Evaluation of the structure of primary maternal and infant healthcare in the state of Roraima, the North region of Brazil, and Brazil, 2012-2017

Gondim, Daniele Alves Damaceno; Campos, Mônica Rodrigues; Castanheira, Débora

doi:10.1590/1413-812320242910.03462023EN

Daniele Alves Damaceno Gondim

study concept

reviewing existing literature

analyzing the collected data

writing the manuscript

Each author played an essential role in carrying out this study and their contributions were fundamental to the quality and integrity of the work presented

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. danieledamaceno@hotmail.com

https://orcid.org/0000-0001-9087-9562

Mônica Rodrigues Campos

study concept

methodological design

data collection

data analysis

critical review of the manuscript

Each author played an essential role in carrying out this study and their contributions were fundamental to the quality and integrity of the work presented

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. danieledamaceno@hotmail.com

https://orcid.org/0000-0002-7443-5977

Débora Castanheira

concept

literature review

data analysis

writing of the manuscript

critical review

Each author played an essential role in carrying out this study and their contributions were fundamental to the quality and integrity of the work presented

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. danieledamaceno@hotmail.com

https://orcid.org/0000-0001-6995-1259

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Id.	2012		2014		2017		Degree of comparability across years
Id.	Variable	Category	Variable	Category	Variable	Category
Q1	I.3.6.1	Specialist Physician	I.3.5.1	Specialist Physician	I.3.2.1	Médico especialista	Total
Q2	I.3.6.2	Psychologist	I.3.5.2	Psychologist	I.3.2.2	Psicólogo	Total
Q3	I.3.6.3	Physiotherapist	I.3.5.3	Physiotherapist	I.3.2.3	Fisioterapeuta	Total
Q4	I.3.6.4	Nutritionist	I.3.5.4	Nutritionist	I.3.2.4	Nutricionista	Total
Q5	I.3.6.5	Social Worker	I.3.5.5	Social Worker	I.3.2.5	Assistente social	Total
Q6	I.7.2.1	Yes/No	I.8.1.1	Yes/No	Not available		High
Q7	I.7.2.2	Yes/No	I.8.1.2	Yes/No	Not available		High
Q8	I.7.2.3	Yes/No	I.8.1.3	Yes/No	Not available		High
Q9	I.8.1.1	Yes/No	I.10.1.35.1	Yes/No	I.6.4.1	Yes/No	Total
Q10	I.8.1.2	Yes/No	I.10.1.35.2	Yes/No	I.6.4.2	Yes/No	Total
Q11	I.8.1.3	Yes/No	I.10.1.35.3	Yes/No	I.6.4.3	Yes/No	Total
Q12	I.8.1.4	Yes/No	I.10.1.35.4	Yes/No	I.6.4.4	Yes/No	Total
Q13	I.8.1.5	Yes/No	I.10.1.35.5	Yes/No	I.6.4.5	Yes/No	Total
Q14	I.9.13	Yes/No	I.10.1.19	Yes/No	I.6.3.8	Sim/Não	Medium
Q15	I.9.14	Yes/No	I.10.1.18	Yes/No	I.6.3.5	Sim/Não	High
Q16	I.9.17	Yes/No	I.10.1.27	Sim/Não	I.6.3.14	Sim/Não	Medium
Q17	I.18.1	Yes/No	I.6.1	Sim/Não	Not available		High
Q18	I.18.2	Yes/No	I.6.2	Sim/Não	Not available		High
Q19	I.17.1.1	Quantity	I.11.1	Quantity	I.7.1	Quantity	Total
QE20	I.17.10	Yes/No	Not available		I.6.3.3	Sim/Não	Medium
QE21	I.11.2/1	Quantity	I.12.2/1	Quantity	I.8.2/1	Quantity	Total
QE22	I.11.3/1	Quantity	I.12.2.1/1	Quantity	I.8.4/1	Quantity	Total
QE23	I.11.4/1	Quantity	I.12.3/1	Quantity	I.8.7/1	Quantity	Total
QE24	I.11.8/1	Quantity	I.12.5/1	Quantity	I.8.9/1	Quantity	Total
QE25	I.11.14/1	Quantity	I.12.10/1	Quantity	I.8.14	Quantity	Total
QE26	I.11.20/1	Quantity	I.12.14/1	Quantity	I.8.15/1	Quantity	Total
QE27	I.11.21/1	Quantity	I.12.15/1	Quantity	I.8.16/1	Quantity	Total
QE28	I.11.25/1	Quantity	I.12.17/1 e I.12.22/1	Quantity	I.8.17 e I.8.18	Quantity	High
QE29	I.12.5	Yes/No	I.16.7	Yes/No	I.12.14	Yes/No	High
QE30	I.12.7	Yes/No	I.16.8	Yes/No	I.12.15	Yes/No	High
QE31	I.12.9	Yes/No	I.16.10	Yes/No	I.12.21	Yes/No	High
QE32	I.12.10	Yes/No	I.16.11	Yes/No	I.12.16	Yes/No	High
QE33	I.12.12	Yes/No	I.16.13	Yes/No	I.12.19	Yes/No	High
QE34	I.12.15	Yes/No	I.16.15	Yes/No	I.12.17	Yes/No	High
QE35	I.12.16	Yes/No	I.16.16	Yes/No	I.12.18	Yes/No	High
QE36	I.13.1	Yes/No	I.13.2	Yes/No	I.9.2	Yes/No	High
QE37	I.13.2	Yes/No	I.13.3	Yes/No	I.9.1	Yes/No	High
Q38	I.14.5	Yes/No	I.18.14	Yes/No	I.15.4.2	Yes/No	Total
Q39	I.14.11	Yes/No	I.18.13	Yes/No	I.15.4.1	Yes/No	Total
Q40	I.14.48	Yes/No	Not available		I.15.9.5	Yes/No	Medium
Q41	I.14.56	Yes/No	I.20.13	Yes/No	I.15.9.13	Yes/No	Total
Q42	I.16.1	Yes/No	I.15.1	Yes/No	I.11.1	Yes/No	High
Q43	I.16.2	Yes/No	I.15.2	Yes/No	I.11.2	Yes/No	High
Q44	I.16.3	Yes/No	I.15.3	Yes/No	I.11.3	Yes/No	High
Q45	I.16.4	Yes/No	I.15.5	Yes/No	I.11.7	Yes/No	High

