The Combined Effects of the Expansion of Primary Health Care and Conditional Cash Transfers on Infant Mortality in Brazil, 1998-2010
The Combined Effects of the Expansion of Primary Health Care and Conditional Cash Transfers on Infant Mortality in Brazil, 1998-2010
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DOI：
10.2105/ajph.2013.301452
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发表时间：
2013-11-01
影响因子：
12.7
通讯作者：
Guanais, Frederico C.
中科院分区：
文献类型：
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作者：
Guanais, Frederico C.
目标。我考察了通过家庭健康计划（FHP）获得初级保健和家庭津贴计划（BFP）有条件现金转移对巴西新生儿后期死亡率（PNIM）的综合影响。本文采用纵向生态分析方法，利用1998 - 2010年巴西4583个城市的面板数据，共54 253个观测值。我估计了固定效应的普通最小二乘回归模型，以PNIM率为因变量，FHP、BFP及其相互作用为主要的自变量。高FHP盖度与低PNIM的相关性随着BFP盖度的增加而增强。在所有其他变量的平均值上，当BFP覆盖率为25%时，对于FHP覆盖率为0%的预测PNIM为5.24(95%置信区间[CI] = 4.95, 5.53)，对于FHP覆盖率为100%的预测PNIM为3.54 （95% CI = 2.77, 4.31）。当BFP覆盖率为60%时，当FHP覆盖率为0%时，预测PNIM为4.65 (95% CI = 4.36, 4.94)；当FHP覆盖率为100%时，预测PNIM为1.38 （95% CI = 0.88, 1.89）。FHP的效果取决于BFP的扩展。对于贫困和服务不足的人口，可能需要结合供需方面的干预措施来改善健康结果。
Objectives. I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil.Methods. I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54 253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest.Results. The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%.Conclusions. The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply-and demand-side interventions may be necessary to improve health outcomes.