Inadequate utilization of prenatal care in two Brazilian birth cohorts

Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review

OBJECTIVES

Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care (ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes.

METHODS

Articles were retrieved from: PubMed, CINAHL, Global Health, Scopus, Web of Science, and the Cochrane Library from January 2008 through 2018. We included evaluation studies that utilized CHWs as all or part of an intervention to improve outcomes, were printed in English, and published in peer-reviewed journals.

RESULTS

Initial electronic database search identified 816 studies and 123 studies met inclusion criteria for full text review. The quality assessment resulted in 0 strong-, 19 moderate-, and 25 weak-rated studies. In most interventions, CHWs were a component of a larger intervention. The majority of the studies (n = 10) found that a CHW intervention can have a positive impact on outcomes. CHW interventions showed improvements in knowledge and ANC. When combined with clinical services, the interventions positively impacted birth outcomes. Most conducted home visits and utilized CHW that were members of the community.

CONCLUSIONS FOR PRACTICE

CHWs serve an important role as health educators conducting home visits as a member of the community they serve. They should also continue to collaborate with clinical providers to address MCH outcomes.

The impact of antenatal care on neonatal mortality in sub-Saharan Africa: A systematic review and meta-analysis

Background

Newborns are at greatest risk of dying at and shortly after the time of birth. Newborn mortality remains an urgent concern and is an important indicator of child health, development and well-being. Studies examining the effectiveness of antenatal care on maternal and newborn health outcomes have provided conflicting results. The aim of this review and meta-analysis was to determine the pooled effect of antenatal care on neonatal mortality in sub-Saharan Africa.

Methods

We searched PubMed, Medline, EMBASE, CINAHL and Google Scholar from September to November 2016 and then updated our search on April 13, 2019. Two independent reviewers extracted data from eligible studies. The quality of each included study was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies (RoBANS). The results were reported based on risk ratio (RR) with 95% confidence intervals (CI) using a random-effects model.

Results

Eight hundred and ninety eight studies were initially identified. During screening, 23 studies were found to be relevant for data extraction. Of these, only twelve studies fulfilled the inclusion criteria and were included in the analysis. In five of the twelve studies included in the analysis, antenatal care service utilization had a significant association with neonatal mortality. The pooled risk ratio by the random-effects model was 0.61 (95% CI: 0.43, 0.86) for neonates born to women who received at least one antenatal care visit by a skilled provider as compared to neonates born to women who did not receive antenatal care.

Conclusion

This review indicates that utilization of at least one antenatal care visit by a skilled provider during pregnancy reduces the risk of neonatal mortality by 39% in sub-Saharan African countries. Thus, in order to accelerate progress towards the reduction of newborn deaths, all pregnant women should receive antenatal care during pregnancy.

Family health strategy and equity in prenatal care: a population based cross-sectional study in Minas Gerais, Brazil

BACKGROUND

Prenatal care coverage is still not universal or adequately provided in many low and middle income countries. One of the main barriers regards the presence of socioeconomic inequalities in prenatal care utilization. In Brazil, prenatal care is supplied for the entire population at the community level as part of the Family Health Strategy (FHS), which is the main source of primary care provided by the public health system. Brazil has some of the greatest income inequalities in the world, and little research has been conducted to investigate prenatal care utilization of FHS across socioeconomic groups. This paper addresses this gap investigating the socioeconomic and regional differences in the utilization of prenatal care supplied by the FHS in the state of Minas Gerais, Brazil.

METHODS

Data comes from a probabilistic household survey carried out in 2012 representative of the population living in urban areas in the state of Minas Gerais. The sample size comprises 1,420 women aged between 13 and 45 years old who had completed a pregnancy with a live born in the last five years prior to the survey. The outcome variables are received prenatal care, number of antenatal visits, late prenatal care, antenatal tests, tetanus immunization and low birthweight. A descriptive analysis and logistic models were estimated for the outcome variables.

RESULTS

The coverage of prenatal care is almost universal in catchment urban areas of FHT of Minas Gerais state including both antenatal visits and diagnostic procedures. Due to this high level of coverage, socioeconomic inequalities were not observed. FHS supplied care for around 80% of the women without private insurance and 90% for women belonging to lower socioeconomic classes. Women belonging to lower socioeconomic classes were at least five times more likely to receive antenatal visits and any of the antenatal tests by the FHS compared to those belonging to the highest classes. Moreover, FHS was effective in reducing low birthweight. Women who had prenatal care through FHS were 40% less likely to have a child with low birthweight.

CONCLUSION

This paper presents strong evidence that FHS promotes equity in antenatal care in Minas Gerais, Brazil.

Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub-Saharan Africa: a multicountry analysis of Demographic and Health Survey data

OBJECTIVES

We analysed the extent of planned, mistimed and unwanted pregnancies and how they predict optimal use of prenatal (timing and number of antenatal) care services in 30 African countries.

