Assistência pré-natal à adolescente e os atributos da Atenção Primária à Saúde

OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC) guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care), Coordination (information systems) and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.OBJETIVO: evaluar la atención prenatal a las adolescentes en unidades de salud, según los atributos de la Atención Primaria a la Salud. MÉTODO: estudio de abordaje cuantitativo, realizado con profesionales de la salud, utilizando el instrumento Primary Care Assessment Tool-Brasil para analizar la presencia y extensión de los atributos vinculados a la APS en las unidades de salud. RESULTADOS: para todas las unidades participantes, el atributo Acceso obtuvo un puntaje =6,6; los atributos Longitudinalidad, Coordinación (integración de cuidados), Coordinación (sistemas de información) e Integralidad obtuvieron puntajes =6,6 y el Puntaje Esencial fue =6,6. Comparando las unidades básicas de salud y las unidades de salud de la familia, los puntajes están igualmente distribuidos: Accesibilidad =6,6 y los demás atributos con puntajes =6,6; sin embargo, el puntaje Esencial en las unidades básicas fue =6,6 y el de las unidades de salud de la familia fue =6,6. CONCLUSIÓN: la ampliación de la cobertura de las unidades de salud de la familia y la capacitación profesional pueden ser estrategias para calificar la atención a la salud.OBJETIVO: avaliar a atenção pré-natal às adolescentes em unidades de saúde, segundo os atributos da Atenção Primária à Saúde. MÉTODO: estudo de abordagem quantitativa, realizado com profissionais de saúde, utilizando-se o instrumento Primary Care Assessment Tool-Brasil, para analisar a presença e extensão dos atributos. RESULTADOS: para todas as unidades participantes, o atributo acesso obteve escore =6,6; os atributos longitudinalidade, coordenação (integração de cuidados), coordenação (sistemas de informação) e integralidade obtiveram escores =6,6 e escore essencial =6,6. Comparando-se as unidades básicas e as unidades de saúde da família, os escores estão igualmente distribuídos: acessibilidade: =6,6 e os demais atributos com escores =6,6, no entanto, o escore essencial nas unidades básicas foi =6,6 e nas unidades de saúde da família foi =6,6. CONCLUSÃO: a ampliação da cobertura das unidades de saúde da família e a capacitação profissional podem ser estratégias para qualificar a atenção à saúde

Health services performance for TB treatment in Brazil: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.</p> <p>Methods</p> <p>This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the <it>Primary Care Assessment Tool </it>adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.</p> <p>Results</p> <p>"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.</p> <p>Conclusions</p> <p>Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.</p

Uses of population census data for monitoring geographical imbalance in the health workforce: snapshots from three developing countries

BACKGROUND: Imbalance in the distribution of human resources for health (HRH), eventually leading to inequities in health services delivery and population health outcomes, is an issue of social and political concern in many countries. However, the empirical evidence to support decision-making is often fragmented, and many standard data sources that can potentially produce statistics relevant to the issue remain underused, especially in developing countries. This study investigated the uses of demographic census data for monitoring geographical imbalance in the health workforce for three developing countries, as a basis for formulation of evidence-based health policy options. METHODS: Population-based indicators of geographical variations among HRH were extracted from census microdata samples for Kenya, Mexico and Viet Nam. Health workforce statistics were matched against international standards of occupational classification to control for cross-national comparability. Summary measures of inequality were calculated to monitor the distribution of health workers across spatial units and by occupational group. RESULTS: Strong inequalities were found in the geographical distribution of the health workforce in all three countries, with the highest densities of HRH tending to be found in the capital areas. Cross-national differences were found in the magnitude of distributional inequality according to occupational group, with health professionals most susceptible to inequitable distribution in Kenya and Viet Nam but less so in Mexico compared to their associate professional counterparts. Some discrepancies were suggested between mappings of occupational information from the raw data with the international system, especially for nursing and midwifery specializations. CONCLUSIONS: The problem of geographical imbalance among HRH across countries in the developing world holds important implications at the local, national and international levels, in terms of constraints for the effective deployment, management and retention of HRH, and ultimately for the equitable delivery of health services. A number of advantages were revealed of using census data in health research, notably the potential for producing detailed statistics on health workforce characteristics at the sub-national level. However, lack of consistency in the compilation and processing of occupational information over time and across countries continues to hamper comparative analyses for HRH policy monitoring and evaluation

Hospitalizações por condições cardiovasculares sensíveis à atenção primária em municípios goianos

