Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil.

Anencephaly, encephalocele, and spina bifida are congenital neural tube defects and are the main causes of neonatal morbidity and mortality and impose a heavy economic burden on health systems. This study to estimates the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, and the prevented cases and cost savings during the period in which mandatory folic acid fortification was in effect in the country (2010-2019). It is a top-down cost-of-illness oriented study based on the prevalence of the disorders in Brazil. Data were collected from the Brazilian Ministry of Health's outpatient and hospital information system databases. The direct cost was estimated from the total patient-years, allocated by age and type of disorder. Prevented cases and cost savings were determined by the difference in the prevalence of the disorders in the pre- and post-fortification periods based on the total number of births and the sum of outpatient and hospital costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$ 92,530,810.63 (Int$ 40,565,896.81) in 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were expressive of all three disorders in the first year of the patient's life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$ 20,381,586.40 (Int$ 8,935,373.25) in hospital and outpatient cost savings. Flour fortification has proved to be a valuable strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and a 22.81% decrease associated in hospital and outpatient costs.

Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review.

BACKGROUND: Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. OBJECTIVE: We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. METHODS: We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. RESULTS: A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 µg/100 g have a higher CBA ratio. The studies with the inclusion of "loss of consumer choice" in the analysis may alter the fortification cost-efficacy ratio. CONCLUSION: We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.

[Primary Health Care users' satisfaction in the Federal District: the importance of timely access and home visits]. / Satisfação do usuário da Atenção Primária no Distrito Federal: a importância do acesso oportuno e da visita domiciliar.

The aim of this cross-sectional study was to analyze user satisfaction in relation to Primary Health Care services in the Federal District and its associated factors. A total of 4,476 users of the 62 existing Family Health Strategy Teams from the Eastern Health Region were included; a pre-tested questionnaire with open and closed questions was applied. As for the "General Satisfaction Level" 54.9% of users were Satisfied and 23.0% Very Satisfied. For this outcome there was less satisfaction in cases that the user didn´t receive the care he sought for (OR 12.1 p=0.01); did not receive a home visit (OR 1.7 p=0.01); is female (OR 1.2 p=0.01) and declared to be non-white (OR 0.77 p=0.021). The "Chance to recommend the Health Unit" was: High (43.4%) and Very High (17.7%). Similarly, the lower chance to recommend was associated with no care received (OR 5.1 p=0.01) and absence of home visit (OR 1.5 p=0.01); there was no association with sociodemographic variables. Evidence showed that health services are satisfactory for most users. The study provides evidence regarding the importance of having the complete Family Health Strategy team and of expanding home visit.

Vivência do residente em nutrição da RMAB no processo de trabalho do NASF na Região de saúde leste do Distrito Federal / Residency experience of the RMAB nutrition resident in the NASF work process in the eastern health region of the Federal District / Experiencia del residente en nutrición de la RMAB en el proceso de trabajo del NASF en el área de salud del este del Distrito Federal

A Residência Multiprofissional na Atenção Básica (RMAB) é uma modalidade de pós-graduação a qual é norteada a desenvolver competências dos profissionais de saúde, para o trabalho com SUS. O nutricionista é um importante profissional na atenção primária, com atuação na promoção e prevenção da saúde, bem como qualifica os planos de intervenção das ações de alimentação e nutrição. A inserção deste profissional no âmbito da atenção básica foi ampliada a partir de 2008, com a constituição dos Núcleos de Apoio à Saúde da Família (NASF). Configuramse como equipes multiprofissionais que atuam de forma integrada com as Equipes de Saúde da Família (ESF), no âmbito da saúde e assistência social, em populações específicas. O objetivo desse trabalho é relatar a experiência do residente de nutrição da RMAB do Hospital Universitário de Brasília (HUB) e da Universidade de Brasília (UNB) no processo de trabalho do NASF na Região de saúde Leste do Distrito Federal. As atividades desenvolvidas foram ações de promoção e prevenção para a saúde, como os grupos de introdução à alimentação infantil, grupo de alimentação saudável para adultos, entre outras demandas da equipe NASF. A vivência do residente de nutrição no NASF contribuiu para compreensão da dinâmica dos processos de trabalho e possibilitou ampliar as ações, dirigidas, sobretudo, à promoção e prevenção no cenário local.

Multiprofessional Residence in Primary Care (RMAB) is a kind of post-graduation which it is orientated to develop competences of the healthcare professionals for the work with SUS. Nutrition is an important professional in the primary attention with acting in the promotion and prevention of health, as well as, to qualify the plans of intervention of the actions of food and nutrition. The insertion of this professional in the context of the basic attention was enlarged from 2008, with the constitution of the Nucleuses of Support to Family Healthcare (NASF) 1. They are shaped like multiprofessional teams who act in the form integrated with the Family Healthcare teams (ESF), in the context of the health and social work, the specific populations. The objective of this work is to report the experience of the resident of nutrition of the RMAB of the University Hospital of Brasilia (HUB) and University of Brasilia (UNB) in the process of work of the NASF in the Region of eastern health of the Federal area. The activities developed together with the perceptions were: healthcare promotion and prevention to as groups of introduction the childlike food and healthy and appropriate food, as well as, other demands of the team NASF. The existence of the nutrition resident in the NASF contributed to understanding of the dynamic one of the processes of work and made possible to enlarge the actions especially gone to the promotion and prevention, in the local scenery.

La Residencia Multiprofesional en Atención Básica (RMAB) es una modalidad de posgrado que hace de guía para el desarrollo de habilidades de profesionales de la salud, para trabajar en el Sistema Único de Salud (SUS). El nutricionista es un importante profesional de la atención primaria en la actuación de la promoción y prevención de la salud. Además, califica los planes de intervención de las acciones de alimentación y nutrición. La inserción del profesional en el ámbito de la atención básica se amplió en 2008, con la constitución de los Núcleos de Apoyo a la Salud de la Familia (NASF)1 . Se configuran como equipos multidisciplinarios que trabajan integrados con Equipos de Salud Familiar (ESF) y la asistencia social con poblaciones específicas. El objetivo del trabajo es informar la experiencia del residente de nutrición de RMAB, del Hospital de la Universidad de Brasilia (HUB) y de la Universidad de Brasilia (UNB), en el proceso de trabajo NASF en la región de salud este del distrito federal. Se desarrollaron actividades en conjunto con la preceptoría: grupos de promoción y prevención de la salud, como introducción a la alimentación infantil y grupos de alimentación sana y adecuada, así como otras demandas del equipo NASF. La experiencia del residente de nutrición en NASF contribuyó a comprender la dinámica de procesos de trabajo. Además, se han ampliado las posibles acciones direccionadas para promover y prevenir en el escenario local.