Banca de QUALIFICAÇÃO: MATTEUS PIO GIANOTTI PEREIRA CRUZ SILVA

Uma banca de QUALIFICAÇÃO de MESTRADO foi cadastrada pelo programa.
STUDENT : MATTEUS PIO GIANOTTI PEREIRA CRUZ SILVA
DATE: 19/12/2025
TIME: 09:30
LOCAL: Remoto
TITLE:

EVALUATION OF THE NATIONAL POLICY FOR COMPREHENSIVE CHILD HEALTH CARE (PNAISC), AXES I AND III: CONSTRUCTION OF THE THEORETICAL MODEL AND USE OF INDICATORS RELATED TO INFANT MORTALITY

KEY WORDS:

Keywords: Saúde da Criança; Health Policy; Prenatal Care.

PAGES: 39
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

Child health is one of the essential pillars of human and social development and a sensitive indicator of the effectiveness of public health policies. The National Policy for Comprehensive Child Health Care (PNAISC), established by the Ministry of Health in 2015, aims to guide integrated, equitable, and continuous actions focused on promoting, protecting, and restoring children's health in Brazil. However, the effectiveness of this policy still lacks systematic evaluations that examine its indicators over time and in different regional contexts. Objective: Evaluate the implementation of the National Policy for Comprehensive Child Health Care (PNAISC), based on the sociodemographic conditions that are implicit in the process of pregnancy and birth. Methodology: A mixed-method study divided into two stages: a methodological review to construct the theoretical model and a quantitative approach with an ecological design, using secondary data from SIM, SINASC, SIS/IBGE, and IPEA. Priority child health indicators were identified based on the 2024-2027 National Health Plan and State Health Plans, with data collection between April and July 2025, covering the last 10 years available. The outcome variable was the Infant Mortality Rate (IMR), calculated as the ratio of deaths of children under one year of age to live births per thousand. The independent variables included demographic, socioeconomic, and health aspects. Statistical analysis was performed using R software, with descriptive calculations of mean and median, hierarchical cluster analysis (Ward.D2 method), and standardized Euclidean distance matrix. Kruskal-Wallis and Dunn tests (with Bonferroni correction) were applied to identify significant differences between groups. Results: The policy results from social and historical factors that shape its context, while Axes I and III define prescriptions aimed at humanized care and child development. The model integrates context, fundamentals, and actions, articulating descriptive and prescriptive theory. Hierarchical cluster analysis sought to identify groups of Brazilian states with similar patterns of infant mortality (IM) and social vulnerability index (SVI), revealing five clusters (k = 5) defined by the Ward.D2 method. The states of the South, Southeast, and part of the Midwest comprised clusters with better social and health conditions, while the North and Northeast concentrated the most vulnerable groups, with higher mortality and elevated SVI. The thematic map highlighted this regional distribution, highlighting clusters IV and V as the most critical. Table 2 showed significant differences between the groups: Cluster V had the best conditions—lower MI (9.7), higher APGAR scores, and higher maternal education—while Cluster III had the worst indicators (MI = 20.9, low APGAR, and lower education). White mothers predominated in Cluster V, and black mothers in Clusters II and IV, confirming ethnic and racial inequalities. The Gini, Palma, and IVS indicators also reflected this disparity, with greater inequalities in the most vulnerable clusters. The Kruskal-Wallis test confirmed significant differences between groups for MI (p = 0.0003) and IVS (p < 0.001), reinforcing that infant mortality is strongly associated with social vulnerability and structural inequalities in the country.

Keywords: Saúde da Criança; Health Policy; Prenatal Care.

COMMITTEE MEMBERS:
Presidente - 1119740 - MAURICIO WIERING PINTO TELLES
Interna - 1242804 - ADRIANA GOMES MAGALHAES
Interno - 1893928 - OSVALDO DE GOES BAY JUNIOR
Externa à Instituição - ANA MARIA FREIRE DE SOUZA LIMA