Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities

Mallmann, Mariana B.; Tomasi, Yaná T.; Boing, Antonio Fernando

doi:10.1016/j.jped.2019.02.008

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • J. Pediatr. (Rio J.) 96 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.jped.2019.02.008 copy

Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities^☆ ☆ Please cite this article as: Mallmann MB, Tomasi YT, Boing AF. Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities. J Pediatr (Rio J). 2020;96:487-94.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify the prevalence and associated factors with the performance of the Guthrie test, hearing, and red reflex screening tests in Brazil.

Methods:

This was a population-based, cross-sectional study that analyzed data on 5,231 children under 2 years of age participating in the National Health Survey of 2013. The study described the prevalence and Confidence Intervals (95% CI) of the three neonatal screening tests performed, in any period, and their association with the country's regions, skin color/ethnicity, private health insurance, and per capita household income. Logistic regression models were used, and odds ratios were calculated by incorporating sample weights.

Results:

The prevalence of Guthrie test screening in Brazil at any time of life was 96.5%, that of the newborn hearing screening was 65.8% and that of the red reflex screening test was 60.4%. The performance of the three screening tests was significantly higher among children whose mothers/guardians reported higher per capita household income, who lived in the South and Southeast regions, and who had private health insurance (p < 0.001). There was no statistically significant difference regarding the performance of the tests according to skin color/ethnicity (p > 0.05). The same inequalities were verified when the tests were performed during the recommended periods, with a strong socioeconomic gradient.

Conclusions:

There are inequalities in the performance of neonatal screening tests in the country, and also in the performance of these tests during the periods established in the governmental guidelines. The guarantee of the performance of these tests in a universal and public health system, as in Brazil, should promote equity and access to the entire population.

KEYWORDS
Neonatal screening; Child health; Public health practice; Healthcare inequalities; Socioeconomic factors

Variable	n (%)	Guthrie test (%) (95% CI)	Hearing test (%) (95% CI)	Red reflex test (%) (95% CI)
Regions
North	1569 (30.0)	89.0 (86.1/91.4)	41.7 (37.3/46.3)	36.1 (32.1/40.2)
Northeast	1569 (30.0)	93.6 (91.9/94.9)	44.1 (40.4/47.8)	35.7 (32.3/39.3)
Midwest	644 (12.3)	98.4 (96.7/99.2)	59.2 (54.4/63.8)	50.0 (44.9/55.1)
Southeast	920 (17.6)	99.5 (98.5/99.8)	83.5 (80.2/86.3)	83.0 (79.7/85.9)
South	529 (10.1)	99.4 (98.3/99.7)	89.4 (85.0/92.6)	81.1 (76.6/84.8)

Skin color/ethnicity
White	2224 (42.8)	97.6 (96.9/98.2)	75.6 (73.5/77.6)	70.8 (68.7/72.9)
Black	278 (5.4)	95.7 (94.5/96.7)	55.5 (51.6/59.2)	53.6 (50.2/56.9)
Mixed-race	2690 (51.8)	95.4 (94.5/96.1)	57.1 (54.3/59.7)	50.6 (48.1/53.1)

Private health insurance
Yes	1264 (29.5)	99.4 (99.0/99.4)	89.5 (87.1/91.4)	84.1 (81.8/86.1)
No	3967 (70.5)	95.2 (94.3/95.9)	55.6 (53.3/57.8)	50.2 (47.9/52.5)

Income
1st quintile	1824 (30.2)	91.9 (90.1/93.4)	43.4 (40.6/46.2)	38.3 (35.6/41.1)
2nd quintile	1312 (25.0)	97.2 (96.1/97.9)	60.2 (57.4/62.9)	53.2 (50.6/55.7)
3rd quintile	858 (18.3)	99.0 (98.6/99.2)	78.5 (75.6/87.2)	72.1 (67.9/75.9)
4th quintile	651 (14.5)	99.1 (98.6/99.4)	85.1 (80.3/88.9)	82.7 (78.6/86.2)
5th quintile	586 (12.0)	99.3 (99.1/99.4)	90.4 (88.8/91.8)	85.7 (83.2/88.0)
Total	5231 (100)	96.5 (95.8/97.0)	65.8 (63.9/67.7)	60.4 (58.5/62.3)

