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Viegas da Silva E, Hartwig FP, Yousafzai A, Bertoldi AD, Murray J. The effects of a large-scale home visiting programme for child development on use of health services in Brazil. Health Policy Plan 2024; 39:344-354. [PMID: 38491997 PMCID: PMC11005834 DOI: 10.1093/heapol/czae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/22/2023] [Accepted: 02/23/2024] [Indexed: 03/18/2024] Open
Abstract
Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01-1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated.
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Affiliation(s)
- Eduardo Viegas da Silva
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
- Human Development and Violence Research Centre (DOVE), Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
- State Health Surveillance Centre, State Health Department, Rio Grande do Sul, Ipiranga - 5400, Porto Alegre, RS 90610000, Brazil
| | - Fernando Pires Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
| | - Aisha Yousafzai
- Department of Global Health and Population, Harvard School of Public Health, 677 - Huntington Avenue, Boston, MA 02115, United States
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
- Human Development and Violence Research Centre (DOVE), Postgraduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro - 1160, Pelotas, RS 96020220, Brazil
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