Suboptimal child healthcare practices and the development of multiple infectious diseases in children aged 24-59 months.

Background: Infections continue to be a major cause of death among children under the age of five worldwide. This study aimed to identify the factors associated with the development of multiple infectious diseases in children aged 24-59 months in Indonesia. Methods: Data from the 2018 Basic Health Research conducted by the Ministry of Health, Republic of Indonesia, were used. Information from 39,948 children aged 24-59 months was analyzed. The outcome variable was the development of multiple infectious diseases, that is, acute respiratory infections, pneumonia, pulmonary tuberculosis, diarrhea, and hepatitis, in the month before the survey. Factors significantly associated with multiple types of infectious diseases were examined using logistic regression. Results: The study found that 76.6% of children aged 24 to 59 months in Indonesia had at least one type of infectious disease. The likelihood of developing multiple types of infectious diseases increased in children whose parents did not practice appropriate handwashing with soap and running water [adjusted odds ratio (aOR) = 1.16, p < 0.001], those who received supplemental food (aOR = 1.38, p < 0.001), those with poor nutritional status (aOR = 1.12, p < 0.001), and those living in urban areas (aOR = 1.07, p = 0.045). Conclusion: Improving caregivers' awareness of adequate child healthcare practices, in addition to nutrition-sensitive and specific interventions to improve children's nutritional status, is required to prevent children from contracting multiple types of infectious diseases.

Determinantes sociais de saúde de crianças em consulta de puericultura: das condições socioeconômicas aos aspectos relacionados à saúde bucal / Social determinants of health of children in child care consultation: from socioeconomic conditions to aspects related to oral health / Determinantes sociales de la salud de los niños en la consulta infantil: de las condiciones socioeconómicas a los aspectos relacionados con la salud bucal

A imaturidade do sistema imunológico, associado a Determinantes Sociais de Saúde (DSS), promove doenças na infância. Especificamente, na cavidade oral, os DSS, representados pelo consumo elevado de açúcar, limitado acesso aos serviços de saúde e deficiência na higiene bucal, favorecem transtornos locais e sistêmicos. Assim, o estudo objetivou associar os DSS, no contexto das condições socioeconômicas, do acompanhamento pelo serviço de saúde e dos aspectos relacionados à saúde bucal de crianças atendidas em Unidades Básicas de Saúde (UBS) de um município cearense. Trata-se de estudo observacional, analítico, transversal e de abordagem quantitativa, conduzido com crianças e suas mães em Acarape - CE. Após consentimento, essas preencheram um questionário. Os dados foram analisados. Das 70 mães, 87,14% e 90,00% tinham idade inferior ou igual a 30 anos e renda de até um salário mínimo, respectivamente. Das 70 crianças, 87,14% tinham seus dentes/gengiva higienizados por seus pais ou responsável. Do total, 94,29% nunca se submeteram a atendimento odontológico. Observou-se associação significativa entre a mãe ter escolaridade superior ao ensino fundamental incompleto e higienizar os dentes/gengiva do filho com escova dental e dentifrício. Constatou-se associação significativa entre a criança ingerir bolacha doce/recheada, não consumir refrigerante e usar escova dental e dentifrício na higienização oral. Conclui-se que as crianças eram acompanhadas nas UBS regularmente; no entanto, esse serviço não esteve relacionado ao atendimento odontológico. Apesar da ausência desse tipo de acompanhamento e do consumo de alimentos cariogênicos, as mães se preocupavam com a saúde bucal das crianças, higienizando a cavidade oral diariamente, com meios adequados.

The immaturity of the immune system, associated with Social Determi- nants of Health (SDH), promotes diseases in childhood. Specifically, in the oral cavity, SDH, represented by high sugar consumption, limited access to health services, and poor oral hygiene, favors local and systemic disorders. Thus, the study aimed to associate the SDH, in the context of socioeconomic conditions, monitoring by the health service and aspects related to children's oral health assisted in Basic Health Units (BHU) of a muni- cipality in Ceará. This is an observational, analytical, cross-sectional study with a quan- titative approach conducted with children and their mothers in Acarape - CE. After con- sent, they filled out a questionnaire. Data were analyzed. Of the 70 mothers, 87.14% and 90.00% were aged less than or equal to 30 years and had income up to one minimum wage, respectively. Of the 70 children, 87.14% had their teeth/gums cleaned by their pa- rents or guardian. Of the total, 94.29% never underwent dental care. There was a signifi- cant association between the mother having higher education than incomplete elementary school and cleaning the child's teeth/gums with a toothbrush and toothpaste. A significant association was found between the child eating sweet/stuffed biscuits, not consuming soft drink, and using a toothbrush and dentifrice for oral hygiene. It is concluded that the chil- dren were regularly monitored at the BHU; however, this service was not related to dental care. Despite the absence of this type of follow-up and the consumption of cariogenic foods, the mothers were concerned about their children's oral health, cleaning the oral cavity daily with adequate means.