Variable	Guthrie test			Hearing test			Red reflex test
Variable	OR	(95% CI)	p	OR	(95% CI)	p	OR	(95% CI)	p
Regions
North	1.00			1.00			1.00
Northeast	1.79	(1.25/2.58)	0.002	1.10	(0.86/1.40)	0.426	0.98	(0.78/1.24)	0.911
Southeast	26.21	(8.03/85.47)	<0.001	7.07	(5.30/9.43)	<0.001	8.68	(6.55/11.51)	<0.001
South	20.28	(6.87/59.86)	<0.001	11.78	(7.60/18.26)	<0.001	7.60	(5.52/10.46)	<0.001
Midwest	7.70	(4.36/17.13)	<0.001	2.02	(1.55/2.65)	<0.001	1.77	(1.35/2.32)	<0.001

Skin color/ethnicity
Black	1.00			1.00			1.0
Mixed-race	0.91	(0.42/1.97)	0.827	1.06	(0.74/1.53)	0.733	0.88	(0.60/1.29)	0.538
White	1.87	(0.82/4.25)	0.134	2.48	(1.70/3.62)	<0.001	2.10	(1.43/3.08)	<0.001

Private health insurance
No	1.00			1.0	-		1.0
Yes	9.20	(3.80/22.28)	<0.001	6.78	(5.13/8.96)	<0.001	5.23	(4.04/6.77)	<0.001

Income
1st quintile	1.00			1.0			1.0
2nd quintile	3.03	(1.98/4.63)	<0.001	1.97	(1.58/2.46)	<0.001	1.83	(1.47/2.26)	<0.001
3rd quintile	8.69	(4.99/15.14)	<0.001	4.78	(3.68/6.22)	<0.001	4.16	(3.17/5.46)	<0.001
4th quintile	10.34	(4.61/23.17)	<0.001	7.45	(5.01/11.09)	<0.001	7.71	(5.41/11.00)	<0.001
5th quintile	12.49	(3.34/46.74)	<0.001	12.35	(8.03/19.02)	<0.001	9.69	(6.18/15.19)	<0.001

Variable	Guthrie test^a a Model: private health plan + skin color/ethnicity + regions + income.			Hearing test^b b Model: private health plan + skin color/ethnicity + income + regions.			Red reflex test^c c Model: private health plan + income + regions + skin color.
Variable	OR	(95% CI)	p	OR	(95% CI)	p	OR	(95% CI)	p
Regions
North	1.00			1.00			1.00
Northeast	1.75	(1.21/2.53)	0.003	1.09	(0.85/1.39)	0.472	0.96	(0.76/1.22)	0.700
Southeast	14.56	(4.34/48.85)	<0.001	4.46	(3.33/5.96)	<0.001	5.72	(4.20/7.78)	<0.001
South	11.60	(3.93/34.20)	<0.001	7.59	(4.74/12.14)	<0.001	4.71	(3.29/6.72)	<0.001
Midwest	5.61	(2.34/13.47)	<0.001	1.34	(1.01/1.77)	0.039	1.75	(0.86/1.53)	0.341

Skin color/ethnicity
Black	1.00			1.00			1.00
Mixed-race	1.15	(0.52/2.55)	0.715	1.25	(0.82/1.90)	0.282	0.98	(0.66/1.44)	0.923
White	1.10	(0.47/2.58)	0.817	1.45	(0.94/2.24)	0.084	1.21	(0.82/1.79)	0.315

Private health insurance
No	1.00			1.0			1.00
Yes	2.65	(1.18/5.93)	0.018	2.98	(2.19/4.06)	<0.001	2.18	(1.63/2.91)	<0.001

Income
1st quintile	1.00			1.0			1.00
2nd quintile	2.02	(1.30/3.15)	0.002	1.32	(1.04/1.66)	0.019	1.20	(0.97/1.50)	0.105
3rd quintile	3.70	(2.01/6.80)	0.000	2.37	(1.79/3.12)	<0.001	2.02	(1.50/2.71)	<0.001
4th quintile	3.35	(1.42/7.88)	0.006	2.91	(1.87/4.51)	<0.001	3.42	(2.26/5.17)	<0.001
5th quintile	3.18	(0.94/10.73)	0.061	3.78	(2.36/6.05)	<0.001	3.50	(2.06/6.10)	<0.001

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail: antonio.boing@ufsc.br (A.F. Boing).

Brasil

Brasil

Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities☆ ☆ Please cite this article as: Mallmann MB, Tomasi YT, Boing AF. Neonatal screening tests in Brazil: prevalence rates and regional and socioeconomic inequalities. J Pediatr (Rio J). 2020;96:487-94.

Abstract

Objective:

Methods:

Results:

Conclusions: