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ABSTRACT Objective To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used. Methods : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities. Results : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively. Conclusion The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

ABSTRACT Objective To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil. Methods Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children. Results Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3). Conclusion Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

ABSTRACT Objective To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata. Methods Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed. Results 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age). Conclusion Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

ABSTRACT Objective To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil. Methods A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI). Results Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination. Conclusion Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

ABSTRACT Objective To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors. Methods This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics. Results Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32). Conclusion Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

ABSTRACT Objective To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. Methods This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson’s chi-square test. Results In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. Conclusion The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

ABSTRACT Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

ABSTRACT Objective To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. Methods This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. Results Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. Conclusion Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

ABSTRACT Objective To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. Methodology National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. Results For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. Conclusion In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children’s schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

Objective: To analyze the insertion of the dimensions of the quadrilateral of Permanent Health Education in the work process under the perception of Primary Health Care nurses. Methods: This is an exploratory-descriptive qualitative study carried out in a municipality belonging to the Macroregion of Fortaleza-Ceará. The study sample consisted of 30 nurses working in Primary Care. Data collection took place between November 2019 and February 2020, in which the semi-structured interview script was used and, soon after, the thematic Content Analysis, proposed by Bardin, was carried out. Results: After compiling and analyzing the narratives, they were divided into thematic units, consistent with the dimensions of Permanent Health Education (teaching, sectoral management, health care and social control) in the nurses' work process. Conclusion: Nurses understand the training policy with emphasis on specific, fragmented and decontextualized actions in the context of the service occurring through nurses from several higher education institutions, with no fixed periodicity to happen and no plan for this process.

Objective: To create and validate a protocol to implement nutritional interventions for the management of childhood obesity in the Primary Health Care scope. Methods: This is a methodological study organized into three phases: elaboration of a systematic review of the “overview” type using the PRISMA recommendations; preparation of the clinical protocol; and content validation using the AGREE II and AGREE-REX instruments. Results: A total of 17 studies were included to create the protocol, indicating effectiveness in interventions with outcomes in a significant BMI reduction, change in eating behaviors and habits, and increase in the knowledge level about healthy eating. The clinical protocol assessment obtained a score >70% and, according to the parameter used (≥50% high quality), it was considered adequate for implementation in the children's health field, more specifically in the management of childhood obesity. Conclusion: A care protocol for the management of childhood obesity in the Primary Health Care scope positively represents a sustainable and flexible strategy with performance of several social actors such as health professionals and family members, among others, contributing to reducing risks of comorbidities associated with obesity and health costs, as well as to promoting healthier behaviors in the pediatric population.

A obesidade é uma doença grave que se caracteriza por aumento excessivo da gordura corporal. Atualmente, é considerada um dos principais problemas de saúde pública. O estudo tem como objetivo geral analisar na literatura científica como as políticas públicas contribuem para a prevenção da obesidade infantil. Trata-se de uma revisão integrativa da literatura (RI), com utilização de descritores e pesquisa nas bases de dados Cinahl, Pubmed, Scopus, com utilização do booleano “and”. Ao todo 13 estudos foram selecionados, destes nove (69,2) apresentavam abordagem quantitativa dos dados, a maioria dos artigos tinha como delineamento os estudos transversais (53,8%) e ensaio clínico randomizado (30,7%). O periódico com mais publicações foi o BMC Public Health (38,4%), a maioria dos estudos eram originários dos Estados Unidos (46,1%), e o inglês foi o idioma que prevaleceu (100%). Os estudos permitiriam ampliar os conhecimentos em relação as políticas públicas voltadas a obesidade infantil, que demonstraram importante resultados quanto a redução do IMC, mudanças dos hábitos alimentares e incentivo a prática de atividade física, entretanto para que sejam bem-sucedidas deve levar em conta a realidade local, os indicadores sociodemográficos, e a intensidade e duração da implementação dessas políticas.

