Access to health and social protection policies by homeless people during the COVID-19 pandemic: a mixed-methods case study on tailored inter-sector care during a health emergency.

Introduction: The article analyzed homeless people's (HP) access to health and social protection policies and tailored inter-sector care, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of Minas Gerais state, Brazil. It intended to provide data on HP and evaluate existing public policies focused on vulnerable populations during this health emergency. Methods: The study adopted a mixed-methods design with triangulation of quantitative and qualitative data. Results: Social cartography showed that in the early months of the pandemic, the health administration had difficulty reordering the health system, which experienced constant updates in the protocols but was nevertheless consolidated over the months. The evidence collected in the study showed that important emergency interventions in the municipality of BH involved activities that facilitated access by HP to the supply of services. Discussion: The existence of national guidelines for inter-sector care for HP cannot be ruled out as a positive influence, although the municipalities are responsible for their implementation. Significantly, a health emergency was necessary to intensify the relationship between health and social protection services. Roving services were among those with the greatest positive evidence, with the least need for infrastructure to be replicated at the local level. In addition, the temporary supply of various inter-sector services, simultaneously with the provision of day shelters by organized civil society, was considered a key factor for expanding and intensifying networks of care for HP during the emergency phase. A plan exists to continue and expand this model in the future. The study concluded that understanding the inter-sector variables that impact HP contributes to better targeting of investments in interventions that work at the root causes of these issues or that increase the effectiveness of health and social protection systems.

Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities.

BACKGROUND: This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old. METHODS: The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies. RESULTS: In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28-1.04) / 0.55 (0.29-1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95-1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97-1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96-1.00), 0.98 (0.97-1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95-0.98), 0.97 (0.95-0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991-1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002-1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002-1.0005), resulting in malnutrition mortality rates increase. CONCLUSION: Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.

Water quality comparison between a supply network and household reservoirs in one of the oldest cities in Brazil.

Water is an essential good for human life. This study aimed to verify the effects of household reservoirs on the physicochemical and microbiological characteristics of water in the municipality of São Mateus, Brazil, founded on 21 September 1544. Samples were collected in 83 residences, two samples per residence, one from the supply network and another from the household reservoir, making a total of 166 samples. The pH values, the free residual chlorine content and the turbidity values were determined. For the microbiological analysis, the defined substrate technology was used, allowing the simultaneous detection and identification of total coliforms and Escherichia coli. The results showed that the samples from household reservoirs were more contaminated than those from the public supply network (p = 0.008). The high degree of microbiological contamination of the two groups may be directly associated to the reduced residual chlorine content in the samples, especially those from household reservoirs.

[The Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais, Brazil]. / O Programa Nacional de Alimentação Escolar sob a ótica dos alunos da rede estadual de ensino de Minas Gerais, Brasil.

The scope of this article is to analyze the Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais. It is a qualitative and quantitative cross-sectional study with a sample of 1500 students, representing the population of the state schools of Minas Gerais, involving the administration of a semi-structured questionnaire. The data were analyzed using simple frequency, mean, standard deviation, Fisher's exact test, the chi-square test and logistic regression (p < 0.05, CI 95%). The effective acceptance of the program was 28.8% and the effective adhesion to the program was 45.1%. Program acceptance was significantly higher among males and students who consumed less extra-institutional food. Acceptance and adhesion to the program was significantly higher among the older students and those who reported participating in activities related to nutritional education. In total, 73.5% of the students suggested improvements in school food. Many of the program's norms and guidelines are not being implemented. The acceptance of school food was negatively influenced by the consumption of extra-institutional foods and positively influenced by food and nutritional education activities.