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de Paula M, Höfelmann DA. Quality assessment of prenatal and puerperium care. EINSTEIN-SAO PAULO 2023; 21:eAO0094. [PMID: 37531474 PMCID: PMC10382073 DOI: 10.31744/einstein_journal/2023ao0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/19/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To evaluate prenatal and puerperium care levels received and identify their association with sociodemographic and obstetric characteristics. METHODS This cross-sectional study was conducted from May to December 2020 and included women who gave birth at the Municipal Hospital of Fazenda Rio Grande, Paraná, Brazil. Data were collected through interviews and review of portfolios and medical records. The variables extracted from the prenatal protocols of Paraná and the Ministry of Health were grouped into five compliance indices: CI1 - clinical examination; CI2 - health education; CI3 - queries; CI4 - examinations and vaccines; and CI5 - postpartum appointments. Prenatal care was considered adequate when 80% or more adequacy was obtained. RESULTS A total of 307 women participated in this study. Prenatal compliance was 16.6% considering the entire set of variables. The best performance was for CI4 (54.7%) and the worst for CI5 (13.3%). The lowest adequacy occurred among single women (10.9%) compared to those who lived with a partner (19.9%) (p=0.043) and among women with black/brown skin color (9.5%) compared to those with white/yellow skin color (20.3%) (p=0.016). CONCLUSION Most women did not receive adequate care, with those in situations of greater social vulnerability received worse quality care.
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Affiliation(s)
- Marcilene de Paula
- Universidade Federal do ParanáCuritibaPRBrazil Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Cassol K, Magni C, Ribeiro VV, Mondelli MFCG, Lopes AC. Validation of the Questionnaire "Knowledge, Attitudes and Practices" in populations of pregnant women exposed to pesticides. Codas 2023; 35:e20210285. [PMID: 37377327 PMCID: PMC10348663 DOI: 10.1590/2317-1782/20212021285pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/20/2022] [Indexed: 06/29/2023] Open
Abstract
PURPOSE to validate the CAP questionnaire in populations of pregnant women exposed to pesticides in the State of Paraná. METHODS 382 pregnant women participated in the study, divided into two groups: Exposed to Pesticides (n = 320) and Not Exposed (n = 62). The validation process involved the validity of content, criteria and construct. The research stages were developed between August / 2018 to December / 2019 in the western and central-western regions of Paraná. RESULTS the instrument demonstrated an acceptable agreement on the content validity through the evaluation of judges; the criterion validity through the established criterion showed no association; in the analysis of construct validity using the technique of known groups, it demonstrated homogeneity in the variables age, nationality and family income. CONCLUSION the developed analysis indicated that the psychometric properties of the validation of the Brazilian version of the scale are consistent and adequate, which allows the recommendation of the application of the instrument in a national context.
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Affiliation(s)
- Karlla Cassol
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil.
| | - Cristiana Magni
- Universidade Estadual do Centro-Oeste - UNICENTRO - Irati (PR), Brasil.
| | | | | | - Andrea Cintra Lopes
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil.
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Reis-Muleva B, Duarte LS, Silva CM, Gouveia LMR, Borges ALV. Antenatal care in Mozambique: Number of visits and gestational age at the beginning of antenatal care. Rev Lat Am Enfermagem 2021; 29:e3481. [PMID: 34730761 PMCID: PMC8570256 DOI: 10.1590/1518-8345.4964.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE 1)to assess the gestational age at the beginning of antenatal care and its covariates; 2)to assess the number of antenatal visits and its covariates; and 3)to identify the reasons for the late initiation of antenatal care and for attending less than four visits among postpartum women living in Nampula, Mozambique. METHOD cross-sectional study conducted with 393 mothers who answered a structured instrument in face-to-face interviews. Logistic regression was used to analyze the covariates of having initiated antenatal care up to the 16thgestational week, having attended four or more antenatal visits, and reporting both situations simultaneously. RESULTS all postpartum women underwent antenatal care, but only 39.9% started it until the 16thgestational week, 49.1% attended four or more visits, and 34.1% reported both events. Having concluded high school (ORadj=1.99; 95%CI=1.19-3.31) or college (ORadj=3.87; 95%CI=1.47-10.18) were aspects associated with reporting both situations. The reasons for the late initiation of antenatal care and attending less than four visits were as follows: not finding it important to attend several visits, not having easy access to the health facility, not being aware about pregnancy, and not having a companion for the visits. CONCLUSION the gestational age at the beginning of antenatal care and the number of antenatal visits are lower than the current recommendations in the country.
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Affiliation(s)
- Belarmina Reis-Muleva
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
- Bolsista da Universidade Lúrio, Nampula, Moçambique
| | - Luciane Simões Duarte
- Secretaria de Estado da Saúde de São Paulo, Coordenadoria de Controle de Doenças, Divisão de Doenças Crônicas Não Transmissíveis, São Paulo, SP, Brazil
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Paiz JC, Ziegelmann PK, Martins ACM, Giugliani ERJ, Giugliani C. Factors associated with women's satisfaction with prenatal care in Porto Alegre, Rio Grande do Sul, Brazil. CIENCIA & SAUDE COLETIVA 2020; 26:3041-3051. [PMID: 34378696 DOI: 10.1590/1413-81232021268.15302020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 05/30/2020] [Indexed: 11/22/2022] Open
Abstract
This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction.