Objetivo: Testar uma intervenção educativa para professores de creche sobre primeiros socorros, quanto aos desfechos de conhecimento e habilidade. Métodos: Estudo quase-experimental do tipo antes e depois, realizado em dez creches municipais públicas no Piauí, no período de setembro a outubro de 2019. A amostra foi composta de 36 professores e a coleta de dados foi realizada em três etapas: pré-teste acerca do conhecimento e habilidades em primeiros socorros; aplicação de atividade educativa teórico-prática; e pós-teste. Os dados foram analisados a partir do teste de Wilcoxon. Resultados: 97,2% são do sexo feminino, a média de idade é de 41,47 (± 9,48) anos, 86,1% são apenas graduados e 13,9% têm pós-graduação. Ademais, 97,2% não realizaram curso de primeiros socorros e 58,3% já haviam presenciado alguma necessidade desse tipo de atendimento. Os participantes apresentaram aumento do conhecimento após a intervenção nos seguintes itens: acionamento de socorro (p=0,000); detecção e conduta na parada cardiorrespiratória (p=0,000; p=0,002); e conduta em hemorragias (p=0,001). A habilidade técnica dos profissionais apresentou aumento em todos os passos do atendimento em vítimas de parada cardiorrespiratória com p

Objetivo: refletir acerca do desenvolvimento infantil ao longo dos tempos, onde ficam perceptíveis as motivações do Estado em assegurar direitos mínimos para o público infantil desde a era medieval, motivado pela garantia de mão-de-obra no futuro. Método: estudo teórico-reflexivo a partir de documentos oficiais brasileiros e internacionais. Resultados: ao assegurar qualidade de vida desde a fase mais tenra, aumentamse as chances desta criança chegar a fase adulta mais saudável, como vem demonstrando a ciência. Porém, ao longo dos anos, várias foram as barreiras a serem rompidas para a consolidação dos direitos na infância e da garantia legal dos cuidados para com elas. No Brasil, a constatação legal que assegurou os direitos na infância só ocorreu a partir de 1988, com a promulgação da Constituição Cidadã. A partir de então, surgiram novos desafios que requereram um aprimoramento constante das leis, uma vez que existia um conflito de interesses entre os órgãos de saúde e a indústria, pois a primeira visa o bem-estar das crianças, enquanto a segunda, o lucro. Conclusão: o desenvolvimento infantil deve ser assegurado por ser um direito, não devendo ser perpetuada a ideia de que a mesma favorecerá a economia, devendo esta última acontecer como consequência.

Introdução: A obesidade é uma doença crônica, de caráter multifatorial, consequente do desequilíbrio entre o consumo e gasto energético. Diante disso, para o seu tratamento é necessário um atendimento multidisciplinar, por meio de programas e estratégias de intervenção que considerem as variadas causas que influenciam o surgimento da doença. Objetivo: Analisar na literatura científica as estratégias de cuidado para o atendimento de pessoas com obesidade em serviços de saúde. Materiais e Métodos: Revisão integrativa realizada em novembro de 2021 com base na consulta às bases de dados: PubMed/Medline, LILACS/IBECS, Web of Science e SciELO. A análise foi realizada com 7 artigos. Resultados: Em relação à caracterização da população participante dos estudos, esta englobou prestadores de cuidados primários, representantes clínicos de serviços especializados em obesidade, membros da equipe multidisciplinar de serviços de saúde, membros de organizações de defesa da saúde e pacientes com obesidade. As estratégias de cuidado citadas nos estudos foram (1) Encaminhamento para um nutricionista, (2) Farmacoterapia, (3) Cirurgia bariátrica, (4) Grupos de apoio, (5) Programas de educação, (6) Desenvolvimento de habilidades e (7) Aumento do acesso a alimentos saudáveis. Conclusão: Pode-se concluir que no tratamento da obesidade deve-se priorizar a interação multidisciplinar frequente e intensiva. Contudo, também é necessário adequar o cuidado para aqueles pacientes que não respondem de maneira suficiente à intervenção no estilo de vida de forma isolada.