Preenchimento da Caderneta de Saúde da Criança e fatores associados: estudo transversal em um município de grande porte populacional

Abstract

The Child Health Card (CHC) is an important monitoring tool. This study aimed to evaluate the quality of the fill in records of oral and general health fields of the CHC and the association between the quality of the fill in records and the type of service used by parents to monitor their children health. A cross-sectional study was conducted with a proportional stratified sample to the nine Health Districts of Belo Horizonte, Minas Gerais (n = 382 including 20% for possible losses), selected among children aged three to five years old, which sought the Basic Health Units in the National Children's Campaign Day for Multivaccination in 2014. A semi-structured interview with one of the parents was performed and the observation of 21 items of the CHC that are essential to monitoring the child development was performed, including two fields on oral health. Descriptive analysis was performed, obtaining the percentage of each item of CHC completed. To characterize the unsatisfactory fill in records of the CHC, the dependent variable was defined as the quality of the fill in records, and it was considered satisfactory when the CHC had 60% or more of completed fields. The dependent variable was constructed calculating a score ranging from 0 to 21 by the sum of the completed fields in the CHC. The main independent variable was the type of service used by the mothers for health follow-up (public or private / health plan). The other independent variables were demographic characteristics of the mother and child, mother and child's health conditions and the health care received by the child. The association of the variables was tested using the chi-square test and logistic regression. Participated in the study 367 (96.10%) respondents, mothers with an average age of 33.75 (SD = 6.54) years old, most mothers with education of >9 years (89.6%) and average per capita income of R$ 1,422.73 (SD=R$ 1,277.46). The fields most frequently filled in were the child's name (99.5%), date of birth (99.2%), mother's name (96.5%) and the registration of vaccines (94.0%). There was a low frequency of fill in records of psychomotor development (6.0%), the use of iron (4.6%), the tooth eruption fields (1.4%) and the dental chart (0.8%). The poor fill in rate was 55.5% and was higher in children from CHC whose mothers did not receive information about the CHC (OR=1.55, 95% CI 1.04 to 2.45) and the CHC without notes of the parents (OR=1.97, 95% CI 1.17 to 3.36). The prevalence of poor fill in of the CHC was lower in mothers with children´s gestational age 37 weeks (OR=0.52, 95% CI 0.27 to 0.98). There was no association of the quality of the fill in records and the type of health service used by parents for monitoring the children. The oral health items have not been filled which could compromise the monitoring and the health promotion of the child. Items considered essential in the CHC showed low frequency of fill in records, regardless of the type of service used by parents to monitor the health of their children. The result indicates the need for improvement in the utilization of the CHC by the health services. To guide and include the participation of mothers are characterized as necessary actions to the utilization of this health instrument.