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Inadequate utilization of prenatal care in two Brazilian birth cohorts

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      Abstract

      Data for two birth cohorts from two Brazilian municipalities, Ribeirão Preto in 1994 and São Luís in 1997/1998, were used to identify and compare factors associated with inadequate utilization of prenatal care and to identify factors capable of explaining the differences observed between the two cities. Prenatal care was defined as adequate or inadequate according to the recommendations of the Brazilian Ministry of Health. The chi-square test and Poisson regression were used to compare differences in the inadequacy of prenatal care utilization. The percentage of inadequacy was higher in São Luís (34.6%) than in Ribeirão Preto (16.9%). Practically the same variables were associated with inadequacy in both cities. Puerperae with lower educational level, without a companion or cohabiting, who delivered in public health units, younger than 20 years, multiparae and smokers, with low family income presented higher percentages of inadequate prenatal care utilization. However, the effects of some variables differed between the two cities. The risk for inadequate use of prenatal care was higher for women attended in the public health sector in São Luís and for cohabiting women in Ribeirão Preto. The effect of the remaining factors studied did not differ between cities. The category of admission accounted for 57.0% of the difference in the inadequate use of prenatal care between cities and marital status accounted for 45.3% of the difference. Even after adjustment for all variables, part of the difference in the inadequacy of prenatal care utilization remained unexplained.

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      Most cited references 25

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      An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index.

       M Kotelchuck (1994)
      The assessment of the adequacy of prenatal care utilization is heavily shaped by the way in which utilization is measured. Although it is widely used, the current major index of utilization, the Kessner/Institute of Medicine Index, has not been subjected to systematic examination. This paper provides such an examination. Data from the 1980 National Natality Survey are used to disaggregate the components of the Kessner Index for detailed analysis. An alternative two-part index, the Adequacy of Prenatal Care Utilization Index, is proposed that combines independent assessments of the timing of prenatal care initiation and the frequency of visits received after initiation. The Kessner Index is seriously flawed. It is heavily weighted toward timing of prenatal care initiation does not distinguish timing of initiation from poor subsequent utilization, inaccurately measures utilization for full- or post-term pregnancies, and lacks sufficient documentation for consistent computer programming. The Adequacy of Prenatal Care Utilization Index offers a more accurate and comprehensive set of measures of prenatal care utilization than the Kessner Index.
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        Factors associated with preterm births in southeast Brazil: a comparison of two birth cohorts born 15 years apart.

        An increase in preterm deliveries in Ribeirão Preto stimulated an analysis of possible explanatory factors. Two cohorts of singleton livebirths were studied, the first based on 6746 births in 1978-9 and the second based on 2846 births in 1994. A logistic regression was carried out to assess the association of preterm birth with several sociodemographic, behavioural and clinical variables, including year of survey. Delivery in private settings compared with a public setting, maternal age of < or = 17 compared with any other age group, and mothers who had had previous abortions and previous stillbirths were associated with greater rates of preterm birth. Although there was an increase in preterm birth rates regardless of mode of delivery, the increase was greater in the caesarean section group than in the vaginal delivery group. Over the study period, deliveries in private hospitals and caesarean section operations increased markedly (from 4% to 36% and from 30% to 51% respectively). Caesarean section may be the main contributor to the increase of preterm birth rate in this study. It is essential to ensure that health-care staff, especially those in private facilities, are properly educated and audited.
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          Epidemiology: Study Design and Data Analysis

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            Author and article information

            Affiliations
            [1] Universidade Federal do Maranhão
            [2] Universidade Federal do Maranhão
            [3] Universidade de São Paulo Brazil
            [4] Universidade Federal do Maranhão Brasil
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            bjmbr
            Brazilian Journal of Medical and Biological Research
            Braz J Med Biol Res
            Associação Brasileira de Divulgação Científica (Ribeirão Preto)
            1414-431X
            September 2007
            : 40
            : 9
            : 1195-1202
            S0100-879X2007000900006

            http://creativecommons.org/licenses/by/4.0/

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            Product Information: SciELO Brazil
            Categories
            BIOLOGY
            MEDICINE, RESEARCH & EXPERIMENTAL
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