Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve?

The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.

Hospitalizations for primary care-sensitive conditions in Pelotas, Brazil: 1998 to 2012. / Hospitalizações por condições sensíveis à atenção primária em Pelotas: 1998 a 2012.

OBJECTIVE:: To verify the hospitalization trend for primary care sensitive-conditions in Pelotas, Rio Grande do Sul, Brazil from 1998 to 2012. METHODS:: An ecological study compared hospitalizations rates of the city of Pelotas with the rest of state of Rio Grande do Sul. Analysis was conducted using direct standardization of rates, coefficients were stratified by sex and the Poisson regression was used. RESULTS:: Hospitalizations for sensitive conditions decreased in Pelotas and Rio Grande do Sul. In Pelotas, a 63.8% decrease was detected in the period observed, and there was a 43.1% decrease in the state of Rio Grande do Sul. Poisson regression coefficients showed a decrease of 7% in Pelotas and of 4% in the rest of Rio Grande do Sul each year. CONCLUSION:: During the study period, several changes were introduced in the Brazilian Unified Health System ("Sistema Único de Saúde") that may have influenced the results, including changes in administration, health funding, and a complete reworking of primary care through the creation of the Family Health Strategy program ("Estratégia Saúde da Família").

Hospitalizações por condições sensíveis à atenção primária em Pelotas: 1998 a 2012 / Hospitalizations for primary care-sensitive conditions in Pelotas, Brazil: 1998 to 2012

RESUMO: Objetivo: Verificar a tendência das taxas de internações por condições sensíveis à atenção primária no município de Pelotas, Rio Grande do Sul, de 1998 a 2012. Métodos: Foi realizado estudo ecológico comparando as taxas de Pelotas com as do restante do estado do Rio Grande do Sul. Na análise, fez-se padronização direta das taxas, os coeficientes foram estratificados por sexo e utilizou-se regressão de Poisson. Resultados: As internações por condições sensíveis diminuíram em Pelotas e no Rio Grande do Sul. Em Pelotas a redução das taxas no período foi de 63,8%, e no restante do Rio Grande do Sul, de 43,1%. Os coeficientes da regressão de Poisson mostraram diminuição de 7% no município de Pelotas e de 4% nas outras partes do Rio Grande do Sul por ano. Conclusão: Durante o período estudado, diversas alterações foram introduzidas no Sistema Único de Saúde (SUS), as quais podem ter contribuído para os resultados encontrados, como modificações na modalidade de gestão, nas formas de financiamento em saúde e na reestruturação da atenção primária mediante a consolidação da Estratégia Saúde da Família.

ABSTRACT: Objective: To verify the hospitalization trend for primary care sensitive-conditions in Pelotas, Rio Grande do Sul, Brazil from 1998 to 2012. Methods: An ecological study compared hospitalizations rates of the city of Pelotas with the rest of state of Rio Grande do Sul. Analysis was conducted using direct standardization of rates, coefficients were stratified by sex and the Poisson regression was used. Results: Hospitalizations for sensitive conditions decreased in Pelotas and Rio Grande do Sul. In Pelotas, a 63.8% decrease was detected in the period observed, and there was a 43.1% decrease in the state of Rio Grande do Sul. Poisson regression coefficients showed a decrease of 7% in Pelotas and of 4% in the rest of Rio Grande do Sul each year. Conclusion: During the study period, several changes were introduced in the Brazilian Unified Health System ("Sistema Único de Saúde") that may have influenced the results, including changes in administration, health funding, and a complete reworking of primary care through the creation of the Family Health Strategy program ("Estratégia Saúde da Família").

[Urban work profile among adolescents aged 14-15 years: a population-based study in Southern Brazil]. / Perfil de trabalho urbano de adolescentes de 14-15 anos: um estudo populacional no Sul do Brasil.

The scope of this article was to describe the urban work patterns among 14 to 15-year-old youths from Southern Brazil. Child labor was characterized as any activity that resulted in retribution in the form of goods, services or money. The analyses were stratified by sex and economic level. Of the 4325 adolescents interviewed, the proportion of labor in the last year was 22.2%, namely 27.7% for the male sex, and 17% for the female sex. This proportion was also higher among the poorer strata of the population (30.0%) than the more affluent (14.3%). The majority of adolescents worked away from home and approximately half of them began working before 14 years of age, and around 80.0% reported that they worked by choice. Only 1.0% had a labor contract or work booklet, 30.0% worked more than six hours per day, and the average income was less than US$85/month. Domestic work predominated among the poorest teenagers. There is a need for greater surveillance of child labor and of interventions seeking to enforce prevailing legislation.

