Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Thomas Hone; Jasper V Been; Valeria Saraceni; Claudia Medina Coeli; Anete Trajman; Davide Rasella; Betina Durovni; Christopher Millett

doi:10.1016/j.lana.2023.100519

Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Lancet Reg Health Am. 2023 May 25:22:100519. doi: 10.1016/j.lana.2023.100519. eCollection 2023 Jun.

Authors

Thomas Hone¹, Jasper V Been², Valeria Saraceni³, Claudia Medina Coeli⁴, Anete Trajman⁴, Davide Rasella^{1

5

6}, Betina Durovni³, Christopher Millett^{1

7}

Affiliations

¹ Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
² Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Department of Obstetrics and Gynaecology, and Department of Public Health, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
³ Health Surveillance Branch, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil.
⁴ Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil.
⁶ ISGlobal, Hospital Clínic- Universitat de Barcelona, Barcelona, Spain.
⁷ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.

Abstract

Background: Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality.

Methods: A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms.

Results: A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth.

Interpretation: Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits.

Funding: DFID/MRC/Wellcome Trust/ESRC.

Keywords: Brazil; Infant health; Infant mortality; Primary care; Universal health coverage.

Grants and funding

MR/P014593/1/MRC_/Medical Research Council/United Kingdom