Qualidade de ações de promoção e prevenção na atenção a menores de dois anos na Atenção Básica no Brasil. Avaliação externa do Programa de Melhoria de Acesso e Qualidade da Atenção Básica: 2012, 2014 e 2018

Abstract

This thesis aimed to evaluate the quality of promotion and prevention actions in the care of children under two years of age in Primary Care in Brazil, with data from the external evaluation of the three cycles of the Primary Care Access and Quality Improvement Program (PMAQ-AB) (2012, 2014/2015 and 2017/18). The instrument had three modules: structure of units (I), team work process (II) and interviews with users (III). Article I assessed the quality of care for children under two years of age through a synthetic indicator containing questions from module III of cycle III of the PMAQ-AB, with a positive answer to the six questions being considered adequate quality. Around 37% of users were classified as having received good quality care, with higher proportions in the Northeast Region, in units that presented all inputs and vaccines and in teams that used protocols and materials, carried out records, active search and healthy eating actions. Article 2 evaluated the receipt of prenatal guidance on exclusive breastfeeding and child care in primary care in Brazil with data from the three PMAQ cycles. The two types of guidance presented proportions greater than 80% in the three PMAQ-AB cycles, but showed significant reductions throughout the cycles. Receiving guidance on exclusive breastfeeding showed a reduction in municipalities with up to 10,000 and more than 30,000 inhabitants, in all FHS and IDHM coverage strata and in the South, Southeast and Northeast regions throughout the cycles. Receiving guidance on care showed significant reductions in the South and Southeast regions, municipalities with FHS coverage less than 100% and with very low or low, high and very high HDI-M and in municipalities with more than 100,000 inhabitants. After stratification for adequate care for pregnant women, more strata were found with a significant reduction for users cared for by teams that did not offer adequate care. Article three evaluated vaccination coverage of the pentavalent vaccine from 2018 to 2022 in the 5,570 municipalities in Brazil with data from DataSus. Coverage was greater than 95% in the reference year (2018), but showed reductions over the years. The reduction occurred differently between regions for each FHS coverage stratum. In general, the reductions were smaller for municipalities that had 100% Family Health Strategy coverage in relation to the general average, except for the North region.