Problemas respiratórios em crianças menores de dois anos e a reprodução social das famílias (estudo populacional no município de Itupeva SP) / Respiratory problems in children under two years old and social reproduction of families (population study in Itupeva city, SP, Brazil)

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

The close relation between childrens health and socioeconomics factors is recognized for a long time; however, even so the most majority of poor children which become sick die more than others. Therefore, its necessary to enlarge de knowledge about the determinants (distal, intermediate and proximal) of most prevalent childrens health problems. Respiratory disease is one of the main causes of infant morbidity and mortality in Brazil and in the world. So its justified to recognize the processes that determine the respiratory problems, considering the social determination of health-disease process. Thus, this work aimed to estimate the prevalence of respiratory problems at different homogeneous social groups; to characterize how these problems are related to social reproduction of families and to evaluate the proximal and distal determinants related to their occurrence. This transverse population study was carried out at the city of Itupeva (São Paulo, Brazil), with a representative sample of 261 children under 2 years old. Based on a hierarchical theoretical model, focused on social reproduction, the profiles of social reproduction were composed by using an operationalmethodological- theoretical basis that pre-defined three homogeneous social groups (HSG): proper ways of working and living (HSG1), proper ways of working or living (HSG2); improper ways of working and living (HSG3). The respiratory problems were detected through information got from the remainder inquiry of the last month. Associations were observed through Chi-square test (scaled variables) or Fischer Test, and Student t-test (continuous variables). The non-conditional logistic regression model was used to accomplish the multiple analyses. In order to avoid exclusion of important variables, it was used a significance level of 0.20, and a level of 0.05 was used to indicate a statistically significant association. At the multiple analysis, the association were expressed by odds ratio (OR) and their confidence interval (CI) to 95%. The prevalence of respiratory problem was 71.6% (CI95% 65.8 - 77), being greater at inferior layers, but without a statistically significant difference: 64.0% at HSG1, 75.8% at HSG2 and 71.5% at HSG3 (p>0.05). With regard to the total of sample, fathers schooling level has showed to be statistically different among children which have presented respiratory problem and children which not presented: 56.1% of fathers (children with respiratory problems) have less than seven years of schooling, while 62.9 of fathers (children without respiratory problems) have more than seven years of schooling. Mothers schooling follows the same tendency. The occurrence of respiratory problems was a little bigger to female children and to those with ages among 12-18 months. The first step of logistic regression has tested each variable associated with the occurrence of respiratory problem (p<0.20). The objective of the second step was to check in each hierarchical level (distal, intermediate and proximal determinants) the variables that kept an association with the occurrence of respiratory problems when analyzed together with others of the same level. The third step has included (in the model) the distal determinants (socialdemographics variables and work of household variables) and intermediate determinants (ways of living). At this stage, the model has chosen, as significantly related to respiratory problems, the fathers schooling level and the house ventilation. These variables have remained in the fourth step, and in these same step it has been included the proximal determinants (infant characteristics and health care). Also the fathers schooling level and childrens age have remained significantly associated to until the last step of the model respiratory problems; this demonstrates the importance of the distal determinants in the conclusion of the process health-disease. Although the improvement of the ways of working and living of the families appear not to be part of attributions of health professionals (once these ways are linked to structural transformations), they are responsible to aware and mobilize the population around a common objective, that is a better social integration

ASSUNTO(S)

social group grupo social respiratory tract diseases child health (public health) doenças respiratórias saúde da criança

ACESSO AO ARTIGO

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