METHODS

We pooled data from Demographic and Health Surveys conducted in 30 African countries between 2006 and 2015. We described the extent of mistimed and unwanted pregnancies and further used mixed effects logistic and Poisson regression estimation techniques to examine the impacts of planned, mistimed and unwanted pregnancies on the use of prenatal health services.

RESULTS

In total, 73.65% of pregnancies in all countries were planned. Mistimed pregnancy ranged from 7.43% in Burkina Faso to 41.33% in Namibia. Unwanted pregnancies were most common in Swaziland (39.54%) and least common in Niger (0.74%). Timely (first trimester) initiation of ANC was 37% overall in all countries; the multicountry average number of ANC visits was optimal [4.1; 95% CI: 4.1-4.2] but with notable disparities between countries. Overall, mistimed and unwanted pregnancies were strongly associated with late ANC attendance and fewer visits women made in the pooled analysis.

CONCLUSIONS

Unintended pregnancies are critical risks to achieving improved maternal health in respect of early and optimal ANC coverage for women in Africa. Programmes targeted at advancing coverage of ANC in Africa need to deploy contextually appropriate mechanisms to prevent unintended pregnancies.

Inadequação do conteúdo da assistência pré-natal e fatores associados em uma coorte no nordeste brasileiro

Resumo O objetivo desta pesquisa foi analisar o conteúdo da assistência pré-natal em São Luís e os fatores associados com sua inadequação. Realizou-se estudo transversal baseado em dados da coorte de nascimento de São Luís em 2010. O conteúdo da assistência pré-natal foi classificado como inadequado quando não atendeu aos critérios do Programa de Humanização no Pré-Natal e Nascimento (PHPN) que estabelece o início precoce, o número mínimo de consultas, os exames laboratoriais básicos, a vacinação antitetânica e os procedimentos obstétricos. Regressão de Poisson foi utilizada para observar associações das variáveis com o desfecho. A taxa de inadequação foi de 60,2%. O pré-natal inadequado foi associado à classe econômica C (RP = 1,39; IC = 1,26-1,55), à D/E (RP = 1,60; IC = 1,43-1,79), à ocupação da mãe não qualificada/desempregada (RP = 1,24; IC = 1,11-1,37), à escolaridade de 5-8 anos (RP = 1,12; IC = 1,06-1,19) e de 0-4 anos (RP = 1,13; IC = 1,01-1,26), a não ter religião (RP = 1,10; IC = 1,04-1,17), ao uso de álcool durante a gestação (RP = 1,13; IC = 1,06-1,20) e ao atendimento no serviço público (RP = 1,75; IC = 1,54-2,00). Os resultados demonstraram inadequação e iniquidade da assistência pré-natal, evidenciando que mulheres de pior condição socioeconômica foram as que receberam assistência de menor qualidade.

THE PREVALENCE OF CONSANGUINEOUS MARRIAGES AND AFFECTING FACTORS IN TURKEY: A NATIONAL SURVEY

This study was carried out by the Turkish Republic Ministry of Health to determine the prevalence of consanguineous marriage and its correlates with socio-demographic and obstetric risk factors in women in Turkey. The cross-sectional, national-level study was carried out from October to December 2013. The study population was composed of women between the ages of 15 and 65 years living in Turkey. The sample size was calculated as 9290 houses within Turkey's 81 provinces so as to improve the Turkish rural-urban expectations by means of systematic stack sampling according to the Turkish Statistical Institute's address-based vital statistics system. The target sample size was 6364, but only eligible 4913 women, who had been married, were included in the study. The consanguineous marriage frequency in the sample was found to be 18.5%, and of these 57.8% were first cousin marriages. Women living in an extended family and whose education level and first marriage ages were low, and whose perceived economic status was poor, had higher frequencies of consanguineous marriage (p<0.001). Consanguineous marriage frequencies were higher (p<0.001) for women who had spontaneous abortions and stillbirths or who had given birth to infants with a congenital abnormality. In this context, it is important to develop national policies and strategies to prevent consanguineous marriages in Turkey.

Uso de diferentes critérios para avaliação da inadequação do pré-natal: um estudo de base populacional no extremo Sul do Brasil

Este estudo mediu a prevalência e identificou fatores associados à inadequação do pré-natal conforme diferentes critérios entre puérperas residentes no Município de Rio Grande, Rio Grande do Sul, Brasil, em 2010. Aplicou-se questionário padrão em até 24 horas após o parto a todas as mães que tiveram filho nas duas maternidades do município. Utilizou-se teste do qui- quadrado para comparar proporções e regressão de Poisson com ajuste robusto da variância na análise multivariável. Foram entrevistadas 2.395 mães (97,2% do total). Os índices de inadequação do pré-natal foram 28%, 27% e 58% segundo Takeda, Coimbra et al. e Silveira et al., respectivamente, com enormes disparidades entre categorias. A razão de prevalências à realização de pré-natal inadequado foi maior entre mães mais pobres. Após ajuste, quase todas as variáveis do modelo mostraram-se significativamente associadas à inadequação do pré-natal para Takeda e Coimbra et al., mas poucas em relação a Silveira et al. Este trabalho mostrou que o índice proposto por Silveira et al. é mais robusto e que é necessário melhorar a qualidade do pré-natal, sobretudo para as mais mães mais pobres.

