The mother-child binomial in Botucatu: epidemiological study with emphasis on maternal and child morbimortality

Abstract

Brazil is one of the 189 countries which, in 2000, signed the agreement to achieve eight goals for the Millennium Development, until 2015. Among such goals is the reduction, by three quarters, in maternal and child mortality. Data from surveillance systems suggest difficulties to achieve this goal, particularly in reducing maternal mortality, a phenomenon whose determinants are still not fully understood. The project "Study on the mother/child binomial: an imperious need to achieve the Millennium Development goals", FAPESP Process 2009/53253-8, whose development was initiated São Paulo state with two sub-projects "Maternal Morbimortality - the product of pregnancy and its characteristics" and "The quality of information on vital events", aims at learning about data/events/situations occurring to women in the immediate gravidic-puerperal cycle and about data/situations/characteristics of the pregnancy product, including an analysis on the classification of events "live births", "fetal loss" and miscarriages, according to international definitions, as well as at evaluating the quality of information on women's mortality and on the completion of three documents in hospitals: Declaration of Death (DD), Declaration of Fetal Death (DFD) Declaration of Live Birth (DLB). The project presented here constitutes an extension, that is, it is intended to be carried out in another city, Botucatu, a medium-sized city in São Paulo state. It is a population, cross-sectional study that will collect data from pregnant women/puerperae hospitalized in three maternity hospitals in Botucatu. Data will be collected by using notes from maternal and children's charts, the Delivery Room Logbook, Prenatal Card and other instruments containing relevant data as well as by complementing with other data obtained by means of interviews with pregnant women/puerperae after signature of an informed consent form. Considering the number of newborns in 2010, it is estimated that approximately 1.500 pregnant women/puerperae and their newborns will be included. The interviewers will be students from the Undergraduate Programs in Health on the Botucatu Campus of UNESP. Data will be collected daily for one year. The variables to be approached are those comprising the protocols designed by the Health Ministry - Technical Area of Women's Health and the São Paulo State Mothers' Program (Programa Mãe Paulistana), by PMSP, in addition to some considered to be specifically important for the local scenario, such as psychosocial factors and neonatal risk factors pointed out on the Agenda of Commitments for Children's Health by the Health Ministry. The forms will be continuously reviewed, codified and entered on a computer by a technical aide and field coordinator. Codification of pregnant women's diseases/health aggravations and death causes (in death cases) as well as newborns' pathologies will be performed by a specialized technician from the Brazilian Center for Disease Classification of FSP/USP (Centro Brasileiro de Classificação de Doenças da FSP/USP). All diagnoses, maternal or the newborns', will be codified by CID-10 (OMS, 1996). Taking advantage of the performance of Sub-Project I and the possibility to refer to the charts of patients hospitalized in Botucatu's maternity hospitals, the second sub-project intends to design new documents (DD-DLB and DFD) for each occurring event and, then, compare them to those provided by the institution. Such comparison will allow for evaluating the quality of the records that are being produced. The results of the sub-projects will make it possible to establish comparisons among municipalities of different sizes and regions. Learning about the situations experienced by women from different scenarios will enable a comprehensive overview of the mother/child binomial in the country and will contribute to the evaluation and establishment of public policies focused on the Millennium Goals. (AU)