Measuring and characterizing the quality of child care in Brazilian primary health care: a latent class analysis

Abstract

Background Ensuring the highest quality of care for children in Primary Health Care is essential to prevent or control risks that compromise a child's growth and development. This study aimed to characterize the quality of child health care provided by Primary Health Care (PHC) teams in Brazil and explore its relationship with municipal characteristics. Methods Using data from the external assessment of the first cycle of the National Program for Access and Quality Improvement in Primary Care, this cross-sectional study evaluated 16,566 PHC teams from the Family Health Strategy. Nine binary indicators of the quality of child care were created based on the recommendations of the Brazilian Ministry of Health. We used latent class analysis to characterize the quality care. Through a multinomial logistic regression, we assessed the association between belonging to a given latent class of quality of care and the municipal covariates region and Brazilian Deprivation Index. Results Three patterns (latent classes) of quality of care were identified: high, intermediate and low adequacy. The pattern labelled "High adequacy” included 31.2% of the PHC teams and had higher conditional probabilities in all nine indicators (over 70%). The pattern “Intermediate adequacy” involved 53.3% of PHC teams, and the "Low adequacy” pattern included only 15.4% of teams. The chance for a PHC team to belong to the "High adequacy” pattern was over two times (OR = 2.34; 95%CI: 1.15–4.76) in the Northeast region compared to the Center-West region. Relating to the Brazilian Deprivation Index, for PHC teams located in municipalities with moderate and low deprivation, the chance of belonging to the "High adequacy” pattern was 2.04 (95%CI: 1.44–2.89) and 9.08 (95%CI: 4.54–18.14) times, respectively, compared to the high deprivation municipalities. Conclusions This study identified three patterns of quality of child care. Most of the PHC teams were included in the “Intermediate adequacy” pattern. Furthermore, the quality of care was associated with the municipality characteristics. Our findings demonstrated that the methodology used in this study allowed us to characterize the quality of care in a more consistently way than with a conventional method using a set of indicators constructed from a national dataset.