Evaluation of the impact of the Family Health Program on infant mortality in Brazil, 1990-2002.
OBJECTIVE
To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s.


METHODS
Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10,000 population, and hospital beds per 1,000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections.


METHODS
13 years (1990-2002) of data from 27 Brazilian states.


RESULTS
From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1,000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1,000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous.


CONCLUSIONS
The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.
Macinko
James
J
Department of Nutrition, Food Studies, and Public Health, New York University, New York, NY 10012-1172, USA. james.macinko@nyu.edu
Guanais
Frederico C
FC
de Fátima
Maria
M
de Souza
Marinho
M
D001938:Brazil / Q000453:epidemiology; D002662:Child Health Services / Q000458:organization & administration; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D003906:Developing Countries; D005192:Family Health; D005260:Female; D006293:Health Promotion / Q000592:standards*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D015397:Program Evaluation; D012307:Risk Factors