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Andegiorgish AK, Elhoumed M, Qi Q, Zhu Z, Zeng L. Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys. BMJ Open 2022; 12:e051675. [PMID: 35149562 PMCID: PMC8845176 DOI: 10.1136/bmjopen-2021-051675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the factors associated with antenatal care (ANC) visits. DESIGN A secondary data analysis from cross-sectional studies was conducted. SETTING Sub-Saharan Africa. PARTICIPANTS 56 002 women aged 15-49 years in Ghana (3224), Kenya (10 981), Malawi (9541), Namibia (2286), Rwanda (4416), Senegal (6552), Tanzania (5536), Uganda (7979) and Zambia (5487) were analysed. OUTCOMES 4+ANC visits. RESULTS Overall, 55.52% (95% CI: 55.11% to 55.93%) of women made 4+ANC visits. The highest 4+ANC visits were in Ghana (85.6%) and Namibia (78.9%), and the lowest were in Senegal (45.3%) and Rwanda (44.5%). Young women 15-19 years had the lowest uptake of 4+ANC visits. Multivariable analysis indicated that the odds of 4+ANC visits were 14% lower among women from rural areas compared with those living in towns (adjusted OR (AOR) 0.86; 95% CI: 0.81 to 0.91). This difference was significant in Kenya, Malawi, Senegal and Zambia. However, in Zambia, the odds of 4+ANC visits were 48% higher (AOR 1.48; 95% CI: 1.2 to 1.82) among women from rural compared with urban areas. Women with higher educational level had more than twofold higher odds of 4+ANC visits in seven of the nine countries, and was significant in Kenya, Malawi, Rwanda and Zambia. Compared with the poorest household wealth category, odds of 4+ANC visits increased by 12%, 18%, 32% and 41% for every 20% variation on the wealth quantile. Women in their first-time pregnancy had higher odds of 4+ANC visits compared with others across all countries, and women who had access to media at least once a week had a 22% higher probability of 4+ANC visits than women who had no access to media (AOR 1.22, 95% CI: 1.15 to 1.29). CONCLUSION The number of ANC visits was considered to be inadequate with substantial variation among the studied countries. Comprehensive interventions on scaling uptake of ANC are needed among the low-performing countries. Particular attention should be given to women of low economic status and from rural areas.
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Affiliation(s)
- Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, Asmara College of Health Sciences, Asmara, Eritrea
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Defilipo ÉC, Chagas PSDC, Silva RMD, Costa QBDS, Guilherme MCO, Ferreira MCP, Ribeiro LC. Assistência pré-natal e perinatal em Governador Valadares, Minas Gerais, Brasil. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35608.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: O acompanhamento pré-natal e as condutas adotadas durante o parto são essenciais para garantir o bom desenvolvimento da gestação, prevenir complicações e proporcionar um parto saudável, sem impacto na saúde da puérpera e do recém-nascido. Objetivo: Analisar a assistência pré-natal e perinatal oferecida em Governador Valadares, Minas Gerais, e verificar se há associação entre a adequação do pré-natal e os fatores socioeconômicos, demográficos, comportamentais e reprodutivos. Métodos: Estudo transversal com base de dados pré-existente. Para a análise da adequação do pré-natal foram utilizados três critérios: 1) início até 16ª semana e número mínimo de consultas de acordo com a idade gestacional; 2) práticas dos profissionais nas consultas de pré-natal; 3) orientações oferecidas às gestantes pelos profissionais. Para a análise dos dados foi utilizada regressão logística multivariada. Resultados: Participaram do estudo 437 puérperas. A assistência pré-natal foi considerada adequada para 72,5%, 93,1% e 50,1% das puérperas, considerando os critérios 1, 2 e 3, respectivamente. As gestantes que apresentaram maior chance de terem o pré-natal inadequado, com relação ao critério 1, foram as com menor escolaridade (RC = 1,68; p = 0,046), que não possuíam companheiro (RC = 2,18; p = 0,002), que não trabalharam durante a gestação (RC = 2,18; p = 0,003) e as que não planejaram a gravidez (RC = 1,76; p = 0,023). Com relação à assistência perinatal, a presença de acompanhante e contato pele a pele foram apropriados, mas a amamentação na primeira hora de vida foi inadequada. Conclusão: Observou-se a necessidade de aprimorar as orientações fornecidas pelos profissionais e incluir a amamentação na primeira hora de vida. Os resultados podem contribuir para otimizar os serviços de saúde materno-infantil em Governador Valadares.
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Defilipo ÉC, Chagas PSDC, Silva RMD, Costa QBDS, Guilherme MCO, Ferreira MCP, Ribeiro LC. Prenatal and perinatal care in Governador Valadares, Minas Gerais state, Brazil. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Prenatal care and the procedures adopted during childbirth are essential to ensure a healthy pregnancy and delivery and prevent complications, without affecting the health of the mother and newborn. Objective: To analyze the prenatal and perinatal care provided in Governador Valadares, Minas Gerais state, Brazil, and to determine whether there is an association between adequate prenatal care and socioeconomic, demographic, behavioral and reproductive factors. Methods: Cross-sectional study with a pre-existing database. The adequacy of prenatal care was analyzed based on three criteria: 1) onset up to the 16th week and a minimum number of checkups according to gestational age; 2) professional practices during prenatal checkups; 3) counseling given to the pregnant women by healthcare professionals. Multivariate logistic regression was used for data analysis. Results: Participants were 437 postpartum women. Prenatal care was considered adequate for 72.5, 93.1 and 50.1% of the participants based on criteria 1, 2 and 3, respectively. The pregnant women who were most likely to receive inadequate prenatal care in relation to criterion 1 were those with the lowest schooling level (OR = 1.68; p = 0.046), who were single (OR = 2.18; p = 0.002), did not work during their pregnancy (OR = 2.18; p = 0.003) and whose pregnancy was unplanned (OR = 1.76; p = 0.023). With respect to perinatal care, the presence of a birth companion and skin-to-skin contact were adequate, but breastfeeding in the first hour of life was not. Conclusion: There is a need to improve the counseling provided by healthcare professionals and include breastfeeding in the first hour of life. The results could contribute to optimizing maternal and child health services in Governador Valadares.
