 36 avoidable deaths by an effective health action in the city map, it was noticed that 19 (52.8%) of deaths occurred in residents of the southern region, 10 (27.8%) in the north region, four (11.11%) in the eastern region and three (8.3%) in the western region. The analysis of the route of care in some situations revealed bottlenecks in the primary care level. Conclusions: The nurse has technical and scientific capacity and indispensable role in monitoring of pregnant women in prenatal, being one of her functions the health education, the basis for promoting welfare and disease prevention. Thus, this study demonstrates the need for better planning of prenatal care and delivery assistance for practices are more efficient and effective by the users, avoiding an unwanted event the death in childhood.