Abstract Objective: To evaluate exclusive breastfeeding at discharge and hospital length-of-stay in pre-term infants undergoing or not the Kangaroo-Mother Care Method (KMC). Methods: A retrospective cohort study was conducted including preterm infants < 1800 g admitted to the neonatal unit of a KMC reference center. The infants were grouped into the KMC group and the non-KMC group. Multiple logistic and Poisson regressions were performed to evaluate the association between the KMC and two outcomes, exclusive breastfeeding at discharge, and hospital length-of-stay, adjusted for potential confounders. Results: 115 mother-infant dyads were included, 78 in the KMC group and 37 in the non-KMC group. In the bivariate analysis, the KMC group had a lower prevalence of maternal adverse conditions (6% vs. 32%, p < 0.001), a higher number of prenatal visits (median 6 vs. 3.5, p < 0.001), higher gestational ages (median 32 vs. 31 weeks, p < 0.05), higher birth weights (median 1530 vs. 1365 g, p < 0.01), a lower prevalence of necrotizing enterocolitis (3.8% vs. 16.2%, p < 0.05), parenteral nutrition (50% vs. 73%, p < 0.05), and deep vascular access (49.7% vs. 78.4%, p < 0.01), a higher prevalence of exclusive breastfeeding (65% vs. 8%, p < 0.001) and a shorter length of hospital stay (median 28 vs. 42 days, p < 0.001). In the multiple regression analysis, the KMC group was 23 times more likely to be exclusively breastfed at discharge (OR = 23.1; 95% CI = 4,85–109,93) and had a 19% reduction in the hospital length-of-stay (IDR = 0.81; 95% CI = 0.76–0.86) compared to the non-KMC group. Conclusions: The KMC is associated with better short-term neonatal outcomes and should be encouraged in all Brazilian maternity hospitals. Objective lengthofstay pre term KangarooMother Kangaroo Mother KMC. . (KMC) Methods 180 center nonKMC non lengthofstay, stay, confounders Results 11 motherinfant mother infant included 7 3 analysis 6% (6 vs 32% 0.001, 0001 0.001 , 0 001 median 35 5 3.5 weeks 0.05, 005 0.05 05 0.05) 153 136 0.01, 0.01 01 0.01) 3.8% 38 8 (3.8 162 16 2 16.2% 50% 50 (50 73 73% 49.7% 497 49 (49.7 784 4 78.4% 65% 65 (65 8% days 0.001. OR 23.1 231 1 95 4,85–109,93 48510993 85 109 93 19 IDR 0.81 081 81 0.76–0.86 076086 76 86 Conclusions shortterm short hospitals (KMC 18 ( 000 0.00 00 3. 0.0 15 13 3.8 (3. 16.2 (5 49.7 (49. 78.4 23. 9 4,85–109,9 4851099 10 0.8 08 0.76–0.8 07608 0. (3 16. 49. (49 78. 4,85–109, 485109 0.76–0. 0760 (4 4,85–109 48510 0.76–0 076 4,85–10 4851 0.76– 07 4,85–1 485 0.76 4,85– 48 0.7 4,85 4,8 4,

Abstract Objective: To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. Methods: 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge’sg. Results: Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). Conclusion: HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge. highfidelity high fidelity casebased case based selfconfidence, selfconfidence self confidence, confidence reasoning communication attitude Methods 3 methods HFS, 18 CBD, (CBD 15. 15 . 15) Selfconfidence Self mixedeffect regressions Hedgesg. Hedgesg Hedge sg. sg Hedge’sg Results 591 59 1 59. 936 93 6 93.6 0.001 0001 0 001 505 50 5 50. 882 88 2 88.2 451 45 45. 632 63 63.2 435 43 43. 567 56 7 56.7 pvalue value 0.01, 0.01 , 01 0.01) group*time grouptime ranking 06565 6565 0.656 03331 3331 0.3331 respectively. respectively respectively) Hedges 115 1.1 2.20. 220 2.20 20 2.20) Conclusion care 9 93. 0.00 000 00 8 88. 4 63. 56. 0.0 0656 656 0.65 0333 333 0.333 11 1. 22 2.2 0. 065 65 0.6 033 0.33 2. 06 03 0.3

