The prevalence of a lack of prenatal care among administrative regions varied between 0. The risk factors identified must be considered when planning actions for the inclusion of women in prenatal care by both the central management and healthcare teams.
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These indicated the municipal areas with greater deficits in prenatal care. The reorganization of the actions to identify women with risk factors in the community can be considered to be a starting point of this process.
In addition, the integration of the activities of local programs that target the mother and child is essential to constantly identify pregnant women without prenatal care. Prenatal care aims to promote maternal and fetal health, monitor risk factors, and treat complications as early as possible. Prenatal care improves clinical and psychological outcomes in pregnancy and postpartum and decreases maternal and child morbidity and mortality.
Many initiatives have been adopted worldwide to provide universal access to adequate reproductive healthcare. In emerging countries such as Colombia and South Africa, this indicator is at Despite the increased coverage and nearly universal prenatal care, a percentage of the target population does not receive this assistance, depending on the level of regional development, access to healthcare services, and organization of the healthcare system.
Moreover, complications such as congenital syphilis, neonatal death, and preterm birth are strongly correlated with a lack of prenatal care. Most studies suggest that a lack of prenatal care is mainly a result of socioeconomic factors low family income and education , access to medical consultations large distance from the place of residence to the healthcare unit and transportation costs , quality of healthcare, and social support.
Considering the relevance of this issue for the development of public policies directed at maternal care during pregnancy, this study aimed to evaluate the factors associated with a lack of prenatal care in a large municipality. The eligibility criteria included women who resided in Pelotas without prenatal care and with live births between and The control group consisted of women who resided in Pelotas and without prenatal care and with live births during the same period.
During the study period, the municipal SINASC had full access to birth registries, which corresponded to 4, births in and 3, births in DNV were issued in triplicate shortly after childbirth in the healthcare unit where delivery occurred. The first form was collected by the Municipal Department of Health, following which it was revised and registered. In addition to DNV, the study used the Hospital Admission Authorization database from the municipality as a source of information.
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Three controls were selected for each case to increase the study power. For the selection of controls, cases and controls were arranged in ascending order of age and were randomly selected. The study included cases 74 in and in and controls in and in After variable selection for this study, the percentage of unknown data on age and place of residence was evaluated. In case of the lack of such information, a search was conducted in the Hospital Admission Authorization database after the approval by the Data Processing Center of the Municipal Department of Health.
The distance traveled on foot from the place of residence for the cases and controls to the nearest prenatal service of the primary healthcare PHC unit m was calculated using Google Earth TM software and Google Maps TM service. To perform the calculation, the addresses of the participants and PHC units in each district of residence were input into the software. Data analysis was performed using Stata software version Bivariate analyses were performed during crude analysis by crossing each variable for the cases and controls.
The variables were included in the adjusted model using two hierarchical levels: in the first level, distance between the place of residence and the nearest PHC unit, assistance model and occupation, level of education, and marital status; in the second level, parity and gestational age. After cases and controls were selected, the Hospital Admission Authorization database was consulted to identify the addresses of 3.
However, when analyzing the number of cases in relation to the total live births in each region, the prevalence of women without prenatal care increased in the regions of Areal, Porto, Center, and Praias Table 1. With regard to age, With regard to the distance between the place of residence and the nearest PHC unit, the highest prevalence of a lack of prenatal care was observed in the category to 1, m for the cases and controls. With regard to the assistance model of the healthcare unit, the nearest unit had a traditional healthcare model in more than Table 3 shows the crude and adjusted OR values for the independent variables.
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After model adjustment, being single had a significant and positive correlation with a lack of prenatal care. However, no significant correlation was found between a lack of prenatal care and distance between the place of residence and the nearest healthcare unit, assistance model, employment, and duration of gestation. The benefits of performing prenatal care have been extensively discussed in the scientific literature, and the most important factors are decreased maternal and infant mortality.
The municipality of Pelotas has offered an extensive network of primary care units since the s, amounting to 42 units in urban areas and 11 units in rural areas. Despite the adequate supply and high prenatal coverage, 1. In Brazil, during these years, the prevalence was 1. Single women had a threefold higher risk of not receiving prenatal care than married women. One hypothesis for this finding may be related to the results of other studies, wherein spousal support during pregnancy favored the adherence to prenatal care. In contrast, the lack of spousal support, along with low education of the mother, contributed to the lack of seeking prenatal care and the decreased number of consultations during pregnancy.
A lack of prenatal care was strongly correlated with the education level, which was considered one of the main factors associated with a lack of healthcare assistance in general. Increased education, in turn, contributed to the achievement of prenatal care even among those belonging to lower socioeconomic classes. The risk of not receiving prenatal care was twofold higher in multiparous women than in primiparous women. Previous studies have shown that nonprimiparous women and women without prior obstetric complications have a tendency of not receiving prenatal care, particularly those with a lack of family support, adverse social context, negative experience of healthcare, and perceptions of disapproval of prenatal care.
The duration of pregnancy was not associated with a lack of prenatal care. The data obtained from DNV classified by gestational age may have been a limiting factor in the accurate assessment of the relationship between preterm birth and a lack of prenatal care. Circuit Court for District Court for Manayunk Manhattan Army posts Commissioner's residence White House performances Willard Maryland Massachusetts Freeman Christa Peter Hiram Perkins Board of Elizabeths Hospital Army Army Headquarters Army Engineers International Tariff Commission Navy ships Attorney for the Eastern District of Attorney for the Western District of Circuit Court for the Eastern District of Circuit Court for the Western District of District Court for the Eastern District of District Court for the Western District of Territorial Court for