Note: Q1, Q2, Q3, Q4, and Q5 (How many professionals are there working in each profession?). Q6; I.7.2., 1.I.8.1.1 (What shifts do they cover? [Morning]). Q7: I.7.2.2, I.8.1.2 (What shifts do they cover? [Afternoon]). Q8: I.7.2.3, I.8.1.3 (What shifts do they cover? [Night]). Q9: I.8.1.1, .10.1.35.1, I.6.4.1 (Are the rooms well-ventilated or air-conditioned?). Q10: I.8.1.2, I.10.1.35.2, I.6.4.2 (Are the rooms well-lit?). Q11. I.8.1.3I, 10.1.35.3, I.6.4.3 (Are the walls and floors of the facility washable?) Q12: I.8.1.4, I.10.1.35.4, I.6.4.4 (Do the facility’s acoustics prevent internal and external noise?). Q13: I.8.1.5 /I.10.1.35.5/I.6.4.5 (Do the consultation rooms ensure privacy for service users?). Q14: I.8.1.5/ I.10.1.35.5/I.6.4.5 (Is there a room exclusively for procedures?); in 2012, >1 is transformed into “yes”; in 2017, included the word “exclusively”. Q15: I.9.14/I.10.1.18/I.6.3.5 (Nebulization room); in 2012, > 1 is transformed into “yes”. Q16: I.9.17/I.10.1.27/I.6.3.14 (Room for group activities); >1 is transformed into “yes”; in 2014 and 2017, change of wording. Q17: I.18.1/I.6.1 (Is there a vehicle available for external activities by the team(s)?, like home visits, campaigns, follow-up and oversight of work in the field, etc.?) Q18: I.18.2/I.6.2 (Does the vehicle available meet the teams’ needs?). Q19: I.17.1.1/I.11.1/I.7.1 (How many working computers are there?). Q20: I.17.10/I.6.3.3 (Do the consulting rooms have a computer with internet connection?). Q21: I.11.2/1; I.12.2/; 1/I.8.2/1 (Adult blood pressure devices: how many in working condition?). Q22: I.11.3/1; I.12.2.1/1; I.8.4/1 (Infant blood pressure devices: how many in working condition?). Q23:I.11.4/1; I.12.3/1; I.8.7/1 (Nebulizers: how many in working condition?). Q24; I.11.8/1; I.12.5/;1I.8.9/1 (Adult scale [up to 150 kg}: how many in working condition?). Q25; I.11.14/1; I.12.10/1; I.8.14 (Light for gynecological examinations: how many in working condition?). Q26; I.11.20/1; I.12.14/1; I.8.15/1 (Examination couch with stirrups: how many in working condition?). Q27: I.11.21/1; I.12.15/1; I.8.16/1 (Examination couch: how many in working condition?). Q28; I.11.25/1; I.12.17/1 and I.12.22/1; I.8.17 and I.8.18 (Pinard horn or stethoscope: how many in working condition?). Add quantities of both equipment. Q29: I.12.5; I.16.7; I.12.14 (Measuring tape always available?); in 2012 and 2014, always/sometimes = yes. Q30: I.12.7; I.16.8; I.12.15 (Disposable speculum always available?); in 2012 and 2014, always/sometimes = yes. Q31: I.12.9; I.16.10; I.12.21 (Endocervical brush always available?); in 2012 and 2014, always/sometimes = yes. Q32: I.12.10; I.16.11; I.12.16 (Ayre spatula always available?); in 2012 and 2014, always/sometimes = yes. Q33: I.12.12; I.16.13; I.12.19 (Slide fixer always available?); in 2012 and 2014, always/sometimes = yes. Q34: I.12.15; I.16.15; I.12.17 (Glass slide with frosted side always available?); in 2012 and 2014, always/sometimes = yes. Q35: I.12.16; I.16.16; I.12.18 (Slide holder always available?); in 2012 and 2014, always/sometimes = yes. Q36; I.13.1; I.13.2; I.9.2 (Pregnancy health booklet always available?); in 2012 and 2014, always/sometimes = yes. Q38; I.14.5; I.18.14; I.15.4.2 (Folic acid). Q39; I.14.11; I.18.13; I.15.4.1 (Ferrous sulphate). Q40; I.14.48; I.15.9.5 (Cephalexin [sodium or hydrochloride]); not available in 2014 (checked by random draw). Q41; I.14.56; I.20.13; I.15.9.13 (Nitrofurantoin). Q42: I.16.1; I.15.1; I.11.1 (Rapid syphilis test); in 2012 and 2014, always/sometimes = yes. Q43: I.16.2; I.15.2; I.11.2 (Rapid pregnancy test - always available?); in 2012 and 2014, always/sometimes = yes. Q44: I.16.3; I.15.3; I.11.3 (Rapid HIV test - always available?); in 2012 and 2014, always/sometimes = yes. Q45: I.16.4; I.15.5; I.11.7 (Malaria screening [thick blood smear] - always available?).
Source: PMAQ-AB 2012, 2014 e 2017.

