[Organization of health practices and vulnerability to childhood diarrhea]

OBJECTIVES: This study aimed to characterize, the organization of health practices related to the reduction of vulnerability to childhood diarrhoea. METHODS: A longitudinal study was carried out, with two interconnected transversal cuts, in 14 health services (11 health centres and 3 hospitals), located in six municipalities of Pernambuco that participated of the Diarrhoea Control Implementation Project coordinated by the Health State Department. The data collection was performed through observation, interviews with professionals and mothers of the children, and clinic histories revision. RESULTS: Overall, there was a high proportion of patients who either did not get consulted or had to wait for a long time after their arrival at the health service. No orientation was given on the use of oral rehydration salts at home; little advice on the signs and symptoms of an aggravating episode was given, an elevated number of drugs were prescribed to the children with diarrhoea; and there was high degree of omission to record the patientś hydration status and the treatment offered. The educational practice is systematic only in 3 services, and only in these services there is delegation of activities to the nursing team and articulation with community health agents. On the 2nd phase of the study, one of the few changes identified was a discrete increase in weight measurement and its recording on a Chart. However, in the intervention period 69.6% of the health team members noticed an improvement on the pediatric assistance. CONCLUSIONS: The results reveal the great deficiency of the evaluated services in operating educational and healing activities related to diarrhoea control. So the observed practices concerning the attention to the children have contributed to increase childhood vulnerability, which shows the need to reorganize disease control actions, among the myriad of other actions related to this social group.