Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil

AbstractThis study aimed to analyze the distribution of stillbirths by birth weight, type of death, the trend of Stillbirth Rate (SBR), and avoidable causes of death, according to social vulnerability clusters in São Paulo Municipality, 2007–2017. Social vulnerability clusters were created with the k-means method. The Prais-Winsten generalized linear regression was used in the trend of SBR by < 2500 g, ≥ 2500 g, and total deaths analysis. The Brazilian list of avoidable causes of death was adapted for stillbirths. There was a predominance of antepartum stillbirths (70%). There was an increase in SBR with the growth of social vulnerability from the center to the outskirts of the city. The cluster with the highest vulnerability presented SBR 69% higher than the cluster with the lowest vulnerability. SBR ≥ 2500 g was decreasing in the clusters with the high vulnerability. There was an increase in SBR of avoidable causes of death of the cluster from the lowest to the highest vulnerability. Ill-defined causes of death accounted for 75% of deaths in the highest vulnerability area. Rates of fetal mortality and avoidable causes of death increased with social vulnerability. The trend of reduction of SBR ≥ 2500 g may suggest improvement in prenatal care in areas of higher vulnerability.

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Risk-factors for antepartum fetal deaths in the city of São Paulo, Brazil

Revista de Saúde Pública ◽

10.1590/s0034-89102007000100006 ◽

2007 ◽

Vol 41 (1) ◽

pp. 35-43 ◽

Cited By ~ 16

Author(s):

Marcia Furquim de Almeida ◽

Gizelton Pereira Alencar ◽

Hillegonda Maria Dutilh Novaes ◽

Ivan França Jr ◽

Arnaldo Augusto Franco de Siqueira ◽

...

Keyword(s):

Risk Factors ◽

Prenatal Care ◽

Intrauterine Growth Restriction ◽

Population Based ◽

Sao Paulo ◽

Growth Restriction ◽

Fetal Mortality ◽

São Paulo ◽

Intrauterine Growth ◽

The City

OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality.

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Causes of Death among People Living with AIDS in the Pre- and Post-HAART Eras in the City of São Paulo, Brazil

PLoS ONE ◽

10.1371/journal.pone.0114661 ◽

2014 ◽

Vol 9 (12) ◽

pp. e114661 ◽

Cited By ~ 13

Author(s):

Carmen-Silvia Bruniera Domingues ◽

Eliseu Alves Waldman

Keyword(s):

Causes Of Death ◽

Sao Paulo ◽

São Paulo ◽

The City

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IMPACT OF MATERNAL AGE ON BIRTH OUTCOMES: A POPULATION-BASED STUDY OF PRIMIPAROUS BRAZILIAN WOMEN IN THE CITY OF SÃO PAULO

Journal of Biosocial Science ◽

10.1017/s0021932005026660 ◽

2005 ◽

Vol 38 (4) ◽

pp. 523-535 ◽

Cited By ~ 21

Author(s):

CARLA JORGE MACHADO

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Maternal Age ◽

Sao Paulo ◽

Outcome Variable ◽

Delivery Mode ◽

São Paulo ◽

Apgar Scores ◽

The City

The aim of this study is to analyse the impact of maternal age at first birth on low birth weight, preterm birth and low Apgar scores at one minute and at five minutes among live births delivered to primiparous Brazilian women in the city of São Paulo. Analyses were based on 73,820 birth records from the 1998 birth cohort. Logistic regression was used to assess the association between maternal age and each outcome variable, controlling for the following risk factors: delivery mode, plurality, sex, maternal education, number of prior losses, prenatal care, race, parity and community development. Maternal ages below 20 and above 30 years were significantly associated with the risks of low birth weight and preterm birth, but no association was found between maternal ages and Apgar score, with the exception that ages 15–19 reduced the odds of a low one-minute score. Even though this result seems to be inconsistent, low birth weight, preterm birth and low Apgar scores measure different dimensions of newborn well-being, and the association of each measure with maternal age is expected to diverge.

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Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil)

BMC Pediatrics ◽

10.1186/s12887-020-02398-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Juliana Coelho Pina ◽

Luana Seles Alves ◽

Luiz Henrique Arroyo ◽

Ricardo Alexandre Arcêncio ◽

Ellen Cristina Gondim ◽

...

Keyword(s):

Social Vulnerability ◽

Sao Paulo ◽

Community Acquired Pneumonia ◽

Additive Models ◽

Density Estimator ◽

São Paulo ◽

Census Tracts ◽

Spatial Risk ◽

The Social ◽

The City

Abstract Background The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. Methods Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. Results The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters). Conclusions The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.

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Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil).

