Access to medicines in Brazil based on monetary and non-monetary acquisition data obtained from the 2008/2009 Household Budget Survey

ABSTRACT OBJECTIVE To investigate the access to medicines by Brazilian families by monetary and non-monetary acquisition data. METHODS This is a cross-sectional study based on data obtained from the 2008/2009 Brazilian Household Budget Survey. The units of assessment were households that participated in the survey and the data on the acquisition of medicines over the 30 days prior to the interviews. The medicines were classified according to the Anatomical Therapeutic Chemical classification system. RESULTS Acquisition of medicines was reported by 82.9% of Brazilian households, with 2.38 medicines/household, and 0.72 medicine/individual. In the South and Southeast regions, the average acquisition was slightly greater than the national average (2.53 and 2.49, respectively). In 22.3% of Brazilian households, it was reported that a medicine was not acquired due to lack of financial resources, mainly in the North and Northeastern regions, and in rural areas. Approximately 15.0% of medicines were obtained with no costs, 90.1% of them by the Brazilian Unified Health System. The medicines most acquired were those acting on the nervous system (28.8% of Brazilian households), on the cardiovascular system (15.7%), on the digestive tract and metabolism (14.3%), and on the respiratory system (12.1%). Overall, the quantity of medicines acquired was greater in higher socioeconomic classes of the population, with the exception of antiparasitic products, most likely because of the precarious sanitary conditions faced by less privileged social classes. CONCLUSIONS The acquisition of medicines is a common practice in Brazil, being reported by over 80.0% of the Brazilian households in 2008/2009. Although the data obtained from the Brazilian Household Budget Survey have some limitations, the information obtained in this study can help health authorities to design national and regional policies to guarantee access to these products while promoting their rational use.

Adoecimento por coqueluche e número de doses administradas de vacinas Pertussis: estudo de caso-controle / Pertussis and number of doses of vaccine administered: a case control study

Objetivo: estimar as chances de adoecimento por coqueluche segundo número de doses de vacinas Pertussis administradas e idade, no Brasil. Métodos: estudo de caso-controle utilizando dados do Sistema de Informação de Agravos de Notificação (Sinan) no período 2007-2011; considerou-se como casos aqueles notificados com coqueluche confirmada, e como controles, aqueles descartados; foram calculadas as odds ratio (OR) e respectivos intervalos de confiança de 95 por cento (IC95 por cento). Resultados: foram incluídos 5.389 casos e 10.689 controles; entre 7-12 meses de idade, a chance de adoecimento foi maior com 1 dose administrada [OR:2,1(IC95 por cento:1,3-3,4)], comparativamente às 3 doses esperadas; entre 1-3 anos, essa chance foi maior sem reforço vacinal [OR 1 dose: 2,4(IC95 por cento:1,6-3,8); OR 2 doses:3,6(IC95 por cento:2,2-6,1); OR 3 doses:1,6(IC95 por cento:1,3-2,2); OR Ø dose:2,8(IC95 por cento:1,7-4,8)], quando este era esperado; entre 7-15 anos, foi maior com 1 reforço [OR:1,6(IC95 por cento:1,2-2,3)], quando 2 eram esperados. Conclusão: o esquema vacinal incompleto aumenta as chances de adoecimento por coqueluche em todas as idades estudadas.

Objective: estimate the likelihood of pertussis according to number of vaccine doses received and age. Methods: Case-control study using 2007-2011 SINAN data. "Cases" were considered to be confirmed reported pertussis cases. "Controls" were the discarded cases. Results: 5,389 cases and 10,689 controls were included. In those aged 7-12 months, cases were twice as likely [OR:2.1 (95 per cent CI: 1.3-3.4)] when only 1 instead of 3 doses had been administered. In 1-3 year--olds, likelihood was greater in those not having boosters (1 booster expected) [OR 1 dose: 2.4 (95 per cent CI:1.6-3.8); OR 2 doses: 3.6 (95 per cent CI: 2.2-6.1); OR 3 doses: 1.6 (95 per cent CI:1.3-2.2); OR Ø dose: 2.8 (95 per cent CI:1.7-4.8)]. In 7-15 year-olds, cases were 60 per cent more likely in those having had 1 booster instead of 2 [OR:1.6 (95 per cent CI:1.2-2.3)]. Conclusion: incomplete immunization increases likelihood of contracting pertussis in all age groups studied, mainly 7-15 years.