Abstract
Abstract Objectives: to identify spatial pattern on hospitalization rates of children with diarrhea in the counties in São Paulo State. Methods: ecological and exploratory study on hospitalized data of children with diarrhea under the age of four in 2008 and 2012, the IDH mothers with low schooling level and children living with a low income less than half minimum wage were obtained from Datasus and inserted into digital map of the counties in São Paulo State. Moran's global index (I) and Pearson's coefficients correlation and thematic maps of hospitalization rates of 1,000 children, Moran maps and kernel map were calculated. Results: there were 34, 802 hospital admissions, with an average rate of 4.7 hospitalizations / 1,000 children (SD=7.2). Hospitalization rates were correlated only with schooling (r= 0.09, p<0.05). Moran's index for hospitalization rate was I=0.31(p<0.01). The thematic map of the hospital admission rates showed a cluster of counties in the west of the State; the kernel map showed a higher density of hospitalization in this region and the Moran map identified 57 counties which deserve attention. Conclusions: the results provide subsidies for the counties and regional managers to implement measurements aiming to reduce these rates.
Highlights
Diarrheal disease is still a severe public health problem and is responsible for the death of 1.5 million of children under the age of five in the world yearly; it is the second leading cause of mortality in this age group, especially in emerging countries.[1]
The analysis of this figure allows to identify the counties with a high hospitalization rate due to diarrhea, showing a cluster of counties in the extreme west of São Paulo State, and the counties with lower rates are located in the Vale do Paraíba and the North Coast
This study allowed to identify the presence of the spatial clusters for the hospitalization rate due to diarrhea in children aged 0 to 4 years of age in the counties located in the West region of São Paulo State between 2008 and 2012; it was possible to correlate positively with maternal schooling and to identify counties that deserve the attention of county and regional managers
Summary
Diarrheal disease is still a severe public health problem and is responsible for the death of 1.5 million of children under the age of five in the world yearly; it is the second leading cause of mortality in this age group, especially in emerging countries.[1] The incidence and the mortality of diarrheal diseases are more prevalent until the child’s first year of life, afterwards these numbers tend to decrease.[2] Reports at the Departamento de Informática do Sistema Único de Saúde (The Information Department of the National Health System) (Datasus) show that in Brazil in 2013 more than 60,000 children up to four years of age were hospitalized due to diarrhea were registered and 88 deaths occurred These hospitalizations, as well as social cost, totaled more than R$ 20 million reais.[3] Studies estimate that about onethird of the Brazilian pediatric hospital beds are occupied by children with diarrheal diseases.[4]. Infectious diarrhea is associated with infant morbidity and mortality and is considered a frequent syndrome[5] and places in bad condition to live and schooling are related to a high incidence of hospitalizations due to diarrhea.[6]
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