Role of Primary Health Care in child hospitalization due to pneumonia: a case-control study

Pina, Juliana Coelho; Moraes, Suzana Alves de; Freitas, Isabel Cristina Martins de; Mello, Débora Falleiros de

doi:10.1590/1518-8345.1731.2892

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 25 • 2017 • https://doi.org/10.1590/1518-8345.1731.2892 copy

Role of Primary Health Care in child hospitalization due to pneumonia: a case-control study^¹ 1 Paper extracted from Doctoral Dissertation "A hierarchized approach to the identification of the factors associated with hospitalization due to pneumonia in children under five years of age: a case-control study", presented to Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil, process #2011/12195-5.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to evaluate the association of primary health care and other potential factors in relation to hospitalization due to pneumonia, among children aged under five years.

Method:

epidemiological study with a case-control, hospital-based design, which included 345 cases and 345 controls, matched according to gender, age and hospital. Data were collected using a pre-coded questionnaire and the Primary Care Assessment Tool, analyzed by means of multivariate logistic regression, following the assumptions of a hierarchical approach.

Results:

the protective factors were: family income >US$216.12 (OR=0.68), weight gain during pregnancy ≥10 kg (OR=0.68), quality of Primary Health Care (OR for scores >3.41=0.57; OR for scores >3.17 and ≤3.41=0.50), gastro-esophageal reflux (OR=0.55), overweight (OR=0.37) and birth interval ≥48 months (OR=0.28). The risk factors included: parity (2 childbirths: OR=4.60; ≥3 childbirths: OR=3.25), out-of-date vaccination (OR=2.81), undernutrition (OR=2.53), history of wheezing (≥3 episodes OR=2.37; 1 episode: OR=2.13), attendance at daycare center (OR=1.67), and use of medicines over the past month (OR=1.67).

Conclusion:

primary health care and its child health care practices, such as nutritional monitoring, immunization, care to prevalent illnesses, prenatal care and family planning need to be prioritized to avoid child hospitalization due to pneumonia.

Descriptors:
Child; Pneumonia; Hospitalization; Primary Health Care; Risk Factors; Protective Factors

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Juliana Coelho Pina Universidade Federal de Santa Catarina. Departamento de Enfermagem Bairro: Trindade CEP: 88040-900, Florianópolis, SC, Brasil E-mail: pina.juliana@ufsc.br

Characteristics		Cases		Controls		ᵡ² *
Characteristics		n	%	n	%	ᵡ² *
Gender						0.939
	Male	179	51.88	179	51.88
	Female	166	48.12	166	48.12
Age range (months)						0.990
	02-05.9	77	22.32	76	22.03
	06-11.9	82	23.77	85	24.64
	12-23.9	98	28.41	95	27.54
	24-59.9	88	25.51	89	25.80
Family income in tertiles (US$)^†						0.113
	1^st tertile (≤123.50)	133	38.55	109	31.59
	2^nd tertile >123.50 and ≤216.12	108	31.30	111	32.17
	3^rd tertile >216.12	104	30.14	125	36.23
Maternal education (years)						0.321
	0-4	31	8.99	30	8.70
	5-8	133	38.55	115	33.33
	≥ 9	181	52.46	200	57.97
Paternal education (years)						0.705
	0-4	43	14.05	42	13.82
	5-8	132	43.14	122	40.13
	≥ 9	131	42.81	140	46.05
Marital status						0.731
	With partner	254	73.62	250	72.46
	No partner	91	26.38	95	27.54
Mother working away from home						0.445
	No	190	55.1	180	52.2
	Yes	155	44.9	165	47.8
Maternal age (years)						0.771
	< 20	27	7.8	30	8.7
	20-34.9	259	75.1	250	72.7
	≥35	59	17.1	64	18.6
No. of rooms in the home						0.693
	≤ 3	65	18.8	61	17.7
	≥ 4	280	81.2	284	82.3
No. of people in the home						0.048
	< 4	73	21.2	99	28.7
	4-5	171	49.6	164	47.5
	≥ 6	101	29.3	82	23.8

Hierarchical levels			Crude OR* (CI95%)	Adjusted OR* (CI95%)
1^st - Socioeconomic Variables
	Family income in tertiles (US$)^†
		1^st tertile (≤123.50)	1.00	1.00
		2^nd tertile >123.50 and ≤216.12	0.80 (0.55 to 1.15)	0.80 (0.55 to 1.15)
		3^rd tertile >216.12	0.68 (0.47 to 0.98)	0.68 (0.47 to 0.98)

2º - Reproductive and Environmental Variables^‡
	Parity (number of births)
		1	1.00	1.00
		2	1.58 (1.09 to 2.28)	4.60 (2.18 to 9.72)
		≥ 3	1.38 (0.96 to 1.99)	3.25 (1.55 to 6.81)
	Birth interval (months)
		< 24	1.00	1.00
		24-47	1.56 (1.02 to 2.39)	0.51 (0.25 to 1.05)
		≥ 48	0.86 (0.62 to 1.20)	0.28 (0.14 to 0.56)
	Weight gain during pregnancy (Kg)
		< 10	1.00	1.00
		≥ 10	0.69 (0.48 to 0.97)	0.68 (0.47 to 0.97)
	Day-care attendance
		No	1.00	1.00
		Yes	1.60 (1.17 to 2.19)	1.67 (1.16 to 2.41)

3^rd - Nutritional, child care and morbidity variables^§
	Z-score of BMI^‖ for age
		Eutrophic	1.00	1.00
		Underweight	1.99 (1.02 to 3.85)	2.53 (1.06 to 6.05)
		Overweight	0.42 (0.21 to 0.81)	0.37 (0.14 to 0.99)
	Essential PHC^¶ Score
		1^st quartile (≤2.79)	1.00	1.00
		2^nd quartile (> 2.79 e ≤3.17)	0.79 (0.53 to 1.18)	0.98 (0.57 to 1.68)
		3^rd quartile (>3.17 e ≤ 3.41)	0.50 (0.32 to 0.76)	0.50 (0.28 to 0.88)
		4^th quartile (>3.41)	0.56 (0.37 to 0.86)	0.57 (0.32 to 0.99)
	Vaccination
		Up-to-date	1.00	1.00
		Delayed	2.11 (1.49 to 2.98)	2.81 (1.76 to 4.49)
	Medicines taken
		No	1.00	1.00
		Yes	1.60 (1.10 to 2.32)	1.67 (1.00 to 2.78)
	Number of wheezing episodes
		0	1.00	1.00
		1	1.98 (1.33 to 2.94)	2.13 (1.31 to 3.47)
		2	1.36 (0.79 to 2.33)	1.04 (0.53 to 2.06)
		≥ 3	2.79 (1.78 to 4.36)	2.37 (1.35 to 4.15)
	Gastroesophageal reflux
		No	1.00	1.00
		Yes	0.72 (0.46 to 1.13)	0.55 (0.31 to 0.99)