1
|
Alves FJO, Ramos D, Paixão ES, Falcão IR, de Cássia Ribeiro-Silva R, Fiaccone R, Rasella D, Teixeira C, Machado DB, Rocha A, de Almeida MF, Goes EF, Rodrigues LC, Ichihara MY, Aquino EML, Barreto ML. Association of Conditional Cash Transfers With Maternal Mortality Using the 100 Million Brazilian Cohort. JAMA Netw Open 2023; 6:e230070. [PMID: 36821115 PMCID: PMC9951038 DOI: 10.1001/jamanetworkopen.2023.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Conditional cash transfers (CCTs) have been consistently associated with improvements to the determinants of maternal health, but there have been insufficient investigations regarding their effects on maternal mortality. OBJECTIVE To evaluate the association between being a Bolsa Família program (BFP) beneficiary and maternal mortality and to examine how this association differs by duration of BFP receipt, maternal race, living in rural or urban areas, the Municipal Human Development Index (MHDI), and municipal primary health care coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis was nested within the 100 Million Brazilian Cohort. Girls and women aged 10 to 49 years (hereinafter referred to as women) who had at least 1 live birth were included, using data from Brazilian national health databases linked to the 100 Million Brazilian Cohort (January 1, 2004, to December 31, 2015). Propensity score kernel weighting was applied to control for sociodemographic and economic confounders in the association between BFP receipt and maternal mortality, overall and stratified by different subgroups (race, urban or rural area, and MHDI), and duration of BFP receipt. Data were analyzed from July 12, 2019, to December 31, 2022. MAIN OUTCOME(S) AND MEASURES Maternal death. RESULTS A total of 6 677 273 women aged 10 to 49 years were included in the analysis, 4056 of whom had died from pregnancy-related causes. The risk of maternal death was 18% lower in women who received BFP (weighted odds ratio [OR], 0.82 [95% CI, 0.71-0.93]). A longer duration receiving BFP was associated with an increased reduction in maternal mortality (OR for 1-4 years, 0.85 [95% CI, 0.75-0.97]; OR for 5-8 years, 0.70 [95% CI, 0.60-0.82]; OR for ≥9 years, 0.69 [95% CI, 0.53-0.88]). Receiving BFP was also associated with substantial increases in the number of prenatal appointments and interbirth intervals. The reduction was more pronounced in the most vulnerable groups. CONCLUSIONS AND RELEVANCE This cross-sectional analysis nested within the 100 Million Brazilian Cohort found an association between BFP receipt and maternal mortality. This association was of greater magnitude in women with longer exposure to BFP and in the most vulnerable groups. These findings reinforce evidence that programs such as BFP, which have already proven effective in poverty reduction, have great potential to improve maternal survival.
Collapse
Affiliation(s)
- Flávia Jôse O. Alves
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Dandara Ramos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Enny S. Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ila R. Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Daiane Borges Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Aline Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Emanuelle F. Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
- Iyaleta Research Association, Salvador, Brazil
| | - Laura C. Rodrigues
- Infectious Disease Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Estela M. L. Aquino
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| | - Maurício L. Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Brazil
| |
Collapse
|
2
|
Cardilli-Dias D, Stoianov M, Santos THF, Molini-Avejonas DR. Potencialidades e fragilidades na rede de cuidados do bebê de alto risco. Rev Esc Enferm USP 2023. [DOI: 10.1590/1980-220x-reeusp-2022-0150pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
RESUMO Objetivo: caracterizar a Rede Cegonha na atenção à saúde ao bebê de alto risco, apontando seus principais desafios. Método: questionários foram aplicados com os responsáveis pelos bebês e com os profissionais de saúde da rede. Os dados foram analisados quantitativamente. Resultados: as variáveis estatisticamente relevantes foram: vínculo com a Unidade Básica de Saúde; conhecimento dos indivíduos sobre a equipe Núcleos de Apoio à Saúde da Família; ciência das equipes de Saúde da Família quanto ao diagnóstico de gravidez de risco e adesão ao pré-natal; via de comunicação do nascimento dos indivíduos; ciência quanto à necessidade de internação hospitalar, bem como sua duração; conhecimento sobre acompanhamento na Atenção Secundária à Saúde; e o desfecho do mesmo, apontando para uma dificuldade no eixo da coordenação e longitudinalidade dos serviços prestados na rede. Conclusão os maiores desafios estão na cobertura do território pelas equipes de estratégia de Saúde da Família, na ampliação de equipes e na solidificação das parcerias com as Instituições de Ensino Superior, garantindo uma formação profissional diferenciada.
Collapse
|
3
|
Cardilli-Dias D, Stoianov M, Santos THF, Molini-Avejonas DR. Strengths and weaknesses in the high-risk baby care network. Rev Esc Enferm USP 2023; 57:e20220150. [PMID: 36946250 PMCID: PMC10081596 DOI: 10.1590/1980-220x-reeusp-2022-0150en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 11/25/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To characterize the Stork Network in health care for high-risk babies, pointing out its main challenges. METHOD questionnaires were applied with those responsible for the babies and with network health professionals. Data were analyzed quantitatively. RESULTS statistically relevant variables were: link with the Basic Health Unit; individuals' awareness of Family Health Support Center team; awareness of Family Health teams regarding the diagnosis of high-risk pregnancy and compliance with prenatal care; means of communication of individuals' birth; awareness of the need for hospitalization as well as its duration; awareness of follow-up in Secondary Health Care; and its outcome, pointing to a difficulty in the axis of coordination and longitudinality of the services provided in the network. CONCLUSION the greatest challenges lie in covering the territory by Family Health strategy teams, expanding teams and solidifying partnerships with Higher Education Institutions, guaranteeing a differentiated professional training.
Collapse
Affiliation(s)
- Daniela Cardilli-Dias
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | | | - Thaís Helena Ferreira Santos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudologia e Terapia Ocupacional, São Paulo, SP, Brazil
| | - Daniela Regina Molini-Avejonas
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudologia e Terapia Ocupacional, São Paulo, SP, Brazil
| |
Collapse
|
4
|
Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KAM. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
Collapse
Affiliation(s)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| |
Collapse
|
5
|
Diaz MDM, Teixeira AD, Postali FAS, Ferreira-Batista NN, Moreno-Serra R. Assessment of the Association between the Brazilian Family Health Strategy and Adult Mortality. Health Policy Plan 2022; 37:461-471. [DOI: 10.1093/heapol/czac011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct association of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discussed heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension, and diabetes.. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasise the role of having sufficient health teams to attend to the population.
Collapse
|