Resumo Introdução: As experiências adversas na infância podem ter impacto em vários aspectos da saúde humana. É importante termos ferramentas que possam identificá-las e quantificá-las. Objetivo: Descrever as etapas iniciais do processo de adaptação transcultural (ATC) do Questionário Internacional de Experiências Adversas na Infância (ACE-IQ) para o português do Brasil. Método: Realizamos a avaliação da equivalência conceitual, semântica e operacional da ATC nas seguintes etapas: preparação (reuniões multidisciplinares); tradução (dois tradutores independentes); reconciliação (grupo multidisciplinar); tradução reversa (tradutor independente); revisão da tradução reversa (grupo multidisciplinar); pré-testes na população-alvo (gestantes de uma maternidade pública no Rio de Janeiro); revisão dos pré-testes (grupo multidisciplinar); prova de leitura; e relatório final (grupo multidisciplinar). Resultados: Os 43 itens do ACE-IQ foram traduzidos e adaptados para português do Brasil. Antes dos pré-testes, cinco itens dos seguintes domínios foram adaptados: etnia e escolaridade (n=2), convivência familiar (n=1) e violência entre os pares (n=2). Seguiram-se três pré-testes consecutivos (10 gestantes cada). Sete itens sofreram adaptações após o primeiro pré-teste: trabalho (n=1), casamento (n=1), relacionamento com pais/responsáveis (n=2) e ambiente familiar (n=3). Após o segundo pré-teste houve somente alteração no formato das opções de resposta. No terceiro pré-teste obteve-se índice de validade de conteúdo entre 0,89 e 1 em todos os itens. Conclusões: A versão brasileira do ACE-IQ mostrou boa equivalência conceitual, semântica e operacional na amostra estudada. Estudos de validade e confiabilidade devem ser conduzidos para confirmar suas propriedades psicométricas. Introdução humana identificálas identificá las quantificálas. quantificálas quantificá las. quantificá-las Objetivo (ATC ACEIQ ACE IQ (ACE-IQ Brasil Método conceitual reuniões multidisciplinares multidisciplinares) dois independentes independentes) grupo multidisciplinar multidisciplinar) tradutor independente independente) prétestes pré testes populaçãoalvo população alvo Janeiro Janeiro) leitura multidisciplinar. . Resultados 4 prétestes, testes, n=2, n2 n n=2 , 2 n=1 n1 (n=1 n=2. Seguiramse Seguiram se 10 (1 cada. cada cada) préteste teste n=1, paisresponsáveis pais responsáveis (n=2 n=3. n3 n=3 3 (n=3) resposta obtevese obteve 089 0 89 0,8 Conclusões estudada psicométricas n= (n= ( (n=3 08 8 0, (n

Abstract Background: Adverse childhood experiences can impact many aspects of human health. It is important to have tools that can identify and quantify them. Objective: To describe initial phases of the cross-cultural adaptation (CCA) of the Adverse Childhood Experiences International Questionnaire (ACE-IQ) to Brazilian Portuguese. Method: We conducted the conceptual, semantic and operational equivalence of the CCA process in nine steps: preparation (multidisciplinary meetings), translation (two independent translators), reconciliation (multidisciplinary group), back-translation (independent translator), back-translation review (multidisciplinary group), pre-tests with the target population (pregnant women from a public maternity hospital in Rio de Janeiro), review of pre-test results (multidisciplinary group), reading proof (multidisciplinary group); final report (multidisciplinary group). Results: The 43-item ACE-IQ has been translated and adapted to Brazilian Portuguese. Before the pre-tests, five items from the following domains were adapted: ethnicity and education (n=2), family life (n=1) and violence between peers (n=2). Three consecutive pre-tests followed (ten pregnant women, each). Seven more items were adapted after the first pre-test: work (n=1), marriage (n=1), relationship with parents/guardians (n=2), family environment (n=3). After the second pre-test, there was only a layout change in the answer options. In the third pre-test, good content validity indexes were obtained in all items (0.89–1.00). Conclusions: The Brazilian version of ACE-IQ showed good conceptual, semantic and operational equivalence in the studied sample. Validity and reliability studies are necessary to confirm its psychometric properties. Background health them Objective crosscultural cross cultural (CCA ACEIQ ACE IQ (ACE-IQ Portuguese Method conceptual steps multidisciplinary meetings, meetings , meetings) two translators, translators translators) group, group group) backtranslation back translator, translator translator) pretests pre tests Janeiro, Janeiro Janeiro) pretest test group. . Results 43item item 43 pretests, tests, n=2, n2 n n=2 2 (n=2) n=1 n1 1 (n=1 n=2. ten each. each each) n=1, parentsguardians parents guardians n=3. n3 n=3 3 (n=3) pretest, test, options 0.89–1.00. 089100 0.89–1.00 0 89 00 (0.89–1.00) Conclusions sample properties 4 n= (n=2 (n= (n=3 08910 0.89–1.0 8 (0.89–1.00 (n 0891 0.89–1. (0.89–1.0 089 0.89–1 (0.89–1. 08 0.89– (0.89–1 0.89 (0.89– 0.8 (0.89 0. (0.8 (0. (0 (

