Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Access to primary health care is an important determinant of health. Within current research there has been limited examination of neighbourhood level variations in access to care, despite knowledge that local contexts shape health. The objective of this research is to examine neighbourhood-level access to primary health care in the city of Mississauga, Ontario. Street address locations of primary care physicians were obtained from the College of Physicians and Surgeons of Ontario (CPSO) website and analyzed using geographic information systems (GIS). A 'Three Step Floating Catchment Area' (3SFCA) method was derived and used to measure multiple dimensions of access for the population as a whole, for specific linguistic groups and for recent immigrants. This research identifies significant neighbourhood-level variations in access to care for each dimension of access and population subgroup studied. The research findings contribute to a more nuanced understanding of neighbourhood-level variability in access to health care.

Six out of every ten children in South Africa are living in poverty. This situation is aggravated by the AlDS pandemic. The pandemic is also the cause of a generation of AlDS orphans and as a consequence a lot of pressure is put on society's resources. Although the fundamental rights of children are entrenched in the Constitution of the Republic of South Africa, 1996, the current legal and administrative framework is not being implemented effectively in order to realise these rights. The Constitutional Court has adjudicated upon several matters regarding the realisation of socio-economic rights, thereby confirming that socio-economic rights are indeed justiciable. This research is specifically concerned with the realisation of children's right to have access to health care as entrenched in sections 27 and 28(l)(c) of the Constitution. Read with section 7(2) of the Constitution, this right places negative as well as positive obligations on the state to respect, protect, promote and fulfil children's right to have access to health care. Children's right to health care are however dependent on the internal limitations contained in section 27(2) of the Constitution which states that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights. Having ratified the UN Convention on the Rights of the Child (CRC), the state is further bound to recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Parties to the CRC shall also strive to ensure that no child is deprived of his or her right of access to such health care services. Good health is dependent on more than a mere right to have access to health care. In order to ensure the highest attainable standard of health for all children, it is necessary that the available services are affordable and accessible on an equitable basis. Access to health care should be seen as part of a more comprehensive social protection package to ensure a minimum standard of living, consistent with the value of human dignity in our Constitution. In order to achieve this, the fragmented health care system which existed before 1994 and which was mainly a result of the previous dispensation of oppression and racial discrimination, had to be transformed in order to reach the ideal of improving the quality of life of all citizens as contained in the preamble of the Constitution. Ten years after the inception of the new constitutional dispensation, it can be said that the government is making progress with the transformation of the health system and making it accessible to all people, including children. After extensive research on the legislative and other measures that the government has implemented in order to realise children's right to access to health care, the following conclusions has been reached: State policies regarding health care are taking account of the needs of children as a vulnerable group of society and it can be said to be reasonable in the formulation thereof. Regarding the implementation of these policies, much remains to be done to ensure that the benefits thereof reach the children, especially more vulnerable groups such as street children and child-headed households - a common occurrence with the high prevalence of HIVIAIDS in South Africa. The enactment of the National Health Act 61 of 2003 is still awaited although it has already been signed. This legislation provides a national framework of norms and standards regarding the health care system and it is mainly based on the rights of patients. A new Children's Bill [B32 - 20031 has been introduced to parliament. The bill deals extensively with the rights of children as contained in the Constitution and also aims to give effect to governments' obligations in terms of the CRC. The enactment of the bill should be given priority, although measures should be implemented to ensure that health care services are also accessible to children who are not assisted by adults such as child-headed households. The allocation of public funds should be considered in order to provide better social assistance to families in dire need but mechanisms to ensure that children benefit from social grants must be implemented. Many of these grants are being abused by parents which means that although the grants are available, the money is not always spent to better the plight of the children. This is especially important in the light of the fact that the primary obligation to take care of children vests in the parents. The courts and especially the Constitutional Court, has taken their role in realising socio-economic rights seriously and very important guidelines has been formulated regarding the reasonableness of legislative and other measures in this regard. After the Khosa-case it should be said that although the courts are allowed to overstep the boundaries of separation of powers, they should not rewrite these boundaries by not taking appropriate account of the availability of financial resources. This also applies to the executive and legislature which should act more effectively to implement the court's decisions. The Human Rights Commission is playing an important role with regard to the realisation of socio-economic rights by monitoring and evaluating the implementation of government programmes and legislation. The Commission also provides valuable guidelines with regard to the realisation of socio-economic rights in the form of annual reports submitted to parliament. It is submitted that the Commission should however consider to define minimum core obligations of socio-economic rights since the Commission is better equipped to do this than the courts are. / Thesis (LL.M. (Public Law))--North-West University, Potchefstroom Campus, 2005.

