Abstract

This study aimed to define the profile of hospitalizations of children in public hospitals of 52 municipalities of the state of Rondônia, Brazil. We performed an ecological time series study using secondary data provided by the Hospital Information System. The annual trend of Hospitalizations was presented by age group and health region. Linear regression was performed using the Prais-Winsten technique of the statistical package Stata, version 11.0. Hospitalizations for gastrointestinal diseases were found to be decreasing in all age groups, just as those for vaccine-preventable diseases in children aged between 1 and 9 years. Hospitalizations for skin and subcutaneous tissue diseases were increasing in all ages, as well as those caused by epilepsies in children aged 1 to 9 and those caused by diseases related to childbirth and puerperium. Health regions showed a varied hospitalization profile. A stable trend was found in the Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, and Vale do Jamari regions, whereas a declining trend was found in the Central and Zona da Mata regions. The high rates of hospitalizations for ambulatory care-sensitive conditions in children show how inefficient strategies and investments in primary care have been in the state of Acre, Brazil.

Key words:
Child health; Hospitalization; Primary health care

Introduction

Hospitalizations for ambulatory care-sensitive conditions (ACSC hospitalizations) are indicators that reveal how efficient primary health care (PHC) actions are in practice¹1 Alfradique ME, Bonolo Pde F, Dourado I, Lima-Costa MF, Macinko J, Mendonça CS, Oliveira VB, Sampaio LF, Simoni CD, Turci MA. Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil). Cad Saude Publica 2009; 25(6):1337-1349.. In Brazil, these actions are developed by the Public Health System (PHS) and are part of the Family Health Strategy (FHS) to monitor communities and families, including children, that are registered and treated by health centers²2 Brasil. Ministério da Saúde (MS). Portaria nº 1.130, de 5 de agosto de 2015. Institui a Política Nacional de Atenção Integral à Saúde da Criança (PNAISC) no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União 2015; 5 ago.^,33 Macinko J, Mendonça CS. Estratégia Saúde da Família, um forte modelo de atenção primária à saúde que traz resultados. Saude Debate 2018; 42 (Esp. 1):18-37..

Specific and timely interventions by PHC may reduce the hospitalization risk in this group by valuing prevention, diagnosis and early treatment of acute diseases. In addition, these actions may help reduce control and monitoring costs of chronic diseases⁴4 Lima RCDSM, Gama MEA, Lima RDSM. Condições sensíveis à atenção primária em hospital de referência pediátrica no maranhão. Rev Pesq Saude. 2017; 18(2):97-101.^,55 Skinner HG, Coffey R, Jones J, Heslin KC, Moy E. The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study. BMC Health Serv Res 2016; 16:77..

Studies show that morbidity in children is directly related to socio-environmental factors, such as basic sanitation, income, access to health services and the specificities of this stage of life, all of which can often help avoid hospitalizations. Unlike adults, children are more often prone to acute diseases, which could be prevented by PHC services⁵5 Skinner HG, Coffey R, Jones J, Heslin KC, Moy E. The effects of multiple chronic conditions on hospitalization costs and utilization for ambulatory care sensitive conditions in the United States: a nationally representative cross-sectional study. BMC Health Serv Res 2016; 16:77.^,66 Pedraza DF, Araujo EMND. Internações das crianças brasileiras menores de cinco anos: revisão sistemática da literatura. Epidemiol Serv Saude 2017; 26(1):169-182. .

In this context, it is known that ACSC hospitalizations in childhood increase the socioeconomic and psychological costs of children and their families, as they require a high volume of PHC resources. In addition, new hospitalizations may predispose to other diseases and conditions, requiring investments that could instead be applied in child health care training in PHC⁷7 Pinto Junior EP, Aquino R, Dourado I, Costa LQ, Silva MGC. Internações por condições sensíveis à atenção primária à saúde em crianças menores de 1 ano no Brasil. Cien Saude Colet 2020; 25(7):2883-2890..