OBJETIVO: Analisar taxas de hospitalização por condições cardiovasculares sensíveis à atenção primária. MÉTODOS: Estudo ecológico com 237 municípios do Estado de Goiás, de 2000 a 2008, utilizando dados do Sistema de Informação Hospitalar e Sistema de Informação da Atenção Básica. As taxas de hospitalização foram calculadas pela proporção entre o número de hospitalizações por condições cardiovasculares e a população acima de 40 anos. Foram avaliadas em triênios: A (2000-2002), B (2003-2005) e C (2006-2008), segundo sexo, faixa etária, porte populacional, pertencimento à região metropolitana, macrorregião de saúde, distância da capital, Índice de Condições de Vida e Saúde e cobertura de Estratégia Saúde da Família. A cobertura populacional potencial da Saúde da Família foi calculada conforme diretrizes do Ministério da Saúde. A variabilidade das taxas foi avaliada segundo teste t e ANOVA. RESULTADOS: Ocorreram 253.254 internações (17,2% do total) por condições cardiovasculares sensíveis à atenção primária. As taxas de hospitalização diminuíram entre os triênios: A (213,5, dp = 104,6), B (199,7, dp = 96,3) e C (150,2, dp = 76,1), com diferença entre os períodos A-C e B-C (p < 0,001). Porte populacional municipal não influenciou o comportamento das taxas. Municípios próximos à capital e aqueles da região metropolitana apresentaram maiores taxas (p < 0,001). Em todos os percentis do Índice de Condições de Vida e Saúde, houve redução das taxas (p < 0,001), exceto no percentil 1. Redução foi também observada em todas as macrorregiões, exceto na região nordeste do estado. A redução das taxas ocorreu independentemente da cobertura da Saúde da Família. CONCLUSÕES: As taxas de hospitalização por condições cardiovasculares sensíveis à atenção primária diminuíram nesses municípios, independentemente da cobertura da Saúde da Família

Inequities in incidence, morbidity and expenditures on prevention and treatment of malaria in southeast Nigeria

<p>Abstract</p> <p>Background</p> <p>Malaria places a great burden on households, but the extent to which this is tilted against the poor is unclear. However, the knowledge of the level of the burden of malaria amongst different population groups is vital for ensuring equitable control of malaria. This paper examined the inequities in occurrence, economic burden, prevention and treatment of malaria.</p> <p>Methods</p> <p>The study was undertaken in four malaria endemic villages in Enugu state, southeast Nigeria. Data was collected using interviewer-administered questionnaires. An asset-based index was used to categorize the households into socio-economic status (SES) quartiles: least poor; poor; very poor; and most poor. Chi-square analysis was used to determine the statistical significance of the SES differences in incidence, length of illness, ownership of treated nets, expenditures on treatment and prevention.</p> <p>Results</p> <p>All the SES quartiles had equal exposure to malaria. The pattern of health seeking for all the SES groups was almost similar, but in one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals. The cost of treating malaria was similar across the SES quartiles. The average expenditure to treat an episode of malaria ranged from as low as 131 Naira ($1.09) to as high as 348 Naira ($2.9), while the transportation expenditure to receive treatment ranged from 26 Naira to 46 Naira (both less than $1). The level of expenditure to prevent malaria was low in the four villages, with less than 5% owning untreated nets and 10.4% with insecticide treated nets.</p> <p>Conclusion</p> <p>Malaria constitutes a burden to all SES groups, though the poorer socio-economic groups were more affected, because a greater proportion of their financial resources compared to their income are spent on treating the disease. The expenditures to treat malaria by the poorest households could lead to catastrophic health expenditures. Effective pro-payment health financing and health delivery methods for the treatment and prevention of malaria are needed to decrease the burden of the disease to the most-poor people.</p

Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS

Regional socioeconomic indicators and ethnicity as predictors of regional infant mortality rate in Slovakia

OBJECTIVE: Exploring the associations of regional differences in infant mortality with selected socioeconomic indicators and ethnicity could offer important clues for designing public health policy measures. METHODS: Data included perinatal and infant mortality in the 79 districts of the Slovak population in 2004. Linear regression was used to analyse the contribution of education, unemployment, income and proportion of Roma population on regional differences in perinatal and infant mortality rates. RESULTS: All the explored socioeconomic indicators and ethnicity individually contributed significantly to both perinatal and infant mortality, with the exception of income. In the model exploring the influence of all these variables together on perinatal and infant mortality, only the effect of the proportion of Roma population remained significant. This model explained 34.9% of the variance for perinatal and 36.4% of the variance for infant mortality. CONCLUSIONS: Living in Roma settlements indicates an accumulation of socioeconomic disadvantage. Health literacy, health-related behaviour and many other factors might contribute to the explanation of the differences in infant mortality, and a better understanding of these processes might help us to design tailored interventions

HIV Risk among MSM in Senegal: A Qualitative Rapid Assessment of the Impact of Enforcing Laws That Criminalize Same Sex Practices

Men who have sex with men (MSM) are at high risk for HIV in Senegal, with a prevalence of 21.5%. In December 2008, nine male HIV prevention workers were imprisoned for “acts against nature” prohibited by Senegalese law. This qualitative study assessed the impact of these arrests on HIV prevention efforts. A purposive sample of MSM in six regions of Senegal was recruited by network referral. 26 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) were conducted in July–August 2009. 14 key informants were also interviewed. All participants reported pervasive fear and hiding among MSM as a result of the December 2008 arrests and publicity. Service providers suspended HIV prevention work with MSM out of fear for their own safety. Those who continued to provide services noticed a sharp decline in MSM participation. An effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law