Childcare appointment at the Family Health Strategy in municipalities in the inland region of the State of Paraíba, Brazil

Pedraza, Dixis Figueroa

doi:10.1590/1413-81232023288.06022023

Brasil

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ARTICLE • Ciênc. saúde coletiva 28 (8) • Aug 2023 • https://doi.org/10.1590/1413-81232023288.06022023EN linkcopy

Childcare appointment at the Family Health Strategy in municipalities in the inland region of the State of Paraíba, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to evaluate the childcare appointments by health professionals working at the Family Health Strategy in municipalities in the State of Paraíba, compare the performance by health team type (The Mais Médicos Program or conventional), and analyze the association of client satisfaction with the developed actions. This cross-sectional study evaluated the structural conditions of health units, the work process of health professionals, and client satisfaction, observing childcare appointments in 22 health teams. Poor employment relationships and professionals’ knowledge about child growth curves were highlighted in the structure. In the 175 appointments observed, we detected neglect in completing the Child Health Booklet (CHB), obtaining data on food consumption, and guidance practices. Only 36% of the appointments were classified with adequate duration. There was greater satisfaction for appointments developed in health teams of the Mais Médicos Program, with longer duration and better performance in guidance practices. The implementation of childcare appointments reveals significant gaps that can influence maternal satisfaction.

Key words: Primary Health Care; Childcare; Process Assessment (Healthcare)

Caracteristics		Total (N=22)	PMM (N=11)	Conventional (N=11)	p-value^a
Caracteristics		n	n	n	p-value^a
Own office for childcare appointments					0.476
	Yes	20	9	11
Availability of child scale and anthropometer					1.000
	Yes	21	10	11
Availability of Child Health Booklet					0.586
	Yes	18	8	10
Professional recruited through public examination					1.000
	Yes	14	7	7
Professional with a stable contract of at least two years					0.387
	Yes	13	5	8
Recording and interpreting head circumference/age based on child growth curves					0.659
	Adequate	14	6	8
Recording and interpreting weight/age based on child growth curves					1.000
	Adequate	16	8	8
Recording and interpreting length/age based on child growth curves					1.000
	Adequate	16	8	8
Recording and interpreting body mass index/age based on child growth curves					1.000
	Adequate	9	5	4

Actions developed and duration of appointments		Total (N=175)		PMM (N=84)		Conventional (N=91)		p- value^a
Actions developed and duration of appointments		n	%	n	%	n	%
Measuring growth and assessing development
	Weight	175	100.0	84	100.0	91	100.0	-
	Length	175	100.0	84	100.0	91	100.0	-
	Head circumference	168	96.0	79	94.1	89	97.8	0.205
	Development	38	21.7	22	26.2	16	17.6	0.168
Guidance on growth and development
	Weight	67	38.3	33	39.3	34	37.4	0.794
	Length	50	28.6	22	26.2	28	30.8	0.503
	Head circumference	29	16.6	11	13.1	18	19.8	0.235
	Development	20	11.4	7	8.3	13	14.3	0.216
Recording growth and development in the CHB
	Weight	115	65.7	56	66.7	59	64.8	0.542
	Length	95	54.3	42	50.0	53	58.2	0.218
	Head circumference	88	50.3	38	45.2	50	54.9	0.140
	BMI	20	11.4	7	8.3	13	14.3	0.216
	Development	21	12.0	11	13.1	10	11.0	0.668
Monitoring growth and development through the CHB
	Monitoring weight	114	65.1	56	66.7	58	63.7	0.369
	Monitoring length	75	42.9	37	44.1	38	41.8	0.760
	Monitoring head circumference	55	31.4	32	38.1	23	25.3	0.099
	Monitoring BMI	11	6.3	6	7.1	5	5.5	0.654
	Monitoring development	12	6.9	7	8.3	5	5.5	0.458
Assessment of food consumption and advice on nutrition
	Using the food consumption marker form in Primary Care	9	5.1	7	8.3	2	2.2	0.104
	Asking about the child’s diet	107	61.1	60	71.4	47	51.6	0.007
	Advising on child nutrition	90	51.4	54	64.3	36	39.6	0.001
General guidelines
	Vaccination	112	64.0	62	73.8	50	55.0	0.009
	Supplementation	45	25.7	31	36.9	14	15.4	0.001
	Accident and violence prevention	5	2.9	3	3.6	2	2.2	0.546