In Brazil, studies on ACSC hospitalizations of Brazilian children gained greater prominence after the Ministry of Health implemented and adapted the Brazilian List of ACSC Hospitalizations, which identifies and classifies different conditions that affect all age groups, i.e., from children to the elderly⁸8 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Portaria nº. 221, de 17 de abril de 2008. Define a Lista Brasileira de Condições Sensíveis à Atenção Primária. Diário Oficial da União 2008; 18 abr..

Available studies on ACSC hospitalizations of Brazilian children reveal a rather varied profile in the Northeast⁶6 Pedraza DF, Araujo EMND. Internações das crianças brasileiras menores de cinco anos: revisão sistemática da literatura. Epidemiol Serv Saude 2017; 26(1):169-182.^,77 Pinto Junior EP, Aquino R, Dourado I, Costa LQ, Silva MGC. Internações por condições sensíveis à atenção primária à saúde em crianças menores de 1 ano no Brasil. Cien Saude Colet 2020; 25(7):2883-2890., Southeast⁹9 Lôbo IKV, Konstantyner T, Areco KCN, Vianna RPT, Taddei JAAC. Internações por condições sensíveis à atenção primária de Menores de um ano, de 2008 a 2014, no estado de São Paulo, Brasil. Cien Saude Colet 2019; 24(9):3213-3226., South¹⁰10 Prezotto KH, Chaves MMN, Mathias TAF. Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region. Rev Esc Enferm USP 2015; 49(1):44-53. and North regions of the country¹¹11 Santos BV, Lima DS, Fontes, CJF. Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016. Epidemiol Serv Saude 2019; 28(1):e2017497.. Gastroenteritis prevailed in the Northern and Northeastern regions, whereas respiratory diseases prevail mostly in the Southern and Southeastern regions. These data show that not only age-related aspects are considered to understand the appearance of diseases, but also climate factors and regional differences, such as access and availability of basic educational and health services¹⁰10 Prezotto KH, Chaves MMN, Mathias TAF. Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region. Rev Esc Enferm USP 2015; 49(1):44-53.^,1212 Sá LYBA. Avaliação em saúde na atenção primária: uma análise a partir dos instrumentos, ICSAP, PCATOOL e PMAQ no município de Manaus no período de 2010 a 2019 [tese]. Belo Horizonte: Universidade Federal de Minas Gerais; 2019.^,1313 Farhat KA, Souza TC, Meneguetti DUO. Morbidade e mortalidade ocasionadas por doenças infecciosas e parasitárias em crianças de uma capital da Amazônia ocidental (2007 a 2017) e sua correlação com o saneamento básico. In: Cesar DJ, Meneguetti DUO, Martins FA, Silva REG, organizadores. Saúde da criança e adolescente: epidemiologia, doenças infecciosas e parasitárias. Rio Branco: Stricto Sensu Editora; 2019. p. 12-28..

In Rondônia, according to a study on ACSC hospitalizations conducted from 2012 to 2016, of 133,958 hospitalizations, 24.8% were caused by preventable health issues. Of this percentage, 14.8% were children aged up to 4 years and 9.3% were aged between 5 and 9, a total of 24.1% of all ACSC hospitalizations in this state¹¹11 Santos BV, Lima DS, Fontes, CJF. Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016. Epidemiol Serv Saude 2019; 28(1):e2017497.. However, in addition to a lack of studies on these conditions in children, there is a high rate of preventable early neonatal deaths, which in turn were related to prenatal care, childbirth and immunization¹⁴14 Moreira KFA, Oliveira TS, Gonçalves TA, Moura CO, Maluf SN, Tavares RSA, Tavares CM. Mortalidade infantil nos últimos quinquênios em Porto velho, Rondônia - Brasil. J Human Growth Develop 2013; 24(1):86-92..