Resumo Introdução: O uso de simulação realística em emergências pediátricas é particularmente valioso, pois permite o treinamento de habilidades técnicas, atitudinais e cognitivas, ajudando a garantir a segurança do paciente. Objetivo: Este estudo tem como objetivo descrever a percepção do aluno sobre o uso da Simulação Realista de Alta Fidelidade nos módulos de emergência pediátrica durante o internato de medicina. Métodos: Estudo observacional, descritivo, com abordagem quantitativa e qualitativa. Um questionário semiestruturado foi aplicado aos estudantes do sexto ano de medicina ao final dos módulos de internato pediátrico, com oito semanas de duração, de agosto a dezembro de 2020. Todos participaram de dois tipos de atividades sobre 14 temas: simulação de alta fidelidade (SRAF) e discussão estruturada de casos clínicos (DCC). Resultados: Dos 33 participantes, 29 responderam ao questionário. A média de idade foi de 24 ± 1,8 anos, sendo 58,6% do sexo feminino. Todos concordaram que a experiência com SRAF contribuiu para um desempenho mais seguro em emergências pediátricas, considerado ótimo por 76% e bom para os demais. A maioria achava que a associação de SRAF e DCC era o método ideal (96%). A análise de conteúdo das respostas sobre a SRAF destacou unidades temáticas em cinco categorias: aprendizagem significativa, contribuição para a formação profissional, habilidades, atitude/comportamento e qualidade da atividade. Conclusões: A reação dos estudantes ao uso da SRAF em emergências pediátricas foi muito positiva, e sua associação com a DCC foi considerada o método de ensino ideal. Conhecer as reações dos alunos ajuda os professores a planejarem suas atividades para melhorar o método de ensino-aprendizagem. Introdução valioso técnicas cognitivas paciente Objetivo Métodos observacional descritivo qualitativa pediátrico duração 2020 1 temas (SRAF DCC. . (DCC) Resultados 3 participantes 2 18 8 1, anos 586 58 6 58,6 feminino 76 demais 96%. 96 96% (96%) categorias significativa profissional atitudecomportamento atitude comportamento atividade Conclusões positiva ensinoaprendizagem. ensinoaprendizagem aprendizagem. ensino-aprendizagem 202 (DCC 5 58, 7 9 (96% 20 (96 (9 (

Abstract Introduction: The use of realistic simulation in pediatric emergencies is particularly valuable, as it allows the training of technical, attitudinal, and cognitive skills, helping to ensure patient safety. Objective: This study aims to describe the student’s perception of using the High-Fidelity Realistic Simulation in the pediatric emergency modules during the internship. Methods: Observational, descriptive study with a quantitative and qualitative approach. A semi-structured questionnaire was applied to sixth-year medical students at the end of the pediatric internship modules, which lasted eight weeks, from August to December 2020. All of them participated in two types of activities on 14 topics: high-fidelity simulation (HFS) and structured discussion of clinical cases (SDCC). Results: Of the 33 participants, 29 answered the questionnaire. The mean age was 24 ± 1.8 years, and 58.6% were female. All agreed that the experience with HFS contributed to safer performance in pediatric emergencies, considered optimal by 76% and good for the remainder. Most thought the association of HFS and SDCC was the ideal method (96%). The content analysis of the responses on HFS highlighted thematic units in five categories: significant learning, contribution to professional training, skills, attitude/behavior, and quality of the activity. Conclusions: Students’ reaction to using HFS in pediatric emergencies was very positive, and its association with SDCC was considered the ideal teaching method. Knowing the students’ reactions helps teachers plan their activities to improve the teaching-learning method. Introduction valuable technical attitudinal skills safety Objective student s HighFidelity High Fidelity Methods Observational approach semistructured semi sixthyear sixth year weeks 2020 1 topics highfidelity high fidelity (HFS SDCC. . (SDCC) Results 3 participants 2 18 8 1. years 586 58 6 58.6 female 76 remainder 96%. 96 96% (96%) categories learning attitudebehavior attitude behavior attitude/behavior activity Conclusions Students positive teachinglearning 202 (SDCC 5 58. 7 9 (96% 20 (96 (9 (