Made available in DSpace on 2016-12-23T13:54:32Z (GMT). No. of bitstreams: 1 Rozane Cristina Schwab Alves Rasseli.pdf: 1306246 bytes, checksum: 94606879b01cb9326465909b26052ca1 (MD5) Previous issue date: 2013-06-26 / A saúde bucal é um componente essencial da saúde geral, por isso é relevante e necessário que os serviços de saúde bucal conheçam o perfil de seus usuários com a finalidade de planejar melhor a assistência prestada. O objetivo deste estudo foi descrever o perfil dos usuários atendidos na clínica odontológica da Secretária de Assuntos Comunitários (SAC), atual Departamento de Atenção à Saude (DAS) da Universidade Federal do Espírito Santo (Ufes). Trata-se de um estudo descritivo seccional, em que foram analisados 415 prontuários de pacientes que realizaram tratamento odontológico na SAC/DAS/Ufes, no período de julho de 2010 a julho de 2012. Foi elaborado um instrumento, com base nesses prontuários, com o objetivo de registrar e organizar as informações coletadas nos prontuários, a saber: dados demográficos, histórico de saúde, hábitos e condição de saúde bucal, razão da procura do serviço e tratamentos realizados. A maioria dos usuários possuía idade superior a 40 anos, e o gênero feminino foi o mais prevalente (59,8%). Verificou-se que 40% dos usuários eram servidores federais e 34,7%, estudantes. Quanto ao motivo principal da procura pelo atendimento, 51,6% dos usuários da clínica relataram ser para controle, 22,9% para prevenção e 14% devido à doença cárie. Em relação aos hábitos de higiene bucal, todos os usuários utilizam a escova de dente (100%), 20% não usam o fio dental e 34,2% dos que o utilizam, o fazem apenas uma vez ao dia. Somente 28,9% dos usuários estão há um ano ou menos sem realizar uma consulta odontológica. Conclui-se que o perfil do usuários da SAC/DAS/Ufes reflete o modelo adotado pela instituição de saúde, entretanto são necessárias mudanças no modelo odontológico oferecido na SAC/DAS/Ufes, passando de modelo cirúrgico restaurador para um modelo de promoção de saúde bucal / Oral health is an essential component of general health that is why it is relevant and necessary that oral health services know the profile of their consumers with the intent to improve the quality of services. With that in mind, the objective of this study was to identify the profile of consumers seen at the Department of Community Issues (SAC), currently known as the Health Attention Department (DAS) of the Federal University of Espírito Santo (Ufes). A sectional descriptive study was conducted, analyzing the charts of 415 patients who received dental treatment at SAC/DAS/Ufes between July 2010 and July 2012. An instrument was elaborated with the objective of registering and organizing the information gathered in the charts, which included: demographic data, health history, oral health habits and its conditions and reasons for treatment search. The majority of consumers were over 40 years old, and female was the most prevalent gender 59.8%. It was verified that 40% of consumers were federal employees and 34.7% were college students. As for the main reason for treatment search, 51.6% of the clinic consumers identified it to be for maintenance, 22.9% for prevention and 14% due to cavity disease. In relation to dental hygiene habits, every consumer use a tooth brush (100%), 20% do not use dental floss, and 34.2% of those who use dental floss, do so once a day. Only 28.9% of consumers have been without an dental consult for one year or less. In conclusion, the consumer s profile of SAC/DAS/Ufes reflects the model adopted by the health institution; however, changes in the dental model offered at SAC/DAS/Ufes are necessary to transition from the surgical restoration model to an oral health promotion model

O trabalho buscou conhecer os motivos que levaram mulheres do município de Piraí, estado do Rio de Janeiro, agendadas para realizar o exame de mamografia, a não comparecer ao mesmo / The study sougth to know the reasons why women Piraí