10.21203/rs.3.rs-28321/v4 ◽

2020 ◽

Author(s):

Juliana Coelho Pina ◽

Luana Seles Alves ◽

Luiz Henrique Arroyo ◽

Ricardo Arcêncio Arcêncio ◽

Ellen Cristina Gondim ◽

...

Keyword(s):

Social Vulnerability ◽

Sao Paulo ◽

Community Acquired Pneumonia ◽

Additive Models ◽

Density Estimator ◽

São Paulo ◽

Census Tracts ◽

Spatial Risk ◽

The Social ◽

The City

Abstract Background: The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas.Methods: Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia.Results: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters).Conclusions: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.

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Prenatal and puerperal care and indicators of severity: a study about the information available on pregnant women’s card

Revista Brasileira de Saúde Materno Infantil ◽

10.1590/1806-93042019000400014 ◽

2019 ◽

Vol 19 (4) ◽

pp. 983-989

Author(s):

Ivelise Araújo de Souza ◽

Mário Ivo Serinolli ◽

Márcia Cristina Zago Novaretti

Keyword(s):

Prenatal Care ◽

Sao Paulo ◽

São Paulo ◽

Cross Sectional ◽

Paulo State ◽

Eastern Zone ◽

São Paulo State ◽

Adequate Prenatal Care ◽

The City ◽

Discharge Summaries

Abstract Objectives: to identify and to discuss the frequency of the prenatal and puerperal care of pregnant women from the eastern zone of São Paulo city, São Paulo State, Brazil, categorizing it according to the Kessner Index modified in 1993 by Takeda. We used the data avai-lable on the card of pregnant woman and the discharge summaries, correlating the results with the indicators of severity in childbirth. Methods: this is a descriptive, cross-sectional quantitative study based on the analysis of the variables of the pregnant woman's card and the diagnoses identified in the discharge summaries. Data were collected through a field survey conducted in the Eastern zone of the city of São Paulo city, São Paulo State, Brazil. A statistical analysis was used to identify asso-ciations between the categorization and the severity indicators listed in the discharge summaries. Results: it was observed that prenatal care in the Eastern zone of São Paulo city, São Paulo State, Brazil was classified as intermediate (56.9%) in the majority of women. Regarding this categorization with the severity indicators, there is a higher incidence of risks for inappropriate categorization (8.89%) when compared to the appropriate (1.67%) and the intermediate (4.44%) ones. Conclusions: it was possible to conclude that the more adequate prenatal care, the lower the chances of unfavorable outcomes and incidence of risks.

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Evaluation of prenatal care at basic health units in the city of Sao Paulo

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692008000600008 ◽

2008 ◽

Vol 16 (6) ◽

pp. 986-992 ◽

Cited By ~ 6

Author(s):

Regina Célia de Menezes Succi ◽

Elisabeth Niglio Figueiredo ◽

Letícia de Carvalho Zanatta ◽

Marina Biffani Peixe ◽

Marina Bertelli Rossi ◽

...

Keyword(s):

Prenatal Care ◽

Sao Paulo ◽

São Paulo ◽

The Public ◽

Basic Health ◽

Medical Visits ◽

Before And After ◽

The City ◽

Basic Health Units

The aim of this study was to evaluate the quality of prenatal care offered in 12 Basic Health Units (BHU) in the city of Sao Paulo, Brazil, through a review of medical and nurse charts, before and after the municipalization of the public health system. The indicator used considered excellence in care as: starting prenatal care in the first quarter of pregnancy; at least six medical visits; at least two results of blood screening for syphilis and one for HIV; returning to BHU up to 42 days after delivery. This indicator was not present in any care delivered in 2000, and only 7.7% of the care delivered in 2004 obtained it (1.1% to 30% of the care per unit assessed). Although there was an evident improvement in care during the period, the low proportion of excellent prenatal care shows an urgent need to improve this care in the BHU of São Paulo city.

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Spatial distribution of low birthweight infants in Taubaté, São Paulo, Brazil

Revista Paulista de Pediatria ◽

10.1590/s0103-05822013000400008 ◽

2013 ◽

Vol 31 (4) ◽

pp. 466-472 ◽

Cited By ~ 7

Author(s):

Luiz Fernando C. Nascimento ◽

Thais Moreira Costa ◽

Maria Stella A. da C. Zöllner

Keyword(s):