Prevalence of hospitalization and associated factors in Pelotas, Southern Brazil.

OBJECTIVE: To estimate the prevalence of hospitalizations and to identify characteristics associated with hospital admission. METHODS: We carried out a population-based cross-sectional study of subjects of both sexes, aged 20-69 years, and who lived in the urban area of Pelotas, Southern Brazil, between 1999 and 2000. Subjects were interviewed using a standardized, pre-coded questionnaire. Analysis was stratified by sex and confounder control was carried out using Poisson regression. Variables analyzed included socioeconomic and demographic characteristics, lifestyle, morbidities, and medical appointments in the last year. RESULTS: Of the 1,916 subjects interviewed, 146 (7.6%; 95%CI: 6.4;8.8) had been hospitalized in the year preceding the interview. Among men, characteristics associated with hospitalization included age above 50 years, schooling between five and seven years, history of smoking, minor psychiatric disorders, and medical appointments in the last year. For women, hospitalization was more frequent among subjects aged 60-69 years, with five to seven years of schooling, and who had had medical appointments within the last year. Women who consumed under 30 g/day of alcohol were less likely to have been hospitalized. Prevalence of hospitalization for primary care-sensitive causes was 13.0% (95%CI: 7.6;18.5). CONCLUSIONS: Prevalence of hospitalization is similar in men and women. Schooling, but not income, was found to be associated with hospitalization.

[Child health in poor areas: findings from a population-based study in Caracol, Piauí, and Garrafão do Norte, Pará, Brazil]. / Saúde infantil em áreas pobres: resultados de um estudo de base populacional nos municípios de Caracol, Piauí, e Garrafão do Norte, Pará, Brasil.

The aim of this study was to evaluate child health indicators in the municipalities (counties) of Caracol, Piauí State, and Garrafão do Norte, Pará State, Brazil. Through household visits using systematic sampling, previously trained interviewers applied a standard questionnaire to mothers of under-five children, investigating socioeconomic status, housing and environmental sanitation, demographic characteristics, disease patterns, and prenatal and childbirth care. The analysis used the t-test and chi-square test to compare indicators between the two municipalities. Of the 1,728 children studied, 60% were from families with incomes less than one monthly minimum wage (approximately U$200), 41% had no type of sewage treatment or disposal, 10% of mothers reported zero prenatal visits, 30% of the children were born in the same municipality, and 30% had been taken to a pediatric consultation in the previous 3 months; 20% had a height-for-age deficit > 2 standard deviations. All target indicators were deficient in both the municipalities (especially in Garrafão do Norte). Expanding health care supply and improving housing and sanitation conditions are priorities in both municipalities.

Perfil de trabalho urbano de adolescentes de 14-15 anos: um estudo populacional no Sul do Brasil / Urban work profile among adolescents aged 14-15 years: a population-based study in Southern Brazil

The scope of this article was to describe the urban work patterns among 14 to 15-year-old youths from Southern Brazil. Child labor was characterized as any activity that resulted in retribution in the form of goods, services or money. The analyses were stratified by sex and economic level. Of the 4325 adolescents interviewed, the proportion of labor in the last year was 22.2%, namely 27.7% for the male sex, and 17% for the female sex. This proportion was also higher among the poorer strata of the population (30.0%) than the more affluent (14.3%). The majority of adolescents worked away from home and approximately half of them began working before 14 years of age, and around 80.0% reported that they worked by choice. Only 1.0% had a labor contract or work booklet, 30.0% worked more than six hours per day, and the average income was less than US$85/month. Domestic work predominated among the poorest teenagers. There is a need for greater surveillance of child labor and of interventions seeking to enforce prevailing legislation.

O objetivo deste artigo foi descrever os padrões de trabalho urbano em jovens de 14-15 anos do Sul do Brasil. O trabalho infantil foi caracterizado como qualquer atividade que resultasse em retribuição na forma de bens, serviços ou dinheiro. As análises foram estratificadas por sexo e nível econômico. Dos 4325 adolescentes entrevistados, a proporção de trabalho no último ano foi de 22,2%, sendo 27,7% para o sexo masculino e 17,0% para o sexo feminino. Essa proporção também foi maior para as classes D/E (30,0%) do que para as classes A/B (14,3%). A maioria dos adolescentes trabalhava fora de casa, aproximadamente metade começou a trabalhar antes dos 14 anos e cerca de 80,0% referiram trabalhar por interesse próprio. Apenas 1,0% tinha contrato ou carteira de trabalho, 30,0% trabalhavam mais de seis horas por dia, e a renda média foi menor do que R$ 150/mês. Os serviços domésticos predominaram entre os mais pobres. Existe a necessidade de maior monitoramento do trabalho infantil e de intervenções que busquem o cumprimento da legislação vigente.

