Effectiveness of Family Health Strategy on child's health indicators in São Paulo State

Venancio, Sonia Isoyama; Rosa, Tereza Etsuko da Costa; Sanches, Maria Teresa Cera; Shigeno, Elza Yoshie; Souza, José Maria Pacheco

doi:10.1590/1806-93042016000300004

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 16 (3) • Jul-Sep 2016 • https://doi.org/10.1590/1806-93042016000300004 copy

Effectiveness of Family Health Strategy on child's health indicators in São Paulo State

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the effectiveness of Family Health Strategy (FHS) on child's health indicators in São Paulo State.

Methods:

longitudinal ecological study involving all the towns in São Paulo State from 1998 to 2009. The outcomes were the coefficients of infant mortality and its components and the rate for pneumonia and diarrhea hospitalizations. The main independent variable was "FHS coverage"; the covariates considered the context of sociodemographic and the health system. Negative binomial regression models of fixed effects and STRATA 11.1 statistical program were used.

Results:

FHS coverage above 50% showed a protective effect in relation to the postneonatal mortality (RR: 0.93; CI 95%: 0.87-1.00) and coverage up to 50% (RR 0.88 CI95% 0.82-0.99) or above 50% (RR: 0.87; CI95%: 0.82-0.92) were protective factors for pneumonia hospitalizations.

Conclusions:

the effectiveness of FHS on the outcomes related to child's health may vary according to local and regional contexts.

Key words
Primary health care; Family health strategy; Child's health; Health assessment; Unified health system

	Infant mortality rate		Neonatal Mortality		Post-Neonatal Mortality
	Gross RR (CI 95%)	RR adjusted (CI 95%)	Gross RR (CI 95%)	RR adjusted (CI 95%)	Gross RR (CI 95%)	RR adjusted (CI95%)
FHS coverage
None	1.00	1.00	1.000	1.00	1.00	1.00
≤ 50%	0.81	0.98	0.824	0.99	0.80	0.96
	(0.79-0.83)	(0.95-1.00)	(0.802-0.846)	(0.96-1.01)	(0.77-0.83)	(0.92-1.00)
> 50%	0.75	0.97	0.766	1.00	0.71	0.93
	(0.72-0.78)	(0.93-1.01)	(0.731-0.803)	(0.95-1.05)	(0.66-0.76)	(0.86-0.99)
IPRS
3/4/5		1.00		1.00		1.00
1/2		0.99		0.98		1.01
		(0.94-1.04)		(0.92-1.04)		(0.92-1.10)
Birth rate		0.998		1.00		0.99
		(0.99-1.00)		(0.99-1.00)		(0.98-1.00)
Cesarean section rate		0.99		0.99		-
		(0.99-1.00)		(0.99-1.00)
ICU hospital beds rate		1.00		1.00		1.00
		(0.99-1.00)		(0.99-1.00)*		(0.99-1.00)
Health plans coverage		1.00		1.00		0.99
		(0.99-1.00)		(0.99-1.00)		(0.99-1.00)
Population size (inhab)
≤10.000		1.00		1.00		1.00
>10.000 ≤50.000		0.93		0.89		0.94
		(0.79-1.10)		(0.73-1.08)		(0.70-1.25)
>50.000		0.91		0.85		0.92
≤100.000		(0.75-1.09)		(0.68-1.07)		(0.65-1.28)
>100.000		0.92		0.85		0.95
		(0.76-1.11)		(0.67-1.07)		(0.68-1.34)
Year
1998		1.00		1.00		1.00
1999		0.93		0.95		0.88
		(0.91-0.95)		(0.92-0.98)		(0.85-0.92)
2000		0.90		0.90		0.89
		(0.87-0.92)		(0.87-0.93)		(0.85-0.94)
2001		0.85		0.87		0.82
		(0.83-0.88)		(0.83-0.91)		(0.78-0.87)
2002		0.80		0.83		0.73
		(0.77-0.83)		(0.80-0.87)		(0.68-0.78)
2003		0.80		0.80		0.78
		(0.76-0.83)		(0.76-0.85)		(0.72-0.85)
2004		0.76		0.78		0.72
		(0.73-0.79)		(0.74-0.82)		(0.67-0.77)
2005		0.71		0.74		0.67
		(0.68-0.75)		(0.70-0.78)		(0.62-0.72)
2006		0.70		0.72		0.67
		(0.67-0.74)		(0.68-0.77)		(0.62-0.73)
2007		0.699		0.71		0.66
		(0.66-0.73)		(0.67-0.76)		(0.61-0.72)
2008		0.66		0.69		0.64
		(0.63-0.70)		(0.64-0.74)		(0.59-0.71)
2009		0.66		0.70		0.60
		(0.63-0.70)		(0.66-0.74)		(0.55-0.65)

	Hospitalization due to diarrhea		Hospitalization due to pneumonia
	Gross RR (CI 95%)	RR adjusted (CI 95%)	Gross RR (CI 95%)	RR adjusted (CI 95%)
FHS coverage
None	1.00	1.00	1.00	1.00
≤ 50%	0.68	0.94	0.66	0.88
	(0.64-0.73)	(0.87-1.03)	(0.64-0.68)	(0.82-0.92)
> 50%	1.19	0.99	0.90	0.87
	(1.10-1.30)	(0.89-1.09)	(0.85-0.94)	(0.82-0.92)
IPRS
3/4/5		1.00		1.00
1/2		0.71		0.66
		(0.62-0.81)		(0.61-0.71)
Health plan coverage		0.99		0.98
		(0.99-0.99)		(0.98-0.99)
ICU hospital beds rate		0.99		1.00
		(0.99-1.00)		(0.99-1.00)
Population size (inhab)
≤ 10.000		1.00		1.00
>10.000 ≤50.000		0.25		0.40
		(0.21-0.29)		(0.37-0.44)
>50.000 ≤100.000		0.05		0.12
		(0.04-0.06)		(0.10-0.13)
> 100.000		0.04		0.09
		(0.03-0.05)		(-0.08-0.10)
Year
1998		1.00		1.00
1999		1.07		0.93
		(0.96-1.19)		(0.88-0.98)
2000		1.25		1.01
		(1.12-1.39)		(0.95-1.07)
2001		1.25		1.02
		(1.11-1.39)		(0.96-1.08)
2002		1.06		0.85
		(0.95-1.19)		(0.79-0.90)
2003		1.01		0.86
		(0.89-1.15)		(0.80-0.91)
2004		0.99		0.88
		(0.88-1.12)		(0.82-0.93)
2005		1.03		0.71
		(0.92-1.16)		(0.67-0.76)
2006		0.94		0.78
		(0.83-1.06)		(0.73-0.83)
2007		0.76		0.78
		(0.67-0.87)		(0.73-0.83)
2008		0.80		0.79
		(0.70-0.92)		(0.74-0.85)
2009		0.88		0.92
		(0.77-1.00)		(0.86-0.99)

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[TFN1] FHS= Family Health Strategy; IPRS= São Paulo Index of Social Responsibility; ICU = Intensive Care Unit;

* ICU = Neonatal Intensive Care Unit; RR= Relative Risk; CI= Confidence Interval. Likelihood-ratio test = 0,000.