Comment on: Access and adequacy of antenatal care in during two phases of the COVID-19 pandemicThe publication on "Access and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic."(1) Is an interesting issue. This study investigated antenatal care consumption and appropriateness among postpartum caregivers at Florianópolis Hospital from 2020 to 2022, with an emphasis on socio-demographic characteristics and antenatal care. Although this study gives significant insights, there are some methodological problems and areas for improvement. The observational cross-sectional design captures only one point in time, restricting the capacity to demonstrate causal linkages. A longitudinal or cohort approach may provide more detailed insights into patterns and changes over time. Furthermore, while antenatal medical records and pamphlets are commonly used as primary data sources, documentation discrepancies and recollection bias can arise, particularly when data points are acquired from historical records. It would be beneficial to include more thorough data sources or analysis tools.
Although the Carvalho and Novaes(2) index is an intriguing method for determining the adequacy of antenatal treatment, its generalizability should be questioned. Can it be used to a wide range of populations and address all areas of healthcare quality? Although we address major barriers, such as the impact of sickness, these considerations may be incomplete. Other barriers, such as socioeconomic status, education level, and cultural characteristics, may have a substantial impact on access and appropriateness of care, but have not been thoroughly investigated. Future study should include a broader range of variables. This encompasses the various aspects that may influence individual healthcare experiences.
This study's focus on adequacy of care and access to healthcare is one of its strengths, but it also raises fundamental problems concerning adequacy measurement. The adequacy rate was 48.6% in 2020, compared to 69.1% in 2022, indicating an improvement, however the causes for this shift remain unknown. Are these developments the result of systematic advances in healthcare delivery, or are these figures influenced by other factors such as changes in population health requirements or healthcare priorities? These issues require more investigation through qualitative interviews and focus groups in order to better understand the underlying causes and enhance the appropriateness of care.
Finally, the findings of this study suggest various areas for future research. Given the tremendous influence that the COVID-19 pandemic has had on healthcare access, future research should look into how pandemic-specific policies, such as the implementation of telemedicine and changes in clinic operations, have affected prenatal care. New approaches could include investigating the views of healthcare providers and patients to better understand the problems clinicians encounter in providing quality treatment during the crisis. Expanding the study to encompass a broader range of health care settings would provide a more complete picture of prenatal care practices and access in different locations and systems.
References
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1 Beatrici NZ, Knobel R, Vieira MS, Alexandrini IF, Trapani Junior A, Andreucci CB. Access and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic. Rev Bras Ginecol Obstet. 2024;46:e-rbgo87. doi: 10.61622/rbgo/2024rbgo87
» https://doi.org/10.61622/rbgo/2024rbgo87 -
2 Carvalho DS, Novaes HM. Avaliação da implantação de programa de atenção pré-natal no Município de Curitiba, Paraná, Brasil: estudo em coorte de primigestas. Cad Saúde Pública. 2004;20 Supl 2:S220-30. doi: 10.1590/S0102-311X2004000800017
» https://doi.org/10.1590/S0102-311X2004000800017
Author's reply to comment on: Access and adequacy of antenatal care in during two phases of the COVID-19 pandemic
AuthorshipSCIMAGO INSTITUTIONS RANKINGSWe appreciate your comments on our publication "Access and Adequacy of Antenatal Care in a City in Brazil during Two Phases of the COVID-19 Pandemic"(1) and fully agree with your observations, which greatly enrich the discussion around the study. We concur that an observational study design has limited power to establish causal relationships, and we recognize this as a limitation of the methodology employed. While this approach captures valuable cross-sectional data, it lacks the depth that longitudinal or cohort studies could provide in identifying dynamic patterns or causal linkages. As you highlighted, we also acknowledge the potential issues related to prenatal records, which may reflect a broader reality in the country.(2) Despite the risk of discrepancies or missing data, we consider these flaws essential findings. In the current state healthcare services organization, hospital teams primarily rely on these records to care for laboring patients. Nevertheless, we agree that specific research is necessary to evaluate the quality of these records and their impact on the care provided. We take this opportunity to emphasize the importance of promoting the electronic integration of prenatal data with hospital care services. Regarding the sample size and potential selection biases, we agree with your observations and have highlighted these issues as limitations in the article. We recognize these as inherent challenges in studies of this nature that require careful attention.
Although the Carvalho and Novaes(3) index is exclusively quantitative, we used it to allow comparisons with other studies and, primarily, with data provided by the Brazilian Unified Health System's information system.(4) While we acknowledge its limitations, we found it to be a useful tool to ensure consistency and comparability within the scope of this research. The Carvalho and Novaes(3) index also has a high positive predictive value on adequate antenatal care access and good levels of adjusted agreement with other antenatal assessment indices.(5)
Finally, we fully agree that this study raises numerous important questions, including those proposed in your letter. These questions require further investigation using diverse methodological approaches to provide comprehensive answers.
References
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1 Beatrici NZ, Knobel R, Vieira MS, Alexandrini IF, Trapani Junior A, Andreucci CB. Access and adequacy of antenatal care in a city in Brazil during two phases of the COVID-19 pandemic. Rev Bras Ginecol Obstet. 2024;46:e-rbgo87. doi: 10.61622/rbgo/2024rbgo87
» https://doi.org/10.61622/rbgo/2024rbgo87 -
2 Camargos LF, Lemos PL, Martins EF, Felisbino-Mendes MS. Avaliação da qualidade dos registros de cartões de pré-natal de mulheres urbanas. Esc Anna Nery. 2020;25:e20200166. doi: 10.1590/2177-9465-EAN-2020-0166
» https://doi.org/10.1590/2177-9465-EAN-2020-0166 -
3 Carvalho DS, Novaes HM. Avaliação da implantação de programa de atenção pré-natal no Município de Curitiba, Paraná, Brasil: estudo em coorte de primigestas. Cad Saúde Pública. 2004;20 Supl 2:S220-30. doi: 10.1590/S0102-311X2004000800017
» https://doi.org/10.1590/S0102-311X2004000800017 -
4 Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Sistema de Informações de Nascidos Vivos (SINASC). 2023 [cited 2024 Oct 10]. Available from: https://svs.aids.gov.br/daent/cgiae/sinasc/
» https://svs.aids.gov.br/daent/cgiae/sinasc/ -
5 Tomasi E, Fernandes PA, Fischer T, Siqueira FC, Silveira DS, Thumé E, et al. Qualidade da atenção pré-natal na rede básica de saúde do Brasil: indicadores e desigualdades sociais. Cad Saúde Pública. 2017;33(3):e00195815. doi: 10.1590/0102-311X00195815
» https://doi.org/10.1590/0102-311X00195815
Publication Dates
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Publication in this collection
24 Mar 2025 -
Date of issue
2025
History
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Received
14 Nov 2024 -
Accepted
03 Dec 2024
