Fatores associados à dificuldade de acesso aos serviços de saúde infantil em São Luís/MA e Ribeirão Preto/SP: contribuições da coorte BRISA

Abstract

Introduction: the inequities in access to health care have directly interfered in infant mortality’s indicators and also have changed the dynamic of health’s system. Despite the importance of the issue, most studies did not analyses with details the factors associated with the difficulty of access at regions that have different socioeconomic characteristics. Objective: analyze the factors associated with the difficulty of access to child’s health services at São Luis/MA and Ribeirão Preto/SP. Methods: a prospective cohort study which involved 3308 children at São Luís and 3128 children at Ribeirão Preto, 13-35 months old. The prevalence rate (RP) was estimated by the Poisson regression with robust error variance in a hierarchical modeling, based on the adaptation of the Behavioral Model of Andersen. Results: the rate of difficult access at São Luís was 29,4%, while at Ribeirão Preto, the rate was 9,0%. At São Luís, the hierarchical analysis showed that the difficult of access was associated with the following variables: male child, more than a brother at home, lower maternal education, lower maternal age, be registered in the Family Health Strategy (ESF), has morbidity and wore perception of health’s state. At Ribeirão Preto, the difficulty of access was associated with the highest number of brothers at home, higher maternal education, lower economic class and be registered in the ESF. Conclusions: social inequalities in access to health were more prevalent at São Luis. The demographic’s predisposing and need factors were more expressive at São Luís, while the social structure’s predisposing and the enabling factors were more expressive at Ribeirão Preto.