Cobertura de puericultura e fatores associados em São Luís (Maranhão), Brasil

Abstract

Pediatric care is fundamental to preventing several diseases during the early years of childhood. Early medical care and having at least nine checkups in the first year of life are the ideal in pediatric care. It is essential to periodically assess whether or not these goals are being met. In 1994, a cross-sectional study was carried out using three-stage cluster sampling to measure coverage of pediatric care and factors associated with that care among children in the city of São Luís, in the state of Maranhão, Brazil. For data collection, a standardized questionnaire was used with the mother of the child or another person responsible for the child. The percentage of those refusing to participate or who were absent was 7%. This work analyzes data concerning 290 children between 1 and 23 months of age. The coverage estimates and 95% confidence intervals took into consideration possible effects of the study design. Cox's regression, modified for cross-sectional studies, was used to estimate adjusted relative risks. Pediatric care coverage for the population studied was 80%. The children had an average of 7.8 checkups in the first year; 44% of the children had six or fewer checkups during the first year of life, well below the recommended number. Eighty-one percent of the children were seen in the Brazilian public health care system (Sistema Unico de Saúde, SUS), and only 15% used health insurance. After adjusting for confounding factors, the factors "greater number of siblings at home" and "father with four or fewer years of schooling" were associated with not having checkups. After adjustment, family income was not associated with the number of checkups. Encouraging educational activities and perhaps also family planning programs are important strategies for increasing the coverage of pediatric care in the city of São Luís.

Frequência de utilização do serviço público de puericultura e fatores associados

“…In a similar study, conducted in Maranhão, Brazil, the association with these two types of factors was also found. 10 These results can be avoided, as they indicate that instruction-related and cultural reasons explain better this behavior, as proposed by the Strategic and Programmatic Actions Department of the Ministry of Health, 2 and they reinforce the situation of iniquity in health found in the country.…”

“…2,[5][6][7][8][9] Despite the advance in researches that aim at analyzing the health care service quality, there are still few studies with child population preoccupied with analyzing the association of social-environmental conditions that influence negatively in the child care service use. [10][11][12][13][14][15] General results point the low frequency in child care in socioeconomically disadvantaged populations, given that the disease is the main reason for seeking the health center.…”

Frequency of public child care service use and associated factors

“…Apesar do avanço em pesquisas que objetivam a análise da qualidade do serviço de saúde, ainda há poucos estudos com a população infantil voltados para a análise da associação das condições socioambientais que afetam negativamente a utilização do serviço de saúde de puericultura [10][11][12][13][14][15] . Os resultados gerais apontam baixa frequência no atendimento de puericultura em populações com condições socioeconômicas desfavoráveis, sendo que a doença é o motivo principal da busca pelo serviço.…”

Pediatria no século 21: uma especialidade em perigo

“…A identificação do pediatra com esses serviços é tão grande que a transcendência da promoção da saúde é uma daquelas percepções de caráter formativo sem as quais não se é pediatra (43) . No Brasil, os poucos levantamentos realizados revelam uma média de 7,5 consultas de Puericultura no primeiro ano de vida (40) , também com maior incidência em classes mais altas -o que seria mais do que suficiente, de acordo com o consenso atual. A entidade norteamericana Institute for Clinical Systems Improvement preconiza de dez a 12 con sultas, dependendo de necessidades específicas da família (44) .…”