Structure and work process regarding child care in Primary Health Care in Brazil: an ecological study with data from the Program for Primary Health Care Access and Quality Improvement 2012-2018

Santos, Danilo Marcelo Araujo dos; Alves, Cláudia Maria Coelho; Rocha, Thiago Augusto Hernandes; Queiroz, Rejane Christine de Sousa; Silva, Núbia Cristina da; Thomaz, Erika Barbara Abreu Fonseca

Danilo Marcelo Araujo dos Santos

Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luís, MA, Brasil

http://orcid.org/0000-0002-7890-438X

Cláudia Maria Coelho Alves

Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luís, MA, Brasil

http://orcid.org/0000-0003-4705-4914

Thiago Augusto Hernandes Rocha

Global Emergency Medicine Innovation and Implementation, Division of Emergency Medicine, Durham, North Carolina, United States

http://orcid.org/0000-0002-6262-3276

Rejane Christine de Sousa Queiroz

Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luís, MA, Brasil

http://orcid.org/0000-0003-4019-2011

Núbia Cristina da Silva

Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil

http://orcid.org/0000-0002-0809-2152

Erika Barbara Abreu Fonseca Thomaz

Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde Coletiva, São Luís, MA, Brasil

http://orcid.org/0000-0003-4156-4067

Correspondence: Danilo Marcelo Araujo dos Santos - Rua Angelo Agostinho, Quadra K, Casa 23, Ipase, São Luís, MA, Brazil. Postcode: 65061-050. E-mail: danilo.santos@huufma.br

Associate Editor

Maryane Oliveira Campos - 0000-0002-7481-7465

Authors’ contributions

Santos DMA, Alves CMC, Rocha TAH and Thomaz EBAF took part in the study concept and design, data interpretation and drafting the manuscript. Queiroz RCS and Silva NC took part in data analysis and drafting the manuscript. All authors reviewed and approved the final version of the article. They declare that they are responsible for all aspects thereof, including the guarantee of its accuracy and integrity

*
Article derived from the Ph.D. thesis entitled ‘Internações pediátricas por condições sensíveis à Atenção Primária no Brasil e indicadores do PMAQ-AB 2012-2018: estudo ecológico multinível [‘Pediatric hospitalizations due to Primary Care sensitive conditions in Brazil and 2012-2018 PMAQ-AB indicators: a multilevel ecological study’], defended by Danilo Marcelo Araujo dos Santos at the Federal University of Maranhão Postgraduate Program in Public Health.

Indicators	Description
Primary health care center (PHCC) structure indicators
Health center operation	Average percentage of PHCCs operating at least five days a week
Health center operation at special times	Average percentage of PHCCs operating during special times: lunchtime, night shift or weekends
Medication dispensing at the health center	Average percentage of PHCCs dispensing medication
Health center facilities	Average percentage of facilities at PHCCs: clinic, nursing room, wound dressing room, procedure room, inhalation room and exclusive vaccination room
Equipment, material and supplies availability	Average percentage of equipment, materials and supplies needed for child care available at PHCCs: anthropometer, adult pressure device, pediatric or neonatal pressure device, nebulizer, 150kg anthropometric scale, child scale, anthropometric ruler, adult stethoscope, pediatric or neonatal stethoscope, exclusive refrigerator for vaccines, glucose meter, clinical flashlight, ophthalmoscope, otoscope, monofilament kit for sensitivity test (esthesiometer), sonar or Pinard's stethoscope, clinical thermometer, tongue depressor, disposable needles of various sizes, thermal boxes for vaccines, measuring tape, serum/macrodrops and microdrops kit, surgical/micropore tape and others, gauze, reagent strips for measuring capillary blood glucose, disposable syringes of various sizes, disposable syringes with attached needle, slide (for malaria) and printed material - Pregnant Women and Child Health Handbooks
Vaccine availability	Average percentage of immunobiologicals recommended by the Brazilian National Immunization Program available at PHCCs for child care
Rapid testing at the health center	Average percentage of rapid tests performed at PHCCs: pregnancy, syphilis, HIV, hepatitis and thick blood smear tests for malaria
Team work process indicators
Emergency care at the health center	Average percentage of PHCC with teams performing emergency care
Team planning	Average percentage of PHCCs with team planning activities
Matrix or institutional support received	Average percentage of PHCCs with teams receiving matrix or institutional support
Defined catchment area and existence of maps	Average percentage of PHCCs with teams in defined catchment area and existence of maps
Population without coverage	Average percentage of PHCCs with teams with population without coverage in the surrounding area
Appointment scheduling	Average percentage of PHCCs with teams scheduling apointments
Specialist appointments scheduling	Average percentage of PHCCs with teams that, if a service user needs to be referred for specialized consultation, schedule and inform the date of the consultation with the specialist
Clinical protocol use	Average percentage of PHCCs with teams using clinical protocols
Exam request	Average percentage of recommended tests that are requested at PHCCs
Service supply and demand control center	Average percentage of PHCCs that refer serive users to the service supply and demand control center, to be forwarded to other care provision sites
Child follow-up	Average percentage of recommended child follow-ups performed by PHCCs: vaccination, childcare, nutritional status, low weight, prematurity, violence, accidents etc.
Educational activities	Average percentage of PHCCs with teams performing educational activities
Home visiting	Average percentage of PHCC teams performing home visits

