[Evaluation of the incompleteness in the filling out of death certificates of children under one year of age in the State of Pernambuco, Brazil, 1999-2011]. / Avaliação da incompletude da declaração de óbitos de menores de um ano em Pernambuco, Brasil, 1999-2011.

In order to assess the incompleteness in filling out death certificates (DC) in the regional health offices of the State of Pernambuco a descriptive study was conducted on data for infant mortality information on deaths of children under one year of age in the municipalities of Pernambuco in the 1999-2001 and 2009-2011 threeyear periods. The percentage of incompleteness was based on the blank/unknown responses in the DCs per regional health office and the proportional variation rate of incompleteness between the two periods. It was observed that the filling out of information did not show a well-defined pattern per office, with a reduction in incompleteness occurring for most variables, though the sex, age and place of occurrence of death variables alone revealed ≤ 5% incompleteness in the second term of study, which was considered excellent in terms of the Romero and Cunha scores. Despite the decrease in incompleteness related to pregnancy, childbirth and mother-related variables, in the second triennium incompleteness between 10 and 20% was observed, with a regular score in the 2009-2011 triennium. Despite the improvement in the filling out of details in the State, it is necessary to strengthen surveillance and training for completing the DCs by the Committees for Prevention of Infant Mortality.

[Spatial analysis of infant mortality and the adequacy of vital information: a proposal for defining priority areas]. / Análise espacial da mortalidade infantil e adequação das informações vitais: uma proposta para definição de áreas prioritárias.

This is an ecological study that sought to assess the relationship between the spatial clustering of infant mortality and the adequacy of vital information. The adequacy of information from the Brazilian Live Birth Database (SINASC) and Mortality Database (SIM) were examined using a validated method that uses five indicators calculated by municipality and population size. Municipalities were classified as either having consolidated data, data currently being consolidated, or not having consolidated data. Voronoi polygons were generated for spatial analysis in order to minimize any proximity issues among municipalities. The local Moran index was applied to identify spatial clustering of infant mortality. It was established that 76.2% of all municipalities had consolidated vital data. Infant mortality clustering was seen in 34 municipalities comprising three spatial clusters. An association was also found between the adequacy of vital information and the spatial clustering of infant mortality. Geostatistical techniques proved to have predictive power to identify spatial clustering with consolidated vital information. The approach will contribute to the improvement of data quality and can be used for planning actions seeking to reduce infant mortality.

Correction of vital statistics based on a proactive search of deaths and live births: evidence from a study of the North and Northeast regions of Brazil.

BACKGROUND: In the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000-2010 by macro-geographical region. METHODS: A proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000-2010. RESULTS: In the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births. CONCLUSIONS: The proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies.

[Correcting vital information: estimating infant mortality, Brazil, 2000-2009]. / Correção de informações vitais: estimação da mortalidade infantil, Brasil, 2000-2009.

OBJECTIVE: To propose a simplified method of correcting vital information and estimating the coefficient of infant mortality in Brazil. METHODS: Vital data in the information systems on mortality and live births were corrected using correction factors, estimated based on events not reported to the Brazilian Ministry of Health and obtained by active search. This simplified method for correcting vital information for the period 2000-2009 for Brazil and its federal units establishes the level of adequacy of information on deaths and live births by calculating the overall coefficient of mortality standardized by age and the ratio between reported and expected live births, respectively, in each Brazilian municipality. By applying correction factors to the number of deaths and live births reported in each county, the vital statistics were corrected, making it possible to estimate the coefficient of infant mortality. RESULTS: The highest correction factors were related to infant deaths, reaching values higher than 7 for municipalities with very precarious mortality information. For deaths and live births, the correction factors exhibit a decreasing gradient as indicators of adequacy of the vital information improve. For the year 2008, the vital information corrected by the simplified method per state were similar to those obtained in the research of active search. Both the birth rate and the infant mortality rate decreased in the period in all Brazilian regions. In the Northeast, the annual rate of decline was 6.0%, the highest in Brazil (4.7%). CONCLUSIONS: The active search of deaths and births allowed correction factors to be calculated by level of adequacy of mortality information and live births. The simplified method proposed here allowed vital information to be corrected per state for the period 2000-2009 and the progress of the coefficient of infant mortality in Brazil, its regions and states to be assessed.

Differentials in vital information in the state of Pernambuco, Brazil, 2006-2008.

