Trends in birth outcomes in the Western region of São Paulo

Abstract

A long literature has documented the importance of fetal development as a determinant of both child and adulthood health, and made the WHO declare investment in early childhood the best way to promote a country's development. Beyond the potentially large long-term health consequences of intrauterine growth restrictions predicted by the Barker hypothesis, the most immediate and obvious consequence of gestational complications is an increased risk of preterm (less than 37 weeks of gestation) and low birth weight (less than 2.500 kg) births - both factors have been shown to substantially increase the risk of neonatal mortality. In an effort to achieve Millennium Development Goals (MDGs) 4 and 5, Brazil has made substantial progress towards reducing infant mortality over the past decade. However, similar improvements in neonatal mortality rates and pre-term and low-weight births have not been observed. Adverse birth outcomes remain common in many areas of the countries, and continue to contribute to the often stark disparities in health outcomes observed. In this project, we propose to use high quality data through an electronic hospital system to more closely analyze the progress made in Brazil in this area over the last decade. More specifically, we propose to explore the detailed medical records collected through the electronic data systems of the University Hospital USP and PROAIM - SMS to analyze the absolute and relative changes in birth outcomes in the Western Region of São Paulo over the past 10 years. The electronic system contains complete records of approximately 30,000 births over the reference period including birth weight, gestation period and child mortality. We will extract the data from the system, geo-code all observations, and use the data set to measure the changes in the overall prevalence of adverse birth outcomes over time in a first step. In a second step, we will assess the effect of recent trends on health disparities. We will divide the region into three socioeconomic groups (low, middle and high income) based on the regional vulnerability index, and assess the absolute and relative health improvements achieved within each stratum.The detailed analysis conducted will not only allow an exact monitoring of the trends in the region, but will also allow us to identify key margins which can be addressed. The generated knowledge may be used for future intervention propositions, as well as public health policy making. (AU)