Submitted by Everaldo Coelho Soares (everaldo.soares@ucsal.br) on 2016-10-06T22:55:50Z No. of bitstreams: 1 SILVA GL 2014.pdf: 1276704 bytes, checksum: 6059da2dada480786eabe881c56bb186 (MD5) / Approved for entry into archive by Maria Emília Carvalho Ribeiro (maria.ribeiro@ucsal.br) on 2016-12-27T21:04:25Z (GMT) No. of bitstreams: 1 SILVA GL 2014.pdf: 1276704 bytes, checksum: 6059da2dada480786eabe881c56bb186 (MD5) / Made available in DSpace on 2016-12-27T21:04:25Z (GMT). No. of bitstreams: 1 SILVA GL 2014.pdf: 1276704 bytes, checksum: 6059da2dada480786eabe881c56bb186 (MD5) Previous issue date: 2011-11-24 / Esta pesquisa consiste num estudo de caso múltiplo de cunho qualitativo, que buscou averiguar a universalidade do acesso aos serviços público de saúde vivenciado pelos idoso-familiares na Unidade Saúde da Família. Para tanto optou-se, como instrumentos de coleta de dados, a entrevista aberta, observação direta, análise documental, visitas domiciliares e o itinerário terapêutico e como método de análise dos dados a análise de conteúdo proposta por Bardin (2004, p. 179). A técnica desenvolvida na análise de conteúdo utilizada foi a análise temática visando descobrir os núcleos de sentido (MINAYO, 2000, p. 303-304), observando que um método complementa o outro visando a conclusão do objetivo da pesquisa. Embora a saúde da família e a de seus membros sejam diferentes, estão interligadas. A situação do estado de saúde/doença de um dos membros afeta a saúde da família. O Programa de Saúde da Família (PSF) constitui, para o usuário, a principal porta de entrada para a atenção à saúde, que deve ser acessível e resolutiva no seu nível de complexidade. Uma das principais características da qualidade dos serviços de saúde, portanto, é a sua acessibilidade. Neste sentido, foi escolhido o termo acesso baseando-se nos conceitos propostos por vários autores que optam para tal termo, centrando-o na entrada inicial dos serviços de saúde. Os resultados indicam os aspectos relacionados à dimensão organizacional mostrando os determinantes na universalidade do acesso, uma vez que elementos como o deficiente sistema de referência e contrarreferência, o modo de agendamento das consultas e exames de média e alta complexidade, o suprimento irregular de medicamentos na unidade acarretaram despesas para os usuários. Facilidades foram observadas no que concerne ao vínculo, à relação profissional-usuário e, sobretudo, à proximidade geográfica da unidade. / This research consists of a multiple case study of qualitative character who sought to ascertain the universality of access to public-health experienced by elderly relatives in the Family Health Unit. To this end, we chose as instruments of data collection structured interviews, direct observation, document analysis, home visits and therapeutic measures and as a method of data analysis content analysis proposed by Bardin (2004, p. 179). The technique developed in the content analysis was used thematic analysis aimed at discovering the core meaning (MINAYO, 2000, p. 303-304), noting that one complements the other method aimed at completing the research objective. Although the health of the family and its members are different, are intertwined. The status of health / illness of one member affects the health of the family. The Family Health Program (PSF) to the user is the main gateway to health care, which should be accessible and resolute in its level of complexity. One of the main features of the quality of health services, so it is accessible to them. In this sense, the term access chosen based on the concepts proposed by various authors who opt for such term, focusing on the initial entry of health services. The results indicate the organizational aspects related to the size determinants are shown in the universality of access, since elements like poor referral system and cross-reference, so the scheduling of appointments and tests of medium and high complexity, the irregular supply drugs resulted in the unit costs for users. Facilities were observed with respect to the bond, the professional-user relationship, and especially the proximity of the unit.

