Perinatal health in Pelotas, Rio Grande do Sul, Brazil: social and biological factors

Abstract

All hospital births occurring during 1982 in Pelotas, Southern Brazil (pop. 260,000) were studied. This a highly representative perinatal population, since in this city less than 1% of the deliveries occur at home. The study was performed through: hospital interviews with mothers and evaluation of the newborn; home visits of a random sample of 15% of the births after the seventh day of life; and monthly checking of birth and death certificates. Overall, the perinatal mortality rate (PNMR) for singletons was 31.9/1,000 births, fetal mortality rate (FMR) being 16.2/1,000 and early neonatal mortality rate (ENMR) 15.9/1,000. The incidence of low birth weight (LBW) babies was 8.1%. Main causes of death were immaturity, anoxia and hyaline membrane disease. In 40% of the deaths the actual cause was not clarified. Social factors were strongly associated with perinatal health indicators. Babies whose families earned up to 1 minimum wage per month presented a PNMR of 44.0/1,000 and LBW in 12.6% of the cases, whereas those newborns of high income families (more than 10 minimum wages/month) showed a PNMR of 13.2/1,000 and 4.2% of LBW. The association of perinatal performance with maternal age and provenience, birth order and smoking was also studied. When a comparison was made between the perinatal outcome of Pelotas babies with that of a highly developed country (Sweden), using standardization techniques, it was seen that although our birth weight distribution may be held responsible for part of our poor performance, failures in our health services are probably still more important.