Abstract Objective To describe the association of maternal and neonatal characteristics with the adherence status to the in-hospital stages of the Kangaroo-Mother Care Method - KMC (full, partial, and no-adherence). Methods Retrospective cohort study including infants < 2500 g admitted to a reference maternity hospital for the KMC in Rio de Janeiro from January to December 2018. Maternal and neonatal characteristics were distributed according to the adherence status to the KMC in-hospital stages. In the first stage, KMC is performed in Neonatal Intensive Care Unit and Conventional Neonatal Intermediate Care Unit. The second stage is completed in Kangaroo Neonatal Intermediate Care Unit. Multinomial multiple regression was performed with KMC adherence as a three-category dependent variable and maternal and neonatal characteristics as independent variables. Results Of 166 dyads, 102 (61.5%) participated in two stages. Those who did not participate in any stage (n = 52; 31.3%) had a lower level of education, a higher frequency of adverse conditions, and were more often single mothers; mothers who participated only in the first stage (n = 12; 7,2%) had more premature and sick infants. Conditions associated with adherence to the two stages compared to no adherence were: high school education (OR = 2.34; 95% CI = 1.08-5.07), presence of a partner (OR = 3.82; 95% CI = 1.7-8.61), no adverse conditions (OR = 3.54; 95% CI = 1.59-7.89) and no neonatal resuscitation (OR = 2.73; 95% CI = 1.22-6.1). Conclusions The study identified maternal and neonatal conditions associated with adherence status to the KMC. The results suggest opportunities to improve adherence.

Objetivos. Determinar la prevalencia de macrosomía y factores asociados en Perú, y describir la ocurrencia de complicaciones durante el parto y posparto. Materiales y métodos. Los pesos al nacer de los niños menores de cinco años fueron analizados usando datos de la Encuesta Demográfica y de Salud Familiar (ENDES) 2013, llevada a cabo por el Instituto Nacional de Estadística e Informática. Los niños con un peso mayor a 4000 g al nacer fueron considerados como macrosómicos. Se empleó un análisis de regresión logística para establecer la asociación independiente de factores sociodemográficos con la macrosomía. Resultados. La muestra estuvo constituida por 6121 niños. La prevalencia de macrosomía fue 5,3% (intervalo de confianza al 95%: 4,8 a 5,9). El sexo masculino, un orden de nacimiento mayor, la obesidad materna y una mayor estatura materna estuvieron independientemente asociados con la macrosomía. Los partos por cesárea fueron más frecuentes en niños macrosómicos (43,9% vs 26,9%). Las complicaciones durante el parto y posparto fueron frecuentes, pero no estadísticamente asociadas con la macrosomía. Conclusiones. La prevalencia de macrosomía en Perú es relativamente baja comparada con otros países de ingresos bajos o medios. Los factores asociados con la macrosomía fueron principalmente no modificables, con excepción de la obesidad materna. Los niños macrosómicos nacieron más frecuentemente por cesárea. La reducción del peso y la prevención de la obesidad en mujeres en edad fértil en Perú podrían potencialmente reducir la macrosomía y las tasas de cesáreas.

