<i>Nascer no Brasil</i>: continuity of care during pregnancy and postpartum period for women and newborns

Bittencourt, Sonia Duarte de Azevedo; Cunha, Elenice Machado; Domingues, Rosa Maria Soares Madeira; Dias, Barbara Almeida Soares; Dias, Marcos Augusto Bastos; Torres, Jacqueline Alves; Leal, Maria do Carmo

doi:10.11606/s1518-8787.2020054002021

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002021 copy

Nascer no Brasil: continuity of care during pregnancy and postpartum period for women and newborns

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate the adequacy of health care during pregnancy and the postpartum period in puerperal women and newborn users of the Unified Health System and verify the factors associated with greater adequacy.

METHODS

We used data obtained in the hospital interview, the prenatal card and the first telephone interview of 12,646 women participating in the study Nascer no Brasil (Birth in Brazil), conducted in 2011 and 2012. In the first stage of the analysis, the sociodemographic and obstetric characteristics of women and the estimation of adequacy of prenatal and postpartum care indicators are described. In the second stage, the cascade of care for actions related to puerperal women and their newborns is presented. Finally, maternal factors associated with the adequacy of the line of care are verified by means of multiple logistic regression.

RESULTS

Only two of the four prenatal indicators were considered satisfactory: initiation up to the 16th week of pregnancy and adequate number of appointments. The guidance on which maternity to go for delivery, as well as the guidance to perform the puerperal appointment and the performance of the heel prick test have reached partial level of adequacy. The puerperal appointment, the first routine appointment of the newborn and the obtaining of the heel prick test results presented unsatisfactory adequacy. In the joint analysis of indicators regarding the effective use of services, only 1.5% of mothers and their babies received all recommended health care. Multiparous women living in the North, Northeast and Midwest, with lower schooling, presented the lowest chances of continuity of care.

CONCLUSIONS

The indicators evaluated indicate that almost all women and their children presented partial and disjointed care, showing that the coordination of care is still a challenge in the health care of women and children in the puerperal pregnancy period.

Maternal and Child Health Services; Prenatal care Pregnancy Postpartum period; Brazilian Unified Health System; Epidemiological Surveys

Sociodemographic characteristics	n	%
Region
Southeast	6,757	41.7
South	1,903	11.7
Midwest	1,059	6.5
Northeast	4,769	29.4
North	1,732	10.7
Age
35 years or older	1,294	8.0
20 to 34 years	11,463	70.7
12 to 19 years	3,464	21.4
Ethnicity
White	4,713	29.1
Brown	9,752	60.1
Black	1,518	9.4
Yellow	173	1.1
Indigenous	63	0.4
Schooling level
College or graduate degree	518	3.2
High school	6,289	38.9
Middle school	4,895	30.3
Some middle school	4,463	27.6
Marital status
With a partner	12,925	79.8
Without partner	3,268	20.2
Employment situation
Yes	5,646	34.8
No	10,572	65.2
Characteristics of current pregnancy
First child
Yes	7,457	46.0
No	8,763	54.0
Vaccination during pregnancy
Satisfied	10,765	66.7
Moderately satisfied	3,761	23.3
Unsatisfied	1,616	10.0
History of chronic disease
No	14,955	92.2
Yes	1,265	7.8
Total	16,220	100.0

Indicators of continuity of care	n	%	95%CI
Initiation of prenatal care up to the 16th gestational week.	11,987	74.8	73.3–76.3
Adequate number of appointments for GA	11,790	75.2	73.5–76.7
Guidance on which hospital, maternity or birthing center to look for	9,231	57.0	54.3–59.5
Guidance to attend the health service to carry out the childbirth revision appointment	10,732	66.5	64.0–68.8
Postpartum appointment in the first 15 days after delivery	10,827	32.2	30.1–34.3
Newborn vaccinated with BCG	16,023	99.1	98.9–99.3
Heel prick test in the first week of life	9,761	60.2	57.4–62.9
Newborn vaccinated against hepatitis B	15,541	96.1	94.9–97.0
First routine appointment of the newborn in the first week of life.	2,953	18.2	16.7–19.9
Obtaining of the heel prick test results in the first month of life.	3,789	23.4	21.1–25.8
Total	16,220	100.0	100.0–100.0

		Composite indicator ^a
	% (95%CI)	Crude OR	95%CI	p	Adjusted OR	95%CI	p
Sociodemographic characteristics
Region
Southeast	2.1 (1.4–3.1)	0.59	0.34–1.05	< 0.001	0.58	0.32–1.05	< 0.001
Midwest	1.7 (1.0–2.9)	0.50	0.26–0.94		0.46	0.24–0.89
Northeast	0.4 (0.2–0.7)	0.10	0.05–0.22		0.10	0.05–0.22
North	0.5 (0.1–1.8)	0.13	0.03–0.55		0.13	0.03–0.54
South	3.4 (2.4–4.9)	1.00			1.00
Age
35 years or older	1.2 (0.6–2.4)	0.71	0.34–1.48	0.460	-	-	-
12 to 19 years	1.3 (0.7–2.4)	0.79	0.47–1.35	0.460	-	-	-
20 to 34 years	1.7 (1.3–2.1)	1.00			-	-	-
Ethnicity
Brown	1.2 (0.9–1.7)	0.52	0.33–0.83	0.013	-	-	-
Black	1.3 (0.7–2.6)	0.57	0.29–1.10	0.013	-	-	-
White	2.3 (1.6–3.3)	1.00			-	-	-
Schooling level
High school	2.0 (1.5–2.7)	0.56	0.31–1.01	< 0.001	0.57	0.31–1.06	0.002
Middle school	1.4 (0.8–2.4)	0.39	0.20–0.77		0.41	0.21–0.82
Some middle school	0.8 (0.5–1.2)	0.22	0.11–0.45		0.27	0.13–0.55
College or graduate degree	3.5 (2.0–6.1)	1.00			1.00
Marital status
Without partner	1.7 (0.9–2.9)	1.10	0.61–1.99	0.741	-	-	-
With a partner	1.5 (1.2–2.0)	1.00			-	-	-
Employment situation
No	1.2 (0.8–1.7)	0.54	0.33–0.90	0.017	-	-	-
Yes	2.2 (1.5–3.1)	1.00			-	-	-
Characteristics of current pregnancy
First child
No	1.2 (0.9–1.6)	0.64	0.47–0.86	0.004	0.67	0.49–0.92	0.014
Yes	1.9 (1.4–2.6)	1.00			1.00
Vaccination during pregnancy
Unsatisfied	0.9 (0.5–1.7)	0.51	0.27–0.97	0.034	-	-	-
Moderately satisfied	1.2 (0.8–2.0)	0.70	0.45–1.10	0.034	-	-	-
Satisfied	1.8 (1.3–2.3)	1.00			-	-	-
History of chronic disease ^b
No	1.5 (1.2–2.0)	1.05	0.61–1.82	0.852	-	-	-
Yes	1.5 (0.9–2.5)	1.00			-	-	-
Total	1.5 (1.2–2.0)

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[1] Correspondence: Sonia Duarte de Azevedo Bittencourt Escola Nacional de Saúde Pública Sergio Arouca Rua Leopoldo Bulhões, 1480 sala 805 21041-210 Rio de Janeiro, RJ, Brasil E-mail: bittencourtsonia@gmail.com