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Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil.
MedLine Citation:
PMID:  21181051     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: To analyze neonatal mortality determinants using multilevel logistic regression and classic hierarchical models.
METHODS: Cohort study including 138,407 live births with birth certificates and 1,134 neonatal deaths recorded in 2003, in the state of Rio Grande do Sul, Southern Brazil. The Information System on Live Births and mortality records were linked for gathering information on individual-level exposures. Sociodemographic data and information on the pregnancy, childbirth care and characteristics of the children at birth were collected. The associated factors were estimated and compared by traditional and multilevel logistic regression analysis.
RESULTS: The neonatal mortality rate was 8.19 deaths per 1,000 live births. Low birth weight, 1- and 5-minute Apgar score below eight, congenital malformation, pre-term birth and previous fetal loss were associated with neonatal death in the traditional model. Elective cesarean section had a protective effect. Previous fetal loss did not remain significant in the multilevel model, but the inclusion of a contextual variable (poverty rate) showed that 15% of neonatal mortality variation can be explained by varying poverty rates in the microregions.
CONCLUSIONS: The use of multilevel models showed a small effect of contextual determinants on the neonatal mortality rate. There was found a positive association with the poverty rate in the general model, and the proportion of households with water supply among preterm newborns.
Authors:
Roselaine Ruviaro Zanini; Anaelena Bragança de Moraes; Elsa Regina Justo Giugliani; João Riboldi
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Revista de saúde pública     Volume:  45     ISSN:  1518-8787     ISO Abbreviation:  Rev Saude Publica     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2010-12-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0135043     Medline TA:  Rev Saude Publica     Country:  Brazil    
Other Details:
Languages:  eng; por     Pagination:  79-89     Citation Subset:  IM    
Affiliation:
Departamento de Estatística, Centro de Ciências Naturais e Exatas, Universidade Federal de Santa Maria, Santa Maria, RS, Brasil. rrzanini@terra.com.br
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