Objectives. To determine the prevalence of macrosomia and factors associated with it in Peru and to describe the occurrence of complications peri- and postpartum. Materials and Methods. Birth weights of children under the age of 5 years were analyzed using data from the 2013 Demographic and Family Health Survey (ENDES) carried out by the Instituto Nacional de Estadística e Informática. Children with a birth weight higher than 4000 g were considered macrosomic. A logistic regression analysis was used to establish the independent association of sociodemographic factors with macrosomia. Results. The sample comprised 6121 children. The prevalence of macrosomia was 5.3% (95% interval confidence: 4.8-5.9%). Being male, a higher birth order, maternal obesity, and greater maternal height were independently linked with macrosomia. Caesarean births were more common in macrosomic children than unaffected ones (43.9% vs 26.9%). Complications during birth and postpartum were common but not statistically linked with macrosomia. Conclusions. The prevalence of macrosomia in Peru is relatively low compared to other low-to-middle income countries. The factors associated with macrosomia were mainly unmodifiable, with the exception of maternal obesity. Macrosomic children were more frequently born by caesarean. Weight reduction and the prevention of obesity in women of childbearing age in Peru could potentially reduce macrosomia and caesarean rates.

OBJETIVOS: Identificar as UTIs pediátricas do Rio de Janeiro, número de leitos, distribuição geográfica, natureza pública ou privada, tipo de atendimento e de hospital, estudar a demanda da população e elaborar propostas de melhoria na eqüidade. MÉTODOS: Foram visitadas todas as UTIs do Estado, de julho de 97 a junho de 98, levantado o número de leitos e tempo médio de permanência. Com essas informações e dados do IBGE, estabeleceu-se a necessidade de leitos e a comparação entre oferta e demanda por regiões, formulando-se propostas de melhoria na eqüidade. RESULTADOS: Foram identificadas 80 UTIs (excluídas seis), totalizando 1.080 leitos; 60% intensivos e 40% semi-intensivos; 57% públicos e 43% privados; 52% em UTIs neonatais exclusivas, 14% em pediátricas e 34% em mistas (65% leitos neonatais), totalizando 791 leitos neonatais (73%). A maioria das UTIs (75%) situava-se em hospitais gerais, 20% em maternidades ou hospitais materno-infantis e somente 5% eram centros universitários; a maioria na região metropolitana (89%), com 93% dos leitos para 74% da população infantil, dos quais a maioria na cidade do Rio de Janeiro (76%), com 73% dos leitos para 37% da população, enquanto que no interior existem apenas oito unidades (11%) e 79 leitos (7%) para 26% da população. CONCLUSÕES: Não há eqüidade na distribuição e no acesso aos leitos disponíveis, com carência no setor público e excesso no privado, grande concentração na região metropolitana e somente 5% das UTIs em hospitais universitários, propondo-se medidas de redistribuição e alocação de novos leitos em regiões mais carentes, associada à criação de uma central de vagas e sistema eficiente de transporte e referência.

OBJECTIVES: To identify the pediatric ICUs at Rio de Janeiro, number of beds, geographical distribution, public or private nature, type of hospital and assistance, studying population demand and to propose measures for improving equity. METHODS: All ICUs of the State were visited from July 97 to June 98, identifying number of beds and average length of stay. With this information along with demographic data from IBGE, the necessity of beds were estimated, comparing availability and demand by region, and proposing improving equity strategies. RESULTS: 80 ICUs were identified (6 excluded), totaling 1080 beds; 60% intensive and 40% semi-intensive; 57% public and 43% private; 52% in exclusive neonatal ICUs; 14% in pediatric and 34% in mixed (65% neonatal beds), totaling 791 neonatal beds (73%). The majority of ICUs (75%) were part of general hospitals, 20% were in obstetric or obstetric-pediatric hospitals, and only 5% were part of university centers; the majority were in metropolitan area (89%), with 93% of beds for 74% of state children population, of whom, the majority were in Rio de Janeiro city (76%), with 73% of beds for 37% of population, contrasting with the inner of the State, with only 8 units (11%) and 79 beds (7%) for 26% of children. CONCLUSIONS: There is no equity in the distribution and accessibility to the available beds, with lack in public and excess in private sectors, a great concentration in the metropolitan area and only 5% of ICUs at university hospitals, recommending a policy of redistribution and allocation of new beds in more needy areas, associated with the creation of an admission center along with an efficient reference and transportation system.

