Reducing childhood mortality from diarrhea and lower respiratory tract infections in Brazil

Abstract

OBJECTIVE: To evaluate the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care in Brazil, on mortality of children younger than 5 years, particularly from diarrheal diseases and lower respiratory tract infections. METHODS: Mortality rates and the extent of FHP coverage from 2000 to 2005 was evaluated from the 2601 (of 5507) Brazilian municipalities with an adequate quality of vital information. A multivariable regression analysis for panel data was conducted by using a negative binomial model with fixed effects, adjusted for relevant demographic and socioeconomic covariates. RESULTS: A statistically significant negative association was observed between FHP coverage levels, classified as none (the reference category), low (<30%), intermediate (≥30% and <70%), or high (≥70%), and all analyzed mortality rates, with a reduction of 4% (95% confidence interval [CI]: 2%–6%), 9% (95% CI: 7%–12%), and 13% (95% CI: 10%–15%), respectively, on mortality rates or children younger than 5. The greatest effect was on postneonatal mortality. Reductions of 31% (95% CI: 20%–40%) and 19% (95% CI: 8%–28%) in mortality rates from diarrheal diseases and lower respiratory infections, respectively, were found in the group of municipalities with the highest FHP coverage. CONCLUSIONS: The FHP, one of the largest comprehensive primary health care programs in the world, was effective in reducing overall mortality of children younger than 5, and particularly deaths related to diarrheal diseases and lower respiratory tract infections.