La inmadurez del sistema inmunológico, asociada a los Determinantes So- ciales de la Salud (DSS), promueve enfermedades en la infancia. Específicamente, en la cavidad bucal, los DSS, representados por el alto consumo de azúcar, el acceso limitado a los servicios de salud y la mala higiene bucal, favorecen los trastornos locales y sisté- micos. Así, el estudio tuvo como objetivo asociar el DSS, en el contexto de las condicio- nes socioeconómicas, el seguimiento por el servicio de salud y los aspectos relacionados con la salud bucal de los niños atendidos en las Unidades Básicas de Salud (UBS) de un municipio de Ceará. Se trata de un estudio observacional, analítico, transversal con enfo- que cuantitativo, realizado con niños y sus madres en Acarape ­ CE. Después del consen- timiento, completaron un cuestionario. Los datos fueron analizados. De las 70 madres, 87,14% y 90,00% tenían edad menor o igual a 30 años e ingresos hasta un salario mínimo, respectivamente. De los 70 niños, al 87,14% se les limpió los dientes/encías por sus pa- dres o tutores. Del total, el 94,29% nunca realizó atención odontológica. Hubo una aso- ciación significativa entre la madre con educación superior a la primaria incompleta y la limpieza de los dientes/encías del niño con cepillo y pasta dental. Se encontró una asoci- ación significativa entre el niño que come galletas dulces/rellenas, no consume gaseosas y usa cepillo de dientes y dentífrico para la higiene bucal. Se concluyó que los niños eran monitoreados periódicamente en la UBS; sin embargo, este servicio no estaba relacionado con el cuidado dental. A pesar de la ausencia de este tipo de seguimiento y del consumo de alimentos cariogénicos, las madres se preocupan por la salud bucal de sus hijos, reali- zando la limpieza de la cavidad bucal diariamente, con medios adecuados.

Relationship between handgrip strength and body composition and laboratory indicators in diabetic and hypertensive patients / Relação da força de preensão com a composição corporal e indicadores laboratoriais de diabéticos e hipertensos

Introduction: The change in handgrip strength (HGS) is an indicator of the emergence of some chronic diseases, such as diabetes mellitus (DM) and systemic arterial hypertension (SAH). Objective: Analyze the relationship between HGS and body composition and laboratory indicators of diabetic and hypertensive patients assisted in Primary Health Care. Methods: The sample consisted of 185 users of a Basic Health Unit in the city of Santarém, Pará, distributed into two groups: control (CTL) ­ users without a diagnosis of DM and/or SAH (n=66); and DM/SAH (n=119) ­ users with DM or SAH or both diseases. Data collection involved sociodemographic, clinical, anthropometric, biochemical, and HGS information. Data were analyzed using descriptive and inferential statistics, adopting p<0.05. Results: It was noted that low HGS in the DM/SAH group was associated with high values of body mass index, abdominal circumference, fat percentage, fat mass, total cholesterol, and triglycerides and with more factors for metabolic syndrome (p<0.05). The CTL group, in relation to DM/SAH for the same HGS classification, demonstrated significance for lower blood pressure values, body mass index, abdominal circumference, fat percentage, and fat mass, as well as a lower chance of developing metabolic syndrome (p<0.05). Conclusion: According to the study proposal, it is concluded that the evaluation and follow-up of HGS in individuals with chronic diseases, especially DM and SAH, is relevant to monitor body adiposity and dyslipidemia and avoid the aggravation of existing diseases or the emergence of new ones (AU).

Introdução: A alteração na força de preensão (FP) manual é indicador para surgimento de algumas doenças crônicas, como a diabetes mellitus (DM) e hipertensão arterial sistêmica (HAS). Objetivo: Analisar a relação da FP com a composição corporal e indicadores laboratoriais de diabéticos e hipertensos assistidos na Atenção Primária à Saúde. Métodos: A amostra foi composta por 185 usuários de uma Unidade Básica de Saúde na cidade de Santarém, Pará, sendo distribuídos em dois grupos: controle (CTL) ­ usuários sem o diagnóstico para DM e/ou HAS (n=66); e DM/HAS (n=119) ­ usuários com DM ou HAS ou as duas doenças. A coleta de dados envolveu informações sócio-demográficas, clínicas, antropométricas, bioquímicas e FP. Os dados foram analisados por estatística descritiva e inferencial, adotando-se p<0,05. Resultados: Notou-se que a FP baixa no grupo DM/HAS apresentou associação com valores elevados do índice de massa corporal, circunferência abdominal, percentual de gordura, massa gorda, colesterol total, triglicerídeos e com mais fatores para a síndrome metabólica (p<0,05). Já o grupo CTL, em rela-ção do DM/HAS para uma mesma classificação de FP, demonstrou significância para menores valores pressóricos, do índice de massa corporal, da circunferência abdominal, percentual de gordura, massa gorda, bem como menor chance para o desenvolvimento da síndrome metabólica (p<0,05). Conclusão: Conclui-se, conforme a proposta do estudo, que é relevante a avaliação e acompanhamento da FP em indivíduos com doenças crônicas, em especial a DM e a HAS, a fim de monitorar a adiposidade corporal e a dislipidemia, evitando o agravo das doenças instaladas ou o surgimento de novas (AU).

LGBTQIA+ vs the Brazilian Unified Health System: Basic Health Unit Use and Associated Factors.

The Brazilian Unified Health System provides universal health care access without regard to sexual orientation and gender identity. We conducted a nationwide study with a cross-sectional design and intentional sampling methods to investigate factors associated with Basic Health Unit (BHU) use by the LGBTQIA+ community. Data were collected via a questionnaire available through social networks. Statistical analysis included Poisson regression with robust variance. A total of 603 LGBTQIA+ community members participated in the study, of whom 417 (69.2%) had visited a BHU in the last year. The factors "transgender woman" and "self-rated health status as very good/good/fair" increased the probability of BHU use in the last year by 10% (PR: 1.10; 95% CI: 1.00-1.20) and 9% (PR = 1.09; 95% CI: 1.01-1.18), respectively. "Not suffering sexual orientation-related discrimination at a BHU" and "Not suffering discrimination by a receptionist or waiting room worker" increased the probability of use by 28% (PR = 1.28; 95% CI: 1.22-1.34) and 22% (PR = 1.22; 95% CI: 1.14-1.30), respectively. Our study supports evidence that access to primary health care services in Brazil can be influenced by the social determinants gender identity and sexual discrimination.