O objetivo deste estudo foi avaliar a qualidade do manejo de casos de infecções respiratórias agudas (IRA) em crianças e identificar possíveis barreiras na atenção prestada. Utilizou-se desenho transversal em amostra representativa de unidades de saúde primárias e ambulatoriais do setor público no Rio de Janeiro. Médicos foram observados atendendo menores de cinco anos com IRA. Em seguida, as crianças foram avaliadas com a utilização de normas padronizadas e os resultados comparados. Foram entrevistados os médicos e avaliados os serviços quanto à disponibilidade de medicamentos. Estudaram-se 29 unidades: 2 hospitais, 20 centros e 7 postos de saúde; observaram-se 267 crianças e entrevistaram-se 46 médicos. A sensibilidade da classificação utilizada pelos médicos para detectar pneumonia foi de 21,8 (IC 95%: 9,3-40,4), a especificidade 77,3 (IC 95%: 70,3-82,4) e a acurácia de 70,6 (IC 95%: 64,7-75,5). Em 8,9% dos casos de IRA antibióticos foram prescritos inapropriadamente. Havia disponibilidade de antibióticos padronizados em todas as unidades. Concluiu-se que a qualidade do manejo da criança com IRA pode ser aprimorada, em especial para os casos mais graves, sendo necessário reforçar a capacitação, a supervisão e a organização da atenção e dos serviços.

The goal of this article was to assess quality of case management for acute respiratory infection (ARI) in children and to detect barriers to proper management. A cross-sectional approach was used with a representative sample of primary and out-patient health care facilities under the Rio de Janeiro Municipal Health Department. Physicians were observed while attending children under five years of age with ARI, and the children were then evaluated according to standard criteria, and the results compared. Physicians were interviewed and health care facilities evaluated for availability of antibiotics. We studied 29 facilities (two hospitals, 20 health centers, and seven health posts), interviewed 46 physicians, and observed 267 children. Sensitivity of the classification used to detect pneumonia was 21.8 (95% CI: 9.3-40.4), specificity was 77.3 (95% CI: 70.3-82.4), and accuracy was 70.6 (95% CI: 64.7-75.5). Antibiotics were prescribed unnecessarily for 8.9% of ARI cases. Standard antibiotics were available in all the health care facilities. We conclude that quality of ARI case management in children can be improved substantially, especially with more training and supervision and better organization of services.

O objetivo deste estudo foi avaliar a qualidade do manejo de casos de infecções respiratórias agudas (IRA) em crianças e identificar possíveis barreiras na atenção prestada. Utilizou-se desenho transversal em amostra representativa de unidades de saúde primárias e ambulatoriais do setor público no Rio de Janeiro. Médicos foram observados atendendo menores de cinco anos com IRA. Em seguida, as crianças foram avaliadas com a utilização de normas padronizadas e os resultados comparados. Foram entrevistados os médicos e avaliados os serviços quanto à disponibilidade de medicamentos. Estudaram-se 29 unidades: 2 hospitais, 20 centros e 7 postos de saúde; observaram-se 267 crianças e entrevistaram-se 46 médicos. A sensibilidade da classificação utilizada pelos médicos para detectar pneumonia foi de 21,8 (IC 95%: 9,3-40,4), a especificidade 77,3 (IC 95%: 70,3-82,4) e a acurácia de 70,6 (IC 95%: 64,7-75,5). Em 8,9% dos casos de IRA antibióticos foram prescritos inapropriadamente. Havia disponibilidade de antibióticos padronizados em todas as unidades. Concluiu-se que a qualidade do manejo da criança com IRA pode ser aprimorada, em especial para os casos mais graves, sendo necessário reforçar a capacitação, a supervisão e a organização da atenção e dos serviços.

The goal of this article was to assess quality of case management for acute respiratory infection (ARI) in children and to detect barriers to proper management. A cross-sectional approach was used with a representative sample of primary and out-patient health care facilities under the Rio de Janeiro Municipal Health Department. Physicians were observed while attending children under five years of age with ARI, and the children were then evaluated according to standard criteria, and the results compared. Physicians were interviewed and health care facilities evaluated for availability of antibiotics. We studied 29 facilities (two hospitals, 20 health centers, and seven health posts), interviewed 46 physicians, and observed 267 children. Sensitivity of the classification used to detect pneumonia was 21.8 (95% CI: 9.3-40.4), specificity was 77.3 (95% CI: 70.3-82.4), and accuracy was 70.6 (95% CI: 64.7-75.5). Antibiotics were prescribed unnecessarily for 8.9% of ARI cases. Standard antibiotics were available in all the health care facilities. We conclude that quality of ARI case management in children can be improved substantially, especially with more training and supervision and better organization of services.