Introduction: Community water fluoridation (CWF) is a measure of recognized importance due to its effectiveness in preventing tooth decay at the population level. However, for the maximum benefit to be achieved, the high-quality standard of CWF must be maintained over time. Objective: To analyze the municipality-level characteristics associated with quality of water fluoridation in São Paulo state, Brazil. Methods: An ecological study was performed using official data sources on fluoride concentration surveillance in 2015. The outcome was municipalities that have not met the quality standard, identified as those with less than 80% of water samples within the optimal level for caries prevention. The independent variables were municipality-level indicators related to demographics, economics, and sanitation characteristics. Crude and adjusted prevalence ratios were estimated using Poisson regression with robust variance. Results: In total, 43.4% municipalities exhibited the outcome. Adjusted by Gini index, the prevalence ratio was 32% higher in municipalities with lower annual gross domestic product per capita. Adjusted by social responsibility index and earlier variables, the prevalence was higher in the municipalities with higher per capita expenditure on sanitation and health surveillance, where the urban population rate was lower, and with a human development index ≤0.761. Adjusted by earlier variables, the prevalence ratio was twice and 3.5 times higher for municipalities, respectively, with per capita income less than or equal to US$574 and where the type of sanitation utility was municipal and private; 50% higher in those with less than 100,000 habitants; and 20% higher in those with a chlorine concentration nonconformity rate above 0.82%. Conclusions: To ensure high quality of CWF, additional management measures should be implemented in municipalities with less than 100,000 habitants, a higher chlorine concentration nonconformity rate, a lower per capita income, and where the type of sanitation utility was municipal or private. Knowledge Transfer Statement: The study showed that the quality of fluoridation was associated with municipality-level characteristics. The findings can be used by policy makers to identify and support municipalities that will need to improve fluoridation quality if they are to reach oral health goals.
RESUMO O objetivo deste artigo foi avaliar o efeito do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) no acesso e na qualidade da Atenção Básica. As internações por condições sensíveis à Atenção Básica foram utilizadas como variável dependente e indicador indireto da qualidade e do acesso a esse nível de atenção. Utilizou-se o método quantitativo de estudo, tendo como unidade de análise todos os municípios brasileiros. O estudo se dividiu em duas fases: na primeira, foi realizada uma análise descritiva exploratória em série temporal sobre os municípios brasileiros, abrangendo o período de 2010 a 2014; e a segunda fase se caracterizou por avaliar o efeito do Programa, durante o mesmo período, no acesso e na qualidade da Atenção Básica, por meio da técnica estatística de regressão com dados de contagem. Os resultados, analisados por região, apontaram que o Programa está apresentando um efeito significativo na qualidade e no acesso da Atenção Básica, principalmente na região Nordeste. Este artigo surge como um importante informativo sobre as políticas de saúde no Brasil e, também, como um meio de instrumentalizar os gestores e os diversos atores envolvidos no desenvolvimento e discussão de um dos principais programas da Atenção Básica.
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