Association of Previne Brasil Program with prenatal care and maternal-child mortality
DOI:
https://doi.org/10.11606/s1518-8787.2025059006735Palavras-chave:
Infant Mortality, Maternal Mortality, Socioeconomic Factors, Primary HealthcareResumo
OBJECTIVE: To investigate the impact of prenatal care on the reduction of maternal-child mortality in Brazilian municipalities following the new primary health care financing model, the Previne Brasil program. METHODS: This study comprised a nationwide cross-sectional observational analysis, utilizing secondary data from Departamento de Informática do Sistema Único de Saúde (Datasus – Information Technology Department of the Unified Health System), Sistema de Informação sobre Mortalidade (SIM – Mortality Information System), Sistema de Informação sobre Nascidos Vivos (Sinasc – Live Birth Information System), Sistema de Informação em Saúde para a Atenção Básica (Sisab – Primary Health Care Information System), and Instituto Brasileiro de Geografia e Estatística (IBGE – Brazilian Institute of Geography and Statistics). Medians of maternal mortality, infant mortality, and prenatal care rates were calculated for Brazilian municipalities from 2016 to 2022. Logistic regression analyses were conducted to assess associations between independent variables (primary care coverage, population size, Gross Domestic Product, and Gini index) and outcomes (variations in maternal and infant mortality rates). Both crude and adjusted odds ratios were estimated, with a significance level of 5%. RESULTS: Prenatal care rates increased by 86.7%, while maternal mortality rates decreased by 30.9%, with no association between them. Region, primary care coverage, municipal Gross Domestic Product, and population size were associated with variations in maternal mortality rates. The Southern region had a higher likelihood of reducing maternal mortality. No association was found between increased prenatal care rates and reduced infant mortality. Regional location, primary care coverage, population size, and the Gini index were associated with variations in infant mortality rates, with greater reductions observed in more populous municipalities and in the Northeast, Southeast, and Midwest. CONCLUSION: The Previne Brasil program led to an increase in prenatal care consultations in Brazilian municipalities but did not significantly impact the reduction of maternal-child mortality.
Referências
Tenorio DS, Brasil AGM, Nogueira BG, Lima NNR, Araújo JEB, Rolim Neto ML. High maternal mortality rates in Brazil: inequalities and the struggle for justice. Lancet Reg Health Am. 2022 Oct;14:e100343. https://doi.org/10.1016/j.lana.2022.100343
Marinho CDSR, Flor TBM, Pinheiro JMF, Ferreira MAF. Millennium Development Goals: the impact of healthcare interventions and changes in socioeconomic factors and sanitation on under-five mortality in Brazil. Cad Saude Publica. 2020 Oct;36(10):e00191219. https://doi.org/10.1590/0102-311X00191219
Lawrence ER, Klein TJ, Beyuo TK. Maternal mortality in low and middle-income countries. Obstet Gynecol Clin North Am. 2022 Dec;49(4):713–33. https://doi.org/10.1016/j.ogc.2022.07.001 https://doi.org/10.11606/s1518-8787.2025059006735 9 Rev. Saude Publica I v.59 I e28 I 2025Previne Brasil: prenatal and mortality Arato CVB et al.
Bugelli A, Da Silva RB, Dowbor L, Sicotte C. The determinants of infant mortality in Brazil, 2010-2020: a scoping review. Int J Environ Res Public Health. 2021 Jun;18(12):e6464. https://doi.org/10.3390/ijerph18126464
Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016 Jan;387(10017):462–74. https://doi.org/10.1016/S0140-6736(15)00838-7
Morosini MVGC, Fonseca AF, Baptista TWF. Previne Brasil, the Agency for the Development of Primary Healthcare, and the Services Portfolio: radicalization of privatization policy in basic healthcare? Cad Saude Publica. 2020 Sep;36(9):e00040220. https://doi.org/10.1590/0102-311X00040220
Ministério da Saúde (BR). Pacto nacional pela redução da mortalidade materna e neonatal. Brasíia: Ministério da Saúde; 2004.
Ministério da Saúde (BR). Boletim epidemiológico da mortalidade infantil no Brasil. Brasília: Ministério da Saúde; 2021.