Prevalência de internação hospitalar e fatores associados em Pelotas, RS / Prevalence of hospitalization and associated factors in Pelotas, Southern Brazil

OBJETIVO: Estimar a prevalência de hospitalizações e identificar características associadas à internação hospitalar. MÉTODOS: Estudo transversal de base populacional realizado com indivíduos de ambos os sexos, de 20 a 69 anos, residentes na zona urbana de Pelotas, RS, entre 1999 e 2000. Foi utilizado questionário padronizado e pré-codificado. Foi realizada análise estratificada entre os sexos e controle de fatores de confusão por meio de Regressão de Poisson. Foram incluídas na análise variáveis socioeconômicas, demográficas, hábitos de vida, morbidades e consulta com médico no último ano. RESULTADOS: Dos 1.916 indivíduos, 146 (7,6 por cento, IC95 por cento:6,4;8,8) haviam sido hospitalizados no último ano desde a entrevista. Entre os homens, as características que se mostraram associadas a internação foram: idade de 50 anos ou mais, entre cinco e sete anos de escolaridade, ex-fumantes, distúrbios psiquiátricos menores e consulta com médico no último ano. Entre as mulheres com idade entre 60 e 69 anos, entre cinco e sete anos de escolaridade e consulta médica no período de um ano antes da entrevista, ocorreram maiores prevalências de hospitalização. As mulheres que consumiam menos de 30 g/dia de álcool mostraram menor freqüência de hospitalização. A prevalência de internação por causas sensíveis à atenção primária foi de 13,0 por cento (IC 95 por cento: 7,6;18,5). CONCLUSÕES: Homens e mulheres apresentaram prevalências semelhantes de internação hospitalar. Foi encontrada associação entre escolaridade e internação, mas não entre renda e internação.

Saúde infantil em áreas pobres: resultados de um estudo de base populacional nos municípios de Caracol, Piauí, e Garrafão do Norte, Pará, Brasil / Child health in poor areas: findings from a population-based study in Caracol, Piauí, and Garrafão do Norte, Pará, Brazil

Este estudo teve por objetivo conhecer indicadores básicos de saúde infantil nos municípios de Caracol, Piauí, e Garrafão do Norte, Pará, Brasil. Mediante visitas domiciliares por amostragem sistemática, aplicaram-se questionários às mães de menores de cinco anos, investigando nível sócio-econômico, condições de habitação e saneamento da família, características demográficas, padrão de morbidade, de utilização de serviços de saúde e de assistência recebida durante a gestação e o parto. A análise consistiu da comparação de indicadores entre os dois municípios e foi avaliada através dos testes t e qui-quadrado. Das 1.728 crianças estudadas, 60 por cento de suas famílias possuíam renda inferior a um salário mínimo mensal; 41 por cento não contavam com qualquer tipo de sanitário; 10 por cento de suas mães não realizaram uma única consulta de pré-natal; 30 por cento nasceram no domicilio; 30 por cento foram levadas à consulta médica nos últimos três meses; 20 por cento apresentavam déficit > 2 desvios-padrão para o indicador altura/idade. Todos os indicadores estudados foram ruins em ambos os municípios, sobretudo em Garrafão do Norte. Aumentar a oferta de cuidados em saúde e melhorar as condições de habitação e saneamento deveriam ser prioridades nessas localidades.

The aim of this study was to evaluate child health indicators in the municipalities (counties) of Caracol, Piauí State, and Garrafão do Norte, Pará State, Brazil. Through household visits using systematic sampling, previously trained interviewers applied a standard questionnaire to mothers of under-five children, investigating socioeconomic status, housing and environmental sanitation, demographic characteristics, disease patterns, and prenatal and childbirth care. The analysis used the t-test and chi-square test to compare indicators between the two municipalities. Of the 1,728 children studied, 60 percent were from families with incomes less than one monthly minimum wage (approximately U$200), 41 percent had no type of sewage treatment or disposal, 10 percent of mothers reported zero prenatal visits, 30 percent of the children were born in the same municipality, and 30 percent had been taken to a pediatric consultation in the previous 3 months; 20 percent had a height-for-age deficit > 2 standard deviations. All target indicators were deficient in both the municipalities (especially in Garrafão do Norte). Expanding health care supply and improving housing and sanitation conditions are priorities in both municipalities.