Macroregion	Primary health care centers
	2012		2014		2017/2018		Total
	N	%	N	%	N	%	N	%
North	1,287	9.2	1,690	7.0	2,384	7.9	5,361	7.8
Northeast	2,824	20.3	9,704	40.3	12,596	41.5	25,124	36.8
Southeast	6,696	48.1	7,165	29.8	8,795	29.0	22,656	33.2
South	2,268	16.3	3,607	15.0	4,341	14.3	10,216	15
Midwest	844	6.1	1,889	7.9	2,230	7.3	4,963	7.3
Brazil	13,919	100.0	24,055	100.0	30,346	100.0	68,320	100.0

Indicators	2012 Mean (%) ± standard deviation						2014 Mean (%) ± standard deviation						2017/2018 Mean (%) ± standard deviation
Indicators	N	NE	SE	S	MW	Brazil	N	NE	SE	S	MW	Brazil	N	NE	SE	S	MW	Brazil
Health center operation	99^a±7	89^b±31	97^c±18	93^d±26	95^c,d±21	95±22	99^a ±6	98^b±9	99^a±6	99^a±6	99^a±6	99±7	100^a,b±4	99^a±5	100^b±5	99a^,b±6	99^a,b±6	99±5
Health center operation at special times	46^a±37	31^b±35	57^c±36	33^b±36	39^d±36	45±37	15^a±19	10^b±14	23^c±16	12^d±19	11^b±17	15±17	16^a±19	13^b±17	25^c±17	11^d±17	9^e±17	16±18
Medication dispensing at the health center	85^a±36	77^b±42	68^b±47	76^b,d±43	72^c,d±45	73±45	81^a ±39	87^b±33	63^c±48	85^b±35	71^d±46	78±41	78^a±42	85^b±36	49^c±50	77^a±42	49^c±50	70±46
Health center facilities	48^a±34	51^b±31	65^c±32	61^d±29	65^c±31	60±32	62^a±16	65^b±14	66^c±13	71^d±11	67^c±13	66±14	45^a±18	49^b±18	51^c±18	48^b±18	50^c±17	49±18
Equipment, material and supplies availability	56^a±22	60^b±24	72^c±17	71^c±19	68^d±21	68±20	68^a±14	71^b±11	74^c±12	77^d±9	73^e±10	73±12	74^a±12	84^b±11	82^c±11	83^b,d±9	83^c,d±10	82±11
Vaccine availability	45^a±43	53^b±38	59^c,d±39	58^c±37	63^d±38	57±39	66^a±35	69^b±28	62^c±39	71^d±36	71^d±35	67±34	72^a±35	80^b±23	66^c±38	72^a±38	78^d±36	74±33
Rapid testing	10^a,d±21	3^b±12	9^a±15	5^c±14	7^d±20	7±16	21^a±27	12^b±21	16^c±22	20^a±23	16^c±24	16±22	53^a±29	63^b±35	51^a±44	80^c±30	61^d±36	61±38

