Avaliação das ações de alimentação e nutrição na atenção primária a saúde no estado de São Paulo
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Data
2016-02-19
Autores
Evangelista, Mayara Martins [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Avaliar a atenção nutricional no serviço primário à saúde do Estado de São Paulo e os fatores que influenciam a sua disponibilidade, frequência, número de participantes e envolvimento dos diferentes profissionais na oferta dos serviços. Métodos: Em 2011/2012 foram coletados dados de 65 municípios do Estado de São Paulo, incluindo 1873 profissionais de equipe de saúde, que responderam um questionário sobre a caracterização dos profissionais, disponibilidade, frequência e recursos para a realização de atividades de alimentação e nutrição. Nesse estudo foram analisadas a associação entre escolaridade do profissional, tempo de escolaridade, titulação, atualização em alimentação e nutrição, orientação recebida de profissional habilitado, disponibilidade de tempo para a realização das atividades, disponibilidade de material informativo para a realização da atividade, estrutura física da unidade de saúde para realização das atividades, total de membros da equipe de saúde, parceiros para a realização das atividades e utilização dos manuais do Ministério da Saúde com as variáveis desfecho: disponibilidade de atividades de alimentação e nutrição, número de participantes das atividades de alimentação e nutrição, frequência de atendimentos nas atividades de alimentação e nutrição e a participação do profissional no cuidado com os grupos nas atividades de alimentação e nutrição para gestantes, pais, crianças, adolescentes, adultos, idosos, família e outros grupos (hipertensos e diabéticos). A associação entre variáveis exposição e desfechos foi testada utilizando análise de regressão log linear de Poisson para estimar a razão de prevalência. Resultados: Entre os profissionais entrevistados, 44% eram graduados e apenas 2% formados em Nutrição. Os profissionais da equipe referiram participar das atividades de alimentação e nutrição em maior número para as gestantes (15,5%) e menor para família (4%) O fato de a equipe não receber orientação de um profissional habilitado influenciou negativamente na disponibilidade de ter ao menos três atividades de alimentação e nutrição para os grupos das gestantes, crianças, adolescentes, adultos e família e também foi associado a uma probabilidade 63% e 71% menor de ter pelo menos 50 participantes/mês participando das atividades de alimentação e nutrição para os adultos e idosos, respectivamente. Quando a unidade de saúde não contava com a presença do profissional graduado em nutrição na equipe, foi associado a uma probabilidade 45% menor para os adultos e 86% menor para os adolescentes, de ter presente nas atividades de alimentação e nutrição ao menos 50 participantes por mês. A unidade de saúde que não apresentou estrutura física, como salas de espera, sala especifica ou pátio no exterior da unidade para realizar atividades de alimentação e nutrição foi 88% menos favorável de ter atividades acontecendo ao menos mensalmente para os pais. Contar com a presença do profissional da equipe com formação mínima de ensino médio completo aumentou em aproximadamente duas vezes as chances de ter a presença de um mesmo profissional participando de três ou mais atividades para as gestantes, crianças e idosos. Conclusão: Houve baixa prevalência das ações de alimentação e nutrição na atenção básica à saúde no Estado de São Paulo, as quais mostraram-se influenciadas pela formação da equipe, presença do nutricionista e infraestrutura disponível para o estudo.
