Social and obstetric inequalities and vaccination in pregnant women

cross-sectional study, performed with 480 women in puerperal. Vaccination of pregnant women was considered a dependent variable and as independent variables were age, skin color, education, steady union, paid work, and number of prenatal consultations. Association between variables was verified by the Poisson’s regression model.

Results:

from 480 pregnant women’s health cards, 10.63% had information on hepatitis B vaccination; 31.46% for tetanus; and 90% of the health cards had not register for influenza. There was an association of paid work and number of prenatal consultations with hepatitis B vaccination.

Conclusions:

lower percentages in absence of vaccination occurred in women who were in the job market and had a higher number of prenatal consultations. This suggests that socioeconomic inequalities may interfere with the vaccination of pregnant women in health services.

Descriptors:
Immunization; Prenatal Care; Pregnant Women; Health Status Disparities; Iniquity

Variables	n (%)	IC 95%
Age (years)
< 20	53 (11.04)	8.52 - 14.18
Between 20 and 34	353 (73.54)	69.39 - 77.30
≥ 35	74 (15.42)	12.44 - 18.94
Color of skin
White	124(25.83)	22.10 - 29.95
Black	44(9.17)	6.88 - 12.10
Brown/dark/mulatto	303(63.13)	58.69 - 67.34
Asian/eastern/indígenous	9(1.87)	0.97 - 3.57
Education
College Education	69(14.41)	11.52 - 17.85
High School	246(51.36)	46.86 - 55.82
None + primary school	164(34.23)	30.10 - 38.62
Steady Union
Do live with partner	337(70.21)	65.94 - 74.14
Does not live with partner	143(29.79)	25.85 - 34.05
Paid work
Yes	248(51.67)	47.17 - 56.12
No	232(48.33)	43.87 - 52.82
Number of pre-natal consultations^* * Median (IQ).	8(7 - 10)

	Vaccine against:
	Hepatitis B		Tetanus*		Influenza
	Vaccination present n (%)	p value	Vaccination present n (%)	p value	Vaccination present n (%)	p value
Age (years)		0.499^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.702^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.503^‡ ‡ Teste Mann-Whitney, Median (IQ); p value in bold < 0.05.
< 20	7(13.21)		14(26.42)		4(7.55)
Between 20 and 34	34(9.63)		113(32.01)		34(9.63)
≥ 35	10(13.51)		24(32.43)		10(13.51)
Color of skin		0.162^§ § performed Fisher's exact test; p value in bold < 0.05.		0.660^§ § performed Fisher's exact test; p value in bold < 0.05.		0.387^§ § performed Fisher's exact test; p value in bold < 0.05.
White	19 (15.32)		37 (29.84)		16 (12.90)
Black	2 (4.55)		11 (25.00)		2 (4.55)
Brown/dark/mulatto	29 (9.57)		101 (33.33)		29 (9.57)
Asian/eastern/indígenous	1 (11.11)		2 (22.22)		1 (11.11)
Education^\|\| \|\| p < 0.05 (post hoc associated with Bonferroni correction, p < 0.016). Equal letters mean similarity between the proportions.		0.045 ^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.636^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.454^† † performed Pearson chi-square test; p value in bold ≤ 0.05.
College Education^A	13(18.84)		25(36.23)		9(13.04)
High School^AB	25(10.16)		75(30.49)		26(10.57)
None + primary school^B	13(7.93)		50(30.49)		13(7.93)
Steady Union		0.093^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.053^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.272^† † performed Pearson chi-square test; p value in bold ≤ 0.05.
Do live with partner	41(12.17)		115(34.12)		37(10.98)
Do not live with partner	10(6.99)		36(25.17)		11(7.69)
Paid Work		0.023 ^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.003 ^† † performed Pearson chi-square test; p value in bold ≤ 0.05.		0.201^† † performed Pearson chi-square test; p value in bold ≤ 0.05.
No	17(7.33)		58(25.00)		19(8.19)
Yes	34(13.71)		93(37.50)		29(11.69)
No of pre-natal consultations^‡ ‡ Teste Mann-Whitney, Median (IQ); p value in bold < 0.05.	10(8 - 12)	< 0.001	9(7 - 10)	0.042	10(9 - 11)	< 0.001

Variables	Absence of vaccination for hepatitis B
	Gross Model	Adjusted Model*
	PR (CI 95%)	PR (CI 95%)
Paid work
No	1	1
Yes	0.93(0.87 - 0.99)	0.91(0.86 - 0.97)
Number of pre-natal consultations	0.97(0.96 - 0.98)	0.98(0.96 - 0.99)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Fernanda Penido Matozinhos E-mail: nandapenido@hotmail.com