Brazil Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):466-472
DOI 10.1590/S0100-72032012001000006
PURPOSES: To elaborate models for the estimation of fetal weight and longitudinal reference intervals of estimated fetal weight (EFW) using a sample of the Brazilian population. METHODS: Prospective observational study. Two groups of patients were evaluated: Group EFW (estimation of fetal weight): to elaborate (EFW-El) and validate (EFW-Val) a model for the prediction of fetal weight; Group LRI (longitudinal reference intervals): To elaborate (LRI-El) and validate (LRF-Val) conditional (longitudinal) percentiles of EFW. Polynomial regression analysis was applied to the data from subgroup EFW-El to elaborate a model for the estimation of fetal weight. The performance of this model was compared to those of previously published formulas. Linear mixed models were used for the elaboration of longitudinal reference intervals of EFW using data from subgroup LRI-El. Data obtained from subgroup LRI-Val were used to validate these intervals. RESULTS: Group EFW consisted of 458 patients (EFW-El: 367; EFW-Val: 91) and Group LRI consisted of 315 patients (LRI-El: 265; LRI-Val: 50). The model obtained for EFW was: EFW=-8.277+2.146xBPDxACxFL-2.449xFLxBPD². The performances of other models were significantly worse than those obtained with our formula. Equations for the prediction of conditional percentiles of EFW were derived from the longitudinal observation of patients of subgroup LRI-El and validated with data from subgroup LRI-Val. CONCLUSIONS: We described a method for customization of longitudinal reference intervals of EFW obtained using formulas generated from a sample of the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(10):466-472
DOI 10.1590/S0100-72032012001000006
PURPOSES: To elaborate models for the estimation of fetal weight and longitudinal reference intervals of estimated fetal weight (EFW) using a sample of the Brazilian population. METHODS: Prospective observational study. Two groups of patients were evaluated: Group EFW (estimation of fetal weight): to elaborate (EFW-El) and validate (EFW-Val) a model for the prediction of fetal weight; Group LRI (longitudinal reference intervals): To elaborate (LRI-El) and validate (LRF-Val) conditional (longitudinal) percentiles of EFW. Polynomial regression analysis was applied to the data from subgroup EFW-El to elaborate a model for the estimation of fetal weight. The performance of this model was compared to those of previously published formulas. Linear mixed models were used for the elaboration of longitudinal reference intervals of EFW using data from subgroup LRI-El. Data obtained from subgroup LRI-Val were used to validate these intervals. RESULTS: Group EFW consisted of 458 patients (EFW-El: 367; EFW-Val: 91) and Group LRI consisted of 315 patients (LRI-El: 265; LRI-Val: 50). The model obtained for EFW was: EFW=-8.277+2.146xBPDxACxFL-2.449xFLxBPD². The performances of other models were significantly worse than those obtained with our formula. Equations for the prediction of conditional percentiles of EFW were derived from the longitudinal observation of patients of subgroup LRI-El and validated with data from subgroup LRI-Val. CONCLUSIONS: We described a method for customization of longitudinal reference intervals of EFW obtained using formulas generated from a sample of the Brazilian population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(9):432-437
DOI 10.1590/S0100-72032012000900008
PURPOSE: To verify the coverage, by Pap testing, of older women and the associated factors. METHODS: A population-based study was conducted by home interviews. The inclusion criteria were women aged 60 and over, living on the north side of the city of Juiz de Fora, Minas Gerais, Brazil, self-sufficient to answer the questionnaire or having someone to answer on their behalf. The interview consisted of sociodemographic questions, regarding the general health of the older women, and preventive practices in women's health. The selection was made by random sampling, stratified and clustered in multiple stages. To analyze associated factors, a theoretical model was formulated with three hierarchical blocks of variables, adjusted to each other in each block. The variables that had a level of significance of 0.2 or less were included in the Poisson regression model and adjusted to their next highest level (p<0.1). RESULTS: Pap testing occurred in 84.1% of cases (95%CI 79.0-88.4). Based on multivariate regression analysis, three variables remained significantly associated with access to Pap testing: the marital status "without partner" (older women who were single, widowed, separated or divorced), self-sufficiency to perform Instrumental Activities of Daily Living (IADLs) and adherence to mammography. In the interblock analysis these variables remained significantly associated with the outcome variable, and self-sufficiency for IADLs had the highest association. CONCLUSIONS: Among the older women comprising the study sample, was observed variation in the use of Pap testing. An adjustment of public health policies towards the formulation of policies giving priority to universal preventive care may be an alternative to solve the disparities observed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(9):432-437
DOI 10.1590/S0100-72032012000900008
