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Two decades of primary health care expansion in latin america and child mortality: A multi-country evaluation study
1
Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Av. 12 de Octubre 1076 y Roca Ecuador
2
Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Ecuador
3
Institute of Collective Health, at the Federal University of Bahia (ISC-UFBA) Brazil
4
Institute of Collective Health, at the Federal University of Bahia (ISC-UFBA)
5
Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador Ecuador
6
School of Goverment, Universidad de los Andes Colombia
7
School of Goverment, Universidad de los Andes
8
Health Research Consortium - CISIDAT Mexico
9
Swiss Tropical and Public Health Institute, Department of Public Health and Epidemiology Switzerland
10
Center for Health Economics, University of York, UK United Kingdom
11
Institute of Global Health (ISGlobal), Barcelona, Spain Spain
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1143
ABSTRACT
Background:
There is an urgent need to understand how Primary Health Care (PHC) strategies in Latin American countries (LACs) can be developed, strengthened, and made more comprehensive, effective, and sustainable – especially given the need for cross-sectoral collaborative platforms to achieve the Sustainable Development Goals (SDGs). This study aimed to evaluate the long-term effect of PHC strategies on child mortality in Brazil, Ecuador, Mexico, and Colombia (BEMC).
Methods:
A multi-country study with a mixed ecological design was carried out. We created a longitudinal dataset (2000-2019) using secondary sources and the analysis included 5,647 municipalities with good quality of vital information. The PHC coverage was calculated and municipalities were classified into four groups: low, intermediate, high, and consolidated coverage. Dependent variables were neonatal, post-neonatal, infant, and child (under-5 and 1 to 4 years of age) mortality rates and under-5 mortality rate (U5MR) due to Primary Care Sensitive Conditions. A set of socioeconomic and health services covariables were used to adjust the models. The effect of PHC was evaluated using conditional negative binomial regression models for panel data with fixed-effects specification and the effect measure was the Rate Ratio (95% Confidence Interval).
Results:
In multivariate analysis, the consolidated PHC municipalities showed significant risk reductions of post-neonatal (27.2%), infant (13.4%), and child mortality (under-5: 18.7% and 1-4 years: 24.3%). A consolidated coverage of PHC was significantly related to lower U5MR by vaccine-preventable and sensitive conditions (RR 0.548; 95% CI 0.528-0.568), diarrhea (RR 0.442; 95% CI 0.421-0.465), anemia (RR 0.631; 95% CI 0.563-0.708), nutritional deficiencies (RR 0.556; 95% CI 0.525-0.588), and pulmonary diseases (RR 0.534; 95% CI 0.294-0.969).
Conclusion:
Despite the limitations of LACs health systems, promoting a PHC strategy has successfully contributed to improving child health. It is necessary to ensure this strategys expansion, sustainability, and equitable distribution.
There is an urgent need to understand how Primary Health Care (PHC) strategies in Latin American countries (LACs) can be developed, strengthened, and made more comprehensive, effective, and sustainable – especially given the need for cross-sectoral collaborative platforms to achieve the Sustainable Development Goals (SDGs). This study aimed to evaluate the long-term effect of PHC strategies on child mortality in Brazil, Ecuador, Mexico, and Colombia (BEMC).
Methods:
A multi-country study with a mixed ecological design was carried out. We created a longitudinal dataset (2000-2019) using secondary sources and the analysis included 5,647 municipalities with good quality of vital information. The PHC coverage was calculated and municipalities were classified into four groups: low, intermediate, high, and consolidated coverage. Dependent variables were neonatal, post-neonatal, infant, and child (under-5 and 1 to 4 years of age) mortality rates and under-5 mortality rate (U5MR) due to Primary Care Sensitive Conditions. A set of socioeconomic and health services covariables were used to adjust the models. The effect of PHC was evaluated using conditional negative binomial regression models for panel data with fixed-effects specification and the effect measure was the Rate Ratio (95% Confidence Interval).
Results:
In multivariate analysis, the consolidated PHC municipalities showed significant risk reductions of post-neonatal (27.2%), infant (13.4%), and child mortality (under-5: 18.7% and 1-4 years: 24.3%). A consolidated coverage of PHC was significantly related to lower U5MR by vaccine-preventable and sensitive conditions (RR 0.548; 95% CI 0.528-0.568), diarrhea (RR 0.442; 95% CI 0.421-0.465), anemia (RR 0.631; 95% CI 0.563-0.708), nutritional deficiencies (RR 0.556; 95% CI 0.525-0.588), and pulmonary diseases (RR 0.534; 95% CI 0.294-0.969).
Conclusion:
Despite the limitations of LACs health systems, promoting a PHC strategy has successfully contributed to improving child health. It is necessary to ensure this strategys expansion, sustainability, and equitable distribution.
| ISSN: | 2654-1459 |
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