scholarly journals Access to and utilization of prenatal care services in the Unified Health System of the city of Rio de Janeiro, Brazil

2013 ◽  
Vol 16 (4) ◽  
pp. 953-965 ◽  
Author(s):  
Rosa Maria Soares Madeira Domingues ◽  
Maria do Carmo Leal ◽  
Zulmira Maria de Araújo Hartz ◽  
Marcos Augusto Bastos Dias ◽  
Marcelo Vianna Vettore

Prenatal care consists of practices considered to be effective for the reduction of adverse perinatal outcomes. However, studies have demonstrated inequities in pregnant women's access to prenatal care, with worse outcomes among those with lower socioeconomic status. The objective of this study is to evaluate access to and utilization of prenatal services in the Sistema Único de Saúde (SUS - Unified Health System) in the city of Rio de Janeiro and to verify its association with the characteristics of pregnant women and health services. A cross-sectional study was conducted in 2007-2008, using interviews and the analysis of prenatal care cards of 2.353 pregnant women attending low risk prenatal care services of the SUS. A descriptive analysis of the reasons mentioned by women for the late start of prenatal care and hierarchical logistic regression for the identification of the factors associated with prenatal care use were performed. The absence of a diagnosis of pregnancy and poor access to services were the reasons most often reported for the late start of prenatal care. Earlier access was found among white pregnant women, who had a higher level of education, were primiparous and lived with a partner. The late start of prenatal care was the factor most associated with the inadequate number of consultations, also observed in pregnant adolescents. Black women had a lower level of adequacy of tests performed as well as a lower overall adequacy of prenatal care, considering the Programa de Humanização do Pré-Natal e Nascimento (PHPN - Prenatal and Delivery Humanization Program) recommendations. Strategies for the identification of pregnant women at a higher reproductive risk, reduction in organizational barriers to services and increase in access to family planning and early diagnosis of pregnancy should be prioritized.

Author(s):  
Luciana Leite de Mattos Alcantara ◽  
Núbia Karla de Oliveira Almeida ◽  
Renan Moritz Varnier Rodrigues de Almeida

Abstract Objective To investigate the patterns of hospital births in the state of Rio de Janeiro (RJ), Brazil, between 2015 and 2016; considering the classification of obstetric characteristics proposed by Robson and the prenatal care index proposed by Kotelchuck. Methods Data obtained from the Information System on Live Births of the Informatics Department of the Brazilian Unified Health System (SINASC/DATASUS, in the Portuguese acronym) databases were used to group pregnant women relatively to the Robson classification. A descriptive analysis was performed for each Robson group, considering the variables: maternal age, marital status, schooling, parity, Kotelchuck prenatal adequacy index and gestational age. A logistic model estimated odds ratios (ORs) for cesarean sections (C-sections), considering the aforementioned variables. Results Out of the 456,089 live births in Rio de Janeiro state between 2015 and 2016, 391,961 records were retained, 60.3% of which were C-sections. Most pregnant women (58.6%) were classified in groups 5, 2 or 3. The percentage of C-sections in the Robson groups 1, 2, 3, 4, 5 and 8 was much higher than expected. Prenatal care proved to be inadequate for women who subsequently had a vaginal delivery, had an unfavorable family structure and a lower socioeconomic status (mothers without partners and with lower schooling), compared with those undergoing cesarean delivery. For a same Robson group, the chance of C-section increases when maternal age rises (OR = 3.33 for 41–45 years old), there is the presence of a partner (OR = 1.81) and prenatal care improves (OR = 3.19 for “adequate plus”). Conclusion There are indications that in the state of RJ, from 2015 to 2016, many cesarean deliveries were performed due to nonclinical factors.


2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Daniel Resende Faleiros ◽  
Francisco de Assis Acurcio ◽  
Juliana Álvares ◽  
Renata Cristina Rezende Macedo do Nascimento ◽  
Ediná Alves Costa ◽  
...  