PURPOSE: To verify the coverage, by Pap testing, of older women and the associated factors. METHODS: A population-based study was conducted by home interviews. The inclusion criteria were women aged 60 and over, living on the north side of the city of Juiz de Fora, Minas Gerais, Brazil, self-sufficient to answer the questionnaire or having someone to answer on their behalf. The interview consisted of sociodemographic questions, regarding the general health of the older women, and preventive practices in women's health. The selection was made by random sampling, stratified and clustered in multiple stages. To analyze associated factors, a theoretical model was formulated with three hierarchical blocks of variables, adjusted to each other in each block. The variables that had a level of significance of 0.2 or less were included in the Poisson regression model and adjusted to their next highest level (p<0.1). RESULTS: Pap testing occurred in 84.1% of cases (95%CI 79.0-88.4). Based on multivariate regression analysis, three variables remained significantly associated with access to Pap testing: the marital status "without partner" (older women who were single, widowed, separated or divorced), self-sufficiency to perform Instrumental Activities of Daily Living (IADLs) and adherence to mammography. In the interblock analysis these variables remained significantly associated with the outcome variable, and self-sufficiency for IADLs had the highest association. CONCLUSIONS: Among the older women comprising the study sample, was observed variation in the use of Pap testing. An adjustment of public health policies towards the formulation of policies giving priority to universal preventive care may be an alternative to solve the disparities observed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(5):235-242
DOI 10.1590/S0100-72032012000500008
PURPOSE: To evaluate the survival and complications associated with prematurity of infants with less than 32 weeks of gestation. METHODS: It was done a prospective cohort study. All preterm infants with a gestational age between 25 and 31 weeks and 6 days, born alive without congenital anomalies and admitted to the NICU between August 1st, 2009 and October 31st, 2010 were included. Newborns were stratified into three groups: G25, 25 to 27 weeks and 6 days; G28, 28 to 29 weeks and 6 days; G30, 30 to 31 weeks and 6 days, and they were followed up to 28 days. Survival at 28 days and complications associated with prematurity were evaluated. Data were analyzed statistically by c² test, analysis of variance, Kruskal-Wallis test, odds ratio with confidence interval (CI) and multiple logistic regression, with significance set at 5%. RESULTS: The cohort comprised 198 preterm infants (G25=59, G28=43 and G30=96). The risk of death was significantly higher in G25 and G28 compared to G30 (RR=4.14, 95%CI 2.23-7.68 and RR=2.84, 95%CI: 1.41-5.74). Survival was 52.5%, 67.4% and 88.5%, respectively. Survival was greater than 50% in preterm >26 weeks and birth weight >700 g. Neonatal morbidity was inversely proportional to gestational age, except for necrotizing enterocolitis and leukomalacia, which did not differ among groups. Logistic regression showed that pulmonary hemorrhage (OR=3.3, 95%CI 1.4-7.9) and respiratory distress syndrome (OR=2.5, 95%CI 1.1-6.1) were independent risk factors for death. There was a predominance of severe hemorrhagic brain lesions in G25. CONCLUSION: Survival above 50% occurred in infants with a gestational age of more than 26 weeks and >700 g birth weight. Pulmonary hemorrhage and respiratory distress syndrome were independent predictors of neonatal death. It is necessary to identify the best practices to improve the survival of extreme preterm infants.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(9):234-239
DOI 10.1590/S0100-72032011000900003
PURPOSE: To analyze comparatively the conditions of birth in Portugal and Brazil from 1975 to 2007. METHODS: Indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the Unified Health System (DATASUS) and the National Institute of Statistics of Portugal (INE), among others. Their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. RESULTS: Births in Portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to Brazil, considering the average of the years from 2004 to 2007. The history of the conquest of maternal and child indicators of excellence in Portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. In Brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. The historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. Despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in Portugal and 45.5% in Brazil), considering the average for the period from 2004 to 2007. CONCLUSION: The indicators of maternal and neonatal death in Portugal and Brazil have aligned themselves to social, economic and contributions of public investments in health. The increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(3):105-111
DOI 10.1590/S0100-72032010000300002
PURPOSE: to evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. METHODS: this was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortion's experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. RESULTS: the prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. CONCLUSIONS: the non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(3):105-111
