04/11/2024 - 17:20 - 18:50
RC9.14 - Fortalecimento das Políticas de Saúde Materno-Infantil: Desafios, Estratégias e Impactos na Atenção ao Pré-Natal e na Mortalidade Infantil no Brasil |
48600 - ASSOCIATION OF THE PREVINE BRASIL PROGRAM IN PRENATAL CARE AND MATERNAL-CHILD MORTALITY
CAIO VIEIRA DE BARROS ARATO - UNICAMP, LUCIANE MIRANDA GUERRA - UNICAMP, LIVIA PROBST - UNICAMP, ANTONIO CARLOS PEREIRA - UNICAMP
Apresentação/Introdução
Maternal mortality (MM) and infant mortality (IM) are significant public health challenges, preventable through prenatal care. MM is annual deaths related to pregnancy per 100,000 live births, while IM is infant death probability in the first year per 1,000 live births. Global efforts to reduce MM and IM have been uneven, with vulnerable groups seeing fewer improvements. Despite Brazilian initiatives, reductions remain limited. The "National Pact for the Reduction of Maternal and Neonatal Mortality" aimed to address this, but targets weren't fully met. While MM decreased from 141 to 68 deaths per 100,000 live births from 1990 to 2010, the goal of a ¾ reduction by 2015 was missed. Recent studies link MM and IM rates to contextual factors. In Brazil, policies like Previne Brasil aim to reduce MM and IM rates by increasing prenatal visits, but they focus on quantity over quality and overlook other influencing factors. This research investigates the impact of such quantitative approaches on prenatal care and mortality rates in Brazilian municipalities, particularly in the post-implementation context of Previne Brasil, aiming to understand how they affect health outcomes.
Objetivos
To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new financing model of Primary Health Care, the Previne Brasil program.
Metodologia
This study, conducted nationwide, used ecological-type epidemiology and followed STROBE guidelines. It analyzed data before (2016-2018) and after (2019-2022) the implementation of a new Primary Health Care (APS PB) financing model in Brazil. Municipalities were categorized based on changes in mortality and prenatal care rates post-implementation, as well as other variables like health care coverage and socioeconomic factors. Logistic regression analyses were conducted, estimating crude odds ratios and adjusted odds ratios for variables with p<0.20, and model fit was assessed using AIC. Results were analyzed using the R program, with a significance level of 5%.
Resultados e Discussão
This nationwide study analyzed data from 5,570 Brazilian municipalities before and after the implementation of a new financing model for Primary Health Care (APS PB). Following the new model, prenatal care rates increased in 86.7% of municipalities, but maternal mortality rates decreased in only 30.9%. There was no significant association between increased prenatal care and decreased maternal mortality. Factors such as region, primary health care coverage, GDP, and population size influenced maternal mortality rates, with the Southern region and municipalities with higher primary health care coverage showing greater reductions. Similarly, there was no significant correlation between increased prenatal care and decreased infant mortality. Factors like region, primary health care coverage, population size, and the Gini index affected infant mortality rates. The study suggests that while the new financing model improved prenatal care access, it didn't significantly impact maternal and infant mortality. It emphasizes the need for policies considering contextual and vulnerability factors to effectively mitigate maternal and infant mortality. Limitations include reliance on secondary data, focus on quantitative variables, and neglect of qualitative aspects of care. Future research should address these limitations for a more comprehensive understanding of maternal and infant mortality dynamics.
Conclusões/Considerações finais
It was concluded that the new financing model of the PHC Program PB led to an increase in prenatal consultations in Brazilian municipalities. However, it did not demonstrate a significant association with the reduction of maternal and infant mortality between the years 2019 and 2022.
Referências
Lawrence ER, Klein TJ, Beyuo TK. Maternal Mortality in Low and Middle-Income Countries. Obstet Gynecol Clin North Am. 2022;49(4):713-733.
Bugelli A, Borgès Da Silva R, Dowbor L, Sicotte C. The Determinants of Infant Mortality in Brazil, 2010-2020: A Scoping Review. Int J Environ Res Public Health. 2021;18(12):6464.
Alkema L, Chou D, Hogan D, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016;387(10017):462-474.
Morosini MVGC, Fonseca AF, Baptista TWF. Previne Brasil, the Agency for the Development of Primary Healthcare, and the Services Portfolio: radicalization of privatization policy in basic healthcare?. Cad Saude Publica. 2020;36(9):e00040220.
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