OBJECTIVE: To assess differentials in official birth and death data for estimating infant mortality. METHODS: An ecological study was conducted based on data obtained from birth and death information systems in the state of Pernambuco, northeastern Brazil, between 2006 and 2008. The following indicators were used: age-standardized mortality rate, relative mean deviation of mortality rate, ratio of reported to estimated live births, relative mean deviation of birth rate and proportion of deaths of unknown cause. These indicators were grouped into three dimensions: mortality, fertility and ill-defined causes. Based on predetermined criteria, municipalities were classified as follows: consolidated vital data; vital data in the consolidation phase; and non-consolidated data. The data were analyzed using EpiInfo and Terraview for map preparation. RESULTS: Of the 185 municipalities in the state of Pernambuco, 141 (76.2%) were classified as having consolidated vital data, accounting for about 85% of the state population, and 17 (9.2%) were classified as having non-consolidated data, accounting for only 4.9% of the population. Larger municipalities (50,000 inhabitants or more) showed better data quality. CONCLUSION: The approach studied proved itself valuable to assess the quality of vital information and identify inequalities in Pernambuco. Reduction of inequalities is a challenge in this state in the sense of enabling vital information to be analyzed directly from data systems at the local level. It will also allow assessing the effectiveness of initiatives to reduce infant mortality in Pernambuco.

[Completeness variable evaluation from death certificate of children less than one year in Pernambuco State, 1997-2005]. / Avaliação da completitude das variáveis da declaração de óbitos de menores de um ano residentes em Pernambuco, 1997-2005.

An evaluative, descriptive, time series study was conducted to evaluate the completeness of variables from death certificate. The study population consisted of all deaths of children less than one year old living in Pernambuco State, Brazil, from 1997 to 2005, contained in the database of the Mortality Information System (SIM), provided by the Data Processing Department of the Unified Health System (DATASUS). We calculated each variable's incompleteness (blank/unknown data) by municipality of residence. Based on these data, we calculated the percentage of municipalities with excellent completeness (>95%) and the tendency qui-square (p>95%). There was a difference in the filling behavior of the variables of the death certificate. While sex, age, race/color, place of occurrence, type of delivery and weeks of gestation had an increase in the percentage of municipalities with excellent filling, death confirmed by autopsy, completion of surgery, complement and medical examination showed a decrease. The study emphasizes the importance of educational actions and a better control in the filling of the variables in death certificates.

[Evaluation of the completeness of variables on Birth Certificates of residents in Pernambuco State, Brazil, 1996 to 2005]. / Avaliação da completitude das variáveis da Declaração de Nascido Vivo de residentes em Pernambuco, Brasil, 1996 a 2005.

An evaluative, descriptive, time series study was conducted to evaluate the completeness of data on certificates of live birth. The study population consisted of all live births of residents in Pernambuco State, Brazil, from 1996 to 2005, contained in the database of the Live Birth Information System (SINASC), provided by the Information Technology Department of the Unified National Health System (DATASUS). We calculated each variable's incompleteness (blank/unknown data) by municipality of residence. Based on these data, we calculated the percentage of municipalities with excellent completeness (> 95%), constructed a simple linear regression model, and calculated the determination coefficient. An important increase was observed in the percentage of municipalities with excellent completeness, highlighting the following variables: race/color, maternal schooling, maternal marital status, and number of prenatal visits. The study emphasizes the importance and relevance of using the SINASC database for analyzing maternal and child health conditions.

Hypothermia on admission: a risk factor for death in newborns referred to the Pernambuco Institute of Mother and Child Health.

The objective of this study was to determine the mortality risk related to hypothermia at the moment of admission and other factors such as clinical and geographical related to the transportation of the newborns admitted to the Instituto Materno Infantil de Pernambuco IMIP from 8 March to 11 June 2000. A prospective study involving 320 newborns arriving from home or health centres was carried out. Babies that were dead on arrival or subsequently transferred to other units were excluded. The risk of death was determined according to exposure to hypothermia and other types of exposure, using logistical regression. The risk of death was higher (RR = 3.09; CI = 2.15-4.43) in the group exposed to moderate hypothermia (temperature between 32.5 degrees C and 35.99 degrees C) than in the non-exposed group (temperature equal to or greater than 36.00 degrees C). The relative risk of death was also higher for newborns with a weight of less than 2500 g, that were less than 1 day old, respiratory distress syndrome, premature babies or with congenital malformations, that had used oxygen and/or intravenous infusion during transit, that came from the interior and that had travelled more than 150 km. In the final result of the multivariate analysis, sepsis ('adjusted' RO = 6.23; 95% CI = 5.66-6.80), respiratory distress syndrome ('adjusted' RO = 5.28; 95% CI = 5.03-5.59), moderate hypothermia ('adjusted' RO = 3.49, 95% CI = 3.18-3.81), and distance undertaken greater than 50 km ('adjusted' RO = 2.39; 95% CI = 2.14-2.63) remained. Hypothermia on admission showed itself to be an important and independent risk factor for neonatal death.