Sônia Lansky - Academia.edu (original) (raw)

Papers by Sônia Lansky

Cadernos de Saúde Pública, 2024

Journal of Epidemiology and Community Health, Aug 1, 2011

Materials and Methods Cluster random sampling in two states (Uttar Pradesh and Haryana) was used.... more Materials and Methods Cluster random sampling in two states (Uttar Pradesh and Haryana) was used. A sample of 100 000 people per district, with four districts per state was identified. Twenty per cent were selected from urban areas and rest from four randomly selected PHCs. In rural areas the survey was conducted with the help of ASHA workers and in Urban areas by the Urban Team. ASHA workers were provided with 2 days of comprehensive training and urban team was also trained. Results We found that the total disability rate (TDR) was 67.3/ 10 000 populationd77.4/10 000 in males and 56.7/10 000 in females (p<0.001). The TDR was significantly higher in urban areas than in rural areas (83.2/10 000 vs 62.9/10 000, p<0.001). The same trend was observed at the state level. The data show that 58.2% of the total disability was due to locomotors defects only (polio, paralysis, epilepsy, congenital and trauma) followed by blindness and multiple disabilities. Further data will be available for the Congress.

Saúde em Redes, Jun 20, 2018

De quem é este bebê? Construção, desconstrução e resistência pelo direito de mães e bebês em Belo... more De quem é este bebê? Construção, desconstrução e resistência pelo direito de mães e bebês em Belo Horizonte Whose baby is this? Deconstruc on, reconstruc on and resistence on the right of women and their newborn in Belo Horizonte, Brazil Saúde da mulher; Direitos humanos; Saúde da criança; Adoção

Revista Brasileira de Saúde Materno Infantil, Dec 1, 2015

Objectives: to examine the profile of avoidable infant deaths investigated and produce a concorda... more Objectives: to examine the profile of avoidable infant deaths investigated and produce a concordance between the basic cause declared on the original death certificate (DO) and the one produced after investigation. Methods: a population-based study examining infant deaths and avoidable deaths investigated by the Belo Horizonte Death Prevention Committee (CMPOFI), in 2010 and 2011. The death certificate issued after investigation was based on analysis of data from outpatient centers, hospitals and households conducted by the CMPOFI. The causes of death were codified according to the 10th edition of the International Statistical Classification of Diseases and Problems Related to Health and the basic cause selected. The concordance between the basic cause of death on the original death certificate and on the one produced after investigation, analyzed according to the reduced list tabulating the causes of infant mortality (LIR-MI), was determined using the Kappa index. Results: the Kappa index was weak (K=0.389; CI95%: 0.192-5.76) when evaluated using the LIR-MI groups. There were significant changes in the cause of death after investigation, with an increase in the proportion of deaths from asphyxia, maternal factors, child infections, perinatal infections, external causes and sudden infant death syndrome. Conclusions: the investigation of deaths shed greater light on the circumstances of avoidable infant deaths and the classification of the basic cause, which are fundamental steps in guiding action to prevent such deaths.

Escola Anna Nery, 2016

Práticas na assistência ao parto em maternidades com inserção de enfermeiras obstétricas, em Belo... more Práticas na assistência ao parto em maternidades com inserção de enfermeiras obstétricas, em Belo Horizonte, Minas Gerais Prácticas de atención al parto en maternidades con inclusión de enfermeras obstetras en maternidades de

Reproductive Health Matters, Mar 1, 2012

This paper addresses equity in health and health care in Brazil, examining unjust disparities bet... more This paper addresses equity in health and health care in Brazil, examining unjust disparities between women and men, and between women from different social strata, with a focus on services for contraception, abortion and pregnancy. In 2010 women's life expectancy was 77.6 years, men's was 69.7 years. Women are two-thirds of public hospital services users and assess their health status less positively than men. The total fertility rate was 1.8 in 2011, and contraceptive prevalence has been high among women at all income levels. The proportion of sterilizations has decreased; lower-income women are more frequently sterilized. Abortions are mostly illegal; women with more money have better access to safe abortions in private clinics. Poorer women generally self-induce abortion with misoprostol, seeking treatment of complications from public clinics. Institutional violence on the part of health professionals is reported by half of women receiving abortion care and a quarter of women during childbirth. Maternity care is virtually universal. The public sector has fewer caesarean sections, fewer low birthweight babies, and more rooming-in, but excessive episiotomies and inductions. Privacy, continuity of care and companionship during birth are more common in the private sector. To achieve equity, the health system must go beyond universal, unregulated access to technology, and move towards safe, effective and transparent care.

