APH 2001, 59, 151-165:

The effects of the family health program on child health in Ceará state, northeastern Brazil.

E. Morsch, N. Chavannes, M. van den Akker, H. Sa, and G. J. Dinant

Keywords: infant mortality, Brazil, family health program

Background: Based on the targets of the 1985 WHO conference "Health of all", the Family Health Program is being implemented in Ceara State, in the poor northeast of Brazil.  Since 1994, increasing numbers of Family Health Teams are developing actions on health promotion, preventive measures and curative care.

Aim: This study intended to assess the effects of the Family Health Program on child health in Ceara over a period of five years, in terms of infant mortality rate (IMR), low birthweight, vaccination coverage, prenatal care, exclusive breastfeeding, monthly weighing, and completion of DTP vaccination at the age of one.

Method: Group A (n = 20) consisted of municipalities participating right from the start in 1994-95, with a coverage of at least 60% of the population, while group B (n = 22) consisted of non-participating municipalities which had not started to implement the program by the end of 1998.  Group differences were tested using simple linear regression with SPSS 8.0.  A comparison of health and preventive health indicators was made, using number of inhabitants as a weighting factor in the regression analysis.

Results: Both group A and B showed significant decreases in IMR during the period 1994-1998, 54.7% and 51.9% respectively.  The proportionate infant mortality showed a relative decline of 49.2% in group A and 45.5% in group B.  The differences between group A and B were not significant however.  Analysis of the influence of socioeconomic group characteristics on the IMR revealed a moderate significant inverse correlation with garbage collection (B = 0,46, P = 0,01).  With respect to the causes of IMR, group A showed a significant reduction in the diarrhea related component of IMR.  Preventive health indicators in both groups showed similar relative increases in participation in prenatal care and exclusive breastfeeding.  Both groups showed about the same rates of vaccination coverage and monthly weighing in 1998, although group B had started from lower rates in 1994.

Conclusion: Both group A and B showed spectacular relative decreases in IMR in the period 1994-1998.  Participation in the Family Health Program in Ceara did not lead to significant improvements in child health indicators as compared to no participation.  Analyses of the specific causes of infant mortality showed that group A had a significant reduction in the diarrhea related component of IMR.