A multilevel analysis of the triple burden of malnutrition in Indonesia: trends and determinants from repeated cross-sectional surveys.

BACKGROUND: Although child malnutrition has been reducing, the coexistence in mothers and children of various forms of malnutrition has continued to rise around the world. In the Indonesian context, a knowledge gap exists on the coexistence of multiple malnutrition burdens. This study examines trends in the coexistence of the triple burden of malnutrition (TBM) among mother-child pairs living in the same house and explores multilevel (individual, household, and community) factors associated with TBM in Indonesia. METHODS: We used data from the 2013 and 2018 Indonesia Basic Health Research, the nationally representative survey of the Indonesian population, as repeated cross-sectional surveys. Study samples were mothers and children (0-59 months old), who resided in the same household and indicated by the same identifier number. The anthropometric measurements of the mothers and children, and the hemoglobin levels of the children were collected. We employed a multilevel mixed-effects model to consider the hierarchical data structure. The model captured the role of cluster, district, provincial differences, and the individual, household, community-level, and TBM status characteristics. RESULTS: Of 3,891 mother-child pairs analyzed, 24.9% experienced TBM. Girls had 63% higher odds than boys of TBM (aOR: 1.63; 95% CI: 1.30 to 2.03). Significantly lower odds were found in children of mothers who had a gestational age lower than 37 weeks (aOR: 0.72; 95% CI: 0.55 to 0.94). At the household level, children with a father who had a high-school, primary-school, or no school education had significantly higher odds of TBM than children of fathers who had graduated from academy. Children of mothers who visited Antenatal Care (ANC) no more than 6 times had significantly lower odds (aOR: 0.65; 95% CI: 0.47 to 0.88). Children of mothers who consumed Iron and Folic Acid (IFA) supplements had significantly lower odds. CONCLUSION: TBM is related to characteristics at not just the individual level but also the family and community levels. To achieve significant outcomes, integrated nutrition interventions in Indonesia should also consider family and community factors.

Influence of Basic Health Care Provision Fund in improving primary Health Care in Kano state, a descriptive cross-sectional study.

BACKGROUND: The Basic Health Care Provision Fund (BHCPF) is a direct financial investment that funds Primary Healthcare (PHC) to improve the quality of services. This study assessed the influence of the BHCPF in improving PHC services. METHODS: A descriptive cross-sectional study was conducted among PHC workers in 100 facilities randomly selected from the 484 designated PHCs for implementing the BHCPF project in Kano state. Using multiple sampling methods, 200 healthcare workers in PHC facilities were selected and assisted by trained data collectors to respond to the questionnaires. Chi-square analysis was used to show associated factors, while binary regression analysis was used to determine the relationship between factors influencing the BHCPF implementation in PHC. RESULT: The findings showed healthcare workers had higher awareness (61.7%) and good utilization (57.1%) of BHCPF. Challenges of the BHCPF implementation were insufficiently skilled health professionals (85%), lack of data management capacity (52.6%), low community participation and awareness (52.0%), delay in releasing funds (60.7%), poor infrastructure (87.8%), and weak financial management and accountability system (58.2%). Healthcare professionals having a diploma were four times more likely to have the National Health Management Information System (NHMIS) in their facilities (AOR = 4.955, 95% CI = 1.120-21.036; P-value 0.035) than those without. Primary healthcare facilities were two times more likely to have the NHMIS (AOR = 2.549, 95% CI = 1.167-5.566: P-value 0. 019) than health post. CONCLUSION: The factors that influenced PHC facilities to promote the implementation of BHCPF included: periodic evaluation of the facilities, availability of functional storage facilities, and improving the standard of care in PHC facilities. There is a need for retraining healthcare workers and creating more community awareness of the BHCPF.

Traditional health services utilization in rural Indonesia: does socioeconomic status matter?

INTRODUCTION: The presence of traditional health services (THS) is expected by governments to fill the lack of modern health facilities available in rural areas. Also, the proportion of poor people in rural areas has been increasing more rapidly than it has in urban areas. The present study analyzed the socioeconomic status and THS utilization in rural Indonesia. METHODS: This cross-sectional study analyzed data from the 2018 Indonesian Basic Health Survey. The study analyzed 357 556 adults (age ≥15 years), examining age, gender, marital status, education, and occupation as control factors, in addition to socioeconomic status (SES; with five divisions from 'lowest' to 'highest') and THS utilization. Binary logistic regression was used to evaluate the data. RESULTS: The results show that those with lower SES were 1.111 times more likely to utilize THS than those with the lowest SES (adjusted odds ratio (AOR) 1.111; 95% confidence interval (CI) 1.085-1.137). Those with middle SES were 1.113 times more likely than those with the lowest SES to utilize THS (AOR 1.113; 95%CI 1.086-1.140). Meanwhile, those with a higher SES are 1.166 times more likely than those with the lowest SES to use THS in rural Indonesia (AOR 1.166; 95%CI 1.139-1.194). Those with the highest SES were 1.166 times more likely than those with the lowest SES to use THS in rural Indonesia (AOR 1.166; 95%CI 1.134-1.200). CONCLUSION: The study concluded that SES status relates to THS utilization in rural Indonesia. All SES levels are more likely than those with the lowest SES to utilize the THS in rural Indonesia. The results indicate that although all SES levels can receive it, the lowest SES group rarely accesses THS.