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Vaichulonis CG, Silva RRE, Pinto AIA, Cruz IR, Mazzetti AC, Haritsch L, Santos KVD, Stepic GS, Oliveira LCD, Silva MFD, Silva JC. Evaluation of prenatal care according to indicators for the Prenatal and Birth Humanization Program. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate prenatal care provided to low-risk pregnant women users of the Sistema Único de Saúde (SUS) (Public Health System) in the city of Joinville, SC. Methods: this is a cross-sectional observational study carried out from March 2018 to February 2019, through interview and analysis of the Pregnant Card of puerperal over 18 years old, from Joinville, who underwent prenatal care at SUS, excluding recent given up puerperal. Prenatal care was evaluated according to the recommended criteria by the Prenatal and Birth Humanization Program. Results: 683 mothers were interviewed. The criteria with the highest levels of adequacy were accessibility (99.6%), early initiation on prenatal care (92.7%) and 6 or more consultations (87.1%) and the criteria with the lowest rates of adequacy were the set of guidelines (17.7%) and the third and first trimester exams (42.5% and 63.5% respectively). Conclusion: it is concluded that the prenatal care provided by SUS in the city of Joinville, despite the almost universal accessibility, the early onset and the prevalence of puerperal women with more than 6 consultations, showed a sharp decline in the analysis of the recommended indicators.
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Dea BD, Andrade F, Silva Junior MF. Self-perceived evaluation of prenatal care: a hierarchical analysis by the users of Primary Health Care services in Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objective: to analyze the factors associated with positive self-perceived evaluation of prenatal care among users of Primary Health Care (PHC). Methods: the analytical cross-sectional study was carried out with secondary data from the 3rd Module of the 2nd cycle (2013 / 2014) of the External Evaluation of the Improvement of Access and Quality of Primary Care Program (PMAQ-AB – Portuguese acronym), collected from users in the Basic Health Units (BHU) that joined the PMAQ-AB in Brazil. The hierarchical analysis was performed using a theoretical model and logistic regression was performed between the self-perceived evaluation (positive - very good/good or negative - regular/poor/very bad) and the sociodemographic characteristics, prenatal care and health service evaluation (p<0.05). Results: the sample consisted of 9,922 women and 81.7% rated care as very good/good. In the final model, positive evaluation was associated to women with incomplete higher education or over (OR=1.05; CI95%=1.01-1.09; p=0.010), who underwent the VDRL exam (OR=1.07; CI95%=1.01-1.14; p=0.020), consultation with the same professional (OR=1.07; CI95%=1.02-1.12; p=0.010), received guidance on the gynecological preventive exam (OR=1.05; CI95%=1.01-1.08; p=0.007), believed that guidance helped with pregnancy and child care (OR=1.24; CI95%=1.05-1.46; p=0.012), evaluated the BHU structure as very good/good (OR=1.19; CI95%=:1.14-1.24; p<0.001) and would not change BHU or team (OR=1.62; CI95%=1.48-1.68; p<0.001). Conclusion: the positive evaluation of prenatal care was associated with sociodemographic factors, prenatal care and health service evaluation.
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Esposti CDD, Santos-Neto ETD, Oliveira AE, Travassos C, Pinheiro RS. Social and geographical inequalities in the performance of prenatal care in a metropolitan area of Brazil. CIENCIA & SAUDE COLETIVA 2020; 25:1735-1750. [PMID: 32402040 DOI: 10.1590/1413-81232020255.32852019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/07/2019] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the social and geographical inequalities in the performance of prenatal medical care in the Unified Health System (SUS) in the Metropolitan Region of Grande Vitória, Espírito Santo, Brazil. A cross-sectional study was carried out with 1,209 puerperae living in this region, admitted for childbirth from 2010 to 2011. Data about prenatal care and contextual, enabling, and social characteristics were collected, following the Andersen's Behavioral Model. The performance of prenatal care was classified into five levels, including information on the number of prenatal visits, initial and repetitive examinations, tetanus vaccination, gestational risk management, and participation in educational activities. The likelihood of different levels of prenatal care performance was analyzed using a multivariate multinomial model, according to maternal social variables. High prenatal coverage (98%) and 4.4% care adequacy were identified. The likelihood of access to prenatal care was increased by enabling, contextual, and social factors. The relationship between prenatal care quality and pregnant women's social and geographical conditions must be considered in the organization of services to achieve equity and reduce maternal and perinatal morbimortality.
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Affiliation(s)
| | | | - Adauto Emmerich Oliveira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brazil,
| | - Claudia Travassos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Morón-Duarte LS, Ramirez Varela A, Segura O, Freitas da Silveira M. Quality assessment indicators in antenatal care worldwide: a systematic review. Int J Qual Health Care 2020; 31:497-505. [PMID: 30295805 DOI: 10.1093/intqhc/mzy206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/15/2018] [Accepted: 09/14/2018] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.
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Affiliation(s)
- Lina Sofia Morón-Duarte
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Andrea Ramirez Varela
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Omar Segura
- SMC-AS Research Unit - Segura, Moron & Castañeda Health Consultants Ltd., Bogotá, D.C., Colombia
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Benzaken AS, Pereira GFM, Cunha ARCD, Souza FMAD, Saraceni V. Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals. CAD SAUDE PUBLICA 2019; 36:e00057219. [PMID: 31939547 DOI: 10.1590/0102-311x00057219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/09/2019] [Indexed: 11/22/2022] Open
Abstract
To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.
