RESUMO
INTRODUCTION: In 2003, Barbados, a developing country with universal health care, launched the Barbados Strategic Plan for Health, a national intervention to promote public health. Teachers, health educators, and clinicians worked to improve children's health, with particular focus on asthma and diabetes. We studied this intervention by using data on preventable hospitalization, an indicator that assesses both the overall effectiveness of public health and access to primary health care. The purpose of this study was to assess the Barbados Strategic Plan for Health by measuring rates of preventable hospitalization among children. Few researchers have studied these hospitalizations for children, and only 1 study has done so in a developing country. METHODS: We calculated annual (2003-2008) population-based rates of preventable hospitalizations from birth through age 19, both summary and disease-specific, for the 5 conditions that define the indicator for children: asthma, diabetes, gastroenteritis, urinary tract infection, and perforated appendix. RESULTS: Across the 6 years, the population rates of preventable hospitalizations increased 115.4% for boys and 67.2% for girls (both P < .001). Asthma accounted for much of the increase. Regression analysis indicated that the average annual increase in asthma hospitalization for boys was 0.45 per 1,000, an average annual increase of 20.6% of the baseline rate. These results suggest generally increasing rates of hospitalization for asthma for boys. There was no evidence of a corresponding rate trend for girls. CONCLUSION: Results suggest an opportunity to improve public health education and access to primary health care. Public health professionals in developing countries can use the approaches of this study to evaluate initiatives to improve child health.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Doença Crônica/prevenção & controle , Acessibilidade aos Serviços de Saúde , Hospitalização/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Saúde Pública/métodos , Adolescente , Assistência Ambulatorial/tendências , Apendicite/complicações , Apendicite/diagnóstico , Apendicite/epidemiologia , Asma/diagnóstico , Asma/epidemiologia , Asma/prevenção & controle , Barbados/epidemiologia , Criança , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Doença Crônica/epidemiologia , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Gastroenterite/prevenção & controle , Indicadores Básicos de Saúde , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Indicadores de Qualidade em Assistência à Saúde/normas , Análise de Regressão , Risco , Fatores Sexuais , Estados Unidos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle , Adulto JovemRESUMO
We evaluated access to primary health care for older women and men in Barbados, a developing country, using a widely accepted access indicator, hospitalization for ambulatory care sensitive conditions. Using 2003-2008 data, we calculated gender-specific total annual population-based rates of these hospitalizations per 1,000 older women and men and individual rates for the six most prevalent conditions. Across the 6 years, these hospitalizations increased 33.6% for women, 30.6% for men (both P < .0001). However, the average rate for diabetes fell 32% for women, 36% for men. Findings suggest an opportunity to improve access to primary health care, particularly for older women.