Submitted by Jamile Barbosa da Cruz (jamile.cruz@ucsal.br) on 2017-01-16T11:57:51Z No. of bitstreams: 1 2014.1 - SANDRA MOREIRA COSTA DE CARVALHO.pdf: 1498054 bytes, checksum: df6bf133731bc981f31b234e3af675dd (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-16T16:48:02Z (GMT) No. of bitstreams: 1 2014.1 - SANDRA MOREIRA COSTA DE CARVALHO.pdf: 1498054 bytes, checksum: df6bf133731bc981f31b234e3af675dd (MD5) / Made available in DSpace on 2017-01-16T16:48:02Z (GMT). No. of bitstreams: 1 2014.1 - SANDRA MOREIRA COSTA DE CARVALHO.pdf: 1498054 bytes, checksum: df6bf133731bc981f31b234e3af675dd (MD5) Previous issue date: 2014-04-24 / Este trabalho se propõe a analisar o paradoxo existente desde 1988 entre a conquista de direitos sociais universais, tais como a saúde, e a falta de mecanismos para sua concretização na prática, analisando o acesso às políticas de saúde por parte das pessoas em situação de rua, percebido na restrição encontrada por essas pessoas na área da saúde, processo vivenciado no trabalho direto da autora, há mais de doze anos, com esse público nessas áreas. O método utilizado será o dialético crítico, com a realização de um estudo teórico empírico de abordagem qualitativa, realizado através de revisão bibliográfica, com consulta a autores que discutem a questão social, capitalismo, trabalho, pobreza extrema, políticas sociais e a situação de rua, além dos últimos censos realizados em Salvador e em âmbito nacional sobre a situação de pessoas nessas condições. Analisam-se a realidade de duas unidades de saúde, de atenção básica, do Centro Histórico de Salvador e as contradições no processo social, político e econômico de negação de direitos que permeia essa questão. O contexto brasileiro, mais especificamente do Centro Histórico de Salvador, demonstra a falta de dispositivos para acesso desses sujeitos a políticas fundamentais como a saúde. Entender essa situação implica considerar que a situação de rua precisa ser analisada na construção e reconstrução de políticas sociais que, ao mesmo tempo em que respondem formalmente às demandas apresentadas por esses sujeitos, contraditoriamente reforçam sua condição de despossuídos de direitos, por não se operacionalizarem na prática. Neste estudo, considera-se importante fundamentar brevemente a situação de rua atrelada à criação, configuração e reconfiguração histórica da pobreza extrema como expressão da questão social no sistema capitalista de produção, entender, na história e na atualidade brasileira e no Centro Histórico de Salvador, e o que se tem construído para a efetivação de direitos sociais dessas pessoas, e os entraves que impedem esse avanço. / This study aims to analyze the paradox since 1988 between the conquest of universal social rights, such as health and lack of mechanisms for their implementation in practice, analyzing access health policies for people living on the street, perceived the restriction found by these people in healthcare, process experienced in the direct work of the author, there are more than twelve years with this audience in these areas. The method used will be critical dialectic, where a theoretical study will be conducted through literature review in consultation with the authors argue that the social question, capitalism, labor, extreme poverty, social policy and the homeless and the last census conducted in Salvador and nationally on the situation of people in these conditions. We sought to analyze the social contradictions in the economic process, and denial of political rights that permeates this question. The Brazilian and more specifically Salvador context demonstrates the lack of access to these devices subject to fundamental policies such as health. Understand it means considering that the homeless need to be analyzed in the construction and reconstruction of social policy, which while formally respond to the demands presented by these subjects, paradoxically reinforce their status as dispossessed of rights, not operationalize in practice. In this study, it is considered important to briefly justify the situation of street tied to the creation, configuration and reconfiguration of historical extreme poverty as an expression of the social question in the capitalist system of production. We seek to understand the history and current Brazilian and Salvador, which has advanced in attaining social rights of these people, and what barriers hinder this progress.