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Affiliation(s)
| | - Gerson Fernando Mendes Pereira
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Alessandro Ricardo Caruso da Cunha
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Flavia Moreno Alves de Souza
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Valéria Saraceni
- Coordenação de Doenças Transmissíveis, Secretaria Municipal de Saúde, Rio de Janeiro, Brasil
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Group Prenatal Care Attendance and Women’s Characteristics Associated with Low Attendance: Results from Centering and Racial Disparities (CRADLE Study). Matern Child Health J 2019; 23:1371-1381. [DOI: 10.1007/s10995-019-02784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sharman Moser S, Rabinovitch M, Rotem R, Koren G, Shalev V, Chodick G. Parity and the use of folic acid supplementation during pregnancy. BMJ Nutr Prev Health 2019; 2:30-34. [PMID: 33235954 PMCID: PMC7664500 DOI: 10.1136/bmjnph-2019-000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/25/2019] [Accepted: 04/13/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Folic acid (FA) supplementation has long been recommended before and during pregnancy to reduce the risk of neural tube defects. Factors influencing adherence to FA supplementation have been extensively evaluated, but little is known on the effect of parity. This study comes to examine the association between parity and maternal use of FA prior to and during pregnancy. Methods In this retrospective population-based study, we identified mothers (N=228 555) of all children (N=578 204) born between the years 2000 and 2016 among members of a large health provider in Israel. Data on FA supplementation purchases were obtained from centralised medical databases. Results The median (IQR) total dose of FA purchased 12 months prior to child birth among previously nulliparous women (120 mg, 48–240) was significantly (p<0.001) higher than the dose purchased by women with one (90 mg (39–202)) and two prior births (84 mg (36–182)). The dose was even lower in women for three or more prior births (75 mg (36–165)). Despite the overall increasing secular trend in FA purchases during the study period, the negative relationship with parity remained. Conclusions Adherence to FA supplementation is negatively associated with parity. Women with increasing parity may be at higher risk for pregnancy complications associated with low FA levels. The results of this study may inform the design of interventions to specifically increase adherence to FA supplementations among multiparous women.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ran Rotem
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Gideon Koren
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Varda Shalev
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Oliveira AAD, Almeida MFD, Silva ZPD, Assunção PLD, Silva AMR, Santos HGD, Alencar GP. Factors associated with preterm birth: from logistic regression to structural equation modeling. CAD SAUDE PUBLICA 2019; 35:e00211917. [PMID: 30673060 DOI: 10.1590/0102-311x00211917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/06/2018] [Indexed: 11/22/2022] Open
Abstract
This study proposed the application of structural equation modeling (SEM) to investigate variables associated with preterm birth based on a theoretical model analyzed previously by hierarchical logistic regression. The data came from a population-based case-control observational study of hospital births to mothers residing in Londrina, Paraná State, Brazil (June 2006 to March 2007). For the SEM, the study considered the association between socioeconomic characteristics and psychosocial aspects pertaining to reproductive history, work and physical activity, complications during the pregnancy, and fetal characteristics. It also considered the relationship between these associations and the outcome preterm birth mediated by adequacy of prenatal care. The weighted least square mean and variance adjusted estimator (WLSMV) was used for categorical data and robust maximum likelihood (MLR) for odds ratios. Three latent variables were created: socioeconomic vulnerability, family vulnerability, and unwanted pregnancy. The effect of socioeconomic and family vulnerability and unwanted pregnancy on prematurity occurred indirectly through inadequacy of prenatal care. The proposed methodology allowed using constructs, verifying the role of mediation by inadequacy of prenatal care, and identifying the variables' direct and indirect effects on the outcome preterm birth.
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Affiliation(s)
| | | | | | | | - Ana Maria Rigo Silva
- Centro de Ciências da Saúde, Universidade Estadual de Londrina, Londrina, Brasil
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Ferreira LB, Melo LFD, Melo MEFD, Sousa TMD, Miranda C, Pereira SCL, Notaro KAM, Santos LCD. Fatores assistenciais e gestacionais associados à anemia em nutrizes atendidas em um banco de leite humano. CIENCIA & SAUDE COLETIVA 2018; 23:3567-3575. [DOI: 10.1590/1413-812320182311.34832016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/04/2017] [Indexed: 11/22/2022] Open
Abstract
Resumo A anemia é um problema de saúde pública que acomete cerca de 30% das gestantes brasileiras, podendo acarretar efeitos deletérios à saúde e qualidade de vida do binômio mãe-filho. O objetivo deste artigo é avaliar os fatores assistenciais e gestacionais associados à anemia entre nutrizes atendidas em um banco de leite humano (BLH) de referência. Estudo transversal com dados secundários referentes a informações sociodemográficas e gestacionais de 12283 nutrizes no período de 2009 a 2012. Aplicaram-se os testes Kolmogorov-Smirnov e Qui-quadrado ou exato de Fisher. Estimaram-se as Razões de Prevalência (RP) e respectivos Intervalos de Confiança-IC95%, por meio da Regressão de Poisson com variância robusta. Identificou-se a prevalência de anemia em 29,2% da amostra, sendo maior entre as mães que não realizaram o pré-natal (RP = 3,84; IC95% 3,26-4,54); as que realizaram até 3 consultas pré-natais (RP = 1,92; IC95% 1,21-3,06) e aquelas que tiveram gestação múltipla (RP = 2,29; IC95% 1,25-4,19). Os resultados apontaram maior prevalência de anemia entre as mulheres que não realizaram o pré-natal apropriado e as que tiveram gestações múltiplas, destacando-se a importância da assistência à saúde como fator de prevenção à anemia e demais intercorrências gestacionais.
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de Almeida KJQ, de Roure FN, Bittencourt RJ, dos Santos RMDB, Bittencourt FV, Gottems LBD, Amorim FF. Active health Ombudsman service: evaluation of the quality of delivery and birth care. Rev Saude Publica 2018; 52:76. [PMID: 30066816 PMCID: PMC6063641 DOI: 10.11606/s1518-8787.2018052017291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/03/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.
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Affiliation(s)
| | - Francis Nakle de Roure
- Secretaria de Estado de Saúde do Distrito Federal. Ouvidoria em Saúde. Brasília, DF, Brasil
| | - Roberto José Bittencourt
- Escola Superior de Ciências da Saúde. Coordenação de Pós-Graduação e Extensão Brasília, DF, Brasil
| | | | - Fernanda Viana Bittencourt
- Fundação de Ensino e Pesquisa em Ciências da Saúde. Coordenação de Projetos Estratégicos. Brasília, DF, Brasil
| | | | - Fábio Ferreira Amorim
- Escola Superior de Ciências da Saúde. Coordenação de Pós-Graduação e Extensão Brasília, DF, Brasil
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Garcia ÉM, Martinelli KG, Gama SGND, Oliveira AE, Esposti CDD, Santos Neto ETD. Gestational risk and social inequalities: a possible relationship? CIENCIA & SAUDE COLETIVA 2018; 24:4633-4642. [PMID: 31778513 DOI: 10.1590/1413-812320182412.31422017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/15/2018] [Indexed: 11/22/2022] Open
Abstract
This study aims to analyze the association between social inequalities and gestational risk in administrative regions of the state of Espírito Santo. This is a cross-sectional study based on two administrative regions of the state of Espírito Santo. The sample consisted of 1,777 women who underwent prenatal care in the municipalities of the Greater Vitória Metropolitan Region (RMGV-ES) and São Mateus Microregion (MRSM) and were admitted to the public health facilities at the time of delivery between 2010 and 2012/2013. The multivariate logistic regression was performed to test the association between social and gestational risk variables. Variables with a significance level < 0.20 in the Chi-square test were adopted for the final model, and only those variables with a p-value < 0.05 remained. An association was found between high gestational risk and women's dwelling place in the RMGV-ES (OR = 1.74; CI95% 1.32-2.28), women as head of households (OR = 3.03; CI95% 1.64-5.61), head of household with less than five years of schooling (OR = 1.58; CI95% 1.14-2.20) and receipt of social benefit "Bolsa Família" (Family Grant) (OR = 1.46; CI95% 1.04-2.03). While some social variables underpin the classification of gestational risk, other social factors have been shown to produce this risk.
