Análise do índice de vulnerabilidade social das áreas de cobertura das equipes saúde da família e sua distribuição territorial em Uberaba MG, 2010

Abstract

With the advent of the paradigm of social determinism, one needs the joint efforts of professionals in their territories, administrators and citizen participation. These efforts should be aimed at monitoring, organizing, and planning, actions in pursuit of practical results, and the strengthening of Primary Health Care (PHC) system with effective, high quality health care with a focus on the family. This study sought to analyze socio-demographic health indicators, the Social Vulnerability Index (IVS) and the territorial distribution of Family Health Strategy (FHS) teams. A cross-sectional observational study utilizing data from the Primary Care Information System (SIAB) regarding 50 FHS teams covering the City of Uberaba-MG in 2010 was conducted. The Geographic Information System (GIS) was used for distribution and mapping overlay. Indicators were calculated based on the Cogitare methodology in four areas: demographic, productivity, life cycle and IVS. Maps were used as cartographic variables. These included maps (a) at the city level, (b) of the FHS areas by IVS classification, and (c) of the Basic Health Units (BHU) including their locations and coverage radius. Measures of centrality and dispersion were calculated when appropriate. Furthermore, Pearson's coefficient, simple and multiple linear regressions, and independent t-tests were used to investigate relationships between variables of interest. All significance levels were set at .05. The results showed that the areas covered by the FHS teams were primarily classified as low (92%) and medium social risk (8%) according to overall IVS scores. Education was the main negative contributor (19.5%) to the calculation of IVS scores, while indirect income indicators (30.7%) were the main protective factors (p&#8804;0.001). The IVS was positively associated with the prevalence of leprosy (r=0.308, p<0.05) and coverage of cervicovaginal cytology (CVC) (r=0.281, p<0.05). Four indicators showed significant differences between IVS levels (F) at low risk (F3) and medium risk (F2): rate of femoral neck fractures> 50 years/1.000 (F3&#956;=0, &#963;=0.92; F2&#956;=0.51, t(46)=3.8, p<0.001), coverage of CVC (F3&#956;=55.6, &#963;=51.06; F2&#956;=19.03, &#963;=26.18, t(48 )= -2.22,p<0.05) and the prevalence of tuberculosis (F3=0, F2=9.59, &#963;=18.89, t(46)=3.481,p<0.01) and leprosy (F2&#956;=1.41, &#963;=2.81; F3&#956;=5.65, &#963;=2.85, t(48)=-2.53, p<0.05). In spatial distribution, higher IVS scores were found in the city s peripheral areas bordering highways that intersect the city, predominantly in rural areas of vulnerability. There was an overlap of BHUs radius coverage, crossing over health districts boundaries. Further, there were no areas in the urban district that was not covered by a BHU, including those areas not covered by FHS teams. Lack of coverage was only found in rural areas distant from the urban center. In conclusion, families living conditions showed good results with low social vulnerability. FHS teams presented high quality performance consistent with life cycle indicators. PHC coverage through the use of FHS teams had a positive influence on the living conditions of its people, serving as a protective factor and combating social vulnerability. Additionally, the BHUs spatial distribution led to a critical reflection regarding the accessibility and the organization of health care services in the City of Uberaba-MG.