Prevalence of children with special healthcare needs: An epidemiological survey in Brazil

Published:September 02, 2022DOI:


      • This is the first epidemiological survey of the prevalence of CSHCN in Brazil.
      • One in every four families had one 0–11-year-old child with special health care needs.
      • The CSHCN prevalence was associated with the child's previous health conditions, family structure, socioeconomic, and political context.
      • The instrument facilitates identification of CSHCN in Brazil and allows international comparisons.



      We aimed to estimate the prevalence and delineate the profile of children with special healthcare needs (CSHCN) in the three municipalities of Brazil's southern and southeastern regions from 2015 to 2017.

      Design and methods

      This cross-sectional study included 6853 children aged 0–11 years. Participants were selected through complex sampling in 32 primary healthcare units. The Brazilian version of the Children with Special Healthcare Needs Screener© and a questionnaire were used to identify sociodemographic and family characteristics, health status, and health services utilization. Simple and multiple logistic regression models were used to evaluate the association between family and child characteristics and prevalence (P < 0.05).


      The prevalence of CSHCN was 25.3% (95% confidence interval: 21.0–30.0). Most participants required health services or were on long-term medication for a current chronic condition; approximately 53% of CSHCN had no formally recorded diagnoses. The most frequent health problems were respiratory conditions, asthma, and allergies. Approximately 60% of the CSHCN patients underwent follow-up examinations of the specialties pneumology, pediatrics, otorhinolaryngology, speech therapy, neurology, and psychology. Children of school age, of male sex, with premature birth, with a history of recurrent hospitalization, from non-nuclear families, and from underprivileged social classes were identified as risk factors for classification as CSHCN.

      Practice implication

      These results contribute to the unprecedented mapping of these children in healthcare networks in Brazil.


      The high prevalence of CSHCN in medium and large municipalities in the southern and southeastern regions was associated with the child's previous health conditions and family structure.



      ABEP (Associação Brasileira de Empresas de Pesquisa (Brazilian Association of Research Companies)), AIC (Akaike′s information criterion), PHC (Primary Healthcare), ATC (Anatomical Therapeutic Chemical), CSHCN (Children with special healthcare needs), CS© (Children with special healthcare needs Screener©), CS©- Brazilian version (Children with special healthcare needs Screener©Brazilian version), PPS (Probability Proportional to Size)
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