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Affiliation(s)
- Érica Marvila Garcia
- Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Katrini Guidolini Martinelli
- Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | | | - Adauto Emmerich Oliveira
- Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Carolina Dutra Degli Esposti
- Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
| | - Edson Theodoro Dos Santos Neto
- Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090 Vitória ES Brasil.
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Rosa CQD, Silveira DSD, Costa JSDD. Factors associated with lack of prenatal care in a large municipality. Rev Saude Publica 2015; 48:977-84. [PMID: 26039401 PMCID: PMC4285828 DOI: 10.1590/s0034-8910.2014048005283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 07/01/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the factors associated with a lack of prenatal care in a large municipality in southern Brazil. METHODS In this case-control age-matched study, 716 women were evaluated; of these, 179 did not receive prenatal care and 537 received prenatal care (controls). These women were identified using the Sistema Nacional de Informação sobre Nascidos Vivos (Live Birth Information System) of Pelotas, RS, Southern Brazil, between 2009 and 2010. Multivariate analysis was performed using conditional logistic regression to estimate the odds ratios (OR). RESULTS In the final model, the variables associated with a lack of prenatal care were the level of education, particularly when it was lesser than four years [OR 4.46; 95% confidence interval (CI) 1.92;10.36], being single (OR 3.61; 95%CI 1.85;7.04), and multiparity (OR 2.89; 95%CI 1.72;4.85). The prevalence of a lack of prenatal care among administrative regions varied between 0.7% and 3.9%. CONCLUSIONS The risk factors identified must be considered when planning actions for the inclusion of women in prenatal care by both the central management and healthcare teams. These indicated the municipal areas with greater deficits in prenatal care. The reorganization of the actions to identify women with risk factors in the community can be considered to be a starting point of this process. In addition, the integration of the activities of local programs that target the mother and child is essential to constantly identify pregnant women without prenatal care.
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Esposti CDD, Oliveira AE, Santos Neto ETD, Travassos C. Representações sociais sobre o acesso e o cuidado pré-natal no Sistema Único de Saúde da Região Metropolitana da Grande Vitória, Espírito Santo. SAUDE E SOCIEDADE 2015. [DOI: 10.1590/s0104-12902015127606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As representações sociais das puérperas sobre o acesso ao cuidado pré-natal destacam aspectos relacionados às barreiras de acesso e às formas de sua superação. O objetivo deste trabalho foi analisar o acesso ao cuidado pré-natal a partir das representações sociais de usuárias do Sistema Único de Saúde. A partir de 1.035 puérperas, selecionaram-se 24 puérperas da Região Metropolitana da Grande Vitória, Espírito Santo: um grupo de 14 puérperas que realizou mais de seis consultas de pré-natal e um grupo de 10 puérperas que realizou nenhuma ou até três consultas. Entrevistas individuais abordaram qualitativamente questões sobre o acesso aos serviços de saúde, segundo as dimensões disponibilidade, capacidade de pagar e aceitabilidade. A análise de conteúdo temática revelou situações de acesso satisfatório, mas também a existência de barreiras de acesso geográfico, organizacionais, indisponibilidade de recursos materiais e humanos, custos diretos e indiretos para a obtenção do cuidado e expectativas não atendidas sobre os procedimentos e os aspectos mais subjetivos, resultados semelhantes nos dois grupos estudados. As diferenças na capacidade de enfrentamento desses obstáculos foram determinantes para o acesso adequado ao cuidado pré-natal. Considera-se que incluir as representações sociais das gestantes na avaliação do cuidado pré-natal facilita a adoção de medidas que assegurem a melhoria do acesso.
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LELONG A, JIROFF L, BLANQUET M, MOURGUES C, LEYMARIE MC, GERBAUD L, LÉMERY D, VENDITTELLI F. Is individual social deprivation associated with adverse perinatal outcomes? Results of a French multicentre cross-sectional survey. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2015; 56:E95-E101. [PMID: 26789995 PMCID: PMC4718350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/27/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes. METHODS A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension. RESULTS Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p = 0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29]. DISCUSSION Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially.
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Affiliation(s)
- A. LELONG
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;,Correspondence: Audrey Lelong, Service de Santé Publique, CHU de Clermont-Ferrand, 7, place Henri Dunant, 63058 Clermont- Ferrand Cedex 1, France - Tel. +33 473750604 - Fax +33 473750619 - E-mail:
| | - L. JIROFF
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand
| | - M. BLANQUET
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C. MOURGUES
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - M.-C. LEYMARIE
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - L. GERBAUD
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - D. LÉMERY
- Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
| | - F. VENDITTELLI
- Service de Santé Publique, CHU de Clermont-Ferrand, Clermont-Ferrand Cedex 1, France;, Service de Gynécologie Obstétrique, CHU de Clermont-Ferrand;, Clermont Université, Université d'Auvergne, EA 4681, Peprade (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France;, Réseau de Santé Périnatale d'Auvergne, France
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Awiti JO. A multilevel analysis of prenatal care and birth weight in Kenya. HEALTH ECONOMICS REVIEW 2014; 4:33. [PMID: 26208933 PMCID: PMC4502077 DOI: 10.1186/s13561-014-0033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/07/2014] [Indexed: 06/08/2023]
Abstract
The paper investigates the effect of adequate use of prenatal care on birth weight in Kenya using data from the Kenya Demographic and Health Survey of 2008-2009 together with additional administrative data. Both a single-level model and a multi-level model are estimated. The estimation strategy controls for potential sample selection bias, potential endogeneity of prenatal care, and potential unobserved heterogeneity. The results indicate that adequate use of prenatal care increases birth weight, holding other factors constant. We further observe that the single-level model overstates the effect of prenatal care on birth weight. The results imply that infant health can be improved by using prenatal care adequately. The study calls for the pursuit of policies that encourage adequate use of prenatal care by expectant mothers such as ensuring availability of skilled health care providers such as doctors and nurses at prenatal care clinics, reducing the average distances mothers have to cover when seeking prenatal care services, intensifying education of females as a way of empowering them to be able to make the right choices regarding when to seek prenatal care and from whom, and increasing income opportunities for households.