Acesso a medicamentos anti-hipertensivos pelos usuários de uma unidade ambulatorial / Antihypertensive drugs access by users of ambulatory unit

Objetivo: caracterizar o acesso aos medicamentos anti-hipertensivos pelas pessoas com hipertensão arterial atendidas em uma unidade ambulatorial. Metodologia: estudo descritivo, quantitativo, desenvolvido com 103 pessoas com hipertensão arterial em uso de anti-hipertensivos. Os dados foram coletados por meio de questionário com perguntas sociodemográficas, sobre tratamento e acesso aos medicamentos anti-hipertensivos. Utilizou-se a estatística descritiva e teste qui-quadrado de Pearson ou exato de Fisher para análise dos dados. Resultados: Predominou a faixa etária de 50-69 (68,9%), sexo feminino (85,4%) e raça/cor autodeclarada preta (46,6%). Quanto ao acesso aos anti-hipertensivos, 70,9% relataram ter acesso gratuito, 60,2% os obtêm nas unidades de saúde, 65,7% não referiram dificuldades na aquisição e 86,4% que tinham acesso total. Todos os participantes que tinham dificuldade econômica também tinham dificuldade de acesso aos anti-hipertensivos. Verificou-se associação significativa entre a dificuldade de acesso aos anti-hipertensivos com forma de acesso (total ou parcial), quantidade de drogas e disponibilidade do medicamento nas farmácias (p<0,005). Conclusão: observou-se que, embora a maioria dos participantes do estudo não encontre dificuldades para obtenção dos anti-hipertensivos nas farmácias das unidades básicas de saúde, ainda assim, existe uma parcela da população sem acesso total aos anti-hipertensivos de forma gratuita, sendo essencial melhorias dos programas de fornecimento de medicamentos.

Objective: to characterize access to antihypertensive drugs by patients with arterial hypertension treated at an ambulatory unit. Methodology: descriptive, quantitative study, developed with a group of 103 people with arterial hypertension currently using antihypertensive drugs. The data were collected through a questionnaire with sociodemographic questions, with respect to treatment and access to antihypertensive drugs. Descriptive statistics and Pearson's chi-square test or Fisher's exact test were used for data analysis. Results: the age group 50-69 (68.9%), female (85.4%) and black self-declared race (46.6%) predominated. Regarding access to antihypertensive drugs, 70.9% reported having free access, 60.2% obtained them at health units, 65.7% did not mention difficulties in acquiring them and 86.4% that had full access. All participants who had economic difficulties also had difficulty accessing antihypertensive drugs. It was identified a significant association between difficulty in accessing antihypertensive drugs and the means of access (total or partial), quantity of drugs and availability of the drug in pharmacies (p<0.005). Conclusion: it was observed that, that most of the study participants did not find it difficult to obtain antihypertensive drugs in the pharmacies of basic health units, notwithstanding, there is a portion of the population without full access to antihypertensive drugs free of charge, improvements in drug supply programs are essential.

Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan.

Introduction: Non-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care. Methodology: This is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs. Results: There was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level. Conclusion: This study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Utilization of Basic Health Services at Primary Health Care Facilities During COVID-19 Pandemic.

BACKGROUND: COVID-19, a novel rapidly emerging respiratory disease has spread across the world in a short span of time, infecting millions of people around the world. Consequently, health systems are overwhelmed by both direct mortality from COVID-19 and indirect mortality from other treatable conditions. Though COVID-19 prevention and control is crucial, it is also equally important to continue basic health services. Therefore, the study aimed to explore the facilitators and barriers of basic health service utilization at primary health facilities during the COVID-19 pandemic. METHODS: An exploratory qualitative study was conducted in the Bidur Municipality of Nuwakot district. Twenty-five telephone interviews were conducted from all the wards of the municipality and each lasted at least 20 minutes. The interviews were translated into English, coded using RQDA software, and analyzed using thematic analysis manually. RESULTS: The participants shared basic health service was interrupted during the pandemic, especially in the first month. However, the prominent factors that were often crosscutting to many factors were socio-economic conditions and fear of acquiring COVID-19. Additionally, inadequate personal protective equipment, mental stress, shortage of health workers, supplies disruptions, social stigma and extended lockdowns come into play for determining the utilization of basic health services during pandemic. CONCLUSIONS: Basic health service was heavily compromised during the pandemic. Fulfillment of the sanctioned posts, enhancement in the use of digital technologies can be promoting options for basic health service utilization during pandemic.

Glaucoma and aging: therapeutic difficulties experienced by the elderly / Glaucoma e envelhecimento: dificuldades terapêuticas vivenciadas por idosos

Introduction: Glaucoma is a public health problem among chronic-degenerative visual diseases due to its high incidence and for causing disability. Thus, the Glaucoma Patient Assistance Program was created to improve follow-up and avoid bleak prognoses.Objectives: to analyze the difficulties of the elderly in the use of eye drops for the treatment of glaucoma.Methods: an exploratory research was carried out where the population was composed of elderly patients with glaucoma treated at the Integrated Unit of Ipiranga linked to Basic Care in District III of João Pessoa-PB, a questionnaire was the instrument for data collection for the 61 participants.Results: it was found that 38 (62.3%) %) of the participants , 53 (87%) received 1-2 minimum wages, and 23 (37.7%) studied only until primary school. As for administration, 37 (60.7%) had no problems remembering if they had already used the eye drops, 39 (63.9%) had no difficulty using it, and 34 (55.7%) were unable to follow its use in the basic assistance. Conclusion: respondents have their obstacles to medication adherence regardless of the disease, the lack of follow-up in basic care only adds another one, so that's why educating them would enable lower dropout rates and better prognoses

