The impact of changing health indicators on infant mortality rates in Brazil, 2000 and 2005.

ABSTRACT

OBJECTIVES: To investigate the associations between changes in indicators of health-related resources and coverage, and variations in infant mortality rates (IMR) in Brazil's 27 states in 2000 and 2005. METHODS: Data were obtained from the Ministry of Health's online database, DATASUS. Stepwise multiple regressions were performed to model changes in IMR and its components (early, late, and post-neonatal mortality), using changes in the selected health indicators as predictors. RESULTS: Regression analysis showed that improving access to prenatal care (B = -0.89 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of gross domestic product (GDP) (B = -0.72 per 1 000; P = 0.031), and increasing access to the water supply (B = -0.22 per 1 000; P = 0.033) were associated with significant reductions in IMR. Declining early neonatal mortality rates were associated with prenatal care (B = -0.14 per 1 000; P = 0.026) and access to sanitation services (B = -0.05 per 1 000; P = 0.026). Reductions in late neonatal mortality rates were associated with prenatal care (B = -0.12 per 1 000; P = 0.003) and inversely correlated to the rate of cesarean deliveries (B = 0.13 per 1 000; P = 0.005). Post-neonatal mortality rate reductions were associated with prenatal care (B = -0.64 per 1 000; P < 0.001), increasing public expenditure on health as a proportion of GDP (B = -0.76 per 1 000; P = 0.005), and access to the water supply (B = -0.17 per 1 000; P = 0.037). CONCLUSIONS: Improving access to prenatal care, increasing public expenditure on health, and access to sanitation and water supply were all independently correlated to declining IMR; however, higher rates of cesarean deliveries were associated with higher late neonatal mortality rates. Continuous collection and analysis of relevant health indicators is recommended for developing evidence-based health policies and accurate predictions of how specific public health interventions might impact IMR.