Access to and use of health services as factors associated with neonatal mortality in the North, Northeast, and Vale do Jequitinhonha regions, Brazil.
OBJECTIVE
To analyze the factors associated with neonatal mortality related to health services accessibility and use.


METHODS
Case-control study of live births in 2008 in small- and medium-sized municipalities in the North, Northeast, and Vale do Jequitinhonha regions, Brazil. A probabilistic sample stratified by region, population size, and information adequacy was generated for the choice of municipalities. Of these, all municipalities with 20,000 inhabitants or less were included in the study (36 municipalities), whereas the remainder were selected according to the probability method proportional to population size, totaling 20 cities with 20,001-50,000 inhabitants and 19 municipalities with 50,001-200,000 inhabitants. All deaths of live births in these cities were included. Controls were randomly sampled, considered as four times the number of cases. The sample size comprised 412 cases and 1772 controls. Hierarchical multiple logistic regression was used for data analysis.


RESULTS
The risk factors for neonatal death were socioeconomic class D and E (OR=1.28), history of child death (OR=1.74), high-risk pregnancy (OR=4.03), peregrination in antepartum (OR=1.46), lack of prenatal care (OR=2.81), absence of professional for the monitoring of labor (OR=3.34), excessive time waiting for delivery (OR=1.97), borderline preterm birth (OR=4.09) and malformation (OR=13.66).


CONCLUSION
These results suggest multiple causes of neonatal mortality, as well as the need to improve access to good quality maternal-child health care services in the assessed places of study.
['Batista|Cristiane B|CB|', 'Carvalho|Márcia L de|ML|', 'Vasconcelos|Ana Glória G|AGG|']
D001938:Brazil D016022:Case-Control Studies D005260:Female D006297:Health Services Accessibility D006801:Humans D007223:Infant D007226:Infant Mortality D007231:Infant, Newborn D008297:Male D011247:Pregnancy D012307:Risk Factors D012959:Socioeconomic Factors
Neonatal mortality Health services accessibility Acesso aos serviços de saúde Case–control studies Estudos de casos e controles Mortalidade Neonatal