Introdução: dentre as doenças crônico-degenerativas visuais, o glaucoma constitui um problema de saúde pública por sua alta incidência e incapacidade. Assim, o Programa de Assistência ao Portador de Glaucoma foi criado para melhorar o acompanhamento e evitar prognósticos sombrios. Objetivos: objetivo é analisar as dificuldades dos idosos no uso do colírio para tratamento do glaucoma. Método: pesquisa exploratória em população composta por pacientes de terceira idade com glaucoma, atendidos na Unidade Integrada do Ipiranga vinculada à Atenção Primária do Distrito III (João Pessoa- PB). O tamanho da amostra foi de 61 participantes, um questionário foi o instrumento para a coleta de dados. Resultados: na caracterização da amostra 38 (62,3%) eram do sexo feminino, 53 (87%) recebem de 1 a 2 salários mínimos e 23 (37,7%) estudaram só até o primário. Quanto à administração, 37(60,7%) não têm problemas para lembrar se já usaram o colírio, 39 (63,9%) não sentem dificuldade ao usá-lo e 34 (55,7%) não conseguem acompanhar seu uso na assistência básica. Discussão: A maioria revelou-se feminina, de baixa renda e desacompanhada da assistência básica neste quesito. Uma parcela significativa também se mostrou de baixa escolaridade. Contudo, apesar das limitações, a predominância revelou cumprir a terapêutica. Conclusão: Após aplicação do questionário foram detectados empecilhos próprios à adesão medicamentosa nos idosos. A falta de acompanhamento na atenção básica só acrescenta mais um desafio, por isso a educação do público possibilitaria menores taxas de abandono e melhores prognósticos.

Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt.

BACKGROUND: The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible. METHODS: We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data. RESULTS: Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital. CONCLUSION: It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.

Qualidade da assistência de enfermagem ao idoso na atenção primária à saúde no interior de minas gerais

Objetivos: Avaliar a confiabilidade, viabilidade, usabilidade e a utilidade dos indicadores de qualidade da assistência ao idoso na Atenção Primária à Saúde e descrever a qualidade da assistência de enfermagem ao idoso nesse nível de atenção. Material e Métodos: Estudo transversal, com abordagem quantitativa, desenvolvido em uma Estratégia de Saúde da Família de um município no interior de Minas Gerais. A população do estudo foi composta pelos profissionais de enfermagem (indicadores coletados por meio de entrevista), prontuários de idosos (indicadores coletados por meio de supervisão), gestores municipais da secretaria de saúde (avaliação da utilidade e usabilidade) e avaliador de campo (avaliação da confiabilidade e viabilidade/disponibilidade). Utilizaram-se 22 indicadores (5 gerenciais e 17 relacionados ao cuidado de enfermagem), disponíveis on-line no Harvard Dataverse. Foram utilizadas análise descritiva por meio de frequências absolutas e percentuais. A confiabilidade dos dados foi mensurada por análise de concordância entre as coletas por meio do índice Kappa. A viabilidade de coleta dos dados foi dada em escala de um a nove, quanto maior melhor a viabilidade; para utilidade e usabilidade foi utilizada escala variando de 1 ponto (não recomendado), a 9 pontos (altamente recomendado). Resultados: A confiabilidade dos indicadores mensurados por meio de entrevistas e análise dos prontuários obteve 100% de respostas concordantes, sendo considerada substancial. Sobre a viabilidade sete indicadores não estavam disponíveis e dentre estes dois foram considerados inviáveis; a utilidade e usabilidade obtiveram avaliação positiva; observou-se baixo percentual de cumprimento dos indicadores, demonstrando baixa qualidade da assistência de enfermagem prestada ao idoso. Conclusões: Os resultados apontaram confiabilidade substancial na coleta, viabilidade na maioria dos indicadores, utilidade e usabilidade com avaliação positiva e baixo percentual de cumprimento dos indicadores.

Objectives: To evaluate the reliability, feasibility, usability and usefulness of the indicators of quality of care for the elderly in primary health care, and to describe the quality of nursing care for the elderly. Materials and Methods: Cross-sectional study with a quantitative approach, developed in the context of the Family Health Strategy program in a municipality of the State of Minas Gerais. The study population consisted of nursing professionals (indicators collected through interviews), elderly medical records (indicators collected through supervision), managers of municipal health departments (assessment of usefulness and usability) and field evaluators (assessment reliability and feasibility/availability). 22 indicators (5 managerial and 17 related to nursing care), available online at the Harvard Dataverse repository, were used. Descriptive analysis was used through absolute and percentage frequencies. Reliability was measured by concordance analysis between the collected data using the Kappa index. Feasibility was measured on a scale of one to nine: the higher the better the feasibility; for usefulness and usability a scale ranging from 1 point (not recommended) to 9 points (highly recommended) was used. Results: The reliability of the indicators, measured through interviews and analysis of medical records, showed 100% of concordant responses, so that it was considered relevant. Seven indicators were not available and, among these, two were considered unfeasible: usefulness and usability had a positive evaluation; there was a low percentage of compliance with the indicators, which shows low quality of nursing care provided to the elderly. Conclusions: The results showed substantial reliability in the collection, feasibility in most of the indicators, usefulness and usability with positive evaluation and low percentage of compliance with the indicators.