Anais, Nov 4, 2016

Tradicionalmente, as mortes infantis têm sido analisadas segundo capítulos da Classificação Inter... more Tradicionalmente, as mortes infantis têm sido analisadas segundo capítulos da Classificação Internacional de Doenças (CID) e, no Brasil, prevalecem as afecções perinatais como principal causa de óbito. O grupo das afecções perinatais, entretanto, reúne causas que demandam intervenções bastante diferenciadas, algumas delas consideradas com maior potencial de evitabilidade. Este estudo utiliza uma classificação detalhada das causas perinatais dos óbitos infantis, baseada em estratégias comuns para sua prevenção, com o objetivo de tentar traduzir melhor os dados em informação adequada para as políticas de saúde infantil. Métodos: Foram utilizados os dados de óbitos do Sistema de Informação sobre Mortalidade-SIM para o período de 1996 a 2010. As causas de morte foram analisadas segundo a lista de tabulação oficial brasileira (CID-BR) e também segundo uma proposta de lista reduzida de tabulação para mortalidade infantil (LIR-MI), com seis categorias de causas perinatais e sete não perinatais. Para minimizar viés de informação devido a problemas na qualidade do dado registrado, foram utilizadas taxas de mortalidade infantil estimadas e os óbitos por causas mal definidas e inespecíficas foram redistribuídos entre as causas definidas. Resultados: As afecções perinatais aumentaram a sua contribuição relativa entre os óbitos infantis no período analisado, representando em 2010 cerca de 60% dos óbitos infantis. Pela CID-BR os transtornos respiratórios e cardiovasculares específicos do período neonatal, que agrupa causas diferenciadas de afecções perinatais, aparecem como

Divulg. saúde debate, 2006

Revista Brasileira De Epidemiologia, 2019

Introduction: Deaths certified with ill-defined causes or garbage codes (GC) compromise the analy... more Introduction: Deaths certified with ill-defined causes or garbage codes (GC) compromise the analysis of mortality and its use for planning and evaluation of public health policies. The hospital investigation of these causes is one of the strategies qualifying the profile of mortality in the country. Objective: To evaluate the change in the hospital mortality profile after investigation of deaths certified with GC in 2017 in Belo Horizonte, Brazil. Methods: A sample of hospital deaths reported with GC in the Mortality Information System (SIM) of Belo Horizonte in 2017 was investigated and subsequently certified by a physician to compare the mortality profile before and after investigation. Results: After investigating 1,395 deaths out of 3,038 reported with GC, a reduction of 35.5% of these causes was observed. Groups of all ages presented decreases in GC occurrence. A higher proportional increase was observed for deaths due to ischemic heart diseases, Alzheimer's disease, chronic obstructive pulmonary disease, ischemic and hemorrhagic stroke, and external causes of death (accidental falls, homicides and traffic/transport accidents). Conclusion: The investigation on reported hospital deaths is one of the strategies to improve mortality statistics, reducing the occurrence of GC among reported deaths and changing the mortality profile in these facilities. The importance of continuous physician training in cause-of-death certification is emphasized.

Tempus Actas de Saúde Coletiva, Dec 29, 2010

Bjog: An International Journal Of Obstetrics And Gynaecology, Sep 12, 2007

In Brazil, it was previously reported that in hospital perinatal, neonatal and infant mortality r... more In Brazil, it was previously reported that in hospital perinatal, neonatal and infant mortality rates are higher for hospitals contracted to the National Public Health System (SUS) compared with non-SUS hospitals. We analyse whether this reflects a compositional effect (selection of patients) or a contextual effect. Population-based cohort study. Belo Horizonte, Brazil, 1999. A total of 36,469 births in 24 hospitals. A multilevel analysis was carried out using information gathered at the individual level on maternal education (used as an indicator of socio-economic status), maternal age, type of pregnancy and delivery, birthweight and sex of the fetus. Perinatal death. Risk factors for perinatal death included male sex (OR = 1.25; 95% CI 1.01-1.55), birthweight of 1500-2500 g (OR = 7.65; 95% CI 5.74-10.20), birthweight of 500-1500 g (OR = 187.54; 95% CI 141.31-248.39), less than 4 years of maternal education (OR = 2.93; 95% CI 1.68-5.10), as well as birth at private-SUS (OR = 2.92; 95% CI 1.87-4.54) or philanthropic-SUS hospitals (OR = 1.81; 95% CI 1.12-2.92). After controlling for individual characteristics, there was still a significant variation in perinatal deaths between hospitals categories. Independent of compositional (or individual) characteristics, hospital factors exert an influence on the risk of perinatal death, primarily hospital category related to SUS. Considering the highest proportion of births in SUS hospitals in Brazil, especially private-SUS hospitals, improving hospital quality of care is an urgent priority for reducing the toll of perinatal and infant mortality, as well as inequalities in these outcomes.

