Determinantes contextuais e individuais da utilização da triagem auditiva neonatal: Pesquisa Nacional de Saúde, 2013.

Abstract

Newborn hearing screening (NHS) is the first standard procedure into the neonatal hearing health care programs. Since 2010, the use of NHS has been become a right for all Brazilian newborns. In 2015, the estimated coverage was only 37.2%, far from the goal of 95% recommended by the Ministry of Health. Particularities of the health system, besides some contextual and women's health characteristics, might be important determinants of NHS use. This study aimed to investigate the contextual and individual determinants of NHS utilization in the capitals of the Brazilian states. The theoretical conceptual model proposed by Andersen and Davidson (2014) guided a multilevel analysis using data from the National Health Survey-2013. At the contextual level, the NHS use was determined by predisposing and enabling characteristics represented by the proportion of extremely poor individuals (Odds ratio OR = 0.90; 95% confidence intervals 95% CI: 0.84-0.97) and by monthly NHS coverage (OR= 1.02; 95% CI 1.01-1.02), respectively. For the timely use of the NHS, the proportion of extremely poor individuals was the only contextual predisposing characteristic associated (OR= 0.85; 95% CI: 0.76-0.95). At the individual level, there were predisposing, enabling characteristics and health behaviors. The odds of using NHS were lower in children whose mothers reported brown race/skin colour (OR= 0.55; 95% CI: 0.30-0.98); and higher among mothers with cash remuneration (OR= 1.67; 95% CI: 1.02-2.72), mostly private prenatal care (OR= 3.11; 95% CI: 1.66 - 5.83) and 7 or more prenatal consultations (OR= 1.81; 95% CI: 1.14 -2.87). Sons of women aged 30 to 39 years had lower odds of timely use of the NHS (OR= 0.38; 95% CI: 0.15-0.99), the inverse was observed when the mothers received some guidance about signs of risk during pregnancy (OR= 3.17; 95% CI: 1.32-7.63). It was estimated that 4.22% of the variation on odds of NHS use can be explained by contextual characteristics of Brazilian capitals. This variation is greater when considering the timely use (11.45%). It is fundamental to support the promotion of actions that systematically reduce situations of vulnerability to which specific subgroups of newborns may be exposed. Some initiatives that could be adopted to ensure an equitable social protection system include the effective application of hearing health laws and policies that already exist, the prioritization of basic health care, as well as health education practices focused on newborns whose mothers have experience unequal use of services.