OBJECTIVE: To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. METHODS: The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. RESULTS: Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. CONCLUSIONS: We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model


2017 ◽  
Vol 17 (2) ◽  
pp. 291-298
Author(s):  
Maria Paula Custódio Silva ◽  
Divanice Contim ◽  
Lúcia Aparecida Ferreira ◽  
Alessandra Bernadete Trovó de Marqui

Abstract Objectives: to investigate pregnant women's perception on Guthrie test and verify how this matter is approached during prenatal care. Methods: this study is an exploratory - descriptive, cross-sectional and quantitative approach design, carried out with 160 pregnant women who attended the Prenatal Care service at the Primary HealthCare in the city of Uberaba-MG. Data collection was performed between December 2014 and February 2015, using a semi-structured questionnaire. A bivariate descriptive statistics was applied by using the Pearson´s Chi-square test. Results: 75% of the pregnant women could not report which pathologies were to be screened, 16.3% reported that the diseases detected by Guthrie test had etiology genetic, 82% mentioned it was necessary to have more information on Guthrie test, 60% referred the necessity on focusing which diseases to be diagnosed. Only 36% of the pregnant women indicated the correct period (3rd to 7th day of the newborn life) for exam collecting. An average of 50% of the participants did not know about this prenatal test. Conclusions: pregnant women showed a low understanding regarding the test; there was a lack of understanding about prenatal matters. The nursing personnel play an important role in this stage to demonstrate their abilities in health education.


2009 ◽  
Vol 4 (1) ◽  
pp. 133 ◽  
Author(s):  
Selma Villas Boas Teixeira ◽  
Cristiane Rodrigues da Rocha ◽  
Diego Silva Domingues de Moraes ◽  
Danielle Moreira Marques ◽  
Alana Stéphanie Esteves Villar

