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.
| Original language | English |
|---|---|
| Article number | 100519 |
| Journal | Lancet Regional Health - Americas |
| Volume | 22 |
| DOIs | |
| Publication status | Published - Jun 2023 |
Bibliographical note
Funding Information:This study was supported by the UK’s Joint Health Systems Research Initiative (DFID/MRC/Wellcome Trust/ESRC) grant number MR/P014593/1. This funder had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication.
Funding Information:
This work was supported by a grant from the Health Systems Research Initiative with funding from the Foreign, Commonwealth and Development Office , the UK Medical Research Council and Wellcome , in collaboration with the UK Economic and Social Research Council (grant no. MR/P014593/1 ).
Publisher Copyright:
© 2023 The Author(s)