Duration and satisfaction with appointments	Total (N=175)		PMM (N=84)		Conventional (N=91)		p- value^a
Duration and satisfaction with appointments	n	%	n	%	n	%
Adequate appointment duration	63	36.0	38	45.2	25	27.5	0.014
Satisfaction with being able to ask questions	149	85.1	78	92.9	71	78.0	0.006
Satisfaction with the appointment’s duration	159	90.9	81	96.4	78	85.7	0.014
General satisfaction	142	81.1	76	90.5	66	72.5	0.002

Actions and duration of appointments		Satisfaction with the childcare appointment
		Yes		No		p-value^a
		n	%	n	%
Measuring weight/length		-				-
	Yes	142	81.1	33	18.9
	No	0	0.0	0	0.0
Measuring head circumference						0.502
	Yes	137	81.6	31	18.4
	No	5	71.4	2	28.6
Evaluating development						0.569
	Yes	32	84.2	6	15.8
	No	110	80.3	27	19.7
Guidelines on weight						0.001
	Yes	63	94.0	4	6.0
	No	79	73.1	29	26.9
Guidelines on length						0.006
	Yes	47	94.0	3	6.0
	No	95	76.0	30	24.0
Guidelines on head circumference						0.022
	Yes	28	96.6	1	3.4
	No	114	78.1	32	21.9
Guidelines on development						0.022
	Yes	20	100.0	0	0.0
	No	122	78.7	33	21.3
Recording weight in the CHB						0.056
	Yes	98	85.2	17	14.8
	No	44	73.3	16	26.7
Recording length in the CHB						0.107
	Yes	82	86.3	13	13.7
	No	60	75.0	20	25.0
Recording head circumference in the CHB						0.165
	Yes	75	85.2	13	14.8
	No	67	77.0	20	23.0
Recording BMI in the CHB						0.052
	Yes	19	95.0	1	5.0
	No	123	79.4	32	20.6
Recording development in the CHB						0.568
	Yes	18	85.7	3	14.3
	No	124	80.5	30	19.5
Monitoring weight through the CHB						0.068
	Yes	97	85.1	17	14.9
	No	45	73.8	16	26.2
Monitoring length through the CHB						0.220
	Yes	64	85.3	11	14.7
	No	78	78.0	22	22.0
Monitoring head circumference through the CHB						0.069
	Yes	49	89.1	6	10.9
	No	93	77.5	27	22.5
Monitoring BMI through the CHB						0.392
	Yes	10	90.9	1	9.1
	No	132	80.5	32	19.5
Monitoring development through the CHB						0.841
	Yes	10	83.3	2	16.7
	No	132	81.1	31	19.0
Using the food consumption marker form in Primary Care						0.211
	Yes	9	100.0	0	0.0
	No	133	80.1	33	19.9
Asking about the child’s diet						0.000
	Yes	99	92.5	8	7.5
	No	43	63.2	25	36.8
Advising on child nutrition						0.000
	Yes	87	96.7	3	3.3
	No	55	64.7	30	35.3
Guidelines on vaccination						0.044
	Yes	97	86.6	15	13.4
	No	45	71.4	18	28.6
Guidelines on supplementation						0.033
	Yes	43	95.6	2	4.4
	No	99	76.2	31	23.8
Guidelines on accident and violence prevention						0.274
	Yes	5	100.0	0	0.0
	No	137	80.6	33	19.4
Appointment duration time						0.002
	Adequate	59	93.7	4	6.3
	Inadequate	83	74.1	29	25.9

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[TFN9] PMM: Mais Médicos (“More Doctors”) Program; ^a Fisher’s Exact Test.

[TFN10] Source: Author.