Abstract
BackgroundThe 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.MethodsIn 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%.ResultsThe 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.ConclusionsIt 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.
Highlights
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
It was concluded that the Family Health Care Strategy was a Primary Care organization model that contributed to the reduction in infant and maternal mortality rates, and so did actors such as Human Development Index (HDI) and cesarean section
Public health managers should prefer this model when planning the organization of Primary Care services for the population
Summary
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. Maternal and infant mortality are serious public health events and the majority of these are readily preventable This has allowed them to be considered the best indicators of the standard of living and social well-being of a population [1]. Infant mortality has two additional dimensions, the neonatal mortality rate, which is the probability of a child dying during the period from 0 to days of life, expressed per 1000 live births, and the post neonatal period, in which a child dies within days up to completing 1 year of age, expressed per 1000 live births. The desired goals of the Millennium Development Goals were not met, because despite the reduction of approximately 45% in maternal mortality and over 50% in neonatal and infant mortality, these events occurred in heterogeneous ways, with smaller or even lower reductions in the most vulnerable populations [4]
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