Considerando a magnitude global da tuberculose, destaca-se que os elementos da dimensão organizacional e de desempenho dos serviços de saúde que integram a Atenção Primária em Saúde (APS), são preponderantes para o controle da doença, quer seja em relação ao acesso, elenco de serviços, vínculo, coordenação da atenção, enfoque familiar, orientação na comunidade ou formação profissional. Nesta perspectiva, o presente estudo objetivou analisar a operacionalização do acesso e do vínculo, aos quais se integrou à adesão ao tratamento, dado que esta se refere, diretamente, as primeiras, além da sua importância para o controle da enfermidade. Trata-se de pesquisa quantitativa, ramo de um Projeto Matriz intitulado Avaliação das Dimensões Organizacionais e de Desempenho dos Serviços de Atenção Básica no Controle da Tuberculose em Municípios do Estado de São Paulo, tendo como referencial a teoria da determinação social do processo saúde-doença e o marco da APS. O projeto foi submetido e aprovado por Comitê de Ética em Pesquisa, e os dados foram coletados, de Julho a Setembro de 2008, por meio de instrumentos específicos, com questões fechadas, destinados a dois grupos de sujeitos: usuários portadores de tuberculose e profissionais de saúde que atuavam no controle da enfermidade, no âmbito de cinco Unidades Básicas de Saúde da Supervisão Técnica de Saúde da Subprefeitura Sé, no Município de São Paulo. Foram entrevistados 53 usuários e 40 profissionais de saúde. Apresentam-se os principais resultados: 79,2% dos usuários eram homens, em idade economicamente ativa (69,9%), com baixa escolaridade (77,3%) e que viviam sós (45,3%); 17,0% eram imigrantes provenientes da Bolívia e 90,5% viviam em áreas vulneráveis, que predispunham à ocorrência da tuberculose, como cortiços (39,6%), ocupações (7,5%) ou em situação de rua (43,4%); 62,2% tinham renda familiar mensal menor que um salário mínimo; 37,8% não tinham ocupação e importante parcela desenvolvia trabalhos esporádicos, com baixa qualificação; ressalta-se que 26,6% deixaram de trabalhar, após o início dos sintomas. Quanto aos profissionais entrevistados, 30,0% eram agentes comunitários de saúde, 30,0% eram auxiliares de enfermagem, 5,0% eram técnicos de enfermagem, 22,5% eram enfermeiros e 12,5% eram médicos. Quanto ao acesso, os principais pontos de estrangulamento foram: a restrição de benefícios; o número diminuído de visitas domiciliarias; dificuldade no encaminhamento para outros serviços, quando necessário; e oferecimento reduzido de informações acerca de outros problemas de saúde. Quanto ao vínculo, de modo geral, os entrevistados apontaram que se efetiva, destacando-se que, quanto menor a qualificação do trabalhador, mais importante é sua relação com os usuários. Quanto à adesão, os usuários apontaram que ocorre em função da motivação para a melhoria das condições de vida, para a recuperação da auto-estima e que os incentivos (cesta básica, vale-transporte e lanche) são importantes neste processo. Conclusão: ainda que o acesso e o vínculo se operacionalizem na região estudada, os resultados deste estudo apontam para a necessidade de aprimoramento da organização e do desempenho dos serviços de saúde da região, com o sentido de contribuir para a adesão ao tratamento e para o controle da tuberculose / Considering the global magnitude of tuberculosis, it is emphasized that the elements of the organizational and effectiveness dimensions of health services that integrate the Primary Health Care (PHC), are fundamental to the control of the disease, whether in relation to accessibility, continuity (bonding), comprehensiveness, coordination, interpersonal and technical accountability. Therefore, this study aimed to analyze the operation of the access and the bonding, to which was integrated the treatment adherence, as it refers directly to them and because of its importance to the control of the disease. It is quantitative research, a branch of a major