Frequency and associated factors with failure to perform the puerperal consultation in a cohort study

Gonçalves, Cristiane de Souza; Cesar, Juraci Almeida; Marmitt, Luana Patrícia; Gonçalves, Carla Vitola

doi:10.1590/1806-93042019000100004

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 19 (1) • Jan-Mar 2019 • https://doi.org/10.1590/1806-93042019000100004 copy

Frequency and associated factors with failure to perform the puerperal consultation in a cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to identify the frequency and factors associated with the non-realization of puerperal consultations in women resident of a medium-sized municipality in Brazil.

Methods:

a prospective cohort study based on data collected in two time points, the first 48h and after the 42^nd day post-childbirth. In order to analyze data, proportions were compared using the chi-square test, and the adjusted analysis was performed using Poisson regression, according to a predetermined hierarchical model. Significance level was set at 5%.

Results:

of the 572 women included in the study, 24.8% did not perform puerperal consul-tations. The factors associated with the non-realization of puerperal consultations were: lower income (1 ^st tercile PR= 2.01; CI95%= 1.21-3.33 – 2 ^nd tercile PR= 1.94; CI95%=1.17-3.20) and schooling (≤ 8 years PR= 2.00; CI95%= 1.24-3.24), comorbidities during preg-nancy (PR= 1.45; CI95%= 1.01-2.09), realization of antenatal care in the public service (PR= 1.74; CI95%= 1.18-2.58) and non-use of contraceptive methods (PR= 3.10; CI95%=1.86-5.16).

Conclusions:

puerperal revision does not seem to be valued in the antenatal care, mainly in the public health system. An important inequality was identified in the provision of this service, since women more prone to recurring pregnancy and with lower income and schooling were the ones that least returned to the puerperal consultation.

Key words
Postpartum period; Prevalence; Health status disparities; Primary health care

Level	Variables	Description of the sample		Prevalence of the non-realization of the puerperal consultation (%)	Prevalence ratio (CI95%)
		n	%		Crude	Adjusted
1^st	Maternal age (years)				p=0.187	p=0.938
	12 to 19	81	14.2	29.6	1.43 (0.93-2.18)	1.07 (0.68-1.69)
	20 to 29	274	47.9	26.6	1.28 (0.93-1.78)	1.06 (0.75-1.49)
	30 or more	217	37.9	20.7	1.00	1.00
	Skin color				p=0.230	p=0.670
	White	409	71.5	23.5	1.00	1.00
	Non-white	163	28.5	28.2	1.20 (0.89-1.62)	0.93 (0.67-1.29)
	Family income (terciles) (n=523)				p<0.001^* * P-value of the linear tendency test;	p=0.009^* * P-value of the linear tendency test;
	First (lower)	176	33.6	31.8	2.63 (1.63-4.22)	2.01 (1.21-3.33)
	Second	190	36.3	27.4	2.26 (1.40-3.66)	1.94 (1.17-3.20)
	Third (higher)	157	30.0	12.1	1.00	1.00
	Maternal schooling (years)				p<0.001^* * P-value of the linear tendency test;	p=0.002^* * P-value of the linear tendency test;
	1 to 8	166	29.0	36.7	2.71 (1.4-4.23)	2.00 (1.24-3.24)
	9 to 11	251	43.9	23.9	1.76 (1.12-2.78)	1.36 (0.84-2.18)
	12 or more	155	27.1	13.5	1.00	1.00
	Work during pregnancy				p<0.001	p=0.223
	No	282	49.4	31.6	1.72 (1.28-2.32)	1.23 (0,88-1.73)
	Yes	289	50.6	18.3	1.00	1.00
2^nd	Parity				p=0.058	p=0.913
	1	289	50.5	21.1	1.00	1.00
	2	178	31.1	26.4	1.25 (0.90-1.74)	1.07 (0.74-1.50)
	3 or more	105	18.4	32.4	1.53 (1.07-2.19)	1.06 (0.72-1.57)
	Anemia				p=0.197	p=0.177
	No			26.4	1.24 (0.89-1.73)	1.28 (0.89-1.85)
	Yes			21.2	1.00	1.00
	Had some morbidity during pregnancy (hypertension, diabetes, anemia, urinary tract infections)				p=0.117	p=0.043
	No	215	37.6	20.6	1.00	1.00
	Yes	357	62.4	26.8	1.30 (0.94-1.81)	1.45 (1.01-2.09)
	Trimester of the first consultation^ Information available for 568 parturients that attended to the prenatal care; 1st, 2nd and 3rd hierarchic levels of the Poisson regression.				p=0.059	p=0.080
	First	460	80.9	23.0	1.00	1.00
	Second or third	108	19.0	31.5	1.37 (0.98-1.89)	1.36 (0.96-1.91)
	Number of consultations performed^ Information available for 568 parturients that attended to the prenatal care; 1st, 2nd and 3rd hierarchic levels of the Poisson regression.				p=0.076	p=0.821
	1 to 5	63	11.1	33.3	1.41 (0.96-2.07)	0.94 (0.57-1.57)
	6 or more	505	88.9	23.6	1.00	1.00
	Type of service in which the prenatal was performed^ Information available for 568 parturients that attended to the prenatal care; 1st, 2nd and 3rd hierarchic levels of the Poisson regression.				p<0.001	p=0.006
	Public	307	53.9	33.9	2.41 (1.72-3.37)	1.74 (1.18-2.58)
	Private	263	46.1	14.1	1.00	1.00
3^rd	Type of delivery				p=0.157	p=0.570
	Vaginal	229	40.0	27.9	1.23 (0.92-1.63)	0.90 (0.63-1.28)
	Cesarean section	343	60.0	22.7	1.00	1.00
	Financing of the delivery				p<0.001	p=0.161
	Public	420	73.4	29.8	2.66 (1.66-4.26)	1.58 (0.83-3.01)
	Private	152	26.6	11.2	1.00	1.00
	Breastfeeding				p=0.246	p=0.414
	No	217	37.9	22.1	1.00	1.00
	Yes	355	62.1	26.5	1.20 (0.88-1.62)	1.17 (0.80-1.70)
	Use of hormonal contraceptive method (n=479)				p<0.001	p<0.001
	None	11	2.3	63.6	2.28 (1.38-3.77)	3.10 (1.86-5.16)
	Oral contraceptive	278	58.0	20.1	0.72 (0.52-1.01)	1.15 (0.81-1.65)
	Injectable contraceptive	190	39.7	27.9	1.00	1.00

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[TFN1] ^*
P-value of the linear tendency test;

[TFN2] ^**
Information available for 568 parturients that attended to the prenatal care; 1^st, 2^nd and 3^rd hierarchic levels of the Poisson regression.