Avaliação do cuidado primário à saúde da criança em municípios do estado da Paraíba, Brasil

Abstract

Introduction: Within the context of public health care, Primary Health Care has been a fundamental requirement as organizing axis of sanitary practices, in which the health care of children is a priority field. Hospitalizations due to Primary Care Sensitive Conditions and completion of the child health surveillance instrument are considered indicators of the quality of assistance provided by the primary care. Objectives: To evaluate the quality of Primary Health Care based on preventable hospitalizations of children under five years old and based on the information recorded in the child health surveillance instrument in two counties the state of Paraíba, northeastern Brazil. Materials and methods: Cross- Sectional study conducted in the counties of Cabedelo and Bayeux, Paraíba. Data were collected in two stages. At first, we analyzed the hospitalization of 627 children under five years oldfromthe studied counties in four pediatric public hospitals of Paraíba. Hospitalization authorization forms were used to gather information on the characteristics of children and of hospitalizations. We analyzed the causes of hospitalizations and the length of stay according to county, sex and age, as well as the association between hospitalizations due to Primary Care Sensitive Conditions and sex, age and hospitalization outcome. In the second stage, care to child health was analyzed through data filled in the surveillance instrument of 321 randomly selected children under five years old in areas covered by health workers. Information on sociodemographic characteristics were collected from mothers. Growth charts, records of supplement with iron and vitamin A and notes on immunization schedule registered inthe instrumentwere analyzed. In the case of children that had the third version of the Child Health Handbook, the association between completion of this handbook and sociodemographic characteristics was analyzed. Results: As for hospitalizations, prevalence of sensitive condition was 82.4%. The most frequent sensitive causes were: bacterial pneumonia (59.38%), infectious gastroenteritis and complications (23.59%) and infection of the kidney and urinary tract (9.67%). Girls had a higher prevalence of sensitive conditions than boys. A median of 4 days of hospitalization due to sensitive conditions were observed. The hospital stay lengthdue to sensitive conditions was significantly longer than the stay due to non-sensitive conditions. Regarding counties, the length of hospitalization was longer in Cabedelo. As for completion of the surveillance instrument, all parameters studied showed high level of inadequacy, ranging from 41.1% for the "age versus weight" chart to 95.7% for the "body mass index versus age" chart, with the worst performance in Bayeux. Age below 25 months represented a factor inversely related to, and thus a protection against, inadequate completion of the Child Health Handbook. Also, the hand books of children living in Bayeux had higher frequency of inadequate completion. Conclusions: The attention given to children under five years of age at Primary Health Care has not been effectively implemented due to the high prevalence of Hospitalizations due to Primary Care Sensitive Conditions and inadequate completion of the surveillance instrument. Results suggest, therefore, a need for qualification and professional training, as well as for integration between the different levels of care.