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Almeida AHDVD, Costa MCO, Gama SGND, Amaral MTR, Vieira GO. Baixo peso ao nascer em adolescentes e adultas jovens na Região Nordeste do Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000300009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivos: avaliar a associação entre as características sociodemográficas, do pré-natal e do parto de mães adolescentes e adultas jovens com o baixo peso ao nascer, em capitais e outros municípios da Região Nordeste do Brasil, no período de 2011 e 2012. Métodos: estudo transversal, de base hospitalar e nível regional, realizado em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera no pós-parto imediato e coletados dados dos prontuários maternos e dos recém-nascidos. Um modelo teórico conceitual foi estabelecido com três níveis de hierarquia e a variável dependente foi o baixo peso ao nascer (BPN). Resultados: do total de 3009 puérperas entrevistadas, 9,7% apresentaram conceptos com baixo peso. As puérperas que realizaram menos que seis consultas no pré-natal apresentaram uma chance 1,7 vezes maior de ter RN com baixo peso; ser primigesta aumentou a chance da ocorrência do BPN em 1,5 vezes; assim como a prematuridade que representou o principal fator de exposição, elevando em 21 vezes a chance desse desfecho. Conclusões: o estudo demonstrou alta frequência de baixo peso ao nascer entre mães adolescentes e adultas jovens, tendo como principais fatores associados o número insuficiente de consultas pré-natal, primigestação e prematuridade.
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Bernardes ACF, da Silva RA, Coimbra LC, Alves MTSSDB, Queiroz RCDS, Batista RFL, Bettiol H, Barbieri MA, da Silva AAM. Inadequate prenatal care utilization and associated factors in São Luís, Brazil. BMC Pregnancy Childbirth 2014; 14:266. [PMID: 25108701 PMCID: PMC4133632 DOI: 10.1186/1471-2393-14-266] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 08/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over the last decades there has been a reduction of social inequalities in Brazil, as well as a strong expansion of health services, including prenatal care. The objective of the present study was to estimate the rate of inadequate prenatal care utilization and its associated factors in São Luís, Brazil, in 2010 and to determine whether there was a reduction of inequity in prenatal care use by comparing the present data to those obtained from a previous cohort started in 1997/98. METHODS Data from the BRISA (Brazilian birth cohort studies of Ribeirão Preto and São Luís) population-based cohort, which started in 2010 (5067 women), were used. The outcome variable was the inadequate utilization of prenatal care, classified according to the recommendations of the Brazilian Ministry of Health. The explanatory variables were organized into three hierarchical levels based on the Andersen's behavioral model of the use of health services: predisposing, enabling and need factors. RESULTS Only 2.0% of the women did not attend at least one prenatal care visit. The rate of inadequate prenatal care utilization was 36.7%. Despite an improved adequacy of prenatal care use from 47.3% in 1997/98 to 58.2% in 2010, social inequality persisted: both low maternal schooling (prevalence ratio (PR) = 2.78; 95% confidence interval (95% CI) 2.23-3.47 for 0 to 4 years of study) and low family income, less than 0.5 monthly minimum wage per capita (PR = 1.37; 95% CI 1.22-1. 54), continued to be associated with higher rates of inadequate prenatal care utilization. Racial disparity regarding adequate utilization of prenatal services was detected, with black (PR = 1.19; 95% CI 1.04-1.36) and mulatto (PR = 1.14; 95% CI 1.02-1.26) women showing higher rates of inadequate use. On the other hand, women covered by the FHP - Family Health Program (PR = 0.92; 95% CI 0.85-0.98) showed a lower rate of inadequate prenatal care utilization. CONCLUSIONS Despite strong expansion of health services and expressive improvements in adequate prenatal care use and social indicators, inequalities in prenatal care use still persist. The FHP seems to be effective in reducing inadequate prenatal care utilization.
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Affiliation(s)
- Ariane Cristina Ferreira Bernardes
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Raimundo Antonio da Silva
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Liberata Campos Coimbra
- />Department of Nursing, Federal University of Maranhão, Brazil, Rua Viana Vaz, 230, Centro, São Luís, Maranhão 65020-660 Brazil
| | | | - Rejane Christine de Sousa Queiroz
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Rosângela Fernandes Lucena Batista
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
| | - Heloisa Bettiol
- />Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes, 3900, Hospital das Clínicas de Ribeirão Preto, Monte Alegre, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Marco Antônio Barbieri
- />Department of Puericulture and Pediatrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, Avenida Bandeirantes, 3900, Hospital das Clínicas de Ribeirão Preto, Monte Alegre, Ribeirão Preto, São Paulo 14049-900 Brazil
| | - Antônio Augusto Moura da Silva
- />Department of Public Health, Federal University of Maranhão, Brazil, Rua Barão de Itapary, 155, Centro, São Luís, Maranhão 65020-070 Brazil
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Fonseca CRBD, Strufaldi MWL, de Carvalho LR, Puccini RF. Adequacy of antenatal care and its relationship with low birth weight in Botucatu, São Paulo, Brazil: a case-control study. BMC Pregnancy Childbirth 2014; 14:255. [PMID: 25085236 PMCID: PMC4131026 DOI: 10.1186/1471-2393-14-255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth weight reflects gestational conditions and development during the fetal period. Low birth weight (LBW) may be associated with antenatal care (ANC) adequacy and quality. The purpose of this study was to analyze ANC adequacy and its relationship with LBW in the Unified Health System in Brazil. METHODS A case-control study was conducted in Botucatu, São Paulo, Brazil, 2004 to 2008. Data were collected from secondary sources (the Live Birth Certificate), and primary sources (the official medical records of pregnant women). The study population consisted of two groups, each with 860 newborns. The case group comprised newborns weighing less than 2,500 grams, while the control group comprised live newborns weighing greater than or equal to 2,500 grams. Adequacy of ANC was evaluated according to three measurements: 1. Adequacy of the number of ANC visits adjusted to gestational age; 2. Modified Kessner Index; and 3. Adequacy of ANC laboratory studies and exams summary measure according to parameters defined by the Ministry of Health in the Program for Prenatal and Birth Care Humanization. RESULTS Analyses revealed that LBW was associated with the number of ANC visits adjusted to gestational age (OR = 1.78, 95% CI 1.32-2.34) and the ANC laboratory studies and exams summary measure (OR = 4.13, 95% CI 1.36-12.51). According to the modified Kessner Index, 64.4% of antenatal visits in the LBW group were adequate, with no differences between groups. CONCLUSIONS Our data corroborate the association between inadequate number of ANC visits, laboratory studies and exams, and increased risk of LBW newborns. No association was found between the modified Kessner Index as a measure of adequacy of ANC and LBW. This finding reveals the low indices of coverage for basic actions already well regulated in the Health System in Brazil. Despite the association found in the study, we cannot conclude that LBW would be prevented only by an adequate ANC, as LBW is associated with factors of complex and multifactorial etiology. The results could be used to plan monitoring measures and evaluate programs of health care assistance during pregnancy, at delivery and to newborns, focusing on reduced LBW rates.
