Assessing the Quality of Prenatal Care Received by Women in Vespasiano, Brazil Público

Abstract

Background: The adequacy of prenatal care (PNC) is often assessed through the timing of initiation and number of visits. Few studies have assessed the adequacy of PNC in terms of the quality or content of care received.

Goal: The goal of this study was to identify variations in and predictors of inadequate care through self-reports of recommended PNC procedures received by women in Vespasiano, Brazil between October 2009 and September 2010.

Methods: A total of 252 women who received PNC between October 2009 and September 2010 were surveyed on demographic characteristics and information about their pregnancy and PNC. Reliability of self-reported data was assessed by a comparison with data recorded on PNC cards. The outcome was self-reported receipt of 11 recommended procedures, a proxy for the quality of PNC received. Factors associated with self-reported procedures were assessed. Additionally, factors associated with the client's satisfaction with PNC were assessed as an overall index of the quality of services received.

Results: Agreement between self-reported receipt of procedures and procedures listed on prenatal care cards (blood pressure, blood analyses, urine analysis, uterine height) was high. Self-reported receipt of specific procedures varied among women. Whereas measurements such as blood pressure (100%) and urine analysis (97%) were reported almost universally, procedures including mammograms (35%) and pap smears (17%) were reported by fewer women. Enrollment in Bolsa, Brazil's social welfare program, and the frequency of community health worker (CHW) visits was positively associated with reported receipt of PNC procedures. The odds of receiving specific procedures were lower among women with lower versus higher educational attainment. Women who reported receiving more frequent CHW visits were more likely to be satisfied; whereas women who identified barriers to care were less likely to be satisfied with the care they received.

Conclusion: The quality of PNC received by women in Vespasiano varied in reported content and satisfaction with care, especially by socioeconomic status, enrollment in Bolsa, utilization of private care, and frequency of CHW visits.

Implication: Evaluating PNC based on the content of care received and satisfaction can better inform strategies to improve the quality of PNC than simply the number and timing of PNC visits.

Table of Contents

Table of Contents

CHAPTER #1: INTRODUCTION................................................................................... 1

Background.................................................................................................................... 1

Theoretical Framework................................................................................................. 2

Study Site....................................................................................................................... 5

Study Goal and Aims.................................................................................................... 5

Significance................................................................................................................... 6

CHAPTER #2: REVIEW OF THE LITERATURE........................................................... 9

CHAPTER #3: METHODS............................................................................................ 25

Study Population......................................................................................................... 25

Study Instrument and Data Collection..................................................................... 26

Reliability of Prenatal Care Recall.......................................................................... 27

Data Quality................................................................................................................ 27

Outcome Variables..................................................................................................... 28

Exposure Variables and Covariates........................................................................... 28

Data Analysis............................................................................................................... 29

CHAPTER #4: RESULTS............................................................................................... 31

Characteristics of the Population............................................................................. 31

Pregnancy and Prenatal Care.................................................................................... 31

Recall Reliability........................................................................................................ 32

Receipt of Prenatal Care Procedures........................................................................ 32

Satisfaction with Prenatal Care................................................................................ 34

CHAPTER #5: DISCUSSION....................................................................................... 35

Findings........................................................................................................................ 35

Strengths and Limitations......................................................................................... 40

Implications, Recommendations, and Conclusions................................................ 41

REFERENCES................................................................................................................. 44

TABLES............................................................................................................................ 49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	prenatal care quality satisfaction maternal and child health Brazil content
Committee Chair / Thesis Advisor	Yount, Kathryn, Emory University
Committee Members	Leon, Juan, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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