Inadequate Prenatal Care Utilization: Late Initiation and Inadequate Subsequent Visits in Vespasiano, Brazil Open Access

Abstract

BACKGROUND: Risk factors for poor uptake of prenatal care are often assessed
with indexes that measure overall prenatal care utilization, but few studies assess
if risk factors for late initiation of prenatal care differ from risk factors for poor
continuation of visits after initiation.
GOAL: To evaluate the risk factors for inadequate prenatal care usage when
comparing the adequacy of prenatal care utilization to its two components,
defined as the adequacy of initiation and the adequacy of subsequent visits.
METHODS: 252 women that received prenatal care in Family Health Units-
Vespasiano, Brazil, between October 2009 and September 2010, were surveyed
about demographic characteristics and their pregnancy. Timing of initiation was
available from participant recall and from the prenatal health information system
(SISPRENATAL). Both data sources were used to assign women to outcome
variables (inadequate initiation, inadequate subsequent visits and inadequate
prenatal care utilization). Factors associated with concordant assignments to the
adequacy of initiation were assessed. Then factors associated with the outcome
variables were assessed.
RESULTS: When comparing recall to SISPRENATAL, there was a fair level of
agreement for assignments to the adequacy of initiation (K=0.35, 95% CI:0.22-
0.48). Concordant assignments were more likely with a shorter recall period,
higher household wealth and non-use of the private sector. Participant recall for
the timing of initiation was used in analysis because, unlike SISPRENATAL, it
captured private sector visits. Of the included women, approximately 30% had
inadequate initiation, 10% had inadequate subsequent visits and 36% had
inadequate overall prenatal care utilization. Not living with a partner was
associated with inadequate subsequent visits (aOR=2.95; 95% CI: 1.01-8.64) but
not significantly associated with inadequate initiation or with inadequate overall
prenatal care utilization. Black skin color was associated with inadequate overall
prenatal care utilization (aOR=2.59; 95% CI:1.26-5.34) but not significantly
associated with initiation or subsequent visits.
CONCLUSIONS: Assessment of the risk factors for late initiation and the risk
factors for poor continuation of prenatal visits can add useful information to
traditional analysis that use summary measures of overall prenatal visitation.
IMPLICATIONS: This evaluation method can help inform the design of
interventions to increase performance of prenatal care visits.

Table of Contents

Table of Contents

• ROLE IN THESIS
• INTRODUCTION AND LITERATURE REVIEW
  • Health Impact of Antenatal Care
  • International Recommendations for Antenatal Care Visits
  • Evaluating Antenatal Care Visit Number
  • Utilization of Antenatal Care in Brazil
  • Brazilian Adaptations of the Utilization Indices
  • Sociodemographic and Behavioral Risk Factors in Brazil
  • Study Site
  • Goals
  • Significance
• METHODS
  • Study
  • Sampling Strategy
  • Recruitment and Consent
  • Independent Variables
  • Outcome Variables
  • Data Quality
  • Data Analysis
• RESULTS
  • Characteristics of the Population
  • Comparison of Timing of Inititiation between SISPRENATAL and Recall
  • Factors Associated with Uptake of Prenatal Care
• DISCUSSION
  • Prevalence of Inadequate Usage
  • Participant Recall Compared to SISPRENATAL
  • Potential Risk Factors According to the Outcome Variables
  • Strengths and Limitations
• IMPLICATIONS AND RECOMMENDATIONS
  • Implications
  • Recommendations
• APPENDIX
• REFERENCES

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Public Health
Keyword	prenatal care adequacy of received services utilization community health workers antenatal Brazil prenatal
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Committee Members	Rochat, Roger, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) University, college or educational institution (other than Emory)

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