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ABSTRACT: Objective
Evaluate how coverage and quality of primary health care (PHC) and a conditional cash transfer (CCT) program associate with child mortality in Brazil.Methods
Multivariate linear regression models and least absolute shrinkage and selection estimator (LASSO) were utilized with the municipal level child mortality rate as the key dependent variable. PHC quality with PHC and CCT coverage were the independent variables. The quality of the Brazilian PHC was assessed using the Brazilian National Program for Access and Quality Improvement in PHC data. PHC and CCT coverage were calculated based on Brazilian official databases. Human developmental index (HDI), municipality size, and country region were used as control variables. A total of 3441 municipalities were evaluated.Results
We found that ESF (Estratégia Saúde da Família) quality variables PLANNING [Family Health Team Planning activities], CITYSUPPORT [municipality support for Family Health Strategy activities], EXAMS [exams offered and priority groups seen by the family health team], and PRENATAL [prenatal care and exams provided by the family health team], as well as HDI, percentage of PHC coverage, percentage of CCT coverage, and population size have significant and negative relationships with 1-year-old child mortality. LASSO regression results confirmed these associations. Quality is an important element of effective social service provision.Conclusion
This exploration represents one of the first investigations into the role of PHC system quality, and how it is related to health outcomes, while also considering PHC and conditional cash transfer program coverage. Quality of PHC, measured by work process variables, plays an important role in child mortality. Efforts on PHC quality and coverage, as well as on CCT program coverage, are important to child mortality reduction. Therefore, this is an important finding to other PHC public health services.
SUBMITTER: Vieira-Meyer APGF
PROVIDER: S-EPMC6964587 | biostudies-literature | 2019 Dec
REPOSITORIES: biostudies-literature
Vieira-Meyer Anya Pimentel Gomes Fernandes APGF de Araújo Dias Maria Socorro MS Vasconcelos Maristela Ines Osawa MIO Rouberte Emilia Soares Chaves ESC de Almeida Ana Mattos Brito AMB de Albuquerque Pinheiro Themis Xavier TX de Lima Saintrain Maria Vieira MV Machado Maria de Fatima Antero Sousa MFAS Dufault Suzanne S Reynolds Sarah Ann SA Fernald Lia L
Canadian journal of public health = Revue canadienne de sante publique 20190729 6
<h4>Objective</h4>Evaluate how coverage and quality of primary health care (PHC) and a conditional cash transfer (CCT) program associate with child mortality in Brazil.<h4>Methods</h4>Multivariate linear regression models and least absolute shrinkage and selection estimator (LASSO) were utilized with the municipal level child mortality rate as the key dependent variable. PHC quality with PHC and CCT coverage were the independent variables. The quality of the Brazilian PHC was assessed using the ...[more]