Cuidado às crianças com obesidade na atenção primária à saúde e seus fatores associados na Paraíba

Abstract

Objective: The objective of this study was to verify the frequency of consultations for children with obesity in Primary Health Care and the associated factors in Paraíba. Methodology: This was a representative cross-sectional study of the care for children with obesity in primary health care in the state of Paraíba, part of a national study by the Ministry of Health entitled “Situational diagnosis of programs and actions related to the National Food Policy and Nutrition (PNAN)", referring to the research and development axis of the "Research, extension and training project for managers and workers of the Unified Health System for the prevention, diagnosis and treatment of obesity in the population of Paraíba", research financed by the Ministry of of Health/National Council for Scientific and Technological Development (CNPQ). The research was carried out from January to September 2021, in the Primary Health Care (PHC) health units in the state of Paraíba. There are 1765 basic health units distributed in 223 municipalities in Paraíba. The sample calculation, carried out and replicated for all states participating in the national study, was developed by the team of researchers from the Federal University of Piauí, considering the random sampling plan by conglomerate, taking into account the margin of error of 5%, with a level of 95% confidence, 4 strata were defined according to the number of the population: A-capital; B-municipalities with more than 150 thousand habitants; C-municipalities between 30 and 150 thousand habitants; D-municipalities smaller than 30,000 habitants. The 642 Basic Health Units (UBS) drawn were organized among 168 municipalities, which made up the final sample of this study, so that they covered all health regions and macro-regions. At the end of data collection, an "n" of 475 UBS was obtained. A loss of 26.5% (167/642) was verified. Of these, 148 were due to unanswered questionnaires and 22 were excluded from the study because they were deactivated units or did not belong to the APS or were anchor units. Analyzes were performed using the Statistical Package for Social Sciences - SPSS version 22.0 software. Results: Most participants were female (90.5%), nurses (65.5%) who worked in Basic Health Units or Family Health Units (75.4%), for over a year (73 .5%). Only 8% had training on obesity management, 88.1% stated that care for individuals with obesity exists in the establishments where they work, with individual actions being the most performed (44.9%), and, 64.1 % of professionals expressed the existence of maps of territories, which contain equipment and spaces for health actions. With regard to the child population, 77.4% of professionals stated that they had carried out actions, with community actions being more frequent (50.2%), when compared to individual actions (30.6%). The age group from 0 to 2 years is the one that receives the most individual assistance (31.9%), while community or group actions are more aimed at older children and adolescents through the Health at School Program (70.5%). Actions for the care of overweight children were not associated with any of the characteristics related to the participating professionals (p >0.05), but municipalities of size C and D, smaller sizes, presented a significantly higher frequency than municipalities of size A and B (A/B versus C p= 0.001 ; A/B versus D p<0.001). Among the resources transferred to Primary Health Care for the development of actions aimed at obesity, the most frequently reported by professionals were the Basic Care Floor-PAB (86.5%) and the National Food and Nutrition Fund-FNAN (84 .8%). Only receiving the Basic Care Floor was associated with the development of actions aimed at caring for children with childhood obesity (p=0.003). Despite the resources from the Growing Healthy Program and funds from the Health at School Program, these programs also showed no association with the development of actions aimed at childhood obesity. Conclusions: The results of this research showed that there are public health policies against childhood obesity and programs involved in this process. Municipalities receive resources and funds earmarked for this purpose. PHC professionals work both in individual and collective actions to combat childhood obesity, and according to them, the UBS where they work have adequate structure and equipment for the care of children with obesity. However, despite these actions and resources, the prevalence of childhood overweight and obesity is still high in most municipalities in Paraíba. A fact that can be justified by the lack of training and education of PHC professionals on the management of childhood obesity, the lack of joint actions between PHC and caregivers of these children and, finally, the deficiency of efficient supervision by competent organizations .