Indicators	2012 Mean (%) ± standard deviation						2014 Mean (%) ± standard deviation						2017/2018 Mean (%) ± standard deviation
Indicators	N	NE	SE	S	MW	Brazil	N	NE	SE	S	MW	Brazil	N	NE	SE	S	MW	Brazil
Emergency care at the health center	75^a,b±32	73^a±33	76^b±31	75^a,b±32	77^b,c±31	75±32	75^a±27	81^b±23	79^c±24	79^c±25	77^a,c±24	79±24	94^a±18	93^b±21	93^a,b±19	92^c±22	94^a,b±19	93±20
Team planning	88^a±20	89^a±19	89^a±20	89^a±19	89^a±19	89a±20	91^a±20	90^a±20	90^a±20	91^a±19	92^a±19	91±20	95^a±14	94^a±17	95^a±15	93^b±18	95^a±15	94±16
Support received	85^a,b±26	85^a±27	83^b±28	83^a,b±28	84^a,b±26	84±27	85^a±27	89^b±23	89^b±24	90^b±23	90^b±22	89±24	86^a±25	84^b,c±27	85^b±27	83^c±28	83^b,c±28	84±27
Defined catchment area and existence of maps	90^a,b±22	91^a±20	90^b±22	90^a,b±21	90^a,b±20	90±21	92^a±20	93^a±20	92^a±20	94^b±18	92^a±21	93±20	95^a±16	95^a,b±18	95^a±17	94^b±20	95^a,b±18	95±18
Population without coverage	43^a±29	38^b±30	40^c±30	38^b,c±30	41^a,b,c±30	39±30	60^a,c±46	67^b±44	61^a±46	63^a±45	57^c±47	63±45	68^a,b±44	67^a±44	69^b±44	67^a,b±44	68^a,b±44	68±44
Appointment scheduling	59^a±48	58^a±48	52^b±49	53^b±49	56^a,b±48	54±49	74^a,b,c±30	75^a,b±31	74^a,c±31	76^b±30	72^c±30	75±30	70^a±27	69^a±29	69^a±28	70^a±29	71^a±29	70±28
Specialist appointment scheduling	41^a±35	42^a±35	41^a±35	36^b±35	39^a,b±34	40±35	36^a±32	41^b±34	36^a±34	41^b±35	34^a±33	39±34	51^a±36	51^a±36	52^a±36	51^a±37	53^a±37	52±36
Clinical protocol use	65^a±37	66^a±37	62^b,c±38	60^b±38	65^a,c±38	63±38	62^a,d,e±38	65^b±37	62^a,c±38	64^b,d±37	59^c,e±37	63±38	87a±21	86^b±23	86^a,b±23	85^b±25	86^a,b±23	86±23
Exam request	89^a±9	89^a±11	89^a±11	90^a±9	89^a±10	89±10	90^a,b±13	89^a±12	90^a,b±13	90^b±13	90^a,b±12	90±13	96^a±13	95^a±16	95^a±15	94^b±18	95^a±15	95±16
Service supply and demand control center	91^a±28	89^a±30	90^a±30	90^a±30	90^a±29	90±30	83^a±36	85^a±35	87^b±33	86^a,b±34	87^b±33	85±34	94^a±23	93^a±25	93^a±24	93^a±25	93^a±24	93±24
Child follow-up	78^a±18	77^a±19	77^a±19	77^a±18	78^a±18	77±19	76^a±26	76^a±26	76^a±26	76^a±26	76^a±26	76±26	88^a±15	87^b±18	87^a±16	85^c±19	87^a,b,c±17	87±17
Educational activities	70^a±28	69^a±28	70^a±27	70^a±28	65^b±29	70±28	75^a±28	71^b±30	75^a±29	74^a±29	73^a±30	73±29	86^a±23	87^a±24	87^a±23	86^a±25	87^a±23	87±23
Home visiting	100^a±5	100^a±7	100^a±7	100^a±6	99^a±7	100±6	93^a±24	93^a±24	94^a±23	94^a±23	94^a±23	94±23	98^a±14	96^b±18	97a±16	96^b±19	97^a,b±16	97±17

[1] Correspondence: Danilo Marcelo Araujo dos Santos - Rua Angelo Agostinho, Quadra K, Casa 23, Ipase, São Luís, MA, Brazil. Postcode: 65061-050. E-mail: danilo.santos@huufma.br

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