Do antenatal care interventions improve neonatal survival in India?

Although antenatal care (ANC) interventions have been in place for a long time, there is hardly any systematic evidence on the association between ANC interventions and neonatal mortality in India. The present study attempts to investigate the association between ANC interventions and neonatal mortality in India using data from the District Level Household Survey conducted in India during 2007-8. The ANC interventions included in the analysis are at least four antenatal visits, consumption of 90 or more iron-folic acid (IFA) tablets, and uptake of two or more tetanus toxoid (TT) injections. We have used discrete-time logistic regression models to investigate the association between ANC interventions and neonatal mortality. Risk of neonatal mortality was significantly lower for infants of mothers who availed four or more antenatal visits [odds ratio (OR): 0.69; 95% confidence interval (CI): 0.60-0.81], consumed 90 or more IFA tablets (OR: 0.85; 95% CI: 0.73-0.99), received two or more TT injections (OR: 0.73; 95% CI: 0.63-0.83). When we analysed different combinations of antenatal visits, IFA supplementation and TT injections, TT injections provided the main protective effect-the risk of neonatal mortality was significantly lower in newborns of women who received two or more TT injections but did not consume 90 or more IFA tablets (OR: 0.69; 95% CI: 0.60-0.78), or who received two or more TT injections but did not avail four or more antenatal visits (OR: 0.75; 95% CI: 0.66-0.86). In the statistical model, 6% (95% CI: 4-8%) of the neonatal deaths in India could be attributed to a lack of at least two TT injections during pregnancy. Indian public health programmes must ensure that every pregnant woman receives two or more TT injections during antenatal visits.

Inadequate prenatal care utilization and associated factors in São Luís, Brazil

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.

Access to and utilization of prenatal care services in the Unified Health System of the city of Rio de Janeiro, Brazil

Prenatal care consists of practices considered to be effective for the reduction of adverse perinatal outcomes. However, studies have demonstrated inequities in pregnant women's access to prenatal care, with worse outcomes among those with lower socioeconomic status. The objective of this study is to evaluate access to and utilization of prenatal services in the Sistema Único de Saúde (SUS - Unified Health System) in the city of Rio de Janeiro and to verify its association with the characteristics of pregnant women and health services. A cross-sectional study was conducted in 2007-2008, using interviews and the analysis of prenatal care cards of 2.353 pregnant women attending low risk prenatal care services of the SUS. A descriptive analysis of the reasons mentioned by women for the late start of prenatal care and hierarchical logistic regression for the identification of the factors associated with prenatal care use were performed. The absence of a diagnosis of pregnancy and poor access to services were the reasons most often reported for the late start of prenatal care. Earlier access was found among white pregnant women, who had a higher level of education, were primiparous and lived with a partner. The late start of prenatal care was the factor most associated with the inadequate number of consultations, also observed in pregnant adolescents. Black women had a lower level of adequacy of tests performed as well as a lower overall adequacy of prenatal care, considering the Programa de Humanização do Pré-Natal e Nascimento (PHPN - Prenatal and Delivery Humanization Program) recommendations. Strategies for the identification of pregnant women at a higher reproductive risk, reduction in organizational barriers to services and increase in access to family planning and early diagnosis of pregnancy should be prioritized.

Assistência pré-natal nos serviços públicos e privados de saúde: estudo transversal de base populacional em Rio Grande, Rio Grande do Sul, Brasil

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.

Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes

OBJECTIVES

The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes.

METHODS

A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction.

RESULTS

Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes.

