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Brazilian Ministry of Health

Work Proposal

The Center for Equity is working on a work proposal that was submitted to the Brazilian Ministry of Health through the Division of Science and Technology of the Department of Science, Technology, and Strategic Plan (DECIT).

The main objectives of this proposal are to conduct a set of analyses of equity in Brazil using selected indicators drawn from the National Demographic and Health Surveys for the years 1986, 1996 and 2006, stratified by indicators of inequality, and to perform a comprehensive literature review on health equity aiming at identifying national surveys or other relevant data sources for the analysis of equity, and keeping databases up-to-date so that they can be a repository of data and relevant documents to the study of inequality.

Analyses of the National Demographic and Health Surveys (PNDS)

One of the main activities of the Center for Equity is the analyses of the National Demographic and Health Surveys. These surveys are conducted periodically following the U.S. Demographic and Health Surveys methodologies. The analysis of standardized indicators at different time points provides an overview of the trends of these indicators over time and allows monitoring socioeconomic and demographic inequalities. The PNDS collected data among childbearing age women and children under five in the five macro-regions of Brazil. More methodological details can be found in the final report of each survey available on the PNDS web site.

An interim report of the analyses was submitted to date to the Brazilian Ministry of Health including the following indicators: modern contraceptive use and delivery in birth centers (1986, 1996, and 2006) and utilization of improved health care facilities (1996 and 2006). These analyses were performed using Stata version 12.0 taking into account the design effect. There were estimated the nationwide coverage and 95% confidence intervals, stratified by income levels (quintiles), macro-regions (central-west, northeast, north, southeast, south), child gender (male or female), maternal education (none, elementary, middle and high school, and college) and area of residence (urban or rural).

Regarding the indicators assessed, the prevalence of delivery in birth centers was high in 1986 (80.5%), and then rose to 97.6% in 2006. Modern contraceptive use increased sharply from 1986 to 1996, reaching 77.1% in 2006. And utilization of improved health facilities, with data estimates for 1996 and 2006 only, showed a 9% increase during this study period.

Literature review on health equity in Brazil

In addition to data analyses and production of reports of results on health equity, the UFPel Center for Equity has the goal to keep an updated database of national and international references on health equity. To achieve this goal the first step was to perform a literature review to identify works on equity published in Brazil and worldwide to set up a database.

By November 2012, there were retrieved over 1,300 references of scientific articles, book chapters, reports, and other documents available on websites of prominent national and international research institutions. Of these, 886 full-text electronic documents were selected to be stored in the Center for Equity database.

The second step of the database setup will require to identify the type of documents (conceptual works, reviews, original articles), study population (children, women, schoolchildren), geographic area where a study was conducted (country, state, region), study design (cohort, cross-sectional, case-control), data sources (PNDS/DHS, PNAD, PNSN, Census, POF, among others), type of socioeconomic and demographic stratification (income, education, housing conditions, ethnicity, child gender, among others), outcomes (breastfeeding, low weight, low height-for-age, mortality, among others) and main results report.

Our strategy for effectively handling out all documents was to begin with original articles published in journals reporting maternal and child health outcomes in Brazil.