	2012
	PMCcov (%)	CHW (n)	FHS (n)	OHS (n)	FHSU (n)¹	PMAQ Participation (%)
Alto Alegre	100.00	52	6	2	0	9.09
Amajari	97.63	17	2	0	0	7.69
Boa Vista	71.14	193	40	0	0	33.33
Bonfim	100.00	35	5	0	0	33.33
Cantá	97.32	39	4	1	0	0.00
Caracaraí	100.00	50	6	0	0	18.75
Caroebe	83.13	22	2	0	0	0.00
Iracema	100.00	26	4	0	0	0.00
Mucajaí	100.00	38	5	0	0	44.44
Normandia	100.00	25	3	0	0	0.00
Pacaraima	100.00	29	4	1	0	14.29
Rorainópolis	74.53	59	0	0	0	42.86
São João Da Baliza	100.00	16	2	0	0	0.00
São Luiz	100.00	20	3	1	0	0.00
Uiramutã	68.70	11	2	0	0	0.00
2014
Alto Alegre	100.00	52	6	2	0	9.09
Amajari	97.63	17	2	0	0	7.69
Boa Vista	71.14	193	40	0	0	33.33
Bonfim	100.00	35	5	0	0	33.33
Cantá	97.32	39	4	1	0	0.00
Caracaraí	100.00	50	6	0	0	18.75
Caroebe	83.13	22	2	0	0	0.00
Iracema	100.00	26	4	0	0	0.00
Mucajaí	100.00	38	5	0	0	44.44
Normandia	100.00	25	3	0	0	0.00
Pacaraima	100.00	29	4	1	0	14.29
Rorainópolis	74.53	59	0	0	0	42.86
São João Da Baliza	100.00	16	2	0	0	0.00
São Luiz	100.00	20	3	1	0	0.00
Uiramutã	68.70	11	2	0	0	0.00
2017
Alto Alegre	100.00	52	7	7	1	100.00
Amajari	95.16	19	3	1	1	0.00
Boa Vista	65.75	297	49	0	3	98.08
Bonfim	100.00	35	6	6	1	100.00
Cantá	100.00	39	5	2	0	100.00
Caracaraí	100.00	47	8	8	1	100.00
Caroebe	97.83	25	4	2	1	100.00
Iracema	100.00	26	5	5	1	100.00
Mucajaí	100.00	43	6	6	1	100.00
Normandia	77.78	0	0	0	0	100.00
Pacaraima	100.00	28	5	4	1	100.00
Rorainópolis	93.23	45	8	5	1	100.00
São João Da Baliza	98.41	14	3	2	1	100.00
São Luiz	95.50	20	3	3	1	100.00
Uiramutã	100.00	29	4	2	1	100.00

