Structure and work process for food and nutrition actions in Primary Health Care in Brazil, 2014

Machado, Patrícia Maria de Oliveira; Lacerda, Josimari Telino de; Colussi, Claudia Flemming; Calvo, Maria Cristina Marino

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 30 (2) • 2021 • https://doi.org/10.1590/S1679-49742021000200015 copy

Structure and work process for food and nutrition actions in Primary Health Care in Brazil, 2014^* * Article derived from the Ph.D. thesis entitled ‘Nutrition in Primary Health Care: analysis of implementation in Brazilian municipalities’, defended by Patrícia Maria de Oliveira Machado at the Federal University of Santa Catarina Postgraduate Program in Public Health in July 2018. Patrícia Maria de Oliveira Machado received a postgraduate scholarship from the Coordination for the Improvement of Higher Education Personnel/Ministry of Education: Grant No. 1422415.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the conditions of structure and work process for food and nutrition actions in Primary Health Care in Brazil.

Methods:

This was a cross-sectional study with secondary data from the Program for Primary Health Care Access and Quality Improvement. The proportions of Primary Health Care Center (PHCC) and health team adequacy were described according to organizational variables, using prevalence ratios and Poisson regression.

Results:

19,793 PHCCs and 24,549 teams were analyzed; 35.0% (n=6,928) of PHCCs were considered adequate in relation to structure and 7.9% (n=1,934) of the teams had adequate work process. Standing out in the analyses of association are PHCCs in the Southern region (44.7%) and teams in the Southeastern region (10.9%), in addition to municipalities with more than 300,000 inhabitants.

Conclusion:

The PHCCs and teams analyzed presented a low proportion of adequacy for structure and work process for food and nutrition actions.

Keywords:
Structure of Services; Primary Health Care; Nutrition Programs and Policies; Cross-Sectional Studies

Variables	Primary Health Care Centers			Health Teams
	Total	Adequate structure		Total	Adequate work process
	n (%)	n	% (95%CI^b)	n (%)	n	% (95%CI^b)
Brazil	19,793 (100.0)	6,928	35.0 (34.3;35.7)	24,549 (100.0)	1,934	7.9 (7.5;8.2)
Region
North	1,207 (6.1)	269	22.3 (20.0;24.7)	1,519 (6.2)	47	4.0 (2.3;4.1)
Northeast	7,845 (39.6)	3,019	38.5 (37.4;39.6)	8,573 (34.9)	555	6.5 (6.0;7.0)
Southeast	5,967 (30.2	1,837	30.8 (29.6;32.0)	8,606 (35.1)	939	10.9 (10.3;11.6)
South	3,105 (15.7)	1,387	44.7 (42.9;46.4)	3,882 (15.8)	304	7.8 (7.0;8.7)
Midwest	1,669 (8.4)	416	24.9 (22.9;27.1)	1,969 (8.0)	89	4.5 (3.7;5.5)
Municipality size (inhabitants)
Up to 10,000	3,280 (16.6)	1,114	34.0 (32.4;35.6)		3,664 (14.9)	202	5.5 (4.8;6.3)
10,001-30,000	6,833 (34.5)	2,154	31.5 (30.4;32.6)	7,222 (29.4)	431	6.0 (5.4;6.5)
30,001-100,000	4,983 (25.2)	1,763	35.4 (34.1;36.7)	5,439 (22.2)	367	6.8 (6.1;7.4)
100,001-300,000	2,276 (11.5)	878	38.6 (36.6;40.6)	3,010 (12.3)	260	8.6 (7.7;9.6)
Over 300,000	2,421 (12.2)	1,019	42.1 (40.1;44.1)	5,214 (21.4)	674	12.9 (12.0;13.9)
Oral Health Team
No	4,106 (20.7)	1,246	30.4 (29.0;31.8)		8,131 (33.1)	710	8.7 (8.1;9.4)
Yes	15,687 (79.3)	5,682	36.2 (35.5;37.0)	16,418 (66.9)	1,224	7.5 (7.1;7.9)
Complete minimum teams
No	3,815 (19.3)	1,317	34.5 (33.0;36.0)		- ^c	- ^c	- ^c
Yes	15,978 (80.7)	5,611	35.1 (34.4;35.9)
Nutritionist
No	10,637 (53.7)	3,339	31.4 (30.5;32.3)		12,737 (51.9)	724	5.7 (5.3;6.1)
Yes	9,156 (46.3)	3,589	39.2 (38.2;40.2)	11,812 (48.1)	1,210	10.2 (9.7;10.8)
Family Health Support Group
No	8,501 (43.0)	2,675	31.5 (30.5;32.5)		10,053 (40.9)	549	5.5 (5.0;5.9)
Yes	11,292 (57.0)	4,253	37.7 (36.8;38.6)	14,496 (59.1)	1,385	9.6 (9.1;10.0)
Population without coverage in the catchment area
Yes	5,871 (33.9)	1,894	32.3 (31.1;33.5)		7,443 (34.1)	450	6.1 (5.5;6.6)
No	11,433 (66.1)	4,433	38.8 (37.9;39.7)	14,352 (65.9)	1,426	9.9 (9.4;10.4)