American Journal of Public Health, May 1, 2007

Objectives. We examined the contribution of hospital type and quality of care to perinatal mortal... more Objectives. We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil.Methods. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category—defined by a hospital’s relation to the national Universal Public Health System (SUS)—and quality of care. We used the Wigglesworth Classification to examine perinatal deaths.Results. After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death.Conclusions. In a class-segregated health care system, such as Brazil’s, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.

BMC Pregnancy and Childbirth, Oct 12, 2022

Background While maternal health is a priority in international goals, maternal health outcomes r... more Background While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country's maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality. Methods The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis. Results Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37-4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67-34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09-3.72), and be low and mid-level income compared to women with high income. Conclusion This study's findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.

Revista medica de Minas Gerais, 1996

European journal of public health, Sep 1, 2020

Journal of Epidemiology and Community Health, Aug 1, 2011

Cadernos de Saúde Pública, 2024

Journal of Epidemiology and Community Health, Aug 1, 2011

Materials and Methods Cluster random sampling in two states (Uttar Pradesh and Haryana) was used.... more Materials and Methods Cluster random sampling in two states (Uttar Pradesh and Haryana) was used. A sample of 100 000 people per district, with four districts per state was identified. Twenty per cent were selected from urban areas and rest from four randomly selected PHCs. In rural areas the survey was conducted with the help of ASHA workers and in Urban areas by the Urban Team. ASHA workers were provided with 2 days of comprehensive training and urban team was also trained. Results We found that the total disability rate (TDR) was 67.3/ 10 000 populationd77.4/10 000 in males and 56.7/10 000 in females (p<0.001). The TDR was significantly higher in urban areas than in rural areas (83.2/10 000 vs 62.9/10 000, p<0.001). The same trend was observed at the state level. The data show that 58.2% of the total disability was due to locomotors defects only (polio, paralysis, epilepsy, congenital and trauma) followed by blindness and multiple disabilities. Further data will be available for the Congress.

Saúde em Redes, Jun 20, 2018

De quem é este bebê? Construção, desconstrução e resistência pelo direito de mães e bebês em Belo... more De quem é este bebê? Construção, desconstrução e resistência pelo direito de mães e bebês em Belo Horizonte Whose baby is this? Deconstruc on, reconstruc on and resistence on the right of women and their newborn in Belo Horizonte, Brazil Saúde da mulher; Direitos humanos; Saúde da criança; Adoção

Revista Brasileira de Saúde Materno Infantil, Dec 1, 2015

Objectives: to examine the profile of avoidable infant deaths investigated and produce a concorda... more Objectives: to examine the profile of avoidable infant deaths investigated and produce a concordance between the basic cause declared on the original death certificate (DO) and the one produced after investigation. Methods: a population-based study examining infant deaths and avoidable deaths investigated by the Belo Horizonte Death Prevention Committee (CMPOFI), in 2010 and 2011. The death certificate issued after investigation was based on analysis of data from outpatient centers, hospitals and households conducted by the CMPOFI. The causes of death were codified according to the 10th edition of the International Statistical Classification of Diseases and Problems Related to Health and the basic cause selected. The concordance between the basic cause of death on the original death certificate and on the one produced after investigation, analyzed according to the reduced list tabulating the causes of infant mortality (LIR-MI), was determined using the Kappa index. Results: the Kappa index was weak (K=0.389; CI95%: 0.192-5.76) when evaluated using the LIR-MI groups. There were significant changes in the cause of death after investigation, with an increase in the proportion of deaths from asphyxia, maternal factors, child infections, perinatal infections, external causes and sudden infant death syndrome. Conclusions: the investigation of deaths shed greater light on the circumstances of avoidable infant deaths and the classification of the basic cause, which are fundamental steps in guiding action to prevent such deaths.

