INFANT-MORTALITY DUE TO ACUTE RESPIRATORY-INFECTIONS - THE INFLUENCE OF PRIMARY-CARE PROCESSES

A population-based case control study was conducted to ascertain wheth er the process of primary care can be a determinant of infant mortalit y due to Acute Respiratory Infection (ARI). Cases were 118 infants who died from ARI, individually matched with 118 infants who suffered an ARI episode and recovered. Information was gathered through interviewi ng mothers. Study variables were assembled into five subsets: children 's characteristics; mothers' characteristics; access to medical servic es; process of primary care, and; sociodemographic variables. An index per subset was built to analyze the independent influence of each on ARI death risk. The index was constructed upon the weighted sum of the adjusted odds ratios (OR) within each subset. Then, the values of eac h index were collapsed into high/low values with the 50 percentile as a cut-off value. Next, by means of a conditional logistic regression p rocedure, an explanatory model of ARI mortality was obtained. The fina l multivariate model included the indexes that showed an independent e ffect: I) Process of care (OR 9.68, Cl 95% 3.59-26.1): inadequate refe rral, attention provided by more than one physician and being attended by a private physician; (If children's characteristics (OR 7.22, CI 9 5% 2.35-22.2): perinatal history, lack of breast-feeding and incomplet e immunization scheme; III) access to medical services (OR 5.27, CI 95 % 2.02-13.7): geographic and economic barriers, lack of confidence in public health services, and; IV) mothers' characteristics (OR 4.03, Ct 95% 1.18-13.8), mainly represented by untimely care seeking. We concl ude that the management of the disease is a key determinant in which f actors relating to the mother and the health services are strongly rel ated. Our study reveals untimely care seeking, difficult access and in adequate disease treatment as important factors which deserve careful attention in the future. We also confirm the importance of biological determinants previously described. A main strategy to reduce infant mo rtality due to ARI should be to encourage training of primary care phy sicians, including private practitioners, focused on providing effecti ve case management and emphasizing the education to mothers.