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Affiliation(s)
| | | | - Lídia Raquel de Carvalho
- />Department of Biostatistics, Institute of Biosciences, Paulista State University, UNESP, Botucatu, São Paulo Brazil
| | - Rosana Fiorini Puccini
- />Department of Pediatrics, Federal University of São Paulo, UNIFESP, São Paulo, São Paulo Brazil
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Fonseca SC, Monteiro DDSA, Pereira CMDSC, Scoralick ACD, Jorge MG, Rozario SD. Desigualdades no pré-natal em cidade do Sudeste do Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:1991-8. [DOI: 10.1590/1413-81232014197.04212013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/18/2013] [Indexed: 11/22/2022] Open
Abstract
O artigo tem por objetivo avaliar a associação de variáveis demográficas e sociais com o pré-natal adequado na cidade de Niterói, RJ. Estudo transversal, realizado de 2000 a 2009. Foram estudados 62.449 nascidos vivos, por meio do Sistema de Informação sobre Nascidos Vivos (SINASC). A análise multivariada por regressão logística considerou como variável dependente o pré-natal quantitativamente adequado - sete ou mais consultas - e como variáveis independentes: idade, escolaridade materna, cor da pele. Também foi analisada a tendência temporal de idade e escolaridade maternas, número de consultas de pré-natal. O nível de significância foi 5%. Houve aumento da escolaridade, redução de gravidez na adolescência e aumento de mães com mais de 35 anos em Niterói. O percentual de mulheres com sete ou mais consultas se manteve acima de 80%, com diferenças de acordo com idade, escolaridade e cor da pele. Tiveram mais chances de pré-natal adequado: adultas (OR=1,4; IC95% 1,39-1,56); com oito anos ou mais de estudo (OR=2,5; IC95% 2,45-2,70); e brancas (OR=2,4; IC95% 2,30-2,53). Identificamos desigualdades na atenção à saúde materna oferecida em Niterói, apesar da melhora temporal dos indicadores sociais e demográficos na cidade.
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Polgliane RBS, Leal MDC, Amorim MHC, Zandonade E, Santos Neto ETD. Adequação do processo de assistência pré-natal segundo critérios do Programa de Humanização do Pré-natal e Nascimento e da Organização Mundial de Saúde. CIENCIA & SAUDE COLETIVA 2014; 19:1999-2010. [DOI: 10.1590/1413-81232014197.08622013] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/28/2013] [Indexed: 11/22/2022] Open
Abstract
O objetivo do artigo é avaliar a adequação do processo da assistência pré-natal prestada às usuárias do Sistema Único de Saúde do município de Vitória, ES, segundo os critérios estabelecidos pelo Programa de Humanização do Pré-natal e Nascimento (PHPN) e pela Organização Mundial de Saúde (OMS). Retiraram-se as informações sobre o acompanhamento pré-natal de 360 cartões de gestantes que se internaram em maternidades públicas do município por ocasião do parto. As informações foram coletadas, processadas e submetidas à análise estatística descritiva pelos cálculos das frequências absolutas e relativas e intervalos de confiança. Nenhuma gestante teve um processo de assistência pré-natal totalmente adequado aos critérios da OMS, e menos de 5% das gestantes realizaram o pré-natal em consonância ao PHPN. Das gestantes, 44,7% não iniciaram o pré-natal até o 4º mês. Em relação à realização de procedimentos técnicos nas consultas destacaram-se a aferição de peso (95,0%) e de pressão arterial (95,6%) maternos. Os resultados sugerem uma revisão do número de consultas de pré-natal e a adoção de estratégias para o cumprimento dos critérios mínimos que devem ser realizados durante o acompanhamento pré-natal nos serviços de saúde pública.
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Patel PB, Rupani MP, Patel SS. Antenatal care registration and predicting factors of late registration among pregnant women. Trop Doct 2013; 43:9-12. [PMID: 23550198 DOI: 10.1177/0049475513480772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of antenatal care (ANC) is prevention, early recognition and treatment of pregnancy related ailments as well as general medical problems. It also provides an opportunity for reproductive health counselling. Early registration at an antenatal clinic is recommended. However, the majority of pregnant women are entered late into an antenatal care programme, especially in developing countries such as India. We explored the factors associated with late antenatal registration in a rural area of Gujarat State.
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Affiliation(s)
- Prakash B Patel
- Department of Community Medicine, Surat Municipal Institute of Medical Education & Research (SMIMER), Surat, Gujarat, India.
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Léticée N, Vendittelli F, Ughetto S, Janky E. [Do the quality of prenatal care have an impact on obstetrical outcomes?]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2013; 41:282-288. [PMID: 22196972 DOI: 10.1016/j.gyobfe.2011.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 03/15/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To assess the rate of pregnant women not having accurate prenatal care utilization. The others goals were to assess the impact of an inadequate quantitative or qualitative prenatal care on obstetrical outcomes. PATIENTS AND METHODS Historical cohort study with a prospective data registration. Hospitalised patients at the maternity ward of the University Hospital of Pointe-à-Pitre were eligible if they gave birth after 22 weeks (or≥500g) at home, outside a maternity ward or in another maternity ward. Early postpartum maternal transfers were included but not medical abortions. The principal outcome was preterm birth (before 37 weeks' gestation). RESULTS Patients without an appointment before 15weeks or without an appointment each month before their delivery represented 27.4% of women (n=2344). We stressed more preterm deliveries outside the maternity ward among the group with an inadequate prenatal care utilization vs. the other group (3,89% vs. 0,88%) (p<0,0001). We did not find any difference concerning the perinatal outcomes among the women with an inadequate quality prenatal care. DISCUSSION AND CONCLUSION Our study did not stress a difference concerning perinatal outcomes among women with an inadequate quantitative or qualitative prenatal care utilization.
