Health capabilities and the determinants of infant mortality in Brazil, 2004\u20132015: an innovative methodological framework

Alexandre Bugelli,Roxane Borgès Da Silva,Claude Sicotte,Ladislau Dowbor

doi:10.1186/s12889-021-10903-9

Abstract

BackgroundDespite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies.MethodA series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates.ResultsThe results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths.ConclusionThe results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.

Highlights

Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies
The results identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths
Other studies on infant mortality in Brazil relied on larger datasets for the analysis of the factors impacting infant mortality in Brazil after the implementation of Family Health Strategy (FHS) and Bolsa Família Program (BFP), our models relied on a longer observational window that allowed us to infer more about specific factors related to infant mortality rates such as the relation between the employment rate and different indicators of infant mortality and between the BFP and the neonatal mortality rate or the threshold of

Summary

Introduction

Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. Context Despite the implementation of a set of social and health policies aiming at improving the health of its populations [1], Brazil has experienced since 2009 a slower decline in infant mortality rates [2], recording major regional disparities and persistent high death levels [3, 4]. Such facts raise questions about the determinants of infant mortality after the implementation of those policies and their role as levers to grant a sustainable decline in infant mortality in Brazil.

Objectives

Methods

Results

Discussion

Conclusion