Page 32 - IJPS-10-3

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

A 2010 study in the state of Rio Grande do Sul, with Regarding the PHPN guidelines, 77.2% of women
1,228 women, observed adequacy in 64.6% (Zanchi et al., complied with the recommendation to start prenatal care
2013). Such studies were carried out at the beginning of before 12 weeks of pregnancy, and 87.3% carried out more
the last decade and, especially before the implementation than six prenatal physician office visits, above the average
of the PHPN (Mario et al., 2019), which represented a of other studies (Camargo et al., 2021; Martin et al., 2022;
great development of prenatal care in Brazil and can be Oliveira et al., 2021), exceeding the MoH recommendations.
associated with the best results achieved in this study. Tomasi et al. (2022) verified these findings in a national
study spanning 2012, 2014, and 2018, reporting a decline
The APNCU index (Kotelchuck, 1994) was developed
to compare populations with varying recommendations in the proportion of women attending six or more visits
over time, with 89.1%, 84.3%, and 77.8%, respectively, and
regarding the frequency and timing of the beginning of that the highest rates were observed in the Southern region
prenatal care. This index is not widely used in national of the country (Tomasi et al., 2022), consistent with our
research; however, it is important to compare it with study.
international studies (Kotelchuck, 1994). With the adapted
APNCU index (Kotelchuck, 1994), 74.4% of the prenatal There was a trend in the reduction of supplementary
care cases were classified as very adequate, along with 5.5% examinations during the prenatal period, falling from
as adequate, totaling 79.9% adequacy. 70% completed examinations in the first trimester to 38%
in the third trimester. In São José, Santa Catarina, the
Using this same index, a study carried out in Aracaju, municipality’s recommendation of a greater number of
Northeast Brazil, found adequate/very adequate prenatal laboratory examinations compared to MoH indications
care in 66.1% of the cases, with a 26.8% level of inadequacy resulted in even lower completion values. A study carried
in prenatal care cases (Ribeiro et al., 2009). The recent studies out in the state of Minas Gerais, in the Southeast region of
conducted in America, where the index was developed, Brazil, also observed this decline, with 31.2% of the routine
demonstrate similar results to our study findings (Osterman examinations completed in the first trimester and a mere
& Martin, 2018; Manjavidze et al., 2020). This suggests that 4.3% in the third trimester (Camargo et al., 2021).
the southern region of Brazil, despite being a region within
a developing country with high maternal morbidity and It is pertinent to investigate whether these examinations
mortality rates, exhibits a prenatal quality level comparable were indeed not performed or if the data reflect an
to developed countries. However, there is no homogeneity underreporting throughout pregnancy. Regardless of the
across different regions of this country, with the North region cause, the consequence is poorly conducted prenatal care,
reporting the lowest adequacy rates (Mario et al., 2019). with examinations either not being released by the health
A study in Amapá state in the North of Brazil confirmed this system or patients’ lack of commitment during pregnancy.
discrepancy, where only 43.3% of prenatal care was adequate In Sergipe (Northeast region), 65% of pregnant women
(Nemer et al., 2021). Furthermore, the analysis carried out performed all the required examinations; however, the
with the SINASC data in Rio de Janeiro, in the Southeast study was carried out by population interview outside the
region, from 2015 and 2016, revealed even lower adequacy puerperium period, potentially introducing memory bias
values (31.55%) (Vale et al., 2021). (Oliveira & Cavalcanti Filho, 2021).
Anversa et al. (2012) stratified the quality of prenatal According to data collected from the pregnant women’s
care by adding more variables to the assessment and, with booklet, 15 – 37.6% of them lacked records of double
the advancement of the levels (from 1 to 4), the assessment tetanus immunization for adults (dT) and hepatitis B
of prenatal care becomes stricter. As shown in our study, vaccination, reflecting a degree of incompleteness similar
as the requirements increase, the quality of prenatal care to findings in another study, where 32.8% of the subjects
decreases: 83.1% of adequacy was found in the first level did not have tetanus vaccination records (Vaichulonis et al.,
– a value similar to the Kessner index modified by Takeda 2021). In a national study from 2018, 90.4% of the subjects
(1993), but 48.5% in level 4, which includes clinical and reported complete tetanus vaccine data; however, this relied
laboratory examinations. In the State of Espírito Santo on participants’ self-reports, without direct verification
(Southeast region), a study conducted between the years (Tomasi et al., 2022). This fragility regarding immunization
2013 and 2014 with 5030 women, corresponding to about among pregnant women is due to different factors such
half of the pregnant women for the period in the State, as maternal socioeconomic conditions, insufficient
revealed a higher prevalence of inadequate prenatal care: information during prenatal visits, and resources and
for level 4, prenatal care was considered adequate in 0.16%, infrastructure deficits (Pedraza & Gomes, 2021).
intermediate in 33.06%, and inadequate in 66.78% of the Regarding prescriptions, iron and folic acid
cases (Maia et al., 2017). supplementation was recommended in 77.6% of patients,

Volume 10 Issue 3 (2024) 26 https://doi.org/10.36922/ijps.1422