That said, establishing the profile of hospitalizations of children helps to understand these phenomena in the health-disease process of this group to guide actions to prevent diseases in a timely manner and avoid unnecessary hospitalizations¹⁵15 Barbosa SFA, Costa FM, Vieira MA. Causas de hospitalização de crianças: uma revisão integrativa da realidade brasileira. Espac Saude 2017; 18(2):129-137.. In addition, results may support municipal managers in planning health care policies aimed at that group in the Health Care Network of Rondônia.

The present study aims to establish the profile of ACSC hospitalizations of children in the state of Rondônia that occurred from 2008 to 2019.

Methods

Study type

We performed an ecological time-series study based on secondary hospitalization data (2008-2019) obtained from the Hospital Information System (HIS-SUS) of the IT Department of the Brazilian Public Health System (www.datasus.gov.br).

The choice of the 2008-2019 time series took into account the initial period of the implementation of the ACSC hospitalization list in Brazil in 2008.

Study population

Study population consisted of children residing in the 52 municipalities of Rondônia who were hospitalized from January 1, 2008 to December 31, 2019 and had their Hospital Admission Authorization (AIH) form filled out according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) of 1997 by the World Health Organization and according to the ACSC Hospitalization List¹1 Alfradique ME, Bonolo Pde F, Dourado I, Lima-Costa MF, Macinko J, Mendonça CS, Oliveira VB, Sampaio LF, Simoni CD, Turci MA. Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil). Cad Saude Publica 2009; 25(6):1337-1349..

Definition of variables

The age variable was studied by age groups according to HIS data (under 1 year, from 1 to 4 years, and from 5 to 9 years).

To establish age delimitation, we used the World Health Organization (WHO) and PNAISC concept of child applied to the scope of the Brazilian Public Health System². The definition of Rondônia’s health regions followed the Resolution 087 of the Bipartite Intermanagement Commission (BIC) of Rondônia of May 8, 2014, which groups the state’s 52 municipalities into seven health regions (Madeira Mamoré, Vale do Jamari, Central, Zona da Mata, Café, Cone Sul, Vale Guaporé)¹⁶16 Brasil. Ministério da Saúde (MS). Comissão Intergestores Tripartite. Resolução nº 8, de 24 de novembro de 2016. Dispõe sobre o processo de pactuação interfederativa de indicadores para o período 2017-2021, relacionados a prioridades nacionais em saúde. Diário Oficial da União 2016; 24 nov.^,1717 Rondônia. Resolução nº 087/CIB/RO de 08 de maio de 2014. Aprova a conformação das 7 (sete) Regiões de Saúde do Estado de Rondônia. Diário Oficial do Estado de Rondônia 2014; 8 maio..

Census data and population estimates of every health region were used as defined by the Brazilian Institute of Geography and Statistics (IBGE) and as available on the website of the IT Department of the Brazilian Public Health System (DATASUS).

Hospitalization causes were analyzed according to the chapters and groupings of the International Statistical Classification of Diseases and Related Health Problems (Tenth Revision, ICD-10)¹1 Alfradique ME, Bonolo Pde F, Dourado I, Lima-Costa MF, Macinko J, Mendonça CS, Oliveira VB, Sampaio LF, Simoni CD, Turci MA. Internações por condições sensíveis à atenção primária: a construção da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil). Cad Saude Publica 2009; 25(6):1337-1349. and the List of Hospitalizations for Ambulatory Care-Sensitive Conditions (ACSC hospitalizations)⁸8 Brasil. Ministério da Saúde (MS). Secretaria de Atenção à Saúde. Portaria nº. 221, de 17 de abril de 2008. Define a Lista Brasileira de Condições Sensíveis à Atenção Primária. Diário Oficial da União 2008; 18 abr., as described in Chart 1.

Organization and statistical analysis of data

HIS Data were collected, entered into MS Excel spreadsheets and analyzed by means of the STATA software program, version 11.0 (College Station, Texas, USA). Annual hospitalization rates were calculated for the period evaluated by age group and health region. Cause-proportional morbidity rates were calculated using the total number of hospitalizations by type in every specific year, divided by the total population of interest in the same area and year and multiplied by 10,000.