Prezotto KH, Oliveira RR, Pelloso SM, Fernandes CAM. Tendência da mortalidade neonatal evitável nos Estados do Brasil. Rev Bras Saude Mater Infant. 2021 Jan-Mar;21(1):291-9. https://doi.org/10.1590/1806-93042021000100015
Ministério da Saúde (BR). Brasil reduziu 8,4% a razão de mortalidade materna e investe em ações com foco na saúde da mulher [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2025 Jun 18]. Available from: https://www.gov.br/saude/pt-br/composicao/saps
Noronha JC, Noronha GS, Pereira TR, Costa AM. The future of the Brazilian Health System: a short review of its pathways towards an uncertain and discouraging horizon. Cienc Saude Colet. 2018 Jun;23(6):2051–9. https://doi.org/10.1590/1413-81232018236.05732018
Massuda A. Primary health care financing changes in the Brazilian Health System: advance ou setback? Cienc Saude Colet. 2020 Mar;25(4):1181-8. https://doi.org/10.1590/1413-81232020254.01022020
Ministério da Saúde (BR). DATASUS [Internet]. Brasília: Ministério da Saúde; c2019 [cited 2025 Jun 18]. Available from: http://datasus.saude.gov.br/
Ministério da Saúde (BR). Sistema de Informação em Saúde para Atenção Básica (SISAB) [Internet]. Brasília: Ministério da Saúde; 2015 [cited 2025 Jun 18]. Availabre from: https://sisab.saude.gov.br/
Instituto Brasileiro de Geografia e Estatística (BR). Estados@. Rio de Janeiro: IBGE; c2023 [cited 2025 Jun 18]. Available from: https://www.ibge.gov.br/cidades-e-estados
Schönholzer TE, Zacharias FCM, Amaral GG, Fabriz LA, Silva BS, Pinto IC. Performance indicators of Primary Care of the Previne Brasil Program. Indicadores de desempeño de la Atención Primaria del Programa Previne Brasil. Rev Latino-Am Enfermagem. 2023 Nov;31:e4007. https://doi.org/10.1590/1518-8345.6640.4008
Witter S, Fretheim A, Kessy FL, Lindahl AK. Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database Syst Rev. 2012 Feb;(2):CD007899. https://doi.org/10.1002/14651858.CD007899.pub2
Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011 Sep;(9):CD008451. https://doi.org/10.1002/14651858.CD008451.pub2
Arruda CL, Marin DFD, Michels BD, Rosa VM, Iser BPM. Maternal mortality in South region of Brazil: an analysis from 2000 to 2018. J Obstet Gynaecol. 2022 Oct;42(7):2715–21. https://doi.org/10.1080/01443615.2022.2099737
Chuang KY, Sung PW, Chang CJ, Chuang YC. Political and economic characteristics as moderators of the relationship between health services and infant mortality in lessdeveloped countries. J Epidemiol Community Health. 2013 Dec;67(12):1006–12. https://doi.org/10.1136/jech-2013-202685
Guerra AB, Guerra LM, Probst LF, Gondinho BVC, Ambrosano GMV, Melo EA, et al. Can the primary health care model affect the determinants of neonatal, post-neonatal and maternal mortality? A study from Brazil. BMC Health Serv Res. 2019 Feb;19(1):133. https://doi.org/10.1186/s12913-019-3953-0 https://doi.org/10.11606/s1518-8787.2025059006735 10 Rev. Saude Publica I v.59 I e28 I 2025Previne Brasil: prenatal and mortality Arato CVB et al.
Duarte LS, Viana MMO, Scalco N, Garcia MT, Felipe LV. Incentivos financeiros para mudança de modelo na atenção básica dos municípios paulistas. Saude Soc. 2023;32(1):e210401pt. https://doi.org/10.1590/S0104-12902023210401pt
De Oliveira H, Wendland E. Changes in the infant mortality rate in twin towns of Brazil: an ecological study. Children (Basel). 2022 Oct;9(11):1662. https://doi.org/10.3390/children9111662
Russo LX, Scott A, Sivey P, Dias J. Primary care physicians and infant mortality: evidence from Brazil. PLoS One. 2019 May;14(5):e0217614. https://doi.org/10.1371/journal.pone.0217614
Carvalho-Sauer R, Costa MCN, Teixeira MG, Flores-Orti R, Leal JTFM, Saavedra R, et al. Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis. Lancet Reg Health Am. 2024 May;35:100774. https://doi.org/10.1016/j.lana.2024.100774
Ministério da Saúde (BR). Portaria GM/MS nº 5.350, de 12 de setembro de 2024. Brasília: Ministério da Saúde; 2024.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2025 Caio Vieira de Barros Arato, Luciane Miranda Guerra , Livia Fernandes Probst, Antonio Carlos Pereira

Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.