Items Investigated	Roraima ^(1)(a)			North Region ^{(1) (b)}			Brazil ^{(1) (c)}
Items Investigated	2012	2014	2017	2012	2014	2017	2012	2014	2017
Total PHC facilities (N)	28	55	86	804	1690	2384	13843	24055	30346
Q6. Opening hours, morning shift (% yes) - ^(b)	100.0	100.0	-	99.5	99.3	-	99.8	99.8	-
Q7. Opening hours, afternoon shift (% yes) - ^(bc)	100.0	98.2	-	93.3	94.1	-	94.9	97.9	-
Q8. Opening hours, night shift (% yes) - ^(b)	7.1	5.5	-	6.6	5.0	-	4.9	5.0	-
Q9. Rooms well ventilated or air-conditioned (% yes) -^(abc)	53.6	67.3	84.9	60.8	64.3	74.2	71.4	68.7	83.1
Q10. Rooms well lit (% yes) - ^(abc)	60.7	70.9	87.2	67.7	73.4	79.2	73.5	79.5	85.6
Q11. Floors, walls, and ceilings with flat/washable surfaces (% yes) - ^(abc)	39.3	49.1	74.4	48.0	53.4	62.8	54.6	58.8	67.4
Q12. Acoustics designed to prevent external noise pollution (% yes) - ^(abc)	35.7	50.9	91.9	42.2	51.7	57.8	40.6	57.2	67.9
Q13. Privacy for users during consultations (% yes) - ^(bc)	100.0	92.7	93.0	86.4	89.7	82.4	89.0	89.8	86.0
Q14. Procedure room (% yes) - ^(bc)	53.6	69.1	55.8	46.6	69.6	37.2	51.8	78.8	42.2
Q15. Nebulization room (% yes) - ^(abc)	25.0	54.5	23.3	20.1	49.6	22.3	30.2	63.4	32.0
Q16. Group activity room. (% yes) - ^(abc)	28.6	23.6	50.0	29.0	27.2	35.2	45.5	42.3	48.9
Q17. Vehicle for off-site activities (% yes) - ^(abc)	42.9	21.8	-	45.3	34.9	-	73.7	67.5	-
Q18. Vehicle to meet health team’s needs (% yes) - ^(bc)	10.7	14.5	-	28.6	28.8	-	50.6	58.2	-
Q20. Computer with internet connection in consultation room (% yes) - ^(bc)	39.3	-	38.4	58.8	-	37.6	58.5	-	54.1
Q1. No. of health workers: specialized physician - (mean quantity) - ^(bc)	0.67	0.67	0.26	0.23	0.60	1.04	0.55	1.10	1.36
Q2. No. of health workers: psychologist - (mean quantity) -^(bc)	0.33	0.28	0.09	0.12	0.44	0.14	0.28	0.62	0.34
Q3. No. of health workers: physiotherapist - (mean quantity) -^(abc)	0.41	0.11	0.04	0.17	0.56	0.22	0.29	0.65	0.32
Q4. No. of health workers: nutritionist - (mean quantity) -^(bc)	0.12	0.28	0.04	0.13	0.48	0.20	0.24	0.54	0.24
Q5. No. of health workers: social worker - (mean quantity) -^(abc)	0.08	0.33	0.17	0.10	0.41	0.16	0.20	0.41	0.18
Q19. No. of working computers - (mean quantity) - ^(abc)	2.00	1.33	5.47	2.66	1.44	4.39	4.02	2.81	5.52