project entitled Organizational and effectiveness dimensions of Primary Care Services in the Control of Tuberculosis in counties in the State of Sao Paulo\", adopting the theory of social determination of health-illness process and in the mark of PHC. The project was approved by a Committee of Ethics in Research, and the data were collected from July to September of 2008, through specific instruments, with closed questions, aimed at two groups of subjects: patients with tuberculosis and health professionals who worked with them in five Primary Care Units from the Technical Supervision of Health of the Sub-prefecture Sé, in the City of São Paulo. 53 users and 40 professionals were interviewed. The main results: 79.2% of the patients were men, in the economically active age (69.9%), with low education (77.3%) and living alone (45.3%); 17.0 % were immigrants from Bolivia and 90.5% were living in vulnerable areas, that predisposed the occurrence of tuberculosis, as tenements (39.6%), occupations (7.5%) or homeless (43, 4%); 62.2% had family income less than a minimum wage, 37.8% had no job and a important part had sporadic work, with low qualifications, emphasizing that 26.6% stopped working after the beginning of the symptoms. As for the professionals, 30.0% were community health workers, 30.0% were nursing assistants, 5.0% were nursing technicians, 22.5% were nurses and 12.5% were physicians. Regarding the accessibility, the main problems were the restriction of the treatment incentives; the decreased number of home visits; difficulty in being referral to other services, when in need; and limited offering of information about other health problems. Regarding the bonding, in general, the respondents indicated that was effective, pointing out that as lower is the qualification of the professionals, the better was its relationship with users. As for adherence, users indicated that it occurs according the motivation to improve living conditions, for the recovery of self-esteem and, also, the incentives (food basket, bus-tickets and snacks) are important in this process. Conclusion: Although the access and the bond occurred within the study area, the results of this study points to the necessity to improve the organization and effectiveness of health services in the area, in order to contribute to treatment adherence and the control of tuberculosis

O trabalho buscou conhecer os motivos que levaram mulheres do município de Piraí, estado do Rio de Janeiro, agendadas para realizar o exame de mamografia, a não comparecer ao mesmo / The study sougth to know the reasons why women Piraí

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / EvidÃncias mostram que indivÃduos com piores condiÃÃes de saÃde sÃo os mais pobres, com menos escolaridade e piores condiÃÃes de vida. A UtilizaÃÃo dos ServiÃos de SaÃde (USS), determinante social intermediÃrio, pode interferir na saÃde dos indivÃduos. No entanto, a busca dos serviÃos de saÃde depende das caracterÃsticas pessoais, dos recursos disponÃveis e da percepÃÃo da necessidade de saÃde segundo o Modelo Comportamental de USS proposto por Andersen. O objetivo do trabalho foi identificar os fatores associados à USS entre crianÃas de 5 a 9 anos na zona urbana do municÃpio de Sobral-CE. O estudo foi um recorte da pesquisa de base populacional âEstudo das condiÃÃes de saÃde, educaÃÃo e qualidade de vida das crianÃas de 5 a 9 anos da zona urbana do municÃpio de Sobral-CEâ. Foram realizadas entrevistas domiciliares com 3.274 crianÃas, em 1999/2000. As variÃveis dependentes foram a USS nas unidades de saÃde da famÃlia (PSF), nos hospitais e nos consultÃrios particulares e conveniados aos planos de saÃde, nos Ãltimos 30 dias e de forma regular. Apenas 558 (17,0%) das crianÃas utilizaram os serviÃos de saÃde nos Ãltimos 30 dias. Quando perguntado o tipo de serviÃo utilizado habitualmente, o PSF foi o mais referido (79,1%), seguido do hospital (13,5%) e dos serviÃos