INFANT-MORTALITY IN A MIDWEST CITY OF SOU THEASTERN BRAZIL, 1990 TO 1992

Introduction Infant mortality was studied in an urban area of Southeas tern Brazil in the period from 1990 to 1992 using data from death cert ificates collected at the registry office, by the application of metho ds for obtaining a collective diagnosis which will assist in the ident ification and choice of strategies for the control of local problems. Material and Method The original data were corrected using documental research into health services and household interviews. Data of the Li ve Birth Information System (SINASC) was used to study variables such as maternal age and birthweight. The quality of original death certifi cates was initially analyzed using the amount of information, sensitiv ity, specificity and Kappa value. Results The global sensitivity for t he underlying cause was 78.84% and Kappa 71.32% for-the total of cause s. One hundred and eighty-nine deaths occurred, 66.15% of them in the neonatal period, (41.28% during the first day of life) and 33.85% in l ate childhood The birthweight of 58.28% of deaths was less than 2,500g . The underlying causes of death were studied the by possibility, of t heir avoidance (a method developed by Erica Taucher), by a ''reduced'' group of causes (utilized in International Collaborative Effort(ICE)) , multiple causes statistics and geographical distribution. It was obs erved that in the deaths occurring up to 27 days, 22.23% could have be en avoided by adequate care during labour; and 20.64% could have been avoided by early diagnosis and early treatment, 13.75% by good pregnan cy care and only 7.94% were unavoidable. Of the deaths occurring in la te childhood, 12.17% were classified as of avoidable causes and 4.23% were considered as unavoidable. Using ICE groups, 58.74% died of immat urity or asphyxia, 19.58 of infection and 12.17% from congenital abnor malities. Conclusions The results suggest that priority be given to ob stetrical care at delivery and during labour and to the pediatric care of low birth weight, among others. The analysis using multiple causes statistics shows that 76.05% of the deaths have underlying causes rel ated to neonatal disorders and confirms the relationship with the weig ht deficiencies of the newborn. The maternal complications were also r elated to weight deficiencies. Great differences were identified in in fant mortality rates in urban zones not only restricted to the value o f the rates but also to the diseases responsible for the occurrence of deaths. We therefore conclude that there is an advantage to be gained in using the four methods, which are complementary, for studying or p lanning actions with a view to prevent infant mortality.