DOI 10.1590/S0100-72032010000300002
PURPOSE: to evaluate the prevalence of spontaneous and induced abortion reported by a sample of Brazilian women interviewed in the National Demographic Health Survey of 1996. METHODS: this was a secondary analysis of the Brazilian DHS-96 database, with information from interviews with a representative sample of 12,612 women about their reproductive life, focusing on the prevalence of spontaneous and induced abortion in the last five years and the associated factors for the various regions of the country and for Brazil as a whole. The sampling method was implemented with a strategy selection in two stages, one for the households and the other for women. The prevalence of spontaneous and induced abortion was estimated for Brazil and regions, and the socio-demographic characteristics of the women were analyzed as a function of the abortion's experience. A multinomial regression model analysis was used for the identification of factors independently associated with both types of abortion; their OR and respective 95% CI are reported. RESULTS: the prevalence of reported spontaneous abortion was 14% and the prevalence of induced abortion was 2.4% for the country as a whole. The state with the highest prevalence of induced abortion was Rio de Janeiro with 6.5%, followed by the Northeast region with 3.1%. The places with the lowest prevalence were the state of São Paulo and the South region. Both spontaneous and induced abortion showed higher prevalences with increasing age of the women studied. Being from the urban area (OR=1.5; 95%CI=1.0-2.3), having had more than one live child (OR=2.2; 95%CI=1.5-3.2) and being non-white (OR=1.4; 95%CI=1.0-1.8) were the main risk factors for induced abortion. CONCLUSIONS: the non-modifiable risk factors for induced abortion identified in this study indicate the need for improvement of educational and contraceptive actions, with priority for these specific demographic groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):17-21
DOI 10.1590/S0100-72032009000100004
PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(1):17-21
DOI 10.1590/S0100-72032009000100004
PURPOSE: to evaluate risk factors for the development of genital prolapse in the Brazilian population. METHODS: case-control study involving 316 patients submitted to prolapse staging, according to the pelvic organ prolapse quantification system. The patients were divided into two groups: in the Case Group there were 107 patients with prolapse at stage III or IV, and in the Control Group, 209 women at stage 0 or I. In the anamnesis, the selected women have been questioned about the presence of possible risk factors for genital prolapse, such as: age, menopause age, parturition, delivery type (vaginal, caesarean section or forceps), occurrence of fetal macrosomia, family history of genital dystopia in first degree relatives, chronic cough and intestinal constipation. RESULTS: The variables that were different between the groups were: age, body mass index, parturition, number of vaginal, caesarean section or forceps deliveries, newborn weight and positive family history for prolapse. Race, menopause age, chronic cough and intestinal constipation did not present differences between the groups. After logistic regression, only three variables have been shown to be independent risk factors: presence of at least one vaginal delivery, fetal macrosomia and positive family history for dystopia. Cesarean section was shown to be a protective factor. CONCLUSION: in the Brazilian population, the independent risk factor for genital prolapse were: personal antecedent of at least one vaginal delivery, fetal macrosomia and family history of dystopia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):614-619
DOI 10.1590/S0100-72032008001200005
PURPOSE: This paper has aimed at estimating the prevalence of infections by Chlamydia trachomatis and by Neisseria gonorrhoeae in pregnant women from six Brazilian cities, identifying its association with socio-economical and demographic variables. METHODS: This study has been part of a multicentric nationwide transversal research, with samples of pregnant women attended from 2004 to 2005 in basic attention pre-natal services from six Brazilian cities (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo and Porto Alegre). Cervico-vaginal samples have been collected from all the pregnant women, and have afterwards been submitted to the hybrid capture technique in order to identify chlamydia and gonococcus. Socio-demographic, medical, sexual and obstetric information have been collected through specific questionnaires. The Odds Ratio (OR) has been used to evaluate risk factors associated to infection by gonorrhea and chlamydia. Statistical analysis has been done with the t-Student, χ2 and Fisher's exact tests. RESULTS: Three thousand and three pregnant women with an average age of 23.8 years old (±6.9) took part in the study. Infection prevalence by chlamydia and gonococcus were 9.4 and 1.5, respectively. Ten per cent of the pregnant women with chlamydia have presented gonococcus simultaneously. The risk of presenting one of those infections was two times higher for the women under 20. The infection main predictors have been: age under 20, race/black, single/separated and report of over one partner in the previous year. CONCLUSIONS: This study has observed high prevalence of infection by Chlamydia trachomatis and by Neisseria gonorrhoeae in Brazilian pregnant women. The main risk factor for the infection has been to be under 20 years old.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(12):614-619
