Page 29 - IJPS-10-3

International Journal of
Population Studies Prenatal care in Santa Catarina, Brazil

criteria became stricter. Adequacy of prenatal care ranged the basic recommendations of the MoH regarding the
from 83.1% according to the Kessner index modified by number of prenatal visits and the beginning of follow-up.
Takeda (1993) and classification by Anversa et al. (2012) at However, only two of the 237 prenatal records reviewed
level 1, to 79.9% according to the adapted APNCU index fulfilled all requirements. The municipality of São José
(Kotelchuck, 1994). However, this percentage decreased to employs a guideline for complementary examinations (São
48.5% at level 4 of the Anversa et al. classification (2012). José, 2015) that are more comprehensive than that of the
The relationship between the adequacy of prenatal care MoH, and only nine women performed all of them, while
according to various indices used and sociodemographic 50 of them (21.1%) completed all laboratory examinations
variables, habits, and clinical data is illustrated in indicated by the MoH.
Tables 4 and 5. Age was a determinant in the outcome An integrative review carried out from 2012 to 2018
of adequate prenatal care according to the APNCU index highlighted the lack of uniformity in the method used
and classification by Anversa et al. (2012) at level 4 to assess the quality of prenatal care in Brazil (Cruz
(Table 4). For the Kessner index adapted by Takeda et al., 2019). According to validated criteria, the best
(1993), after adjusting for education and HRPN (Table 5), evaluation category for each index yielded different
women aged over 35 years exhibited a higher prevalence results, contributing to discrepancies in populations from
of adequacy (adjusted PR = 1.17, 95% CI 1.05; 1.30), nearby regions or those following the same guidelines. In
as well as for the adapted APNCU index (Kotelchuck, the state of Rio de Janeiro, a study that used the Sistema
1994) (adjusted PR = 1.2, 95%, CI 1.08; 1.36). For the de Informação de Nascidos Vivos (SINASC, Live Birth
classification by Anversa et al. (2012) at level 4, younger Information System) data for the years 2015 and 2016
women (age <20 years) had a 53% higher prevalence of discovered that 80.88% of prenatal care was adequate
adequacy compared to those aged 20 – 34 years (adjusted according to the Kessner index modified by Takeda (1993),
PR = 1.53, 95% CI 1.18; 1.97). while a lower rate was obtained when using the APNCU
index (Kotelchuck, 1994), with only 31.55% of prenatal
Regarding education, after fit analysis, having 12 years care procedures deemed adequate and very adequate (Vale
or more of schooling increased the prevalence of adequacy et al., 2021).
by 33% for the Kessner index adapted by Takeda (1993).
Referral to HRPN revealed an influence on the quality of A study carried out from October to December 2020
prenatal care across all indices, with a 20 – 30% higher during the COVID-19 pandemic in Florianópolis, a city
prevalence of adequacy (Table 5). located in the same micro-region and with a protocol
similar to the municipality of São José, found that 35.8%
Pregnancy planning was associated with an increased of prenatal care was adequate, with 46.8% considered
proportion of adequacy in both the Kessner index modified intermediate, and 17.4% inadequate according to the
by Takeda (PR = 1.22, 95% CI 1.10; 1.36) and the adapted Kessner index (Martin et al., 2022; Kessner et al., 1973). In
APNCU index (PR = 1.28, 95% CI 1.13; 1.45) (Table 5). a previous study carried out in São José (Pilau et al., 2014)
In the binary analysis, previous smoking worsened in 2013, prenatal care was inadequate in 77.1% of pregnant
the outcome of adequate prenatal care according to the women and partially adequate in the others; in other
Anversa classification at level 4 (Table 4); however, after words, none was considered adequate. This difference,
adjusting the variables, this interference did not persist despite an 8-year span, was probably due to the different
(Table 5), even with the use of other adjustment variables analysis methods, as the previous study only considered
in additional models tested (Table A1). prenatal care meeting all recommendations as adequate.

4. Discussion In our study, 83.1% of prenatal care cases were
considered adequate according to the modified Kessner
In this study, we evaluated the quality of prenatal care for index by Takeda (1993). This finding is in line with findings
women in the city of São José, Santa Catarina, who delivered from the 2013 National Health Survey, a household survey
at the local maternity hospital (HRSJ) under the SUS. The carried out by the IBGE in conjunction with the MoH and
adequacy of prenatal care ranged from 48.5 to 83.1%, Fiocruz, which reported that the adequacy of prenatal care
according to the various normative criteria used, and was was 80.6% in Brazil, 86.3% in the Southeast region, 82.7%
associated with older maternal age and education, referral in the Southern region, 80% in the Midwest, 76.1% in the
to HRPN, and pregnancy planning. Using more variables Northeast, and 69.5% in the Northern region (Mario et al.,
and stricter criteria, as in the classification by Anversa 2019). A study conducted in the state of Minas Gerais in
et al. (2012) at level 4, naturally resulted in lower adequacy 2011 with 200 pregnant women found 67.7% adequacy
rates. It was found that more than 75% of the women met and 32.4% intermediate adequacy in prenatal care cases.

Volume 10 Issue 3 (2024) 23 https://doi.org/10.36922/ijps.1422