Items investigated	Roraima ^(1)(a)			North Region ^{(1) (b)}			Brazil ^{(1) (c)}
Items investigated	2012	2014	2017	2012	2014	2017	2012	2014	2017
Total PHC facilities (N)	28	55	86	804	1690	2384	13843	24055	30346
Q21. Adult blood pressure device - (mean quantity) - ^(abc)	2.36	2.60	4.02	2.26	2.36	2.72	3.17	3.15	3.27
Q22. Pediatric or neonatal blood pressure device - (mean quantity) - ^(abc)	0.29	1.22	1.17	0.56	1.32	0.96	0.73	1.45	1.18
Q23. Nebulizer - (mean quantity) - ^(bc)	1.43	1.66	1.25	1.01	1.19	1.10	1.47	1.74	1.31
Q24. 150 kg scale - (mean quantity) - ^(abc)	0.82	2.11	1.49	1.07	1.28	1.16	1.29	1.58	1.21
Q25. Light for gynecological examination - (mean quantity) - ^(abc)	1.32	1.18	2.33	1.10	1.26	1.38	1.35	1.45	1.50
Q26. Examination couch with stirrups - (mean quantity)- ^(bc)	1.18	1.25	1.10	1.07	1.17	1.24	1.25	1.33	1.32
Q27. Examination couch - (mean quantity) - ^(abc)	2.50	3.07	3.90	2.20	2.50	3.13	2.86	3.13	3.74
Q28. Pinard horn or stethoscope - (mean quantity)- ^(abc)	1.68	2.22	3.33	1.25	2.04	2.09	1.59	2.32	2.38
Q29. Measuring tape (% yes) - ^(c)	92.9	96.4	90.7	96.8	97.3	91.1	97.5	98.3	92.8
Q30. Disposable speculum (% yes) - ^(bc)	100.0	96.4	90.7	95.9	93.7	88.6	92.3	95.5	92.7
Q31. Endocervical brush (% yes) - ^(bc)	100.0	96.4	93.0	94.2	91.9	88.8	96.7	97.2	93.1
Q32. Ayre spatula (% yes) - ^(c)	100.0	96.4	91.9	93.7	91.7	88.0	96.5	97.2	92.8
Q33. Slide fixer (% yes) - ^(abc)	71.4	90.9	93.0	84.7	86.3	86.8	83.6	94.0	91.7
Q34. Glass slide with frosted side (% yes) - ^(bc)	100.0	94.5	93.0	91.2	89.6	87.7	95.9	96.9	93.1
Q35. Slide holder (% yes) - ^(bc)	96.4	92.7	94.2	77.1	78.3	82.4	83.6	89.2	89.0
Q36. Printed matter: pregnancy health booklet (% yes) -^(bc)	96.4	96.4	88.4	96.0	96.6	84.4	87.8	94.1	88.9
Q37. Printed matter: infant health booklet (% yes) - ^(bc)	92.9	78.2	74.4	84.2	81.8	74.9	76.8	79.8	75.4
Q38. Folic acid. (% yes) - ^(abc)	85.7	38.2	59.3	68.5	61.4	60.4	71.3	66.6	58.5
Q39. Ferrous sulphate. (% yes) - ^(abc)	92.9	43.6	77.9	75.7	65.3	58.0	72.4	68.2	57.8
Q40. Cephalexin (sodium or hydrochloride). (% yes) - ^(bc)	89.3	-	73.3	61.9	-	49.9	59.7	-	51.9
Q41. Nitrofurantoin (% yes) - ^(c)	3.6	3.6	4.7	8.1	7.0	5.0	17.1	15.9	13.3
Q42. Rapid syphilis test (% yes) - ^(abc)	28.6	81.8	74.4	10.4	39.8	73.5	3.5	28.7	68.8
Q43. Rapid pregnancy test (% yes) - ^(abc)	75.0	34.5	51.2	19.4	17.0	25.9	6.8	28.5	39.9
Q44. Rapid HIV test (% yes) - ^(abc)	14.3	85.5	80.2	11.6	40.3	73.8	15.9	30.2	69.8
Q45. Malaria screening (thick blood smear) (% yes) - ^(bc)	50.0	50.9	38.4	18.4	18.5	13.6	2.3	2.1	1.2

[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Brasil

Brasil

Evaluation of the structure of primary maternal and infant healthcare in the state of Roraima, the North region of Brazil, and Brazil, 2012-2017

Abstract