Banca de DEFESA: POLIANA REBOUCAS DE MAGALHAES
Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.DISCENTE : POLIANA REBOUCAS DE MAGALHAES
DATA : 21/09/2020
HORA: 09:00
LOCAL: Remotamente
TÍTULO:
Social determinants in the mortality of children from 28 days to 59 months in Brazil: a study from the Cohort of 100 Million Brazilians.
PALAVRAS-CHAVES:
Social conditions, Child mortality; Social Determinants; CohortPÁGINAS: 144
GRANDE ÁREA: Ciências da Saúde
ÁREA: Saúde Coletiva
RESUMO:
Worldwide, fewer children die in almost all countries, but their chance of survival still depends on where and under what socioeconomic conditions they were born. From 2000 to 2017, all but one of the 97 low to middle income countries that account for the vast majority of child deaths have lowered their infant mortality rates, and evidence shows that this is related to significant improvements in vaccination coverage, care qualified childbirth, maternal education, sanitation and family income. We analyzed the socioeconomic predictors of child mortality from 28 days to 59 months of age in the baseline of the Cohort of 100 Million Brazilians, taking advantage of its large number of variables and large population size. The general objective is to estimate the effect of social determinants and birth conditions on the death of children aged between 28 days and 59 months in Brazil, between 2001 and 2015. The proposed project includes 3 articles, each with a methodology explained briefly below , along with a brief description of the results and conclusions. Article 1: Family poverty and its characteristics: methodological approaches from the Cohort of 100 Million Brazilians. Methodology: Descriptive and methodological study. The data source is the CIDACS Cohort of 100 million Brazilians. The population is made up of families with children under 5, considered more vulnerable, enrolled in the Single Registry between 2011 and 2015. Poverty was measured through the Family Development Index and a construct developed through Latent Class Analysis. Results: Both methods demonstrated sensitivity to measure poverty, with results similar to official measures of income. There are gradients of poverty, even among very poor families, which is also observed when stratifying by regions and states. Conclusion: Poverty is not homogeneous, being better characterized by multidimensional indices. The IDF is a robust marker to represent poverty in the CADU. However, the ACL can be used in different populations and types of aggregation to characterize poverty, the two measures being appropriate to characterize poverty and its levels. Article 2: Mortality of children from 28 days to 59 months attributed to socioeconomic inequality in Brazil: a cohort study of 100 million Brazilians. Methodology: Design: cross-sectional study nested in a cohort. Population: 7,537,093 children aged between 28 days and 59 months present in the CADU baseline were analyzed. Among these, after being linked to SIM records, 12,394 deaths were observed. Analysis: Poverty was defined by quintiles of the IDF (Family Development Index): measure that aggregates family information related to income, access to education, working conditions, vulnerability, child development and housing conditions. The childhood mortality rate in all quintiles was calculated. Mortality attributable to socioeconomic inequality was defined as the difference between the total deaths observed and those in the least poor quintile, divided by the total number of deaths. An analysis of inequality by causes of death related to poverty was made, stratified by age group, place of residence and size of the municipality. Results: 27.8% (95% CI 27.0 - 28.6) of deaths were attributed to inequality among low-income children, corresponding to 3,447 deaths or 1 in 4 deaths between 2011 and 2015. The causes that most contributed were diarrhea (60.2%), malnutrition (67.2%), accidental drowning (58.5%), ill-defined causes (53.5%) and flu and pneumonia (35%) . Inequality was greater among children of black, brown and indigenous mothers than among white mothers, living in small municipalities (less than 20 thousand inhabitants). Conclusion: 1 in 4 deaths of low-income children aged between 28 days and 59 months in Brazil were attributed to inequality. This suggests an inequality in access to basic public policies, with greater difficulty among the poorest, even in a period of improvement in the social conditions of the poorest in the country, which constitutes an important challenge for both public health and social policies generally. Article 3: Effects of the determinants of mortality of children from 28 days to 59 months in Brazil: a cohort study of 100 million Brazilians. Methods: Design: Retrospective dynamic cohort. Population: 14,204,187 records of children under 5 years of age present in the CADU baseline, linked to SINASC birth records, were analyzed. Of these, 27,750 were linked to SIM records. The logistic model considering the hierarchical scheduling at distal, intermediate and proximal levels was adjusted in order to quantify the effect of the family's socioeconomic variables, the conditions related to the mother, the home environment and the use of the health service, of these on the conditions of birth and biological characteristics of the child and mother, and finally, on deaths. The analysis was stratified by age group and per capita family income. Results: The greatest chance of death was among post-neonatal children, residents of rural areas, daughters of black or indigenous mothers. The final general model expresses a predominance of biological factors in determining infant deaths and an important weight of maternal and child health care in determining the deaths of children between 28 days and 59 months of age. However, there are differences between age subgroups, where family socioeconomic factors are important in determining the death of post-neonatal children and also differences in the final models according to the family per capita income stratum, where there is a greater determination of socioeconomic factors in the deaths of older children. poor. Conclusion: The results allow us to infer that poverty is still an important factor in determining children's health, even though there has been an improvement in living conditions in the years analyzed by the study. There is still a situation of chronic deprivation of historically excluded population groups, which exposes persistent social disparities in Brazilian society.
MEMBROS DA BANCA:
Externo ao Programa - 1103090 - DANDARA DE OLIVEIRA RAMOS
Externo à Instituição - MARCIA FURQUIM DE ALMEIDA
Presidente - 118.180.505-87 - MAURICIO LIMA BARRETO - UFBA
Interno - 287722 - ROSEMEIRE LEOVIGILDO FIACCONE
Externo à Instituição - TEREZA HELENA GABRIELLI BARRETO CAMPELLO