Acesso das pessoas menores de quinze anos com tuberculose aos serviços de saúde

Abstract

The access to the care network is essential for the tuberculosis diagnosis and treatment in children and adolescents. The objective of this study is to analyze the access to health services for people under 15 years old with tuberculosis, in the perception of the parents, nurses and coordinators of the tuberculosis control program of the priority cities for the control of the disease in the state of Rio Grande do Norte. This research consists of a case study with a qualitative approach carried out in two priority cities to control tuberculosis in a Brazilian state. Initially, the number of tuberculosis cases in children under 15 years old in 2014 was surveyed. Subsequently, there were semi-structured interviews with 11 parents of people under 15 years old with tuberculosis, 11 nurses from the basic health units and three coordinators of the Program, selected in an intentional way. The interviews were recorded, transcribed and organized in Atlas Software ti. For the analysis of the statements, the methodological assumptions of Bardin (2011) was used. As a result, three categories emerged: Paths traveled: the search for the diagnosis and treatment of tuberculosis; The experience of tuberculosis: factors that hindered and facilitated the access to health services; The stigma and prejudice of tuberculosis in the family and in the society. This study identifies that parents used the emergency services as an entry point into the health system, showing the fragility of the family bond with the primary care. The diagnosis was done in children´s hospitals, confirmed through imaging tests. It evidences the failures in the suspicion of tuberculosis during the approach of the professionals and the difficulty in performing examinations in this age group. The treatment was carried out in the primary health units and the follow-up was done by two services at the same time. The closure of the cases shows difficulties due to the lack of information on the parents and the non-accomplishment of home visits by the professionals. The evaluation of the process is positive in the distance between the residence and the health service, the time spent, the availability of collective transportation, the service by spontaneous demand, the assistance incentive, by basic grocery package and the free supply of medicines. Factors such as violence in the territory, problems of mobility, lack of knowledge about the organization and the opening hours of the units are barriers to this access. The expenses from this process are related to transportation, food, hygiene material, absences from parents to work, hiring of people to take care of the child, loss of employment, routine or imaging examinations and acquisition of financial loans. Stigma and prejudice were observed in the family, in professionals and in the community. Because it is difficult to diagnose in children, the study suggests investigating adults with tuberculosis, to train professionals at different levels of care on children´s tuberculosis and to increase health education about the disease in the most accessible media. Therefore, the political, financial and personnel investment is fundamental, as well as an integrated and resolute health care network.