Annual trend analysis of hospitalizations was performed by means of a linear regression using the Prais-Winsten technique, after the serial autocorrelation had been checked using the Durbin and Watson test. Trends were classified as decreasing, stable and increasing.

Theoretical foundation was developed by means of the Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO) published in Portuguese, which provided full texts indexed by the following descriptors: hospitalization, child, preventable causes.

Ethical aspects

The present study is part of a larger research project entitled “Study on morbidities in Rondônia”, approved under CAAE - 46586315.9.0000.5300 by the Research Ethics Committee of the UNIR according to the guidelines of Resolution 466/CNS/2012 of the National Health Council¹⁸18 Brasil. Ministério da Saúde (MS). Resolução nº 466, de 12 de dezembro de 2012. Incorpora referenciais da bioética, tais como, autonomia, beneficência, justiça e equidade, dentre outros, e visa a assegurar os direitos e deveres que dizem respeito aos participantes da pesquisa, à comunidade científica e ao Estado. Diário Oficial da União 2012; 12 dez..

Results

From 2008 to 2019, the annual ACSC hospitalization trend in children in the state of Rondônia varied among age groups and ACSC hospitalization groups.

Table 1 shows that the trend of ACSC hospitalizations caused by infectious gastroenteritis and complications decreased in the three age groups (< 1 year: -8.62%; 1 to 4 years: -7.25%; 5 to 9 years: -4.95%). On the other hand, skin and subcutaneous tissue infections showed an increasing annual trend in all age groups (14.32%; 17.87%; 18.18%).

In children, ACSC hospitalizations caused by respiratory diseases showed a stable trend in all age groups (< 1 year: -1.24%; 1-4 years: 0.32%; 5-9 years: 1.75%), just as hospitalizations caused by kidney and urinary tract infections (-1.15%; -1.49%; 0.01%).

ACSC hospitalizations due to immunization-preventable diseases/sensitive conditions showed a stable trend in two age groups (< 1 year: -2.60%; 5-9 years: -3.76%) and a declining trend in children aged 1 to 4 (-8.51%). The group defined as “others” also showed a stable trend in two age groups (1-4 years: -3.44%; 5-9 years: -1.64%), but an increasing trend in children under one year (2,75%).

The annual trend of ACSC hospitalizations caused by epilepsies increased in the age groups of 1-4 years (12.05%) and 5-9 years (12.17%). Regarding children under one year, diseases related to prenatal care and childbirth also showed an increasing annual trend (24.20%).

Considering the regions of the state of Rondônia, Table 2 shows that the annual trend of ACSC hospitalizations varied in all the three age groups. Regions with a stable trend included Vale do Guaporé (-3.92%), Cone Sul (-1.68%), Vale do Jamari (-0.95%), Café (2.10%), and Madeira-Mamoré (2.73%). A declining trend was found in the Central (5.66%) and Zona da Mata (-3.97%) regions.

Discussion

The present study identified high rates of ACSC hospitalizations in children in the state of Rondônia which showed important variations between age groups and condition groups. Its findings corroborate other studies performed in Brazil¹⁹19 Castiglioni AH. Transição urbana e demográfica no Brasil: características, percursos e tendências. Ateliê Geográfico 2020; 14(1):6-26.

20 Prezotto KH, Lentsck MH, Aidar T, Fertonani HP, Mathas TAF. Hospitalizações de crianças por condições evitáveis no estado do Paraná: causas e tendência. Acta Paul Enferm 2017; 30(3):254-261.^-2121 Ribeiro MGC, Filho ACAA, Rocha SS. Hospitalizações por condições sensíveis à atenção primárias em crianças no Nordeste brasileiro. Rev Bras Saude Mater Infant 2019; 19(2):499-506. and in European countries, such as Italy. Those countries show a considerable decrease in the rate of ACSC hospitalizations in children²²22 Zucco R, Pileggi C, Vancheri M, Papadopoli R, Nobile CGA, Pavia M. Preventable pediatric hospitalizations and access to primary health care in Italy. PLoS One 2019; 14(10):e0221852..

