Caldart Raquel Voges, Marrero Lihsieh, Basta Paulo Cesar, Orellana Jesem Douglas Yamall
Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, Brasil,
Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brasil.
Cien Saude Colet. 2016 May;21(5):1597-606. doi: 10.1590/1413-81232015215.08792015.
In developing countries, pneumonia is the leading cause of sickness and mortality in childhood, especially among vulnerable groups. The scope of this study was to analyze the factors associated with pneumonia in Yanomami children hospitalized for Ambulatory Care Sensitive Conditions (ACSC). Hospital admissions were divided into two groups: i) pneumonia; and ii) other causes, according to the Brazilian ACSC list. Adjusted hospitalization rates were estimated and unconditional logistic regression was used to analyze factors associated with pneumonia. Over 90% of the registered cases were considered ACSC. The adjusted rate of ACSC was 18.6/1000. The odds ratio of hospitalization for pneumonia was 2.7 (CI: 1.3-5.4) times higher in children aged between 0.1 and 5.9 months; 1.9 (CI: 1.1-3.3) times higher in children who were hospitalized for 8-14 days; and three (CI: 1.2-7.5) times higher in children with a secondary diagnosis of malnutrition. The excess of avoidable hospitalizations is a clear indication of the low quality of care and limited accessibility to primary health care in indigenous territories, which is contrary to the assistance model proposed by the indigenous healthcare subsystem in Brazil, which should in theory focus on welfare technologies based on primary health care.
在发展中国家，肺炎是儿童患病和死亡的主要原因，尤其是在弱势群体中。本研究的范围是分析因门诊护理敏感疾病（ACSC）住院的亚诺马米儿童中与肺炎相关的因素。根据巴西ACSC清单，医院入院病例分为两组：i）肺炎；ii）其他原因。估计调整后的住院率，并使用无条件逻辑回归分析与肺炎相关的因素。超过90%的登记病例被视为ACSC。ACSC的调整率为18.6/1000。0.1至5.9个月龄儿童因肺炎住院的比值比高2.7（CI：1.3 - 5.4）倍；住院8 - 14天的儿童高1.9（CI：1.1 - 3.3）倍；有营养不良二级诊断的儿童高3（CI：1.2 - 7.5）倍。可避免住院的过多情况清楚表明，土著地区的医疗质量低下且初级卫生保健的可及性有限，这与巴西土著医疗子系统提出的援助模式相反，该模式理论上应侧重于基于初级卫生保健的福利技术。