Birth Weight ◽

Spatial Analysis ◽

Low Birth Weight ◽

Low Birthweight ◽

Sao Paulo ◽

Health Centers ◽

São Paulo ◽

Low Birth Weight Infants ◽

Census Tracts ◽

The City

OBJECTIVE: To identify the spatial pattern of low birth weight infants in the city of Taubaté, São Paulo, Southeast Brazil. METHODS: Ecological and exploratory study, developed with the data acquired from the Health Department of Taubaté, regarding the period from January 1st 2006 and December 31st 2010. Birth certificates were used to obtain the data from infants weighing less than 2500g. A digital basis of census tracts was applied and the Global Moran index (IM) was estimated. Thematic maps were built for the distribution of low birth weight, health centers and tracts, according to the priority care (Moran map). The adopted statistical significance was α=5% and TerraView software conducted the spatial analysis. RESULTS: There were 18,915 live births during the study period, with 1,817 low birth weight infants (9.6%). The low birth weight infants' prevalence during the period ranged from 9.3 to 9.8%. A total of 1,185 infants with known addresses, compatible with the digital base (65.2% of low birth weight infants), were included. The IM for low birth weight was 0.12, with p<0.01; regarding the health centers distribution, IM was -0.07, with p=0.01. The Moran map identified 11 census tracts with high priority for intervention by health managers, located in the outskirts of the city. CONCLUSIONS: The spatial analysis identified the low birth weight distribution by census tracts and the sectors with a high priority for intervention.

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Using geo-spatial analysis for assessing the Risk of Hospital Admissions due to Community-Acquired Pneumonia in Children and its association with socially vulnerable areas (Brazil)

10.21203/rs.3.rs-28321/v2 ◽

2020 ◽

Author(s):

Juliana Coelho Pina ◽

Luana Seles Alves ◽

Luiz Henrique Arroyo ◽

Ricardo Arcêncio Arcêncio ◽

Ellen Cristina Gondim ◽

...

Keyword(s):

Social Vulnerability ◽

Sao Paulo ◽

Community Acquired Pneumonia ◽

Additive Models ◽

Density Estimator ◽

São Paulo ◽

Census Tracts ◽

Spatial Risk ◽

The Social ◽

The City

Abstract Background: The concentration of child morbidity and mortality due to pneumonia in developing countries reflects the social inequities, which lead to greater exposure to risk factors and make access to prevention, diagnosis and treatment of the disease more difficult. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. Methods: Ecological study, carried out in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized children under the age of five, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were measured from the Radius of the distance of 7,589km, with p<.01, found using the Incremental Spatial Autocorrelation tool. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. Results: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. Conclusions: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution, and address the interface with individual and institutional factors.

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Using geo-spatial analysis for assessing the risk of hospital admissions due to community-acquired pneumonia in under-5 children and its association with socially vulnerable areas (Brazil).

10.21203/rs.3.rs-28321/v3 ◽

2020 ◽

Author(s):

Juliana Coelho Pina ◽

Luana Seles Alves ◽

Luiz Henrique Arroyo ◽

Ricardo Arcêncio Arcêncio ◽

Ellen Cristina Gondim ◽

...

Keyword(s):

Social Vulnerability ◽

Sao Paulo ◽

Community Acquired Pneumonia ◽

Additive Models ◽

Density Estimator ◽

São Paulo ◽

Census Tracts ◽

Spatial Risk ◽

The Social ◽

The City

Abstract Background: The concentration of under-5 child morbidity and mortality due to pneumonia in developing countries reflects the social inequities. This study aimed to map and assess the spatial risk for hospitalization due to Community-Acquired Pneumonia in children under 5 years of age and its association with vulnerable areas. Methods: Ecological study in the city of Ribeirão Preto, state of São Paulo, Brazil. The study population consisted of hospitalized under-5 children, diagnosed with community-acquired pneumonia, in Ribeirão Preto-São Paulo-Brazil, from 2012 to 2013. Data were collected in different databases, by a trained team, between March 2012 and August 2013 and from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics. The 956 urban census tracts were considered as the units of analysis. The incidence of cases per 10,000 inhabitants was calculated by census tracts during the study period. For the identification of the spatial risk clusters, the Kernel density estimator and the Getis-Ord Gi* technique were performed. Generalized additive models were used to verify the association between areas with social vulnerability and the occurrence of childhood pneumonia. Results: The study included 265 children under the age of five, hospitalized due to community-acquired pneumonia. A concentration of cases was identified in the regions with greater social vulnerability (low income, poor housing conditions and homelessness), as well as a lower occurrence of cases in the most developed and economically privileged area of the city. The majority of the children lived in territories served by traditional primary healthcare units, in which the health surveillance and family and community focus are limited. It is important to highlight that the tracts with the highest degrees of vulnerability, such as those identified as high vulnerability (urban) and very high vulnerability (subnormal urban clusters). Conclusions: The results contribute to the comprehension of the social factors involved in child hospitalization due to pneumonia, based on the analysis of the spatial distribution. This approach revealed a strategic tool for diagnosing the disparities as well presenting evidences for the planning in health and strength health care system in achieving equity, welfare and social protection of children.

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