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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Can the primary health care model affect the determinants of neonatal, post-neonatal and maternal mortality? A study from Brazil

Authors: Alexandre Bergo Guerra, Luciane Miranda Guerra, Livia Fernandes Probst, Brunna Verna Castro Gondinho, Gláucia Maria Bovi Ambrosano, Estêvão Azevedo Melo, Valéria Silva Cândido Brizon, Jaqueline Vilela Bulgareli, Karine Laura Cortellazzi, Antonio Carlos Pereira

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

The state of São Paulo recorded a significant reduction in infant mortality from 1990 to 2013, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality (considering the neonatal and post-neonatal dimensions) and maternal mortality in the state of São Paulo, Brazil.

Methods

In this ecological study, data from national official open sources were used to conduct a population-based study. The units analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality (in both neonatal and post-neonatal dimensions) and maternal mortality rates were calculated for every 1000 live births, referring to 2013. Subsequently, the association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. For statistical analysis, we used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted “p” at 5%.

Results

The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates.

Conclusions

It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model when planning the organization of Primary Care services for the population.
Literature
1.
Ruiz JI, Nuhu K, McDaniel JT, Popoff F, Izcovich A, Criniti JM. Inequality as a Powerful Predictor of Infant and Maternal Mortality around the World. PLoS One. 2015; doi: 10.1371 / journal.pone.0140796.
2.
3.
4.
Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the un Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; doi: 10.1016 / S0140–6736(15)00838–7.
5.
6.
7.
8.
Victora CG, Aquino EM, Leal MC do, Monteiro CA, Barros FC, Szwarcwald CL. Maternal and child health in Brazil: progress and challenges. Lancet. 2011; doi: 10.1016 / S0140–6736(11)60138–4.
9.
10.
Mendes JDV, Osiano VLRL. A Mortalidade Materna no Estado de São Paulo. Brasil BEPA. 2013;10:17–29.
11.
Carvalho RA da S, Santos VS, Melo CM De, Gurgel RQ, Oliveira CC da C. Inequalities in health: living conditions and infant mortality in Northeastern Brazil. Rev Saude Publica. 2015; doi: 10.1590 / S0034–8910.2015049004794.
12.
Shi L. Primary care, infant mortality, and low birth weight in the states of the USA. J Epidemiol Community Heal. 2004; doi: 10.1136 / jech.2003.013078.
13.
Chuang K-Y, Sung P-W, Chang C-J, Chuang Y-C. Political and economic characteristics as moderators of the relationship between health services and infant mortality in less-developed countries. J Epidemiol Community Health. 2013; doi: 10.1136 / jech-2013-202685.
14.
15.
16.
17.
18.
SAS. SAS Software, Version 9,1, Cary. North Carolina: SAS Institute Inc. 1999. site. Accessed 01 Feb 2018.
19.
20.
Reside AE, VanDerWal J, Kutt A, Watson I, Williams S. Fire regime shifts affect bird species distributions. Divers Distrib. 2012; doi: 10.1111 / j.1472–4642.2011.00818.x.
21.
Lourenço E Do C, Guerra LM, Tuon RA, Vidal e Silva SMC, Ambrosano GMB, Corrente JE, et al. Variáveis de impacto na queda da mortalidade infantil no Estado de São Paulo, Brasil, no período de 1998 a 2008. Cien Saude Colet. 2014; doi: 10.1590 / 1413–81232014197.18822013.
22.
World Health Organization. VOSviewer software. 2015.
23.
Perry HB, Rassekh BM, Gupta S, Freeman PA. Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact. J Glob Health. 2017; doi: 10.7189 / jogh.07.010907.
24.
Victora CG, Aquino EM, Leal MC do, Monteiro CA, Barros FC, Szwarcwald CL. Maternal and child health in Brazil: Progress and challenges. Lancet. 2011; doi: 10.1016 / S0140–6736(11)60138–4.
25.
Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G, et al. Improvement of child survival in Mexico: the diagonal approach. Lancet. 2006; doi: 10.1016 / S0140–6736(06)69569-X.
26.
Barros FC, Matijasevich A, Requejo JH, Giugliani E, Maranhão AG, Monteiro CA, et al. Recent Trends in Maternal, Newborn, and Child Health in Brazil: Progress Toward Millennium Development Goals 4 and 5. Am J Public Health. 2010; doi: 10.2105 / AJPH.2010.196816.
27.
Mendes A da CG, Sá DA de, Miranda GMD, Lyra TM, Tavares RAW. Assistência pública de saúde no contexto da transição demográfica brasileira: exigências atuais e futuras. Cad Saude Publica. 2012; doi: 10.1590 / S0102-311X2012000500014.
28.
World Health Organisation Appropriate technology for birth. Lancet. 1985; doi: 10.1016 / S0140–6736(85)92750–3.
29.
Rosendo TMS De S, Roncalli AG. Near miss materno e iniquidades em saúde: análise de determinantes contextuais no Rio Grande do Norte, Brasil. Cien Saude Colet. 2016; doi: 10.1590 / 1413–81232015211.20802014.
30.
Souza JP, Cecatti JG, Parpinelli MA, Sousa MH de, Serruya SJ. Revisão sistemática sobre morbidade materna near miss. Cad Saude Publica. 2006; doi: 10.1590 / S0102-311X2006000200003.
31.
Frias PG de, Szwarcwald CL, Souza Jr PRB de, Almeida W da S De, Lira PIC. Correção de informações vitais: estimação da mortalidade infantil, Brasil, 2000–2009. Rev Saude Publica. 2013; doi: 10.1590 / S0034–8910.2013047004839.
32.
Girodo AM, Campos D, Bittencourt SD De A, Szwarcwald CL, França EB. Cobertura do Sistema de Informações sobre Nascidos Vivos e potenciais fontes de informação em municípios de pequeno porte em Minas Gerais, Brasil. Rev Bras Saúde Matern Infant. 2015; doi: 10.1590 / S1519–38292015000300007.
33.
34.
Maia LT De S, Souza WV De, Mendes A da CG. Diferenciais nos fatores de risco para a mortalidade infantil em cinco cidades brasileiras: um estudo de caso-controle com base no SIM e no SINASC. Cad Saude Publica. 2012; doi: 10.1590 / S0102-311X2012001100016.
35.
Nascimento EMR Do, Costa MDCN, Mota EL, Paim JS. Estudo de fatores de risco para óbitos de menores de um ano mediante compartilhamento de bancos de dados. Cad Saude Publica. 2008; doi: 10.1590 / S0102-311X2008001100014.
36.
Silva LP da, Moreira CMM, Amorim MHC, Castro DS de, Zandonade E. Avaliação da qualidade dos dados do Sistema de Informações sobre Nascidos Vivos e do Sistema de Informações sobre Mortalidade no período neonatal, Espírito Santo, Brasil, de 2007 a 2009. Cien Saude Colet. 2014; doi: 10.1590 / 1413–81232014197.08922013.
Metadata
Title
Can the primary health care model affect the determinants of neonatal, post-neonatal and maternal mortality? A study from Brazil
Authors
Alexandre Bergo Guerra
Luciane Miranda Guerra
Livia Fernandes Probst
Brunna Verna Castro Gondinho
Gláucia Maria Bovi Ambrosano
Estêvão Azevedo Melo
Valéria Silva Cândido Brizon
Jaqueline Vilela Bulgareli
Karine Laura Cortellazzi
Antonio Carlos Pereira
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-3953-0

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