Mortes maternas no Brasil: análise do preenchimento da variável da declaraçäo de óbito / Maternal deaths in Brazil: An analyses of related variable in death certificates

RESUMO

A importância dos dados relativos à mortalidade materna é inegável. É conhecido o fato de que as causas de morte decorrentes da gravidez, parto e puerpério são, talvez, umas das mais mal informadas nas declarações de óbito (DO). Visando à melhoria da qualidade dessa informação, o Ministério da Saúde (MS) introduziu, nesse documento, item a ser preenchido pelo médico relativo à presença de gravidez no momento da morte ou nos 12 meses anteriores à mesma. O objetivo deste trabalho é avaliar esse item nas DO referentes ao Brasil, em 1996 e 1997. Os resultados mostram o mau preenchimento, com resposta "ignorado" para gravidez no momento da morte em 89,3% e 87,4% dos casos e em 91,4% e 90,4% para gravidez 12 meses antes, respectivamente em 1996 e 1997. Analisando as causas básicas de morte das mulheres que estavam ou estiveram grávidas, 19,4% e 38,1% de óbitos foram por causas maternas, em 1996, valores considerados baixos. Das mortes maternas (Capítulo XV da CID-10), em 30,7% e 45,3% havia informação de que "estavam" ou "estiveram" grávidas, em 1996 e 1997. Considerando a elevada freqüência de "ignorado" e a falta de clareza do item, sugere-se que o MS reveja a sua formulação e reforce, junto aos médicos, a importância do adequado preenchimento da DO

ABSTRACT

Maternal mortality data is a matter of concern in Public Health. It is well known that causes of death related to pregnancy, childbirth and puerperium are perhaps the worst reported for death certificate (DC) records. Looking to improve the quality of these data, the Ministry of Health (MH) introduced an item in DC records, to be filled out by physicians, indicating whether or not the deceased was pregnant at the moment of death or during the period 12 months prior to death. The objective of this paper is to evaluate these items in Brazilian DC records for 1996 and 1997. In these years, respectively, and "unknown" response was present in 89.3% and 87.4% of the DC for the question of whether or not the deceased was pregnant at the time of death, and 91.4% and 90.4% for the question of whether or not the deceased had been pregnant at any time during the 12 months prior to death. These values represent a real need for improvement in gathering data. Among those DC's with a positive response as to the presence of pregnancy, only 19.4% and 38.1% of the deaths were attributed to maternal causes in 1996 values considered to be low. Information related to pregnancy was obtained in 30.7% and 45.3% of the records attributed to maternal causes (Capter XV of ICD-10) in 1996 and 1997, respectively. Considering the high frequency of "unknown" as a response and the items' obscureness, it is proposed to the MH to revise the question and to reinforce the importance of adequate reporting in filling out DC's by physicians