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Affiliation(s)
- Janini Cristina Paiz
- Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400 2º andar Faculdade de Medicina, Campus Saúde. 90035-003 Porto Alegre RS Brasil.
| | - Patrícia Klarmann Ziegelmann
- Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400 2º andar Faculdade de Medicina, Campus Saúde. 90035-003 Porto Alegre RS Brasil.
| | - Ana Cláudia Magnus Martins
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul. Porto Alegre RS Brasil
| | - Elsa Regina Justo Giugliani
- Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400 2º andar Faculdade de Medicina, Campus Saúde. 90035-003 Porto Alegre RS Brasil.
| | - Camila Giugliani
- Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2400 2º andar Faculdade de Medicina, Campus Saúde. 90035-003 Porto Alegre RS Brasil.
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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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Cesar JA, Camerini AV, Paulitsch RG, Terlan RJ. Non-performance of serological tests for syphilis during prenatal care: prevalence and associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200012. [PMID: 32130400 DOI: 10.1590/1980-549720200012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/13/2018] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION Syphilis is a sexually transmitted disease, easy to diagnose and treat, but whose incidence is increasing in Brazil. This study estimated the prevalence of the non-performance of serological tests for syphilis during prenatal care, in addition to evaluating its trend and identifying its associated factors in the municipality of Rio Grande, Rio Grande do Sul, Southern Brazil. METHODS This is a cross-sectional survey that included all pregnant women living in this municipality who gave birth between January 1 and December 31, 2007, 2010, and 2013. A single standardized questionnaire was administered to the mothers within 48 hours of delivery, while they were still in the maternity ward. We used the χ2 test for proportions and linear trend, and Poisson regression with robust adjustment in the multivariate analysis. The effect measure adopted was prevalence ratio (PR). RESULTS Among the 7,351 mothers who had at least one prenatal visit, the prevalence of non-performance of serological tests for syphilis in the three years studied was 2.9% (95% confidence interval - 95%CI 2.56 - 3.33), with 3.3% (95%CI 2.56 - 3.97) in 2007, 2.8% (95%CI 2.20 - 3.52) in 2010, and 2.7% (95%CI 2.12 - 3.38) in 2013. Black mothers, those with low household income and schooling, and who had few prenatal visits showed higher PR of non-performance of this test. DISCUSSION The prevalence of non-performance has virtually not changed in the period, and women with high-risk pregnancy showed a greater probability of not undergoing the test. CONCLUSIONS This municipality needs to reach mothers with lower socioeconomic status, restructure the local health services, and enhance their operationalization to improve the quality of prenatal care.
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Affiliation(s)
- Juraci Almeida Cesar
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Adriana Vieira Camerini
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Renata Gomes Paulitsch
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
| | - Rodrigo Jacobi Terlan
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Rio Grande - Rio Grande (RS), Brasil
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de Lima THB, Katz L, Kassar SB, Amorim MM. Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study. BMC Pregnancy Childbirth 2018; 18:401. [PMID: 30314456 PMCID: PMC6186100 DOI: 10.1186/s12884-018-2020-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the associations of maternal variables - sociodemographic, obstetrical and maternal near miss (MNM) variables - with neonatal near miss (NNM) using the new concept of NNM formulated by the Centro Latino-Americano de Perinatologia (CLAP) and the corresponding health indicators for NNM. METHODS An analytical prospective cohort study was performed at maternity hospital for high-risk pregnancy in Northeastern Brazil. Puerperal women whose newborn infants met the selection criteria were subjected to interviews involving pretested questionnaires. Statistical analysis was performed with the Epi Info 3.5.1 program using the Chi square test and Fisher's exact test when appropriate, with a level of significance of 5%. A bivariate analysis was performed to evaluate differences between the groups. All the variables evaluated in the bivariate analysis were subsequently included in the multivariate analysis. For stepwise logistic regression analysis, a hierarchical model was plotted to assess variable responses and adverse outcomes associated with MNM and NNM variables. RESULTS There were 1002 live births (LB) from June 2015 through May 2016, corresponding to 723 newborn infants (72.2%) without any neonatal adverse outcomes, 221 (22%) NNM cases, 44 (4.4%) early neonatal deaths and 14 (1.4%) late neonatal deaths. The incidence of NNM was 220/1000 LB. Following multivariate analysis, the factors that remained significantly associated with increased risk of NNM were fewer than 6 prenatal care visits (odds ratio (OR): 3.57; 95% confidence interval (CI): 2.57-4.94) and fetal malformations (OR: 8.78; 95% CI: 3.69-20.90). Maternal age older than 35 years (OR: 0.43; 95% CI: 0.23-0.83) and previous cesarean section (OR: 0.45; 95% CI: 0.29-0.68) protected against NNM. CONCLUSION Based on the large differences between the NNM and neonatal mortality rates found in the present study and the fact that NNM seems to be a preventable precursor of neonatal death, we suggest that all cases of NNM should be audited. Inadequate prenatal care and fetal malformations increased the risk of NNM, while older maternal age and a history of a previous cesarean section were protective factors.
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Affiliation(s)
- Telmo Henrique Barbosa de Lima
- Health Sciences University of Alagoas (UNCISAL), Maceió, Brazil
- Health Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Maternidade Santa Mônica, Maceió, Brazil
| | - Leila Katz
- Postgraduate Program, Fernando Figueira Institute of Integral Medicine (IMIP), Obstetric Intensive Care Unit, IMIP, Recife, Brazil
| | | | - Melania Maria Amorim
- Postgraduate Program, Fernando Figueira Institute of Integral Medicine (IMIP), Obstetric Intensive Care Unit, IMIP, Recife, Brazil
- Federal University of Campina Grande (UFCG), Campina Grande, Brazil
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