The Determinants of Infant Mortality in Brazil, 2010-2020: A Scoping Review.

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

doi:10.3390/ijerph18126464

Abstract

Despite the implementation of social and health policies that positively affected the health of the populations in Brazil, since 2009 the country has experienced a slower decline of infant mortality. After an economic and political crisis, Brazil witnessed increases in infant mortality that raised questions about what are the determinants of infant mortality after the implementation of such policies. We conducted a scoping review to identify and summarize those determinants with searches in three databases: LILACS, MEDLINE, and SCIELO. We included studies published between 2010 and 2020. We selected 23 papers: 83% associated infant mortality with public policies; 78% related infant mortality with the use of the health system and socioeconomic and living conditions; and 27% related to individual characteristics to infant mortality. Inequalities in the access to healthcare seem to have important implications in reducing infant mortality. Socioeconomic conditions and health-related factors such as income, education, fertility, housing, and the Bolsa Família. Program coverage was pointed out as the main determinants of infant mortality. Likewise, recent changes in infant mortality in Brazil are likely related to these factors. We also identified a gap in terms of studies on a possible association between employment and infant mortality.

Highlights

As a useful resource applied to other studies of the determinants of health that used an adapted framework on the determinants of health [22], we introduced some changes in the original Conceptual Model of Health Capability (CMHC) framework, in order to identify the factors that are likely to effect on infant mortality in Brazil
With regard individual factors linked to the internal dimension of the CMHC, the results suggest that age and maternal education are factors subject to confusion when associated with low birth weight and infant mortality rates [39]
Socioeconomic conditions and health-related factors interacting in the four dimensions of the CMHC such as income, educational attainment, fertility rate, housing, access to healthcare, and the Bolsa Família Program (BFP) coverage rate were pointed out as the main determinants of infant mortality

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The infant mortality rate is a reliable indicator of population health and effectiveness of health systems that is capable of estimating the extent of social and health inequalities between populations [1,2,3]. Despite the implementation of a set of social and health policies that positively affected the health of population [4], since 2009, Brazil has been experiencing a slower decline in infant mortality [5] that has remained at high levels and presents significant regional disparities. In 2016, the country recorded an increase in the mortality of children under one and under five years old, which disrupted a 25-year downward trend [5,6]

Methods

Discussion

Conclusion