Impactos de desastre hidrológico durante a pandemia de covid 19 no acesso a serviços de saúde por crianças para prevenção e promoção da saúde

Abstract

Introduction: Climate change has threatened years of public policy advances in child health. Billions of children around the world are at high risk of health impacts. In Brazil, these risks are mainly due to natural disasters, mostly associated with rainfall. However, despite the direct and indirect impacts on health that have already been shown, there may also be impacts on access to preventive care and health promotion, which have not yet been sufficiently studied. Objective: to estimate the impact of a hydrological disaster on children's access to health services for prevention and health promotion, considering the overlap between this event and the COVID-19 pandemic. Method: An ecological, descriptive and analytical study. We studied the monthly number of preventive and health promotion visits (well-child visit) to children under 9 years old in public primary health care services of Petrópolis, a city in the mountainous region of the Rio de Janeiro State, in southeastern Brazil, reached by a natural disaster associated with rainfall in 2022. For comparative analyses, a set of control municipalities similar (size, GDP, HDI and primary health care) the reached municipality was adopted. Visit rates in the six months after the disaster were compared with during the pandemic and with before the pandemic, using the Mann-Whitney U test and percentage differences. The rates were also compared month by month using the ratio between the observed rates after the disaster and the average rates before the pandemic, analyzing the 95% Confidence Interval. Results: 130,221 visits were studied, most of them involving children less than one year old. After the disaster, compared to before the pandemic, in the reached municipality there were significant reductions in the visit rates not observed in the controls. The reduction was 39% among children under one year old and almost 30% among those between one and four years old Compared to during the pandemic, the impacts observed were in the opposite direction: among children under one year old, in the reached municipality there was a small reduction of 3% while in the controls there was a significant increase of 77%. When analyzing the rates month by month, impacts with significant reductions were observed up to the fifth month after the month of the disaster among children under one year old. The closer in time to the disaster, the more intense the monthly reductions in visits. Conclusion: there was impacts of a natural disaster associated with rainfall on the use of health services by children for prevention and health promotion. These impacts persisted for up to five months after the month of the disaster, with reductions in visits compared to before the pandemic and no resumption of visits compared to the COVID-19 pandemic period.