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Health capabilities and the determinants of infant mortality in Brazil, 2004-2015: an innovative methodological framework.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001-
    • Subject Terms:
      Income* ; Infant Mortality*; Brazil/epidemiology ; Child ; Educational Status ; Female ; Humans ; Infant ; Infant, Newborn ; Mortality ; Pregnancy ; Socioeconomic Factors
    • Abstract:
      Background: Despite the implementation of a set of social and health policies, Brazil has experienced a slowdown in the decline of infant mortality, regional disparities and persistent high death levels, raising questions about the determinants of infant mortality after the implementation of these policies. The objective of this article is to propose a methodological approach aiming at identifying the determinants of infant mortality in Brazil after the implementation of those policies.
      Method: A series of multilevel panel data with fixed effect nested within-clusters were conducted supported by the concept of health capabilities based on data from 26 Brazilian states between 2004 and 2015. The dependent variables were the neonatal, the infant and the under-five mortality rates. The independent variables were the employment rate, per capita income, Bolsa Família Program coverage, the fertility rate, educational attainment, the number of live births by prenatal visits, the number of health professionals per thousand inhabitants, and the access to water supply and sewage services. We also used different time lags of employment rate to identify the impact of employment on the infant mortality rates over time, and household income stratified by minimum wages to analyze their effects on these rates.
      Results: The results showed that in addition to variables associated with infant mortality in previous studies, such as Bolsa Família Program, per capita income and fertility rate, other factors affect child mortality. Educational attainment, quality of prenatal care and access to health professionals are also elements impacting infant deaths. The results also identified an association between employment rate and different infant mortality rates, with employment impacting neonatal mortality up to 3 years and that a family income below 2 minimum wages increases the odds of infant deaths.
      Conclusion: The results proved that the methodology proposed allowed the use of variables based on aggregated data that could hardly be used by other methodologies.
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    • Contributed Indexing:
      Keywords: Health capabilities; Health economics; Infant mortality; Multilevel panel data with fixed effect nested within-clusters; Public policies; Social determinants of health
    • Publication Date:
      Date Created: 20210501 Date Completed: 20210524 Latest Revision: 20240401
    • Publication Date:
      20240401
    • Accession Number:
      PMC8086285
    • Accession Number:
      10.1186/s12889-021-10903-9
    • Accession Number:
      33931073