Equitable access to health services for children aged 5 to 9 in a medium city of northeasth of Brazil: a result of Family Health Strategy.

INTRODUCTION: The Brazilian National Health System may reduce inequalities in access to health services through strategies that can reach those most in need with no access to care services. OBJECTIVE: To identify factors associated with the use of health service by children aged 5 to 9 years in the city of Sobral, Ceará, northeastern Brazil. RESULTS: Only 558 (17.0%) children used health care services in the 30 days preceding this survey. Children with any health condition (OR = 3.90) who were frequent attenders of primary care strategy of organization (the Family Health Strategy, FHS) (OR = 1.81) and living in the city's urban area (OR = 1.51) were more likely to use health services. Almost 80% of children used FHS as their referral care service. Children from poorer families and with easier access to services were more likely to be FHS users. CONCLUSION: The study showed that access to health services has been relatively equitable through the FHS, a point of entry to the local health system.

Social Determinants of Health among children aged between 5 and 9 years within the urban area, Sobral, Ceará, Brazil.

INTRODUCTION: In the district of Sobral, for the decade of 2000 at the same time that political measures were implanted towards the decrease of children mortality, discussions have begun about health and educations conditions, as well as life quality of children aged between 5 and 9, which is an age group of lesser vulnerability as far as health goes, although of major importance in the development of healthy habits and for the child's development itself. OBJECTIVE: Based on such scenario, it was set up a cohort of children aged between 5 and 9 and residents of the urban area of the district in order to study health and education conditions and quality of life which are essential for the future of these children in light of the Social Determinants of Health. METHODS: This is a cross-sectional study with a cohort of children born from 1990 to 1994, home interviews, clinical evaluation and lab exams. The structure for the development of the research was elaborated based on the model of attention towards the health of Family Health Strategy. In this report, the results of such home interviews shall be presented in regards to socio-demographic and environmental conditions in general, with a more detailed analysis of life styles, educational levels, child labor, nutrition and the use of health services by children.

The effects of a people-centred model on longitudinality of care and utilization pattern of healthcare services--Brazilian evidence.

Brazil is experiencing a time of change in pattern of care: from 'traditional' to Family Health Strategy (FHS), a model guided by the principles of people, family and community-centred medicine. The heterogeneity in care currently offered affects the primary care impact. This study aims to evaluate the longitudinality of care and correlate this primary care principle to the utilization pattern of care among patients hospitalized due to preventable conditions, comparing the two care models currently offered in Brazil. It is a cross-sectional, analytical and descriptive study with a quantitative approach. The sample consisted of 501 patients from 0 to 14 years old. Data was collected in 2011 and the Primary Care Assessment Tool (PCATool-Brazil) child version was used. Bivariate and multivariate analyses were performed including patient-related variables (age, maternal education, income and type of diagnosis) and care model. From the hospitalizations occurred during the period, 65.2% were Ambulatory Care Sensitive Conditions. Patients evaluated 'longitudinality' as regular. Both the care continuity dimension and the utilization pattern of care services showed a link with the care model offered. Findings suggest that the FHS care model, based on the assumptions of people-centred medicine, was associated with better ratings of care continuity, which was reflected in a more appropriate utilization pattern of care services.

A abordagem das dores recorrentes na infância / The approach of recurrent pain in children

A queixa de dores recorrentes é muito frequente na infância, sendo mais prevalentes a dor abdominal, a cefaleia e a dor em membros. O atendimento desses pacientes não é uma tarefa fácil, tanto pelo caráter vago e subjetivo do sintoma como pela complexidade de fatores que podem estar implicados em sua etiologia. O objetivo do presente artigo é apresentar uma proposta de abordagem dessas queixas de dores recorrentes em crianças...

Recurrent pain is very common in childhood, the most frequent are abdominal pain, headache and limb pain. The care of these patients is not an easy task, because of both the subjective and the vagueness of the symptom as well as the complexity of factors that may be implicated in its etiology. The aim of this paper is to present a proposal to address the children with recurrent pain...

Causes of hospitalization among children ages zero to nine years old in the city of São Paulo, Brazil.

