Análise da concordância entre as informações reportadas pelas mães e dos cartões de vacina das crianças no Brasil (2013 e 2015) / Analysis of the agreement between information on child vaccination reported by mothers and that on the children's vaccination cards in Brazil (2013-2015)

Resumo Introdução Este trabalho discute a possibilidade de utilização de informações sobre a vacinação infantil reportada pelas mães em inquéritos domiciliares para a construção de indicadores de cobertura vacinal no Brasil. Objetivo Avaliar o potencial das informações declaradas pelas mães sobre a imunização das crianças em inquéritos domiciliares como uma fonte para o cálculo do indicador de cobertura vacinal. Método Analisaram-se os indicadores de confiabilidade (precisão) e validade (concordância) entre as informações disponíveis nos cartões de vacina das crianças menores de 2 anos e as informações reportadas pelas mães em pesquisas domiciliares realizadas nos anos de 2013 e 2015 no município de Santo Antônio do Monte, Minas Gerais. Resultados O principal resultado mostra que, em um contexto de alta cobertura, as mães tendiam a informar sobre a vacinação de seus filhos de forma aleatória, ou seja, informações reportadas pelas mães apresentavam baixa validade. Conclusão Embora a coleta de informações dos cartões de vacina das crianças seja um procedimento mais custoso, essa é a forma mais adequada e confiável de se mensurar a cobertura vacinal no contexto brasileiro.

Abstract Background This study discusses the possibility of using information on child vaccination reported by mothers through household surveys to construct indicators of immunization coverage in Brazil. Objective Evaluate the potential of information reported by mothers on the immunization of children in household surveys as a source to calculate a vaccination coverage indicator. Method The indicators of reliability (accuracy) and validity (concordance) between the information available on the vaccination cards of children under two years of age and that reported by mothers in two household surveys conducted in 2013 and 2015 in the municipality of Santo Antônio do Monte, state of Minas Gerais, Brazil. Results The main result shows that, in a context of high coverage, the mothers tended to inform randomly about the vaccination of their children, that is, the information reported by mothers presented low validity. Conclusion Although collecting information from children's vaccination cards is a more costly procedure, it is the most adequate and reliable way to measure vaccination coverage in the Brazilian context.

Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil.

BACKGROUND: Prenatal care coverage is still not universal or adequately provided in many low and middle income countries. One of the main barriers regards the presence of socioeconomic inequalities in prenatal care utilization. In Brazil, prenatal care is supplied for the entire population at the community level as part of the Family Health Strategy (FHS), which is the main source of primary care provided by the public health system. Brazil has some of the greatest income inequalities in the world, and little research has been conducted to investigate prenatal care utilization of FHS across socioeconomic groups. This paper addresses this gap investigating the socioeconomic and regional differences in the utilization of prenatal care supplied by the FHS in the state of Minas Gerais, Brazil. METHODS: Data comes from a probabilistic household survey carried out in 2012 representative of the population living in urban areas in the state of Minas Gerais. The sample size comprises 1,420 women aged between 13 and 45 years old who had completed a pregnancy with a live born in the last five years prior to the survey. The outcome variables are received prenatal care, number of antenatal visits, late prenatal care, antenatal tests, tetanus immunization and low birthweight. A descriptive analysis and logistic models were estimated for the outcome variables. RESULTS: The coverage of prenatal care is almost universal in catchment urban areas of FHT of Minas Gerais state including both antenatal visits and diagnostic procedures. Due to this high level of coverage, socioeconomic inequalities were not observed. FHS supplied care for around 80% of the women without private insurance and 90% for women belonging to lower socioeconomic classes. Women belonging to lower socioeconomic classes were at least five times more likely to receive antenatal visits and any of the antenatal tests by the FHS compared to those belonging to the highest classes. Moreover, FHS was effective in reducing low birthweight. Women who had prenatal care through FHS were 40% less likely to have a child with low birthweight. CONCLUSION: This paper presents strong evidence that FHS promotes equity in antenatal care in Minas Gerais, Brazil.

[Equity in coverage by the Family Health Strategy in Minas Gerais State, Brazil]. / A equidade na cobertura da Estratégia Saúde da Família em Minas Gerais, Brasil.