Objetivos: Evaluar la confiabilidad, factibilidad, usabilidad y utilidad de los indicadores de calidad del cuidado a la persona mayor en la Atención Primaria de Salud y describir la calidad del cuidado de enfermería a la persona mayor en este nivel de atención. Material y Método: Estudio transversal con enfoque cuantitativo, desarrollado en una Estrategia de Salud de la Familia de un municipio del interior de Minas Gerais, Brasil. La población de estudio estuvo compuesta por profesionales de enfermería (indicadores recolectados a través de entrevistas), prontuarios de personas mayores (indicadores recolectados a través de la supervisión), gestores de departamentos de salud municipales (evaluación de utilidad y usabilidad) y evaluadores de campo (evaluación de confiabilidad y factibilidad/disponibilidad). Se utilizaron 22 indicadores (5 gerenciales y 17 relacionados con el cuidado de enfermería), disponibles en línea en Harvard Dataverse. Se utilizó análisis descriptivo a través de frecuencias absolutas y porcentuales. La fiabilidad se midió mediante el análisis de concordancia entre colecciones utilizando el índice Kappa. La factibilidad se dio en una escala de uno a nueve, cuanto más alta, mejor factibilidad; para la utilidad y usabilidad se utilizó una escala que va desde 1 punto (no recomendado) hasta 9 puntos (muy recomendable). Resultados: La confiabilidad de los indicadores, medidos a través de entrevistas y análisis de historias clínicas, obtuvo el 100% de repuestas concordantes, considerándose sustancial. Siete indicadores no estaban disponibles y, entre estos, dos se consideraron inviables; la utilidad y usabilidad tuvo evaluación positiva; hubo bajo porcentaje de cumplimiento de los indicadores, lo que demuestra baja calidad de la atención de enfermería brindada a las personas mayores. Conclusiones: Los resultados mostraron una fiabilidad sustancial en la recogida, viabilidad en la mayoría de los indicadores, utilidad y usabilidad con evaluación positiva y bajo porcentaje de cumplimiento de los indicadores.

Prevalência de enteroparasitas em crianças atendidas pelas unidades básicas de saúde do município de Fortaleza, Ceará / Prevalence of enteroparasites in children attending basic health units in the municipality of Fortaleza, Ceará / Prevalencia de enteroparasitosis en niños atendidos en unidades básicas de salud del municipio de Fortaleza, Ceará

As Enteroparasitoses são um problema socioeconômico de países subdesenvolvidos que atingem principalmente crianças, sendo um grupo de maior propensão a exposição a ambientes contaminados. Diante disso, o objetivo desse estudo foi verificar a prevalência de enteroparasitoses em crianças atendidas pelas unidades básicas de saúde de Fortaleza, Ceará, a fim de contribuir para o desenvolvimento de medidas preventivas e terapêuticas mais eficazes para o controle dessas infecções e na saúde da população. Para isso, foram utilizadas para a análise 76 amostras fecais de crianças de 1 a 15 anos, atendidas pelas unidades básicas de saúde do município, adotando a técnica de sedimentação espontânea em água, conforme descrita por Hoffman, Pons e Janer (1934). A prevalência geral de enteroparasitas, parasitas e protozoários, foi de 51,3% na população estudada. Dentre os parasitas encontrados, os protozoários mais frequentes foram: Blastocystis hominis (55,1%) seguido de Giardia lamblia (12,2%) e Entamoeba coli (12,2%). Já os parasitas helmintos, houve ocorrência de Ascaris lumbricoides (6%) e Enterobius vermicularis (2%). Com base nos resultados obtidos, pode-se concluir que a população de crianças estudada apresentou uma alta taxa de infecção por enteroparasitas, com predomínio de protozoários intestinais. Esses achados reforçam a importância da implementação de medidas preventivas e melhoria das condições higiênico-sanitárias para o controle dessas infecções e na promoção da saúde da população.

Enteroparasitoses are a socioeconomic problem in underdeveloped countries that mainly affect children, a group with a higher propensity to be exposed to contaminated environments. Therefore, the aim of this study was to verify the prevalence of enteroparasitoses in children attending basic health units in Fortaleza, Ceará, in order to contribute to the development of more effective preventive and therapeutic measures for the control of these infections and the health of the population. For this purpose, 76 fecal samples from children from 1 to 15 years old, attended in basic health units of the city were used for analysis, adopting the technique of spontaneous sedimentation in water, as described by Hoffman, Pons and Janer (1934). The overall prevalence of enteroparasites, parasites and protozoa, was 51.3% in the studied population. Among the parasites found, the most frequent protozoans were: Blastocystis hominis (55.1%) followed by Giardia lamblia (12.2%) and Entamoeba coli (12.2%). As for the helminth parasites, there were Ascaris lumbricoides (6%) and Enterobius vermicularis (2%). Based on the results obtained, it can be concluded that the population of children studied presented a high rate of infection by enteroparasites, with a predominance of intestinal protozoa. These findings reinforce the importance of implementing preventive measures and improving the hygienic-sanitary conditions for the control of these infections and in promoting the health of the population.

Las enteroparasitosis son un problema socioeconómico en los países subdesarrollados que afecta principalmente a los niños, grupo con mayor propensión a estar expuesto a ambientes contaminados. Por lo tanto, el objetivo de este estudio fue verificar la prevalencia de enteroparasitosis en niños que asisten a unidades básicas de salud en Fortaleza, Ceará, con el fin de contribuir al desarrollo de medidas preventivas y terapéuticas más eficaces para el control de estas infecciones y la salud de la población. Para ello, se utilizaron para el análisis 76 muestras fecales de niños de 1 a 15 años, atendidos en unidades básicas de salud de la ciudad, adoptando la técnica de sedimentación espontánea en agua, descrita por Hoffman, Pons y Janer (1934). La prevalencia global de enteroparásitos, parásitos y protozoos, fue de 51,3% en la población estudiada. Entre los parásitos encontrados, los protozoos más frecuentes fueron: Blastocystis hominis (55,1%), seguido de Giardia lamblia (12,2%) y Entamoeba coli (12,2%). En cuanto a los helmintos parásitos, había Ascaris lumbricoides (6%) y Enterobius vermicularis (2%). En base a los resultados obtenidos, se puede concluir que la población infantil estudiada presenta una elevada tasa de infección por enteroparásitos, con predominio de protozoos intestinales. Estos hallazgos refuerzan la importancia de implementar medidas preventivas y mejorar las condiciones higiénico-sanitarias para el control de estas infecciones y en la promoción de la salud de la población.