ABSTRACTObjective: to describe the socio-economic-cultural pregnant women who use outpatient prenatal care and identify the themes of education for the pregnancy and puerperal period elected by women. Methods: it’s a cross-sectional, exploratory and descriptive study. In a prenatal care from healthcare center located in Rio de Janeiro were carried out 90 semi-structured interviews with pregnant women. This study was approved by Research Ethics Committee in Health Municipal Secretariat-RJ, number of register 231/08. Results: the predominant age group (48%) was that of pregnant women 18 to 25 years, most (62%) did not complete high school and are employed in the service sector. The absolute majority (94%) have family income less than three minimum wages. The most women (76%) did not plan the current pregnancy and 33% had previous abortion. Some women were drinking alcohol (13.3%) and smoking (7.7%). Signs and symptoms of labor was the theme of education elected by the majority (56%). Conclusion: to understand the socio-economic and cultural allowed be identified vulnerabilities to the health of women. This research has great relevance to support the planning of health care. Through health education we can contribute to a good outcome of pregnancy and future pregnancies and to reduce the rates of maternal and neonatal mortality. Descriptors: nursing; health education; prenatal. RESUMO Objetivos: descrever o perfil sócio-econômico-cultural das gestantes que utilizam o ambulatório de pré-natal e identificar os temas de educação referentes ao período puerperal e gestacional eleitos pelas gestantes. Métodos: estudo transversal, exploratório e descritivo. Foram realizadas 90 entrevistas semi-estruturadas com gestantes acompanhadas no ambulatório de pré-natal de um Centro Municipal de Saúde localizado na cidade do Rio de Janeiro. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Secretaria Municipal de Saúde – RJ, número de registro 231/08. Resultados: a faixa etária predominante (48%) foi a de gestantes de 18 a 25 anos. A maioria (62%) não completou o 2° grau e trabalha no setor de serviços. A renda familiar de 94% das entrevistadas é inferior a três salários mínimos. Grande parte (76%) delas não planejou a atual gravidez e 33% têm histórico de abortos anteriores. Algumas admitiram ingerir bebidas alcoólicas (13,3%) e 7,7% delas são tabagistas. Os “sinais e sintomas do trabalho de parto” foi o tema educativo eleito pela maioria. Conclusão: conhecer o perfil das gestantes permitiu que fossem identificadas as vulnerabilidades que fragilizam sua saúde. A pesquisa desenvolvida é relevante e pode fundamentar o planejamento da assistência prestada. A educação em saúde é uma ferramenta capaz de colaborar com um bom prognóstico da gravidez e diminuir os índices de mortalidade materna e neonatal. Descritores: enfermagem; educação em saúde; pré-natal. RESUMENObjetivo: describir el perfil socio-económico-cultural de las mujeres embarazadas que utilizan ambulatorio prenatal e identificar los temas de la educación para el embarazo y el puerperio elegidos por las mujeres. Métodos: estudio transversal, exploratorio y descriptivo. Fueran hechas 90 entrevistas semi-estructuradas con las mujeres embarazadas acompañadas en la atención prenatal de un centro de salud situado en Río de Janeiro. Lo estudio fue aprobado por lo Comité de Ética en Investigación de la Secretaría Municipal de Salud-RJ, número de registro 231/08. Resultados: el grupo etario de las mujeres embarazadas predominante fue 18 a 25 años (48%), la mayoría (62%) no completaron la escuela secundaria y están empleados en el sector de servicios. El ingreso familiar de la mayoría (94%) fue menor que tres salarios mínimos. La mayoría (76%) no habían planificado el embarazo actual y 33% tenía realizado abortos. Algunos dijeron que bebían alcohol (13,3%) y 7,7% eran fumadores. Los signos y síntomas del trabajo de parto fue el tema de la educación elegidos por la mayoría (56%). Conclusión: conocer la situación socioeconómica y cultural permitió que fuesen identificadas las vulnerabilidades para la salud de la mujer. Este estudio tiene gran relevancia para apoyar la planificación de la atención de la salud. La educación en salud es una herramienta capaz de contribuir con un buen desenlace del embarazo y los embarazos futuros y así reducir las tasas de mortalidad materna y neonatal. Descriptores: enfermería; salud y educación; prenatal. 


2018 ◽  
Vol 12 (5) ◽  
pp. 1365
Author(s):  
Diego Da Silva Dantas ◽  
Rosemar Barbosa Mendes ◽  
José Marcos De Jesus Santos ◽  
Thiago Dos Santos Valença ◽  
Claudiane Mahl ◽  
...  

