NEONATAL PUBLIC HEALTHPOLICYFossari, MarcioMolinari, SilvanaDos Santos, RobertaReiser, Karina

City of Itajaí - BRA

NEONATAL CAREExploring the Possibilities towards Better Healthca

THE CITYWe have 205.271 habitants

A average of 2.991 live births/year

About 2.400 in the Public Maternity

It´s a port town City

It has a human development index of0,795 3rd in the province

We have about 76% of the City total Areacover by the Family Health Strategy anddivided in the micro-areas.

The Family Health team has at least onenurse, one medical doctor and acommunity health worker (variable aboutthe number of people)

http://cod.ibge.gov.br/232T9

http://dab.saúde.gov.br

CHILD < 1Y MORTALITY 2010-2013

dez-10 dez-11 dez-12 dez-13

Early Neonatal 18 19 22 22

Late Neonatal 3 13 7 11

After Neonatal 9 12 10 19

[VALOR]19

22 22

0

5

10

15

20

25

CHILD < 1Y MORTALITY 2010-2013

[VALOR]

1922

22

3

13

7

11

9 12 1019

Early Neonatal Late Neonatal After Neonatal

2011 2012 20132010

30

44

39

52

2700 2900 310

Total live births

DEATHS

2011

2012

2013

2010

CHILD < 1Y MORTALITY 2010-2013

13.3

10.9

15.2

12.8

17

2009 2010 2011 2012 201

Mortality Rate

CHILD < 1Y MORTALITY 2009-2013

CHILD MORTALITY < 1YEAR 2013

The second highest rate of child mortality from theprovince

One of the largest number of child death from the province

A fickle line of child mortality

The oscilatory curve demonstrates increase and decreasein mortality rate by chance, and not associated to anefficient Public Health Policy

It`s a surprise ?

RESOURCERESULTS

We’ve been here in the past.

We have to care our children in their homes !!!

WHICH ARE THE PILLARSTO ADEQUATE HEALTH

CARE

SURVEILLANCE

Public health surveillance is the continuous, systematic collection, analysis an

interpretation of health-related data needed for the planning, implementation, an

evaluation of public health practice. (WHO)

We have a systematic collection of data (a lot of manual work), but We were n

efficient at analysis and interpretation.

We were not anticipating the healthcare processes. (Very Important !!).

http://www.who.int/topics/public_health_surveillance/en

CARE

kind of care We?

Home visit based care

The Mother care and baby care

Breastfeeding empowerment

No more than 7 days to do the visit

Better if the community health worker

don’t go alone � have to be with the

nurse or the community doctor or both.

WHO technical consultation on newborn health indicators: Every Newborn Ac

Plan Metrics

SUPPORT

PrimaryLevel

IntermediateLevel

AdvancedLevel

We have to support our teams

We must be prepared for the needsthat We have and support them

We need to evaluate and think aboutthe strategy often

We have to give conditons for theproperly work of our teams

Preventive Care in all Levels

We began talk with the largest working

group in the public health, the community

health worker, and the nurses, most of

then are the supervisors from the health

facilities at primary care.

Total about 300 people.

We talk with all comumunity medical

doctors about the numbers of mortality.

Action

Re-evaluateAction

Evaluate

do We Start ?

ATTENTIVE CAREX

THERAPEUTICCARE

Mother/Baby

Breastfeeding

Desnutrition

Jaundice

Screeningtests

We were worried about a attentive care,

more about the visit at home for the

mother and the baby and less about a

medical appointment.

We tried thinking about a integrative

care and more of it, a care with

responsability, like to care about the

mother and the baby.

25.14

23.2

1.2 1.1

26.7

28.2

2013 2014

Features

Mother Age Number of Children Weeks at Birth

When We look for the very briefprofile from the mothers in 2013,

don’t found a socialdeterminant for the number ofneonatal death.

need to measure andevaluate the expected results,

tried to antecipated them.

say ?

A CARE MOVEMENT

Prenatal Care

BreastfeedingEmpowerment

Diabetes

Maternal Nutrition

Maternal Hypertension

Urinary tract Infection

Syphilis

Intrapartum care

• Attendant skilled healthstaff

• The Golden hour

• The father together orsomeone from theFamily

• Newborn measuresand physicalexamination after 1 hour

Home care

• Start at the Hospital

• No more than 7 days

• Look for some riskfactor

• Child log book

• Nurse or Medical Visi(same of prenatal care)

A CARE MOVEMENTIN THE CITY ??

World breastfeeding week (40%)

World Health day

First walk of breastfeeding

A municipal “law” for support breastfeeding actions

Better information (computers in all health facility)

CHILD <1Y MORTALITY 2013-2014

22

19

11

2

19

12

0

5

10

15

20

25

som 52 som 33

< 7 days 7- 27days 28 - 1year

2013 2014

CHILD < 1Y MORTALITY 2010-2014

dez-10 dez-11 dez-12 dez-13 dez-14

Early Neonatal 18 19 22 22 19

Late Neonatal 3 13 7 11 2

After Neonatal 9 12 10 19 12

[VALOR]19

22 22

19

0

5

10

15

20

25

13.3

10.9

15.2

12.8

17.3

10

2009 2010 2011 2012 2013 201

Mortality Rate

CHILD < 1Y MORTALITY 2010-2014

30

44

39

52

33

2700 2800 2900 3000 3100 3200 3300 340

Total live births

DEATHS

2011

2012

2014

2013

2010

CHILD < 1Y MORTALITY 2010-2014

WE MUST CONTINUE !!

• We believe that the set of all actions and not just one or the other has beenessential for improved results.

• We need to get a better result for the neonatal early deaths

• We have to improved a lot our prenatal assistance

• We must to continue all the actions and have more patterns for help

• Invest in education for all !!

THE CITY HALL ANDOUR TEAM

OUR

FAMILY