Qualidade da atenção pré-natal na rede básica de saúde do Brasil: indicadores e desigualdades sociais

Abstract

The aim of this study was to describe quality indicators for prenatal care in Brazil as part of the Program for the Improvement of Access and Quality (PMAQ-AB). The study analyzed number of prenatal visits, vaccination status, prescription of ferrous sulfate, physical examination, orientation, and laboratory tests, based on which a summary quality indicator was constructed. Data were collected in 2012-2013 during interviews conducted by External Evaluators of the PMAQ-AB, with 6,125 users who had done their last prenatal follow-up in Family Health units. During prenatal follow-up, 89% reported six or more visits, more than 95% received a tetanus booster and prescription of ferrous sulfate, 24% reported having received all the procedures in the physical examination, 60% received all the orientation, and 69% had all the recommended laboratory tests. Only 15% of interviewees had received adequate prenatal care, including all the recommended measures, and there was a significantly higher proportion of "complete" care in pregnant women that were older, with higher income, in the Southeast region of Brazil, in municipalities with more than 300,000 inhabitants, and in those with (HDI) in the upper quartile. There are persist social and individual inequalities that can be targeted by measures to upgrade the teams' work processes.

Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais

“…Prenatal care plays an important role in negative pregnancy outcomes and reflects the mother's social, economic, and psychological conditions. According to a comprehensive analysis of quality indicators for prenatal care in Brazil, 15% of pregnant women receive adequate prenatal care and 60% receive all the recommended orientation and complementary tests 15 . Their living conditions and emotional and affective vulnerabilities can influence their knowledge on health during pregnancy 8,13,27,28…”

“…Another aspect in parallel is that families headed by women result partly from early or unwanted pregnancy, family instability, and abandonment 14 . The social vulnerability experienced by women may also be associated with a degree of emotional vulnerability involving feelings of abandonment, violence, and disempowerment which fails to ensure the conditions for adequate prenatal care and access to medicines 15 . Unplanned pregnancy is associated with smoking during pregnancy, using less folic acid, late initiation of prenatal care, and interruption of pregnancy 16 .…”

<b> Produção das equipes da Estratégia Saúde da Família antes e após a implantação do PMAQ-AB / Production of the Family Health Strategy teams before and after the implementation of PMAQ-AB

“…Um estudo que descreveu os indicadores de qualidade da atenção pré-natal no Brasil no âmbito do PMAQ-AB mostrou que, das 6.125 gestantes entrevistadas que fizeram seu último pré-natal nas unidades de saúde da família, apenas 15% receberam atenção pré-natal adequada. Esse percentual revela que são necessárias ações de qualificação dos processos de trabalho das eSFs visando minimizar as desigualdades sociais e individuais que ainda persistem nos serviços de saúde (17) . O cadastro e acompanhamento da maior parte das gestantes da área de abrangência é uma ação que auxilia o planejamento das ações desenvolvidas pelas eSFs na atenção à saúde da mulher.…”

“…Na perspectiva de atenção integral, os cuidados prestados ao binômio mãe-filho devem ser realizados pela equipe multiprofissional que atua nas UBSs. O acolhimento da mulher e de sua família obterá melhores resultados se houver condições de acessibilidade, estímulo à permanência e ao vínculo, qualificação dos profissionais e capacitação das eSFs, especialmente quanto ao gerenciamento do território e dos protocolos de risco (17)(18) . No período avaliado, o único indicador relacionado ao diabetes que apresentou decréscimo foi o de proporção de diabéticos cadastrados acompanhados por ACS no G1.…”

Determinantes sociais da saúde na consulta de enfermagem do pré-natal*

“…19 Low education and socioeconomic conditions stand out as factors that interfere with maternal health and may cause damage to the quality of prenatal care, as they increase the obstetric risk and hinder women's adherence, which contributes to the inadequacy of the process of prenatal care. 20 The prenatal performance is also influenced by culture, because pregnancy symbolizes a complex and unique phenomenon, which directly interacts with culture, therefore, nurses should work with pregnant women respecting these values and beliefs that each brings with them. Decisions during prenatal and postpartum are linked to culture, lifestyle and the influence of society.…”