Indicadores do Programa Nacional de Imunizações em menores de um ano: tendência temporal no Maranhão, Brasil, 2010 a 2021 / Indicators of the National Immunization Program for children under one year old: time trend in Maranhão, Brazil, 2010 to 2021

Resumo Objetivou-se analisar a tendência dos indicadores do Programa Nacional de Imunizações (PNI) em menores de um ano e classificar os municípios quanto ao risco de transmissão de doenças imunopreveníveis (RTDIp) no Maranhão de 2010 a 2021. Estudo ecológico de série temporal, baseado em dados secundários de cobertura vacinal (CV), homogeneidade de cobertura vacinal (HCV), proporção de abandono (PA) e RTDIp, com abrangência estadual, para vacinas do calendário nacional infantil. Regressão de Prais-Winstein estimou tendência (α = 5%) e variação percentual anual (VPA) dos indicadores. Houve CV flutuantes e discrepantes entre as vacinas, com tendência decrescente (p < 0,01), exceto contra hepatite B (p = 0,709) e rotavírus (p = 0,143). As quedas mais acentuadas foram para as vacinas contra febre amarela e BCG. Todas as taxas de HCV estavam abaixo do esperado, com a diminuição a partir de 2014 e VPA de 5,75% a 14,02%. Houve tendência crescente da PA para pentavalente e poliomielite. No período de 2015 e 2021 houve incremento de 52,54% na proporção dos municípios maranhenses com RTDIp muito alto (p = 0,025) e alto (p = 0,028). Ao longo de 12 anos, houve piora dos indicadores do PNI em menores de um ano, reafirmando a suscetibilidade para o surgimento de doenças imunopreveníveis.

Abstract We aimed to analyze the trend of indicators of the National Immunization Program (acronym in Portuguese. PNI) in children under one-year-old and classify municipalities regarding the risk of transmission of vaccine-preventable diseases (RTVPD) in Maranhão from 2010 to 2021. This ecological time series study was based on secondary data on vaccination coverage (VC). vaccination coverage homogeneity (VCH). proportion of abandonment (PA). and RTVPD. with state coverage for vaccines in the national children's calendar. Prais-Winsten regression estimated trends (α=5%) and the indicators' annual percentage change (APC). We identified fluctuating and discrepant VC between vaccines. with a decreasing trend (p < 0.01). except those against Hepatitis B (p = 0.709) and oral human rotavirus (p = 0.143). The sharpest falls were for Yellow Fever (APC = 12.24%) and BCG (APC = 12.25%) vaccines. All VCH rates were lower than expected. with a drop from 2014 and APC between 5.75% (Pneumococcal 10; p = 0.033) and 14.02% (Poliomyelitis; p < 0.01). We observed an increasing trend in PA for Pentavalent (APC = 4.91%; p < 0.01) and Poliomyelitis (APC = 3.55%; p < 0.01). We identified an increase of 52.54% in the proportion of municipalities in Maranhão from 2015 to 2021. with extremely high (p = 0.025) and high (p = 0.028) RTVPD. The PNI indicators deteriorated. reaffirming the susceptibility to the emergence of vaccine-preventable diseases.

Can Strategic Health Purchasing Reduce Inefficiency and Corruption in the Health Sector? The Case of Nigeria.

Despite limited government budgets for health in many sub-Saharan African countries, some countries have improved health outcomes at low cost by being strategic in allocating and spending available resources. Strategic health purchasing is receiving increasing attention as a way to improve health system performance within financial constraints. Health purchasing, one of the health financing functions of health systems, is the transfer of pooled funds to health providers to deliver covered services. Strategic health purchasing uses evidence and information about population health needs and health provider performance to make decisions about which health services should have priority for public funding, which providers will provide these services, and how and how much providers will be paid to deliver those services. Strategic purchasing has enabled some countries to make progress on health sector goals while improving efficiency, equity, transparency, and accountability. However, when countries have high levels of corruption and low levels of accountability, as in Nigeria, strategic purchasing may be less effective and more money for health may not yield the expected public health benefits. This commentary uses the Strategic Health Purchasing Progress Tracking Framework developed by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners to examine health purchasing functions in Nigeria's main health financing schemes, how corruption affects the effectiveness of health purchasing in Nigeria, and opportunities to use strategic purchasing as a tool to address corruption in health financing by improving the transparency and accountability of health resource allocation and use.

Decisões suportadas por informações geradas em Unidades Básicas de Saúde, no contexto da covid-19 / Decisions supported by information generated in Basic Health Units, in the context of covid-19 / Decisiones apoyadas en la información generada en las Unidades Básicas de Salud, en el contexto de covid-19

O estudo proposto neste artigo buscou evidenciar como as informações geradas em uma Unidade Básica de Saúde (UBS) auxiliam os gestores nas suas decisões envolvendo as ações de controle da covid-19. A pesquisa ficou caracterizada como um estudo misto, pois apresentou dados quantitativos e qualitativos e adotou como método o estudo de caso, abrangendo as UBS do município de Fazenda Rio Grande, no estado do Paraná. Como recurso tecnológico foi utilizada a plataforma Google Forms®, para elaborar o questionário em formato eletrônico que foi posteriormente enviado por e-mail. Para análise estatística foram aplicados os softwares Excel® e SPSS® (Statistical Package for the Social Sciences); ao passo que na análise qualitativa foi utilizado o software Atlas.ti®, que propiciou a elaboração dos mapas de rede e a verificação das percepções dos respondentes. Esses procedimentos possibilitaram aos pesquisadores estabelecer parâmetros distintos que resultaram na conclusão do trabalho, ao identificarem que, mesmo havendo uma descentralização, ao estabelecerem vários pontos de atendimento à população identificados como UBS, as unidades atuaram de modo colaborativo, durante a pandemia. As unidades assumiram um papel relevante no contexto social ao mitigarem as diferenças sociais, estabelecendo um elo entre a sociedade e os órgãos de saúde pública.