RESUMOObjetivo: Avaliar a qualidade da assistência pré-natal a partir do Programa de Humanização no Pré-Natal e Nascimento. Método: Estudo quantitativo, transversal, com 260 puérperas que realizaram o acompanhamento pré-natal no Sistema Único de Saúde em Lagarto, Estado de Sergipe, Brasil. As informações foram obtidas por meio de entrevistas e visualização do cartão de pré-natal. A análise estatística foi realizada no software SPSS 20.0. Resultados: Pouco mais da metade das puérperas haviam iniciado seu acompanhamento pré-natal antes da 16ª semana gestacional e também realizaram seis ou mais consultas (66,9%; n = 174, cada variável). Somente 41,5% (n = 108) das participantes receberam informações sobre a maternidade de referência para o parto e 42,7% (n = 111) sobre as atividades para facilitar o parto. Quanto aos exames, foi identificada elevada cobertura no primeiro trimestre, com discreta redução no terceiro. Conclusão: A assistência pré-natal oferecida às usuárias do SUS de Lagarto se mostrou inadequada às recomendações do Programa de Humanização no Pré-Natal e Nascimento, pois foi evidenciado o início tardio, número insuficiente de consultas, poucas orientações e cobertura insatisfatória dos exames preconizados pelo Ministério da Saúde. Descritores: Saúde Materna; Gravidez; Gestantes; Cuidado Pré-Natal; Saúde Materno-Infantil; Humanização da Assistência.ABSTRACTObjective: To evaluate the quality of prenatal care based on the Prenatal and Birth Humanization Program. Method: Quantitative and cross-sectional study conducted with 260 puerperal women who underwent prenatal care in the Unified Health System of Lagarto, State of Sergipe, Brazil. The data were obtained through interviews and prenatal records. The statistical analysis was performed using the SPSS 20.0 software. Results: A little more than half of the puerperal women had initiated prenatal care before the 16th gestational week and had also attended six or more consultations (66.9%, n = 174, each variable). Only 41.5% (n = 108) of the participants received information about reference maternities for childbirth, and 42.7% (n = 111) about activities to facilitate childbirth. Regarding the exams, there was high coverage in the first trimester, with a slight reduction in the third. Conclusion: Prenatal care provided to users of the Unified Health System of Lagarto was inadequate with respect to the recommendations of the Prenatal and Birth Humanization Program, since there was evidence of late initiation of prenatal care, insufficient number of consultations, few guidelines, and unsatisfactory performance of the exams recommended by the Ministry of Health. Descriptors: Maternal Health; Pregnancy; Pregnant Women; Prenatal Care; Maternal and Child Health; Humanization of Assistance.RESUMENObjetivo: Evaluar la calidad de la asistencia prenatal a partir del Programa de Humanización en Prenatal y Nacimiento. Método: Estudio cuantitativo y transversal conducido con 260 puérperas que realizaron cuidado prenatal en el Sistema Único de Salud en Lagarto, Estado de Sergipe, Brasil. La información fue obtenida por medio de entrevistas y expedientes de prenatal. El análisis estadístico se realizó en el software SPSS 20.0. Resultados: Poco más de la mitad de las puérperas habían iniciado cuidado prenatal antes de la 16ª semana gestacional y también realizaron seis o más consultas (66,9%, n = 174, cada variable). Sólo el 41,5% (n = 108) de las participantes recibieron información sobre la maternidad de referencia para el parto y el 42,7% (n = 111) sobre las actividades para facilitar el parto. En cuanto a los exámenes, se observó una elevada cobertura en el primer trimestre, con discreta reducción en el tercero. Conclusión: La asistencia prenatal ofrecida a las usuarias del Sistema Único de Salud de Lagarto fue inadecuada con respecto a las recomendaciones del Programa de Humanización en Prenatal y Nacimiento, pues se evidenció inicio tardío, número insuficiente de consultas, pocas orientaciones y cobertura insatisfactoria de los exámenes preconizados por el Ministerio de Salud. Descriptores: Salud Materna; Embarazo; Mujeres Embarazadas; Cuidado Prenatal; Salud Materno-Infantil; Humanización de la Asistencia.


Author(s):  

Objective: The objective of this study was to determine the prevalence of pregnant colonization by group B Streptococcus (GBS) and to verify whether socioeconomic and demographic conditions are risk factors for colonization by this bacterium. Method: This cross-sectional study included the collection of sociodemographic data through a questionnaire and authorization to access the result of the cultivation of vaginal swabs for the investigation of GBS of 50 women treated at the Unified Health System (SUS) in a laboratory in the municipality of Medianeira, PR, between august and september 2020. Results: The population studied showed a 14% prevalence of colonization by GBS, within national and world standards. Among the factors analyzed, the only significant and protective association was living with fewer people in the same house, up to two people, reducing the risk of developing a positive culture for GBS by more than 5 times (5.54) when compared to pregnant women who live with more than 3 people in the same residence (p <0.1; RR = 0.181, CI 90% 0.04-0.82). There was no association between colonization by GBS with age, skin color, school education, occupation and type of housing, income, fixed partner, parity and gestational symptoms. Conclusion: This study requires greater sampling for statistical strengthening, however it indicates basic data for the creation of GBS disease prevention protocols based on the applied community.