por convÃnio ou particulares (3,4%). Em torno de 116 crianÃas, 3,5% da amostra, eram levadas a outros serviÃos como farmÃcias, rezadeiras, madrinhas, avÃs, entre outros. Os fatores associados à USS no Ãltimo mÃs foram: a ocorrÃncia de problemas de saÃde (OR=3,9); a utilizaÃÃo regular do PSF (OR=1,8); a coleta do lixo, direta e indireta (OR=1,3 e 1,9) e a localizaÃÃo da residÃncia na sede do municÃpio (OR=1,5). Os fatores associados à utilizaÃÃo regular do PSF foram: escolaridade materna e condiÃÃes econÃmicas menores, morar na sede dos distritos e prÃximo ao PSF, realizar consulta sempre ou Ãs vezes no mesmo dia da procura, ser cadastrado no PSF e nÃo ter plano de saÃde. Associados ao hospital foram: escolaridade materna e condiÃÃes econÃmicas maiores, morar na sede do municÃpio e distante do PSF, melhores condiÃÃes de escoadouro de dejetos, realizar consulta sempre no mesmo dia da procura, nÃo ser cadastrado no PSF e nÃo possuir plano de saÃde. Associados aos consultÃrios particulares/conveniados foram: escolaridade materna e condiÃÃes econÃmicas maiores, nÃo ser cadastrado no PSF e possuir cobertura de plano de saÃde. Os resultados mostraram que a USS no municÃpio de Sobral-Ce praticamente nÃo mostrou desigualdade no acesso entre a faixa etÃria estudadas. Atribui-se a implantaÃÃo da EstratÃgia SaÃde da FamÃlia que alcanÃou os grupos populacionais mais vulnerÃveis e historicamente excluÃdos da atenÃÃo à saÃde. / Evidence shows that individuals with worse health conditions are poorer, less educated and poorer living conditions. The Health Services Use (HSU), a social determinant intermediary, can interfere with the health of individuals. However, the pursuit of health services depends on personal characteristics, available resources and the perceived need for health according to the Behavioral Model of HSU proposed by Andersen. The objective was to identify factors associated with HSU among children 5 to 9 years in the urban area of Sobral, CE. The present study was part of a research population-based "Study of the health, education and quality of life for children 5-9 years of the urban area of Sobral-CE". Home interviews were conducted with 3,274 children in 1999/2000. The dependent variables were the HSU in family health units (PSF), in hospitals and private clinics and insured health plans in the last 30 days and regularly. Only 558 (17.0%) children used health services in the last 30 days. When asked what type of service commonly used, the PSF was the most frequently mentioned (79.1%), followed by hospital (13.5%) and services by private agreement or (3.4%). Around 116 children, 3.5% of the sample were taken to other services such as pharmacies, mourners, godmothers, grandmothers, and others. Factors associated with HSU in the last month were: the occurrence of health problems (OR = 3.9), regular use of the PSF (OR = 1.8), garbage collection, direct and indirect (OR = 1.3 and 1.9) and location of residence in the town (OR = 1.5). Factors associated with regular use of the PSF were maternal education and lower economic conditions, living in the headquarters district and close to the PSF, conduct consultation always or sometimes the same day seeking to be registered with the PSF and not have health insurance. Associated with the hospital were: maternal education and higher economic conditions, living in the town and away from the PSF, better outlet for waste, carry out consultation on the same day of demand, not registered in the PSF and do not have health insurance. Associated with private offices / insured were maternal education and higher economic conditions, the PSF is not registered and has health plan coverage. The results showed that the HSU in Sobral-CE showed almost no inequality in access between the age group studied. Is attributed to the implementation of the Family Health Strategy which reached the most vulnerable populations and historically excluded from health care.