DOI 10.1590/S0100-72032008001200005
PURPOSE: This paper has aimed at estimating the prevalence of infections by Chlamydia trachomatis and by Neisseria gonorrhoeae in pregnant women from six Brazilian cities, identifying its association with socio-economical and demographic variables. METHODS: This study has been part of a multicentric nationwide transversal research, with samples of pregnant women attended from 2004 to 2005 in basic attention pre-natal services from six Brazilian cities (Manaus, Fortaleza, Goiânia, Rio de Janeiro, São Paulo and Porto Alegre). Cervico-vaginal samples have been collected from all the pregnant women, and have afterwards been submitted to the hybrid capture technique in order to identify chlamydia and gonococcus. Socio-demographic, medical, sexual and obstetric information have been collected through specific questionnaires. The Odds Ratio (OR) has been used to evaluate risk factors associated to infection by gonorrhea and chlamydia. Statistical analysis has been done with the t-Student, χ2 and Fisher's exact tests. RESULTS: Three thousand and three pregnant women with an average age of 23.8 years old (±6.9) took part in the study. Infection prevalence by chlamydia and gonococcus were 9.4 and 1.5, respectively. Ten per cent of the pregnant women with chlamydia have presented gonococcus simultaneously. The risk of presenting one of those infections was two times higher for the women under 20. The infection main predictors have been: age under 20, race/black, single/separated and report of over one partner in the previous year. CONCLUSIONS: This study has observed high prevalence of infection by Chlamydia trachomatis and by Neisseria gonorrhoeae in Brazilian pregnant women. The main risk factor for the infection has been to be under 20 years old.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):24-31
DOI 10.1590/S0100-72032006000100005
PURPOSE: to verify the coverage and factors associated with Papanicolaou (Pap) testing in Londrina (PR), Brazil. METHODS: this is a cross-sectional study, carried out in 2004, in microareas of five Basic Health Units (BHU) of Londrina. One or two microareas from each BHU were selected and a list of all women aged 20-59 years resident in these places, was made through search in the Basic Attention Information System, the women being then visited and interviewed. Those with a Pap test in the last three years were considered as having an updated examination, and the remaining as delayed. The association of some factors with the examination situation was investigated. Data analysis was performed using Epi-Info 6.04d. RESULTS: Pap smear coverage among the 513 participants of the study was 80.7%, ranging from 71.5% to 88.4%. Delay in taking the test was higher (p<0.05) among women who worked only at home (22.4% as compared with 14.3% among those who worked outside), and among those who belonged to D/E social classes (24.9%) as compared to C (17.5%) and A/B (8.3%) classes. The proportion who ignored the next test date was higher (p<0.01) among those who had the last Papanicolaou testing at a BHU (14.7%), as compared to those who had been attended privately or by a health insurance company (5.8%). CONCLUSION: the coverage of Pap smear in the studied areas can be considered satisfactory, although there is a need of improving compliance with Pap test, mainly among women who are the poorest and who work only at home.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(1):24-31
DOI 10.1590/S0100-72032006000100005
PURPOSE: to verify the coverage and factors associated with Papanicolaou (Pap) testing in Londrina (PR), Brazil. METHODS: this is a cross-sectional study, carried out in 2004, in microareas of five Basic Health Units (BHU) of Londrina. One or two microareas from each BHU were selected and a list of all women aged 20-59 years resident in these places, was made through search in the Basic Attention Information System, the women being then visited and interviewed. Those with a Pap test in the last three years were considered as having an updated examination, and the remaining as delayed. The association of some factors with the examination situation was investigated. Data analysis was performed using Epi-Info 6.04d. RESULTS: Pap smear coverage among the 513 participants of the study was 80.7%, ranging from 71.5% to 88.4%. Delay in taking the test was higher (p<0.05) among women who worked only at home (22.4% as compared with 14.3% among those who worked outside), and among those who belonged to D/E social classes (24.9%) as compared to C (17.5%) and A/B (8.3%) classes. The proportion who ignored the next test date was higher (p<0.01) among those who had the last Papanicolaou testing at a BHU (14.7%), as compared to those who had been attended privately or by a health insurance company (5.8%). CONCLUSION: the coverage of Pap smear in the studied areas can be considered satisfactory, although there is a need of improving compliance with Pap test, mainly among women who are the poorest and who work only at home.