2020 ◽  
Author(s):  
Xue Yang ◽  
Bo Song ◽  
Anise Wu ◽  
Phoenix K H Mo ◽  
Jiangli Di ◽  
...  

BACKGROUND Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. OBJECTIVE This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. METHODS An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. RESULTS Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (<i>χ</i><sup>2</sup><sub>14</sub>=495.21; <i>P</i>&lt;.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; <i>β</i>=.02, 95% CI 0.01-0.02; <i>P</i>=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; <i>β</i>=.03, 95% CI 0.02-0.03; <i>P</i>=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. CONCLUSIONS Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.


Author(s):  
Leny Leny

ABSTRACT Prenatal care is health care by health personnel to care the pregnant according to standards. Worlrd Health Organization (WHO) estimates more than 500.000 women die during pregnancy or childbirth. Maternal mortality in Indonesia is 307 per 100,000 live births. The quantity of pregnant women’s visit in Kabupaten Banyuasin in 2009 of 89.1%. The purpose of this study to determine the relationship between education and occupation with prenatal care at Puskesmas Mariana  Kecamatan Banyuasin I Kabupaten Banyuasin in 2011. This study uses analytic approach survey by Cross Sectional methods, the population are 1.946 pregnant women and the samples as many as 332 people. The results of univariate analysis study of pregnant women who are higher education as much as 45.2%, and  low maternal education as much as 54.8%. In pregnant women who work of 43.4%, and pregnant women who do not work for 56.6%. From the results of bivariate analysis and Chi-Square statistical tests found a significant association between education of pregnant women with prenatal care with P Value = 0.000, and there was a significant association between occupation of pregnant women with prenatal care with P Value = 0.000. Can be concluded that there is a relationship between education and occupation of pregnant women with prenatal care. Expected to health workers to provide counseling on the importance of prenatal care in pregnant women and expected future studies may explore again the factors associated with prenatal care with the different variables.   ABSTRAK Pemeriksaan kehamilan adalah pelayanan kesehatan oleh tenaga kesehatan untuk memeriksakan ibu hamil sesuai standar. World Health Organization (WHO) memperkirakan lebih dari 500.000 ibu pertahunnya meninggal saat hamil atau bersalin. AKI di Indonesia 307 per 100.000 kelahiran hidup. Jumlah kunjungan ibu hamil di Kabupaten Banyuasin tahun 2009 sebesar 89,1%. Tujuan penelitian ini untuk mengetahui hubungan antara pendidikan dan pekerjaan dengan pemeriksaan kehamilan di Puskesmas Mariana Kecamatan Banyuasin I Kabupaten Banyuasin tahun  2011. Penelitian ini menggunakan metode survey analitik dengan pendekatan Cross Sectional, populasi ibu hamil dengan jumlah 1.946 orang dan jumlah sampel sebanyak 332 orang. Hasil penelitian Analisa Univariat adalah ibu hamil yang pendidikan tinggi sebanyak 45,2%, dan pendidikan rendah ibu hamil sebanyak 54,8%. Pada variabel pekerjaan ibu hamil yang bekerja sebesar 43,4%, dan ibu hamil yang tidak bekerja sebesar 56,6%. Dari hasil analisa bivariat dan uji statistik Chi-Square  didapatkan hubungan yang bermakna antara pendidikan ibu hamil dengan pemeriksaan kehamilan dengan  P Value = 0,000, dan ada hubungan yang bermakna antara pekerjaan ibu hamil dengan pemeriksaan kehamilan dengan P Value = 0,000. Dapat disimpulkan bahwa ada hubungan antara pendidikan dan pekerjaan ibu hamil dengan pemeriksaan kehamilan. Diharapkan kepada petugas kesehatan agar dapat memberikan penyuluhan tentang pentingnya pemeriksaan pada ibu hamil dan diharapkan penelitian yang akan datang dapat menggali lagi faktor-faktor yang berhubungan dengan pemeriksaan kehamilan dengan variabel yang berbeda.


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