However, it should be noted that hospitalization features vary and are directly associated with several intrinsic regional factors, such as epidemiological conditions and their level of socioeconomic and cultural development²³23 Carvalho FFB, Cohen SC, Akerman M. Refletindo sobre o instituído na promoção da saúde para problematizar 'dogmas'. Saude Debate 2017; 41(Esp. 3):265-276..

In Brazil, typical regional conditions also impact the health indicators of its population. The Observatory of Children and Adolescents and the Brazilian Institute of Geography and Statistics, IBGE (2017) show that indicators of access to water and sewage network not only reveal Brazil’s inequalities in general, but also show greater and more frequent differences in the Northern and Northeastern regions, including the state of Rondônia²⁴24 Observatório da Criança e do Adolescente (Fundação Abrinq). Cenário da infância e adolescência no Brasil. São Paulo: Fundação Abrinq; 2021.^,2525 Instituto Brasileiro de Geografia e Estatística (IBGE). Brasil/Rondônia/Panorama. Rondônia: cidades e estados [Internet]. [acessado 2022 jul 7]. Disponível em: https://www.ibge.gov.br/cidades-e-estados/ro.html
https://www.ibge.gov.br/cidades-e-estado... . We also found that in this region, access is not expanded, which means that peripheral municipalities are the most affected ones by the lack of resources required to promote health¹¹11 Santos BV, Lima DS, Fontes, CJF. Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016. Epidemiol Serv Saude 2019; 28(1):e2017497..

However, only 12.2% of the population had access to a sewage system in the state of Rondônia in 2018 and in 2019, this figure decreased to 11.4%. Similarly, 49.4% of the total population had access to the public water distribution system in 2018, which decreased to 46.9% in 2019. This scenario is due to populational increase and the lack of urban planning in the state, to the detriment of the population²⁴24 Observatório da Criança e do Adolescente (Fundação Abrinq). Cenário da infância e adolescência no Brasil. São Paulo: Fundação Abrinq; 2021..

The epidemiological scenario in the state of Rondônia is strongly influenced by persistent structural issues, such as its socioeconomic and nutritional precariousness, lack of basic sanitation, among other factors, which results in a high number of ACSC hospitalizations in children. Some age groups even reach similar rates as those of parasitic diseases¹¹11 Santos BV, Lima DS, Fontes, CJF. Internações por condições sensíveis à atenção primária no estado de Rondônia: estudo descritivo do período 2012-2016. Epidemiol Serv Saude 2019; 28(1):e2017497..

Likewise, as corroborated by international literature, hospitalizations for preventable causes in children are directly associated with a variety of socioeconomic factors that contribute to high rates of hospital admissions in areas of greater vulnerability, as shown by the context of the present study²⁶26 Bettenhausen JL, Colvin JD, Berry JG, Puls HT, Markham JL, Plencner LM, Krager MK, Johnson MB, Queen MA, Walker JM, Latta GM, Riss RR, Hall M. Association of income inequality with pediatric hospitalizations for ambulatory care-sensitive conditions. JAMA Pediatr 2017; 171(6):e170322..

The state of Rondônia shows a comparable scenario, since the monthly household income of the resident population in 2020 lay below the national average²⁵25 Instituto Brasileiro de Geografia e Estatística (IBGE). Brasil/Rondônia/Panorama. Rondônia: cidades e estados [Internet]. [acessado 2022 jul 7]. Disponível em: https://www.ibge.gov.br/cidades-e-estados/ro.html
https://www.ibge.gov.br/cidades-e-estado... , according to IBGE (2020). Thus, ACSC hospitalizations of children for skin and subcutaneous tissue infections showed the highest annual trend in the 1-4 and 5-9 age groups, as well as an increasing trend in all age ranges, which may be due to unfavorable socioeconomic conditions to health.

