[ XXXX mortality in a midwestern municipality of the State of S  o Paulo, Brazil, 1990 to 1992].

@entity1 @entity154 @entity4670 @entity353 @entity281 @entity1763 @entity204 @entity44
INTRODUCTION: @entity1 mortality was studied in an urban area of Southeastern Brazil in the period from 1990 to 1992 using data from @entity204 certificates collected at the registry office, by the application of methods for obtaining a collective diagnosis which will assist in the identification 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 Live Birth Information System (SINASC) was used to study variables such as maternal age and birthweight. The quality of original @entity204 certificates was initially analyzed using the amount of information, sensitivity, specificity and Kappa value. RESULTS: The global sensitivity for the underlying cause was 78.84% and Kappa 71.32% for the total of causes. One hundred and eighty-nine @entity204 occurred, 66.15% of them in the neonatal period, (41.28% during the first day of life) and 33.85% in late childhood. The birthweight of 58.28% of @entity204 was less than 2.500 g. The underlying causes of @entity204 were studied the by possibility, of their 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 observed that in the @entity204 occurring up to 27 days, 22.23% could have been avoided by adequate care during labour, and 20.64% could have been avoided by early diagnosis and early treatment, 13.75% by good pregnancy care and only 7.94% were unavoidable. Of the @entity204 occurring in late childhood, 12.17% were classified as of avoidable causes and 4.23% were considered as unavoidable. Using ICE groups, 58.74% died of @entity44 or @entity1763 , 19.58 of @entity281 and 12.17% from @entity154 . CONCLUSIONS: The results suggest that priority be given to obstetrical 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 @entity204 have underlying causes related to @entity4670 and confirms the relationship with the @entity353 of the newborn. The maternal complications were also related to @entity353 . Great differences were identified in @entity1 mortality rates in urban zones not only restricted to the value of the rates but also to the diseases responsible for the occurrence of @entity204 . We therefore conclude that there is an advantage to be gained in using the four methods, which are complementary, for studying or planning actions with a view to prevent @entity1 mortality.