To assess the nutrition attention and factors that influence the availability, frequency, number of participants, and participation of professionals from different areas on the primary health attention services offered in the Sao Paulo State. Methods: In 2011 and 2012 the data was collected in 65 municipalities at the Sao Paulo State in Brazil, including 1873 professionals working in the health attention teams, who responded to a questionnaire designed to assess health professionals, availability, frequency, and resources designated to the development of food and nutrition activities. With this study we assessed the association between the health professional education, duration of the education, schooling, specialization, orientation provided by licensed professional, availability of time, informative supplies, physical infrastructure, number of members of the health professional team, partners, and the guidelines, for the development of the activities as exposures, with the availability of activities, frequency of health care, number of participants in each activity, and the attendance of the health professional team at the food and nutrition activities were analyzed as outcomes. All the analyses were stratified by the group to whom the activities were supposed to focus, as follows: pregnant, parents, adolescents, children, adults, elderly, families, and other groups such as diabetic or hypertensive persons. The prevalence ratio was and the 95% confidence interval were assessed using the Poisson regression model embedded in the generalized linear regression model. Results: Among the health professionals included in this study, 44% were graduated, but only 2% were graduated in Nutrition. The health professional team components reported to attend to more food and nutrition activities for the group of pregnant (15,5%) and less for families (4%). When the health professional team was not trained by a licensed professional, it was less likely to offer food and nutrition activities in three or more days of the week for pregnant, children, adolescents, adults and families and it was 63% and 71% less likely to include 50 or more participants per month in the activities for groups of adults and elderlies, respectively. When there was not health professional graduated in nutrition in the health team, it was 45% less likely to have an attendance of 50 or more adults and 86% for adolescents. The absence of infrastructure of the health unit, such as waiting room, offices, or courtyard, it was 88% less likely to develop monthly activities for parents. Additionally, when the health professional team had attended to high school level or more, it was as twice as likely to have the same health professional attending to three or more activities for pregnant, children, and adults. Conclusion: We found a low prevalence of food and nutrition activities in the primary health attention in the Sao Paulo State. Such activities were influenced by the level of education of the health professional team, the presence of the nutritionist, and the infrastructure.
To assess the nutrition attention and factors that influence the availability, frequency, number of participants, and participation of professionals from different areas on the primary health attention services offered in the Sao Paulo State. Methods: In 2011 and 2012 the data was collected in 65 municipalities at the Sao Paulo State in Brazil, including 1873 professionals working in the health attention teams, who responded to a questionnaire designed to assess health professionals, availability, frequency, and resources designated to the development of food and nutrition activities. With this study we assessed the association between the health professional education, duration of the education, schooling, specialization, orientation provided by licensed professional, availability of time, informative supplies, physical infrastructure, number of members of the health professional team, partners, and the guidelines, for the development of the activities as exposures, with the availability of activities, frequency of health care, number of participants in each activity, and the attendance of the health professional team at the food and nutrition activities were analyzed as outcomes. All the analyses were stratified by the group to whom the activities were supposed to focus, as follows: pregnant, parents, adolescents, children, adults, elderly, families, and other groups such as diabetic or hypertensive persons. The prevalence ratio was and the 95% confidence interval were assessed using the Poisson regression model embedded in the generalized linear regression model. Results: Among the health professionals included in this study, 44% were graduated, but only 2% were graduated in Nutrition. The health professional team components reported to attend to more food and nutrition activities for the group of pregnant (15,5%) and less for families (4%). When the health professional team was not trained by a licensed professional, it was less likely to offer food and nutrition activities in three or more days of the week for pregnant, children, adolescents, adults and families and it was 63% and 71% less likely to include 50 or more participants per month in the activities for groups of adults and elderlies, respectively. When there was not health professional graduated in nutrition in the health team, it was 45% less likely to have an attendance of 50 or more adults and 86% for adolescents. The absence of infrastructure of the health unit, such as waiting room, offices, or courtyard, it was 88% less likely to develop monthly activities for parents. Additionally, when the health professional team had attended to high school level or more, it was as twice as likely to have the same health professional attending to three or more activities for pregnant, children, and adults. Conclusion: We found a low prevalence of food and nutrition activities in the primary health attention in the Sao Paulo State. Such activities were influenced by the level of education of the health professional team, the presence of the nutritionist, and the infrastructure.
Descrição
Palavras-chave
Atenção primária à saúde, Ações de alimentação e nutrição, Promoção da saúde, Segurança Alimentar e Nutricional, Vigilância Alimentar e Nutricional, Primary health care, Food and nutrition activities, Health promotion, Food and Nutrition Surveillance, Food and Nutrition Safety