Although infectious gastroenteritis showed a declining trend in all age groups, it remains the main cause of ACSC hospitalizations in children aged 1-4 and 5-9 years. On the other hand, in children under one year, infectious gastroenteritis was the second leading cause of hospitalizations, a finding that differs from other studies conducted in other Brazilian states, according to which this cause was also predominant in children under one year⁷7 Pinto Junior EP, Aquino R, Dourado I, Costa LQ, Silva MGC. Internações por condições sensíveis à atenção primária à saúde em crianças menores de 1 ano no Brasil. Cien Saude Colet 2020; 25(7):2883-2890..

A study performed in the state of Ceará found that of 388,973 records of ACSC hospitalizations of children under 5 years of age that took place from 2000 to 2012, the highest rates of hospitalizations occurred in children under one year and the post-neonatal component was the main hospitalization cause. Therefore, the high rates of ACSC hospitalizations in children under one year may be related to the developmental stage in which the body’s immune system is still in the process of formation and/or maturing²⁷27 Costa LQ, Pinto EP, Silva MGC. Tendência temporal das internações por condições sensíveis à atenção primária em crianças menores de cinco anos de idade no Ceará, 2000 a 2012. Epidemiol Serv Saude 2017; 26(1):51-60..

In the present research, diseases related to prenatal care and childbirth showed a higher and increasing annual trend in children under one year, just as ACSC hospitalizations caused by skin and subcutaneous tissue infections and the group identified as others. ACSC hospitalizations caused by diseases related to prenatal care and childbirth may have an impact on the increasing trend of ACSC hospitalizations caused by epilepsies in the 5-9 age group and on the partially stable trend in the 1-4 age group, since in children, ACSC hospitalizations may be associated with issues that occur during prenatal care and result from the neonatal phase²⁷27 Costa LQ, Pinto EP, Silva MGC. Tendência temporal das internações por condições sensíveis à atenção primária em crianças menores de cinco anos de idade no Ceará, 2000 a 2012. Epidemiol Serv Saude 2017; 26(1):51-60.. This assessment is corroborated by national²⁸28 Sales KGS, Abreu LC, Ramos JLS, Bezerra IMP. Internações hospitalares por condições sensíveis à atenção primária à saúde. Rev Bras Promoc Saude 2019; 32:9664. and international²⁹29 Laberge M, Wodchis WP, Barnsley J, Laporte A. Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada. Soc Sci Med 2017; 181:24-33. studies which state that children under 5 years are more vulnerable to ACSC hospitalizations at this stage of life.

Research in Brazil’s northern region, i.e., the setting of this study, shows that respiratory diseases, especially asthma and pneumonia, showed the highest rate of ACSC hospitalizations in children under 5 years, which reveals how inefficient early diagnosis and treatment of those diseases in Primary Care are. It also reveals the lack of territorial searches for socio-environmental factors that favor their emergence and worsening that currently takes place⁶6 Pedraza DF, Araujo EMND. Internações das crianças brasileiras menores de cinco anos: revisão sistemática da literatura. Epidemiol Serv Saude 2017; 26(1):169-182.^,1212 Sá LYBA. Avaliação em saúde na atenção primária: uma análise a partir dos instrumentos, ICSAP, PCATOOL e PMAQ no município de Manaus no período de 2010 a 2019 [tese]. Belo Horizonte: Universidade Federal de Minas Gerais; 2019.^,3030 Instituto Nacional de Pesquisas Espaciais (INPE). Portal do Monitoramento de Queimadas e Incêndios. [acessado 2022 jul 7]. Disponível em: https://www.cptec.inpe.br/ro/porto-velho
https://www.cptec.inpe.br/ro/porto-velho... .