Escola Anna Nery, 2016

Práticas na assistência ao parto em maternidades com inserção de enfermeiras obstétricas, em Belo... more Práticas na assistência ao parto em maternidades com inserção de enfermeiras obstétricas, em Belo Horizonte, Minas Gerais Prácticas de atención al parto en maternidades con inclusión de enfermeras obstetras en maternidades de

Reproductive Health Matters, Mar 1, 2012

This paper addresses equity in health and health care in Brazil, examining unjust disparities bet... more This paper addresses equity in health and health care in Brazil, examining unjust disparities between women and men, and between women from different social strata, with a focus on services for contraception, abortion and pregnancy. In 2010 women's life expectancy was 77.6 years, men's was 69.7 years. Women are two-thirds of public hospital services users and assess their health status less positively than men. The total fertility rate was 1.8 in 2011, and contraceptive prevalence has been high among women at all income levels. The proportion of sterilizations has decreased; lower-income women are more frequently sterilized. Abortions are mostly illegal; women with more money have better access to safe abortions in private clinics. Poorer women generally self-induce abortion with misoprostol, seeking treatment of complications from public clinics. Institutional violence on the part of health professionals is reported by half of women receiving abortion care and a quarter of women during childbirth. Maternity care is virtually universal. The public sector has fewer caesarean sections, fewer low birthweight babies, and more rooming-in, but excessive episiotomies and inductions. Privacy, continuity of care and companionship during birth are more common in the private sector. To achieve equity, the health system must go beyond universal, unregulated access to technology, and move towards safe, effective and transparent care.

Anais, Nov 4, 2016

Tradicionalmente, as mortes infantis têm sido analisadas segundo capítulos da Classificação Inter... more Tradicionalmente, as mortes infantis têm sido analisadas segundo capítulos da Classificação Internacional de Doenças (CID) e, no Brasil, prevalecem as afecções perinatais como principal causa de óbito. O grupo das afecções perinatais, entretanto, reúne causas que demandam intervenções bastante diferenciadas, algumas delas consideradas com maior potencial de evitabilidade. Este estudo utiliza uma classificação detalhada das causas perinatais dos óbitos infantis, baseada em estratégias comuns para sua prevenção, com o objetivo de tentar traduzir melhor os dados em informação adequada para as políticas de saúde infantil. Métodos: Foram utilizados os dados de óbitos do Sistema de Informação sobre Mortalidade-SIM para o período de 1996 a 2010. As causas de morte foram analisadas segundo a lista de tabulação oficial brasileira (CID-BR) e também segundo uma proposta de lista reduzida de tabulação para mortalidade infantil (LIR-MI), com seis categorias de causas perinatais e sete não perinatais. Para minimizar viés de informação devido a problemas na qualidade do dado registrado, foram utilizadas taxas de mortalidade infantil estimadas e os óbitos por causas mal definidas e inespecíficas foram redistribuídos entre as causas definidas. Resultados: As afecções perinatais aumentaram a sua contribuição relativa entre os óbitos infantis no período analisado, representando em 2010 cerca de 60% dos óbitos infantis. Pela CID-BR os transtornos respiratórios e cardiovasculares específicos do período neonatal, que agrupa causas diferenciadas de afecções perinatais, aparecem como

Divulg. saúde debate, 2006

Revista Brasileira De Epidemiologia, 2019

Introduction: Deaths certified with ill-defined causes or garbage codes (GC) compromise the analy... more Introduction: Deaths certified with ill-defined causes or garbage codes (GC) compromise the analysis of mortality and its use for planning and evaluation of public health policies. The hospital investigation of these causes is one of the strategies qualifying the profile of mortality in the country. Objective: To evaluate the change in the hospital mortality profile after investigation of deaths certified with GC in 2017 in Belo Horizonte, Brazil. Methods: A sample of hospital deaths reported with GC in the Mortality Information System (SIM) of Belo Horizonte in 2017 was investigated and subsequently certified by a physician to compare the mortality profile before and after investigation. Results: After investigating 1,395 deaths out of 3,038 reported with GC, a reduction of 35.5% of these causes was observed. Groups of all ages presented decreases in GC occurrence. A higher proportional increase was observed for deaths due to ischemic heart diseases, Alzheimer's disease, chronic obstructive pulmonary disease, ischemic and hemorrhagic stroke, and external causes of death (accidental falls, homicides and traffic/transport accidents). Conclusion: The investigation on reported hospital deaths is one of the strategies to improve mortality statistics, reducing the occurrence of GC among reported deaths and changing the mortality profile in these facilities. The importance of continuous physician training in cause-of-death certification is emphasized.