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Affiliation(s)
- N Léticée
- Service de gynécologie-obstétrique, hôpital Necker, AP-HP, Paris cedex 15, France
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Cesar JA, Sutil AT, Santos GBD, Cunha CF, Mendoza-Sassi RA. Assistência pré-natal nos serviços públicos e privados de saúde: estudo transversal de base populacional em Rio Grande, Rio Grande do Sul, Brasil. CAD SAUDE PUBLICA 2012; 28:2106-14. [DOI: 10.1590/s0102-311x2012001100010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 08/07/2012] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve por objetivo avaliar a assistência recebida durante o pré-natal nos setores público e privado em Rio Grande, Rio Grande do Sul, Brasil. Aplicou-se questionário padronizado a todas as mães residentes nesse município, cujos filhos nasceram nas duas únicas maternidades locais entre 1º de janeiro e 31 de dezembro de 2010. Os locais de consultas avaliados no setor público foram as unidades básicas de saúde (UBS) com e sem Estratégia Saúde da Família (ESF) e os ambulatórios; no setor privado foram as clínicas de convênio e os consultórios particulares. Utilizou-se o teste qui-quadrado para comparar proporções. A taxa de respondentes foi de 97,2% (2.395 em 2.464). Dentre as 23 variáveis e indicadores avaliados nesses locais, sete mostraram nítida vantagem para mães que consultaram na ESF e seis para mães atendidas em clínica de convênio e consultório particular. Quatro variáveis mostraram cobertura praticamente universal nos cinco locais estudados. A assistência pré-natal mostrou melhor cobertura para gestantes atendidas no setor privado. Gestantes atendidas na ESF apresentaram cobertura semelhante àquela observada no setor privado.
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Viegas Andrade M, Noronha K, Singh A, Rodrigues CG, Padmadas SS. Antenatal care use in Brazil and India: Scale, outreach and socioeconomic inequality. Health Place 2012; 18:942-50. [DOI: 10.1016/j.healthplace.2012.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/24/2022]
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Kakogawa J, Sadatsuki M, Matsushita T, Simbo T. Predisposing individual characteristics and perinatal outcomes of women in the Tokyo metropolitan area who initiate prenatal care late in their pregnancy: a case-control study. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:945628. [PMID: 22928116 PMCID: PMC3423917 DOI: 10.5402/2012/945628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/26/2012] [Indexed: 11/23/2022]
Abstract
Purpose. The purpose of this study was to investigate the individual characteristics and perinatal outcomes of women who initiate prenatal care late in their pregnancy in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who initiated prenatal care after 22 weeks of gestation (late attenders) and control women who initiated prenatal care prior to 11 weeks of gestation participated in the study at the National Center for Global Health and Medicine between January 1, 2007 and June 30, 2011. We compared the maternal characteristics and perinatal outcomes of late attenders with those of the control group. Results. A total of 121 late attenders and 1,787 controls were enrolled. Late attenders had a higher incidence of unmarried compared with the control group (P < 0.01). There were no differences in the incidence of preterm delivery and low birth weight; however, babies of the late attenders had a higher incidence of admission to the neonatal intensive care unit compared with the control group (P < 0.01). Conclusions. Our results indicate that there is a pressing need for further steps to promote the importance of receiving prenatal care during pregnancy.
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Affiliation(s)
- Jun Kakogawa
- Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Domingues RMSM, Hartz ZMDA, Dias MAB, Leal MDC. Avaliação da adequação da assistência pré-natal na rede SUS do Município do Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2012; 28:425-37. [DOI: 10.1590/s0102-311x2012000300003] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/20/2011] [Indexed: 11/22/2022] Open
Abstract
A persistência de desfechos perinatais negativos no Município do Rio de Janeiro, Brasil, sugere problemas na qualidade da assistência pré-natal. A última investigação realizada nessa cidade mostrou adequação de apenas 38% dessa assistência. O objetivo deste estudo é avaliar a adequação da assistência pré-natal na rede do SUS do Município do Rio de Janeiro. Foi realizado um estudo transversal, em 2007-2008, por meio de entrevistas com 2.422 gestantes em atendimento nos serviços de pré-natal de baixo risco. Para avaliação da adequação da assistência, foi utilizado o índice PHPN, com as recomendações do Programa de Humanização do Pré-natal e Nascimento, do Ministério da Saúde, e um índice PHPN ampliado, em que foram acrescentados procedimentos clinico-obstétricos, prescrição de sulfato ferroso suplementar e ações educativas. Foi encontrada adequação de 38,5% para o PHPN e 33,3% para o PHPN ampliado. Estratégias de ampliação da captação precoce das gestantes e melhor utilização dos contatos com os serviços para a realização de ações de atenção à saúde são prioritárias para a reversão desse quadro.
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Tran TK, Gottvall K, Nguyen HD, Ascher H, Petzold M. Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam. BMC Health Serv Res 2012; 12:40. [PMID: 22335834 PMCID: PMC3305637 DOI: 10.1186/1472-6963-12-40] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 02/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background Antenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam. Methods Totally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews. Results Living in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector. Conclusion Low education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.
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Affiliation(s)
- Toan K Tran
- Family Medicine Department, Hanoi Medical University, Vietnam.
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Lack of prenatal care in a traditional community: trends and perinatal outcomes. Arch Gynecol Obstet 2011; 285:1237-42. [DOI: 10.1007/s00404-011-2153-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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Mendoza-Sassi RA, Cesar JA, Teixeira TP, Ravache C, Araújo GD, Silva TCD. [Differences in prenatal care between health services under the Family Health Strategy and traditional primary care clinics in Rio Grande, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2011; 27:787-96. [PMID: 21603762 DOI: 10.1590/s0102-311x2011000400018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 02/28/2011] [Indexed: 11/21/2022] Open
Abstract
This study aimed to evaluate differences in prenatal care between services under the Family Health Strategy (FHS) and traditional public primary care clinics in Rio Grande, Rio Grande do Sul State, Brazil. A cross-sectional study was performed with all women who gave birth from January 1st to December 31st, 2007, and who received prenatal care in the municipal health system. The procedures recommended by the Ministry of Health were compared according to model of care. Among the 961 pregnant women, those treated under the FHS received a higher percentage of some forms of care (use of ferrous sulfate, tetanus vaccination, and HIV and syphilis tests). Other procedures were also more frequent under the FHS, but failed to reach the recommended levels (breast examination and Pap smear). Measurement of blood pressure, uterine height, and weight were quite frequent in both groups. Identification of pregnant women in the first trimester failed to reach 70%. Women under the FHS received better care, but some procedures still fell short of expected levels, and efforts are thus needed to improve the quality of prenatal care.