Variables	Structure adequacy				Work process adequacy
Variables	PR^b (95%CI^c) crude	p-value^d	PR^b (95%CI^c) adjusted¹	p^d	PR^b (95%CI^c) crude	p^d	PR^b (95%CI^c) adjusted¹	p-value^d
Region
North	1.00	<0.001	1.00	<0.001	1.00	<0.001	1.00	<0.001
Northeast	1.72 (1.55;1.93)		1.76 (1.53;2.02)		2.09 (1.56;2.80)		1.48 (1.10;2.01)
Southeast	1.38 (1.25;1.55)		1.31 (1.14;1.51)		3.53 (2.64;4.70)		2.08 (1.54;2.80)
South	2.00 (1.79;2.24)		1.91 (1.65;2.20)		2.53 (1.87;3.42)		1.61 (1.18;2.20)
Midwest	1.12 (0.98;1.28)		1.15 (0.97;1.36)		1.46 (1.03; 2.07)		1.28 (0.89;1.82)
Municipality size (inhabitants)
Up to 10,000	1.00	<0.001	1.00		1.00	<0.001	1.00
10,001-30,000	0.93 (0.87;0.98)		0.91 (0.84;0.98)		1.08 (092;1.27)		1.15 (0.96;1.37)
30,001-100,000	1.04 (0.98;1.11)		1.04 (0.95;1.13)		1.22 (1.04;1.45)		1.21 (1.01;1.46)
100,001-300,000	1.14 (1.06;1.22)		1.19 (1.08;1.31)		1.57 (1.31;1.87)		1.48 (1.22;1.81)
Over 300,000	1.24 (1.16;1.32)		1.29 (1.18;1.41)		2.34 (2.02;5.73)		1.75 (1.46;2.09)
Oral Health Team
No	1.00	<0.001	1.00		1.00	<0.001	1.00
Yes	1.19 (1.13;1.26)		1.18 (1.10;1.26)		0.85 (0.78;0.93)		1.07 (0.97;1.19)
Complete minimum teams
No	1.00	0.489	-		- ^d		- ^d
Yes	1.02 (0.97;1.07)
Nutritionist
No	1.00	<0.001	1.00		1.00	<0.001	1.00
Yes	1.25 (1.20;1.30)		1.13 (1.06;1.20)		1.80 (1.64;1.97)		1.31 (1.17;1.47)
Family Health Support Team
No	1.00	<0.001	1.00		1.00	<0.001	1.00
Yes	1.20 (1.15;1.24)		1.03 (0.97;1.10)		1.75 (1.59;1.92)		1.22 (1.07;1.38)
Population without coverage in the catchment area
Yes	1.00	<0.001	1.00		1.00	<0.001	1.00
No	1.20 (1.15;1.26)		1.19 (1.13;1.26)		1.64 (1.48;1.82)		1.52 (1.36;1.69)
Structure adequacy
Inadequate	-	-	-		1.00	<0.001	1.00
Adequate					2.09 (1.92;2.28)		1.70 (1.55;1.87)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Patrícia Maria de Oliveira Machado - Universidade Federal da Integração Latino-Americana, Instituto Latino-Americano de Ciências da Vida e da Natureza, Jardim Universitário, Loteamento Universitário das Américas, Av. Tarquínio Joslin dos Santos, No.1000, sala G201, Foz do Iguaçu, PR, Brazil. Postcode: 85870-650 E-mail: patriciamomachado@gmail.com