It is noteworthy that in children under one year, ACSC hospitalizations caused by diseases that can be prevented by immunization/sensitive conditions, in addition to nutritional deficiencies and infections of the kidney and urinary tract, showed a persistently stable trend throughout all the years we analyzed. These findings may be related to the increased coverage of actions such as systematic vaccination of children and the intensification of educational health activities aimed at childcare in the context of PHC³¹31 Pinto Junior EP, Costa LQ, Oliveira SMA, Medina MG, Aquino R, Silva MGC. Expenditure trends in ambulatory care sensitive conditions in the under-fives in Bahia, Brazil. Cien Saude Colet 2018; 23(12):4331-4338..

In the present study, ACSC hospitalizations in children by health regions of the state of Rondônia maintained a stable trend in the Madeira-Mamoré and Café regions. According to a report by the State Health Department¹⁷17 Rondônia. Resolução nº 087/CIB/RO de 08 de maio de 2014. Aprova a conformação das 7 (sete) Regiões de Saúde do Estado de Rondônia. Diário Oficial do Estado de Rondônia 2014; 8 maio. , both regions have a strong impact on the general rate of ACSC hospitalizations in the state, as they are populous municipalities and run the greatest number of hospital infrastructures, which corroborates studies conducted in other states³²32 Farias YN, Leite IC, Siqueira MAMT, Cardoso AM. Iniquidades étnico-raciais nas hospitalizações por causas evitáveis em menores de cinco anos no Brasil, 2009-2014. Cad Saude Publica 2019; 35(Suppl. 3):e00001019.. Thus, partnerships between different health areas result in stability in populous regions.

The present study allows us to conclude that the profile of ACSC hospitalizations of children in Rondônia varies among age groups and condition groups. As can be seen, some of the preventable diseases in PHC, such as skin and subcutaneous tissue infections, tend to increase in all age groups, which reveals a large scenario of unnecessary hospitalizations, as well as the neglect of healthcare managements. This scenario exposes serious failures in child healthcare of PHC, since it shows serious restrictions in the reception and early identification of health issues that mainly affect children up to one year.

These findings highlight the fact that municipal health management actions and strategies urgently need to be (re)planned, especially regarding investments in service infrastructure and training of health professionals so that children and their families may be assisted in time to avoid health complications that could be fully addressed by primary care.

Limitations of the present study are due to incomplete admission forms, especially regarding the fields on patients’ gender and residential address, since admissions are manually quantified in physical forms and later entered in a digital system, which is prone to produce mistakes, since several people take part in the process. In addition, the ecological bias corroborates a limitation of the specificities of every health center of the public health network. However, those limitations do not invalidate our findings, as the sample analyzed during the study period is considerably large.

Conclusion

In Rondônia, ACSC hospitalizations of children that took place between 2008 and 2019 were associated with intrinsic and extrinsic factors of primary care actions.

Most hospitalizations were caused by either skin infections or gastroenteritis, which shows to what extent common clinical symptoms, such as diarrhea and colic, are neglected and which also reveals gaps and serious flaws in care and guidance aimed at the full growth and development of children.

The trends of stable and declining ACSC hospitalization rates in the state of Rondônia reflect the national trends, but show a higher number of hospitalizations, which raises concern over social and health determinants that are getting worse and impact the child health-disease process.

Health service managers and professionals should urgently review child health surveillance strategies at different care levels, especially Family Health Strategy teams in the field of Primary Health Care of every municipality, by considering local peculiarities.

Acknowledgements

The authors would like to thank the Rondônia Fundação de Amparo à Pesquisa do Estado de Rondônia (FAPERO); the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq); the Centro de Estudo e Pesquisa em Saúde Pública (CEPESCO); the Fundação Universidade Federal de Rondônia (UNIR); and the Secretária de Estado da Saúde de Rondônia (SESAU).

References

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