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Affiliation(s)
- Raul A Mendoza-Sassi
- Faculdade de Medicina, Universidade Federal do Rio Grande, Rua General Osório s/n, Rio Grande, RS, Brazil.
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Kakogawa J, Sadatsuki M, Ogaki Y, Nakanishi M, Minoura S. Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:856027. [PMID: 22111021 PMCID: PMC3202094 DOI: 10.5402/2011/856027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 08/29/2011] [Indexed: 11/23/2022]
Abstract
Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of nonattenders. Results. A total of 83 attenders and 45 nonattenders were enrolled. The mean gestational age at the first PNC visit was 31.1 weeks in the attenders. Attenders were found to have a lower incidence of preterm delivery, pregnancy-induced hypertension, emergency cesarean section, low birth weight, and the NICU admission than nonattenders (P < 0.05). Conclusions. The utilization of social service PNC greatly improved perinatal outcomes among women with socioeconomic problems problems in the Tokyo metropolitan area.
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Affiliation(s)
- Jun Kakogawa
- Department of Obstetrics and Gynecology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan
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Cesar JA, Mendoza-Sassi RA, Gonzalez-Chica DA, Mano PS, Goulart-Filha SM. Características sociodemográficas e de assistência à gestação e ao parto no extremo sul do Brasil. CAD SAUDE PUBLICA 2011; 27:985-94. [DOI: 10.1590/s0102-311x2011000500016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 04/05/2011] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve por objetivo comparar a assistência à gestação e ao parto entre mães adolescentes e não adolescentes residentes no Município de Rio Grande, Rio Grande do Sul, Brasil. Entre 1º de janeiro e 31 de dezembro de 2007 aplicou-se questionário padronizado a todas as mães destes recém-nascidos buscando informações sobre cuidados recebidos do inicio da gravidez até momento do parto. Utilizou-se teste do qui-quadrado para comparar proporções. Um quarto (516) dos recém-nascidos era filho de mães adolescentes. Em relação às demais mães, uma menor proporção de adolescentes completou seis ou mais consultas de pré-natal (61% x 75%), iniciou o pré-natal no primeiro trimestre de gravidez (58% x 77%), recebeu vacina antitetânica (81% x 85%) e fez todo o pré-natal com o mesmo profissional (70% x 78%); no entanto, foram mais comumente suplementadas com sulfato ferroso (66% x 57%), submetidas a fórcipe (11% x 6%), à episiotomia (86% x 66%), e atendidas no SUS (92% x 76%). Estes dados mostram que a assistência recebida pelas mães adolescentes foi sistematicamente pior àquela recebida pelas demais mães.
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Affiliation(s)
- Juraci A. Cesar
- Universidade Federal do Rio Grande, Brasil; Universidade Federal de Pelotas, Brasil
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Long Q, Zhang T, Hemminki E, Tang X, Huang K, Xiao S, Tolhurst R. Utilisation, contents and costs of prenatal care under a rural health insurance (New Co-operative Medical System) in rural China: lessons from implementation. BMC Health Serv Res 2010; 10:301. [PMID: 21040560 PMCID: PMC2988781 DOI: 10.1186/1472-6963-10-301] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 11/01/2010] [Indexed: 12/01/2022] Open
Abstract
Background In China, the New Co-operative Medical System (NCMS), a rural health insurance system, has expanded nationwide since 2003. This study aims to describe prenatal care use, content and costs of care in one county where prenatal care is included in the NCMS and two counties where it is not. It also explores the perceptions of stakeholders of the prenatal care benefit package in order to understand the strengths and weaknesses of the approach in the context of rural China and to draw lessons from early implementation. Methods This study is based on the data from a cross-sectional survey and a qualitative investigation conducted in 2009. A survey recruited women giving birth in 2008, including 544 women in RC County (which covered prenatal care) and 619, and 1071 in other two counties (which did not). The qualitative investigation in RC included focus group discussions with women giving birth before or after 2007, individual interviews with local policy makers and health managers, NCMS managers and obstetric doctors in township hospitals. Results There were no significant differences in prenatal care use between RC County (which covered prenatal care) and other two counties (which did not): over 70% of women started prenatal visits early and over 60% had five or more visits. In the three counties: a small proportion of women received the number of haemoglobin and urine tests recommended by the national guideline; 90% of women received more ultrasound tests than recommended; and the out-of-pocket expenditure for prenatal care consumed a high proportion of women's annual income in the low income group. In RC: only 20% of NCMS members claimed the reimbursement; the qualitative study found that the reimbursement for prenatal care was not well understood by women and had little influence on women's decisions to make prenatal visits; and several women indicated that doctors suggested them taking more expensive tests. Conclusions Whether or not prenatal care was included in the NCMS, prenatal care use was high, but the contents of care were not provided following the national guideline and more expensive tests were recommended by doctors. Costs were substantial for the poor.
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Affiliation(s)
- Qian Long
- Department of Public Health, University of Helsinki, Mannerheimintie 172, Helsinki, Finland
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Abstract
Bioelectrical impedance vector analysis (BIVA) is a new method that is used for the routine monitoring of the variation in body fluids and nutritional status with assumptions regarding body composition values. The aim of the present study was to determine bivariate tolerance intervals of the whole-body impedance vector and to describe phase angle (PA) values for healthy term newborns aged 7-28 d. This descriptive cross-sectional study was conducted on healthy term neonates born at a low-risk public maternity. General and anthropometric neonatal data and bioelectrical impedance data (800 μA-50 kHz) were obtained. Bivariate vector analysis was conducted with the resistance-reactance (RXc) graph method. The BIVA software was used to construct the graphs. The study was conducted on 109 neonates (52.3% females) who were born at term, adequate for gestational age, exclusively breast-fed and aged 13 (SD 3.6) d. We constructed one standard, reference, RXc-score graph and RXc-tolerance ellipses (50, 75 and 95%) that can be used with any analyser. Mean PA was 3.14 (SD 0.43)° (3.12 (SD 0.39)° for males and 3.17 (SD 0.48)° for females). Considering the overlapping of ellipses of males and females with the general distribution, a graph for newborns aged 7-28 d with the same reference tolerance ellipse was defined for boys and girls. The results differ from those reported in the literature probably, in part, due to the ethnic differences in body composition. BIVA and PA permit an assessment without the need to know body weight and the prediction error of conventional impedance formulas.
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