INTRODUCTION: The profile of child morbidity is an important parameter for defining and altering health policies. Studies about infant mortality are more numerous than those on morbidity, especially related to hospital admissions. The objective of this study is to describe the causes of admission in the public health system for children from zero to nine years of age in the city of São Paulo during the years 2002 to 2006 and compare these results to those from the national data. METHOD: Through a cross-sectional study, data were obtained from the Hospital Information System, which is available in the Information System of the Unified Health System - DATASUS. RESULTS: Within the period, 16% of the total admissions corresponded to children from zero to nine years of age, with most of the children being younger than one year of age. In the city of São Paulo, the admission coefficient increased 11%, and in Brazil, it decreased 14%. Respiratory diseases were the main causes of hospitalization. In São Paulo, the second most frequent causes of admission were diseases that originated during the perinatal period (15.9%), and in Brazil, the second most frequent cause of admission was infectious-parasitic diseases (21.7%). Admissions for perinatal diseases increased 32% in São Paulo and 6% in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was recorded in the city of São Paulo for children under five years old. CONCLUSIONS: The findings of this study show a paradoxical increase in the number of hospitalizations during an expansion of primary attention, indicating that the rise was not associated with a significant improvement in the quality of service.

Causes of hospitalization among children ages zero to nine years old in the city of São Paulo, Brazil

Introduction: The profile of child morbidity is an important parameter for defining and altering health policies. Studies about infant mortality are more numerous than those on morbidity, especially related to hospital admissions. The objective of this study is to describe the causes of admission in the public health system for children from zero to nine years of age in the city of São Paulo during the years 2002 to 2006 and compare these results to those from the national data. Method: Through a cross-sectional study, data were obtained from the Hospital Information System, which is available in the Information System of the Unified Health System - DATASUS. Results: Within the period, 16 percent of the total admissions corresponded to children from zero to nine years of age, with most of the children being younger than one year of age. In the city of São Paulo, the admission coefficient increased 11 percent, and in Brazil, it decreased 14 percent. Respiratory diseases were the main causes of hospitalization. In São Paulo, the second most frequent causes of admission were diseases that originated during the perinatal period (15.9 percent), and in Brazil, the second most frequent cause of admission was infectious-parasitic diseases (21.7 percent). Admissions for perinatal diseases increased 32 percent in São Paulo and 6 percent in Brazil. While hospitalizations for diarrhea decreased in Brazil, an increase was recorded in the city of São Paulo for children under five years old. Conclusions: The findings of this study show a paradoxical increase in the number of hospitalizations during an expansion of primary attention, indicating that the rise was not associated with a significant improvement in the quality of service.

Projeto Trevo de Quatro Folhas: apoiando a mãe, incentivando a vida / The four-leaf shamrock project: supporting mother, stimulating life

Apesar da mortalidade no municipio de Sobral (Ceará) estar caindo nos últimos anos, ainda persistia elevada no final de 2001, com 29,2 óbitos por mil nascidos vivos. Constatou-se que muitos óbitos eram devidos às dificuldades das gestantes e mães de exercerem a maternidade. No final de dezembro de 2001, implantou-se o Projeto Trevo de Quatro Folhas, com o objetivo de reorganizar a assistência ao pré-natal, ao parto, ao puerpério e ao bebê, além de dar apoio às mulheres enquanto gestantes e mães, apoio este fornecido pela `mãe social` e pela `madrinha/padrinho social`. A mãe social é uma mulher que reside próximo à familia e assume as tarefas domésticas nas situações em que a mãe estiver impossibilitada, recebendo uma diária do projeto, a madrinha/padrinho social é uma pessoa da sociedade que assume a criança como afilhada, contribuindo para o financiamento das mães sociais. O Projeto Trevo contribuiu para reduzir a mortalidade infantil de 29,2 em 1002 para 18,7 óbitos por mil nascidos vivos em 2002. Atualmente, foram selecionadas e capacitadas 160 mães sociais, sendo que durante o ano de 2002, 273 estiveram em atuação. Estão contribuindo102 madrinhas/padrinhos sociais