CONCLUSION

Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Público versus privado: avaliando a assistência à gestação e ao parto no extremo sul do Brasil

OBJETIVOS: avaliar a assistência à gestação e ao parto entre o setor público e privado no município de Rio Grande, RS. MÉTODOS: aplicou-se questionário padronizado a todas as gestantes residentes neste município que tiveram filho em 2007. Investigaram-se aspectos relativos a cuidados recebidos desde o início da gestação até o pós-parto imediato. A análise estatística consistiu da comparação de proporções nestes dois grupos através do teste de qui-quadrado. RESULTADOS: dentre os 2584 nascimentos cujas mães residiam no município, foram obtidas informações sobre 2557, o que representa 98,9% do total. Destas mães, 96% realizaram pelo menos uma consulta de pré-natal. Gestantes atendidas no setor privado iniciaram o pré-natal mais cedo, realizaram um maior número de consultas médicas, exame de sangue e ultrassonografia pélvica, exame ginecológico, das mamas e citopatológico de colo uterino. Gestantes do setor público realizaram maior número de exames de urina e sorologia para sífilis e foram mais comumente suplementadas com sulfato ferroso. Todas estas diferenças foram estatisticamente significativas (p<0,05). CONCLUSÕES: gestantes do setor privado receberam de forma sistemática melhor assistência durante o pré-natal em termos de consultas e exames realizados, tiveram seu parto mais comumente realizado por médico, foram mais afetadas por intervenções desnecessárias como cesariana e episiotomia e menos frequentemente suplementadas com ferro.

Desempenho de indicadores de processo do Programa de Humanização do Pré-natal e Nascimento no Brasil: uma revisão sistemática

Em 2000 iniciou-se o Programa de Humanização do Pré-natal e do Nascimento (PHPN), com critérios quantitativos para o cuidado obstétrico, e o SISPRENATAL foi seu instrumento de informação. O presente estudo compilou os dados nacionais sobre o acompanhamento pré-natal, utilizando o SISPRENATAL ou outras fontes de informação. Trata-se de uma revisão sistemática, com busca eletrônica de artigos no MEDLINE, EMBASE e SciELO. Compilaram-se publicações a partir de 2001 que utilizaram os indicadores de processo do PHPN. Foi realizada metanálise, estimando-se a proporção média de cada indicador com seu respectivo IC95%. Os indicadores de processo apresentaram incremento ao longo do período, mas o SISPRENATAL registra baixa cobertura do PHPN quando comparado com outras fontes de informação. O PHPN tem pela frente o desafio da correta documentação da informação pelo SISPRENATAL. Deve-se priorizar a conscientização da importância do registro da informação, treinamento para sua inclusão no sistema e aprimoramento de instrumentos mais acessíveis e menos burocráticos de registro de dados.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

BACKGROUND

The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.

METHODS

A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression.

RESULTS

Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.

CONCLUSION

Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Examining life-course influences on chronic disease: the Ribeirão Preto and São Luís birth cohort studies (Brazil)

More than any other low- and middle-income country, Brazil has the longest research tradition of establishing, maintaining and exploiting birth cohort studies. This research pedigree is highlighted in the present issue of the Brazilian Journal of Medical and Biological Research, which contains a series of twelve papers from the Ribeirão Preto and São Luis birth cohort studies from the Southeast and Northeast of Brazil, respectively. The topics covered in this raft of reports vary and include predictors of perinatal health and maternal risk factors, early life determinants of cardiovascular risk factors in childhood and adolescence, use of health services, and a description of dietary characteristics of young adults, amongst other topics. There is also a guide to the background, objectives, sampling and protocols employed across these studies, which, together with similar pieces published in past issues of the Brazilian Journal, serve as a very useful starting point, particularly for potential collaborators. In the fervent hope that further follow-up of these cohorts will take place--we provide our own justification for cohort maintenance and extension in this issue--future data collection could include: genetic material, atherosclerosis, ascertained, for instance, by intima-media thickness, and IQ testing in children--scores from which are emerging as potentially important predictors of adult health outcomes up to six decades later.

[Socioeconomic differentials in performing urinalysis during prenatal care]

OBJECTIVE

Urinalysis is an essential component of the prenatal routine, as urinary tract infections during pregnancy may lead to preterm delivery and neonatal morbidity. The objective of the study was to analyze factors associated to the solicitation of urinalysis during pregnancy.

METHODS

During 2004, 4,163 women living in the urban area of Pelotas (Southern Brazil) and who had received prenatal care were interviewed after delivery in the maternity hospitals of the city. Prevalence of the non-performance of urinalysis was analyzed in relation to socioeconomic and demographic variables, as well as to characteristics of prenatal care. After a bivariate analysis, logistic regression was conducted to identify factors associated with the outcome, controlling for possible confusion factors at a 5% level of significance.

RESULTS

The prevalence of not having had the test was 3%. The multivariate analysis showed that black skin color, poverty, low schooling, being unmarried and having fewer than six prenatal visits were associated with a higher probability of not carrying out the test. Women who were black, poor and with low schooling presented a 10% probability of not being examined, compared to 0.4% for mothers who were white, wealthy and highly educated.

CONCLUSIONS

Despite the fact that urinalysis is essential for preventing complications for the mother and newborn, 3% of the women were not screened. Screening coverage may serve as an indicator to assess the quality of prenatal care. Pregnant women who are black, poor, with low schooling and unmarried should be targeted in programs for improving the quality of care.