The study proposed in this article sought to highlight how the information generated in a Basic Health Unit (BHU) assist managers in their decisions involving control actions of the covid-19. The research was characterized as a mixed study, presenting quantitative and qualitative data, adopting as method the case study, covering the BHU of Fazenda Rio Grande municipality, in the state of Paraná. As a technological resource, the Google Forms® platform was used to prepare the questionnaire in electronic format later sent via e-mail. For statistical analysis, Excel® and SPSS® (Statistical Package for the Social Sciences) software were applied, while for qualitative analysis, Atlas.ti® software was used, enabling the preparation of network maps and verification of respondents' perceptions. These procedures enabled the researchers to establish different parameters that resulted in the conclusion of the work, identifying that even though there was a decentralization by establishing several points of care to the population identified as BHU, it was clear that they acted in a collaborative way during the pandemic, assuming a relevant role in the social context by mitigating social differences establishing a link between society and public health agencies.

El estudio propuesto en este artículo buscó destacar cómo la información generada en una Unidad Básica de Salud (UBS) ayuda a los gestores en sus decisiones que implican acciones de control del covid-19. La in-vestigación se caracterizó como un estudio mixto al presentar datos cuantitativos y cualitativos, adoptando como método el estudio de caso, abarcando las UBS del municipio de Fazenda Rio Grande, en el estado de Paraná. Como recurso tecnológico, se utilizó la plataforma Google Forms® para la elaboración del cuestion-ario en formato electrónico y su posterior envío por correo electrónico. Para el análisis estadístico se aplic-aron los softwares Excel® y SPSS® (Statistical Package for the Social Sciences), mientras que en el análisis cualitativo se utilizó el software Atlas.ti®, que permitió elaborar mapas de redes y verificar las percepciones de los encuestados. Estos procedimientos permitieron a los investigadores establecer diferentes parámetros que dieron lugar a la conclusión del trabajo, identificando que incluso con una descentralización mediante el establecimiento de varios puntos de atención a la población identificada como UBS, quedó claro que actuaron de forma colaborativa durante la pandemia, asumiendo un papel relevante en el contexto social al mitigar las diferencias sociales, estableciendo un vínculo entre la sociedad y los organismos de salud pública.

Cuidado e questões de gênero: invisibilidade, paternalismo, autossacrifício e a crise de cuidados. Entrevista com Ilze Zirbel / Care and gender issues: invisibility, paternalism, self-sacrifice and the care crisis. Interview with Ilze Zirbel / Cuidado y cuestiones de genero: invisibilidad, paternalismo, autosacrificio y crisis del cuidado. Entrevista con Ilze Zirbel

Este texto apresenta uma conversa-entrevista entre um grupo de pesquisa sobre as práticas de profissionais de saúde atuantes na Atenção Básica em Saúde e a Dra em filosofia Ilze Zirbel, pesquisadora do campo das Teorias do Cuidado. A conversa ocorreu durante um encontro do grupo de pesquisa, na cidade de Santos, no dia 29.11.2019 e foi registrada em áudio sendo, em seguida, transcrita e editada na forma de entrevista. Nela são abordadas questões de gênero, classe e raça envolvidas nas atividades e relações de cuidado, o que toca nas temáticas do privilégio e da exploração, do autossacrifício e da coerção, bem como da autonomia e da interdependência de seres humanos. O pano de fundo é o da necessidade de políticas públicas visando o cuidado da população e desenvolvimento do senso de cuidado tanto em homens quanto em mulheres.

This text presents a conversation-interview between a research group on the practices of health professionals working in Primary Health Care and a researcher in the field of Care Theories. It addresses issues of gender, class and race involved in care activities and relationships, which touches on the themes of privilege and exploitation, self-sacrifice and coercion, as well as autonomy and interdependence. The background is the need for public policies aimed at the care of the population and the development of a sense of care for both men and women.

Este texto presenta una conversación-entrevista entre un grupo de investigación sobre las prácticas de los profesionales de la salud que trabajan en Atención Primaria y un investigador en el campo de las Teorías de la Atención. Aborda temas de género, clase y raza involucrados en las actividades y relaciones de cuidado, que toca los temas de privilegio y explotación, autossacrificio y coacción, así como autonomía e interdependencia. El trasfondo es la necesidad de políticas públicas orientadas al cuidado de la población y al desarrollo de un sentido de cuidado tanto para hombres como para mujeres.

Level of Trust of the Population in the Unified Health System in the Midst of the COVID-19 Crisis in Brazil.

OBJECTIVE: to assess the level of trust in health services during the COVID-19 pandemic in Brazil. METHODS: A cross-sectional study, carried out between 2020 and 2021, among Brazilians over 18. Nonprobabilistic sampling was used. Descriptive and inferential statistics were applied, using the local bivariate Moran's technique to verify the existence of spatial dependence between the incidence and mortality of COVID-19 and trust in health services. Furthermore, multinomial regression was also used to analyze the factors associated with the confidence level, with the calculation of the odds ratio and with a confidence interval of 95%. RESULTS: A total of 50.6% reported trust in hospital services, while 41.4% did not trust primary health care services. With the application of the local bivariate Moran, both for the incidence and mortality of COVID-19, the trust in tertiary care and primary care services showed a statistically significant spatial association predominant in the Midwest (high-low) and North (low-high) regions of Brazil. The level of trust was associated with education, religion, region of the country and income. CONCLUSIONS: The level of trust in hospital services, more than primary health care services, may be related to the population's culture of prioritizing the search for hospital care at the detriment of health promotion and disease prevention.