The Family Health Strategy (FHS) plays an important role in prevention and in monitoring families in the Brazilian Unified National Health System. This study aims to analyze equity in the coverage of these services in the urban areas of Minas Gerais State, Brazil. The research is unprecedented and analyzes several markers for four target groups: women, pregnant women, children, and the elderly. The study is representative of the various health macro-regions. In 2012, 6,797 households were surveyed, with 5,820 women, 1,758 children, and 3,629 elderly. To analyze equity, FHS coverage rates were calculated according to family income, and concentration indices and curves were estimated. The results show that the FHS is an equitable policy. The indicators show that poorer households have higher visitation rates under the FHS. Coverage of the eligible population is quite high: 88% of households received at least one visit from FHS professionals in the previous 12 months, resulting in a concentration index near zero.

A equidade na cobertura da Estratégia Saúde da Família em Minas Gerais, Brasil / Equity in coverage by the Family Health Strategy in Minas Gerais State, Brazil / La equidad en la cobertura de la Estrategia de Salud Familiar en Minas Gerais, Brasil

A Estratégia Saúde da Família (ESF) tem papel relevante na prevenção e no acompanhamento das famílias no Sistema Único de Saúde. O presente estudo tem como objetivo analisar a equidade na cobertura desses serviços ofertados na área urbana de Minas Gerais, Brasil. A pesquisa analisa diversos marcadores considerando quatro grupos-alvo: mulheres, gestantes, crianças e idosos, sendo representativa por macrorregião de saúde. Foram investigados em 2012, 6.797 domicílios, sendo entrevistados 5.820 mulheres, 1.758 crianças e 3.629 idosos. Para analisar a equidade, foram construídas taxas de cobertura da ESF por classe de riqueza e estimados índices e curvas de concentração. Os resultados revelam que a ESF é uma política equitativa. Os indicadores mostram que os domicílios mais pobres apresentam maiores taxas de visitação da ESF. Considerando a população residente nas áreas adscritas às equipes de saúde, o nível de cobertura é bastante elevado: 88% da população investigada receberam pelo menos uma visita dos profissionais da ESF nos últimos 12 meses, o que resulta em índices de concentração perto de zero.

The Family Health Strategy (FHS) plays an important role in prevention and in monitoring families in the Brazilian Unified National Health System. This study aims to analyze equity in the coverage of these services in the urban areas of Minas Gerais State, Brazil. The research is unprecedented and analyzes several markers for four target groups: women, pregnant women, children, and the elderly. The study is representative of the various health macro-regions. In 2012, 6,797 households were surveyed, with 5,820 women, 1,758 children, and 3,629 elderly. To analyze equity, FHS coverage rates were calculated according to family income, and concentration indices and curves were estimated. The results show that the FHS is an equitable policy. The indicators show that poorer households have higher visitation rates under the FHS. Coverage of the eligible population is quite high: 88% of households received at least one visit from FHS professionals in the previous 12 months, resulting in a concentration index near zero.

La Estrategia de Salud Familiar (ESF) tiene un papel importante en la prevención y el seguimiento de las familias en el Sistema Único de Salud. Este estudio analiza la equidad en la cobertura de estos servicios ofertados en el área urbana de Minas Gerais, Brasil. La investigación es inédita y analiza marcadores para cuatro grupos objetivo: mujeres, mujeres embarazadas, niños y ancianos. La muestra es representativa por macrorregiones de salud. En 2012, fueron investigados 6.797 domicilios y fueron entrevistados 5.820 mujeres, 1.758 niños y 3.629 adultos mayores. Para el análisis de la equidad, se construyeron las tasas de cobertura por clase de riqueza y se estimaran los índices y curvas de concentración. Los resultados revelan que el ESF es una política equitativa. Los indicadores muestran que los hogares más pobres tienen mayores tasas de visitas de ESF. Teniendo en cuenta la población elegible, la cobertura es muy alta: el 88% de la población recibió al menos una visita de profesionales de la ESF en los últimos 12 meses, lo que resulta en índices de concentración cerca de cero.