Tempus Actas de Saúde Coletiva, Dec 29, 2010

Bjog: An International Journal Of Obstetrics And Gynaecology, Sep 12, 2007

In Brazil, it was previously reported that in hospital perinatal, neonatal and infant mortality r... more In Brazil, it was previously reported that in hospital perinatal, neonatal and infant mortality rates are higher for hospitals contracted to the National Public Health System (SUS) compared with non-SUS hospitals. We analyse whether this reflects a compositional effect (selection of patients) or a contextual effect. Population-based cohort study. Belo Horizonte, Brazil, 1999. A total of 36,469 births in 24 hospitals. A multilevel analysis was carried out using information gathered at the individual level on maternal education (used as an indicator of socio-economic status), maternal age, type of pregnancy and delivery, birthweight and sex of the fetus. Perinatal death. Risk factors for perinatal death included male sex (OR = 1.25; 95% CI 1.01-1.55), birthweight of 1500-2500 g (OR = 7.65; 95% CI 5.74-10.20), birthweight of 500-1500 g (OR = 187.54; 95% CI 141.31-248.39), less than 4 years of maternal education (OR = 2.93; 95% CI 1.68-5.10), as well as birth at private-SUS (OR = 2.92; 95% CI 1.87-4.54) or philanthropic-SUS hospitals (OR = 1.81; 95% CI 1.12-2.92). After controlling for individual characteristics, there was still a significant variation in perinatal deaths between hospitals categories. Independent of compositional (or individual) characteristics, hospital factors exert an influence on the risk of perinatal death, primarily hospital category related to SUS. Considering the highest proportion of births in SUS hospitals in Brazil, especially private-SUS hospitals, improving hospital quality of care is an urgent priority for reducing the toll of perinatal and infant mortality, as well as inequalities in these outcomes.

American Journal of Public Health, May 1, 2007

Objectives. We examined the contribution of hospital type and quality of care to perinatal mortal... more Objectives. We examined the contribution of hospital type and quality of care to perinatal mortality rates in the city of Belo Horizonte, Brazil.Methods. We used a cohort study of all births (40953) and perinatal deaths (826) in Belo Horizonte in1999. After adjusting for maternal education and birthweight, we compared mortality rates according to hospital category—defined by a hospital’s relation to the national Universal Public Health System (SUS)—and quality of care. We used the Wigglesworth Classification to examine perinatal deaths.Results. After we controlled for birthweight and maternal education, the highest perinatal death rates were observed in private and philanthropic SUS-contracted hospitals (relative to private, non-SUS-contracted hospitals). Hospital quality was also directly associated with perinatal death rates. Mortality rates were especially high for normal-birthweight babies born in private SUS-contracted hospitals. Intrapartum asphyxia was the leading cause of preventable death.Conclusions. In a class-segregated health care system, such as Brazil’s, disparities in quality of care between SUS-contracted and non-SUS-contracted hospitals contribute to the unacceptably high rates of perinatal mortality.

BMC Pregnancy and Childbirth, Oct 12, 2022

Background While maternal health is a priority in international goals, maternal health outcomes r... more Background While maternal health is a priority in international goals, maternal health outcomes remain poor in many regions of the world. In Brazil, maternal mortality has decreased over the past decades, but the country's maternal mortality ratio is higher than over half of all countries at 59 deaths per 100,000 live births. The Brazilian maternal health care model facilitates high rates of medical interventions during labor and childbirth; 56% of births are by cesarean birth. Doula support is considered a potential strategy to reduce medically unnecessary interventions during childbirth that contribute to maternal mortality. Methods The cross-sectional study analyses associations with use of doula support and normal birth among Brazilian women who participated in a health education intervention named the Senses of Birth (SoB). The SoB intervention, implemented in five cities from 2015 to 2017, was developed to educate about normal birth and to evidence-based practices (EBP) reduce medically in childbirth. Chi-Square tests were performed to identify the relationship between doula support during childbirth and sociodemographic characteristics, childbirth information, perceived knowledge, and use of EBPs during labor. Logistic regression was performed to identify associations in adjusted analysis. Results Controlling for covariates, doula support was associated with vaginal delivery (OR 2.47, 95% CI: 1.37-4.45.) Findings also suggest that women who had doula support were more likely to use non-pharmacological pain relief methods during labor (OR 9.68, 95% CI: 2.67-34.61), deliver in a public hospital (OR 2.02, 95% CI: 1.09-3.72), and be low and mid-level income compared to women with high income. Conclusion This study's findings suggest that doula support is significantly associated with vaginal birth. The results may be useful for advocating for changes to the childbirth care model in Brazil. Incorporating EBPs, such as doula support, for all women who desire may improve maternal and child outcomes.

Revista medica de Minas Gerais, 1996

European journal of public health, Sep 1, 2020

Journal of Epidemiology and Community Health, Aug 1, 2011