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Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):323-330
DOI 10.1590/S0100-72032013000700007
PURPOSE: To estimate the prevalence and identify the factors associated with delayed pap smear test of the cervix (carried out more than three years ago) among mothers with sons under two years of age, who attended the prenatal care. METHODS: Cross-sectional, population-based household survey. Women with sons under two years old, living in the northern area of the city of Juiz de Fora (MG), Brazil, were interviewed. Stratification and clustering were used in a complex sampling procedure. We applied a survey questionnaire to capture women's demographic and socioeconomic characteristics of women and information about prenatal and practices for preventing cancer of the cervix. For statistical analysis of the possible bivariate association of factors, we used χ² test and a logistic regression model with the explanatory variables that had a significance less than or equal to 0.05 in the bivariate analysis. RESULTS: We found a delayed test prevalence of 26.6% (95%CI 21.3 - 32.6), including women who were never submitted to the exam. The variables associated with the non-adherence to the examination within the stipulated time were: to be married (OR 0.5; 95%CI 0.2 - 0.9), and divorced/widowed (OR 0.1; 95%CI 0.02 - 0,8), having performed gynecological examination in prenatal care (OR 0.3; 95%CI 0.1 - 0.6) and number of prenatal visits (OR 0.09; 95%CI 0.03 - 0.25 for more than 11 visits), being all protection factors. CONCLUSIONS: The prevalence of adherence to Pap smear guidelines is slightly lower than the percentage recommended by the World Health Organization. Apart from that, the fact that the woman was submitted to the prenatal care did not guarantee the adherence to Pap smear frequency guidelines.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2013;35(7):323-330
DOI 10.1590/S0100-72032013000700007
PURPOSE: To estimate the prevalence and identify the factors associated with delayed pap smear test of the cervix (carried out more than three years ago) among mothers with sons under two years of age, who attended the prenatal care. METHODS: Cross-sectional, population-based household survey. Women with sons under two years old, living in the northern area of the city of Juiz de Fora (MG), Brazil, were interviewed. Stratification and clustering were used in a complex sampling procedure. We applied a survey questionnaire to capture women's demographic and socioeconomic characteristics of women and information about prenatal and practices for preventing cancer of the cervix. For statistical analysis of the possible bivariate association of factors, we used χ² test and a logistic regression model with the explanatory variables that had a significance less than or equal to 0.05 in the bivariate analysis. RESULTS: We found a delayed test prevalence of 26.6% (95%CI 21.3 - 32.6), including women who were never submitted to the exam. The variables associated with the non-adherence to the examination within the stipulated time were: to be married (OR 0.5; 95%CI 0.2 - 0.9), and divorced/widowed (OR 0.1; 95%CI 0.02 - 0,8), having performed gynecological examination in prenatal care (OR 0.3; 95%CI 0.1 - 0.6) and number of prenatal visits (OR 0.09; 95%CI 0.03 - 0.25 for more than 11 visits), being all protection factors. CONCLUSIONS: The prevalence of adherence to Pap smear guidelines is slightly lower than the percentage recommended by the World Health Organization. Apart from that, the fact that the woman was submitted to the prenatal care did not guarantee the adherence to Pap smear frequency guidelines.
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. 2010;32(11):563-569
DOI 10.1590/S0100-72032010001100008
PURPOSE: to evaluate the evolution of adequacy of the care process among pregnant users of the Brazilian Single Health System (SUS, acronym in Portuguese) and to consolidate a methodology for monitoring the prenatal care. METHODS: this is a multiple time series study with auditing of prenatal cards of pregnant women who were attended for prenatal care in a city of the Brazilian Southeast (Juiz de Fora, Minas Gerais) in the initial semesters of 2002 and 2004 (370 and 1,200 cards, respectively) and gave birth using SUS services in term pregnancies (p < 0.05). A three complementary level sequence was respected: utilization of prenatal care (beginning and number of visits) at level 1; utilization of prenatal care and obligatory clinical-obstetric procedures during prenatal visits (assessment of blood pressure (BP), weight, uterine fundal height (FH), gestational age (GA), fetal heart rate (FHR) and fetal presentation) at level 2; and utilization of prenatal care, obligatory clinical-obstetric procedures and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (PHPN, acronym in Portuguese) (ABO/Rh, hemoglobin/hematocrit (Hb/Htc), VDRL, glycemia and urinalisys) at level 3. RESULTS: it was confirmed the high prenatal care coverage (99%), the increased mean number of visits per pregnant woman (6.4 versus 7.2%) and the decreased gestational age at the time of the first visit (17.4 versus 15.7 weeks). The proper registration of procedures and exams (exceptions: fetal presentation and blood typing) has significantly increased: BP (77.8 versus 83.9%); weight (75.4 versus 83.5%); FH (72.7 versus 81.3%); GA (58.1 versus 71.5%); FHR (79.5 versus 86.7%); Hb/Htc (14.9 versus 29%), VDRL (11.1 versus 20.7%), glycemia (16.5 versus 29%) and urinalisys (13.8 versus 29.8%). As a result, there was significant (p < 0.001) improvement of the adequacy between 2002 and 2004: 27.6 versus 44.8% (level 1); 7.8 versus 15.4% (level 2); 1.1 versus 4.5% (level 3). This trend was also noted in care provided by the majority of the municipal services/teams. CONCLUSIONS: the persistence of low adequacy, despite good coverage and PHPN implementation, confirmed the need to increase health managers, professionals and users' compliance with the rules and routines of care, including the institutionalization of a monitoring program of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(11):563-569
DOI 10.1590/S0100-72032010001100008
PURPOSE: to evaluate the evolution of adequacy of the care process among pregnant users of the Brazilian Single Health System (SUS, acronym in Portuguese) and to consolidate a methodology for monitoring the prenatal care. METHODS: this is a multiple time series study with auditing of prenatal cards of pregnant women who were attended for prenatal care in a city of the Brazilian Southeast (Juiz de Fora, Minas Gerais) in the initial semesters of 2002 and 2004 (370 and 1,200 cards, respectively) and gave birth using SUS services in term pregnancies (p < 0.05). A three complementary level sequence was respected: utilization of prenatal care (beginning and number of visits) at level 1; utilization of prenatal care and obligatory clinical-obstetric procedures during prenatal visits (assessment of blood pressure (BP), weight, uterine fundal height (FH), gestational age (GA), fetal heart rate (FHR) and fetal presentation) at level 2; and utilization of prenatal care, obligatory clinical-obstetric procedures and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (PHPN, acronym in Portuguese) (ABO/Rh, hemoglobin/hematocrit (Hb/Htc), VDRL, glycemia and urinalisys) at level 3. RESULTS: it was confirmed the high prenatal care coverage (99%), the increased mean number of visits per pregnant woman (6.4 versus 7.2%) and the decreased gestational age at the time of the first visit (17.4 versus 15.7 weeks). The proper registration of procedures and exams (exceptions: fetal presentation and blood typing) has significantly increased: BP (77.8 versus 83.9%); weight (75.4 versus 83.5%); FH (72.7 versus 81.3%); GA (58.1 versus 71.5%); FHR (79.5 versus 86.7%); Hb/Htc (14.9 versus 29%), VDRL (11.1 versus 20.7%), glycemia (16.5 versus 29%) and urinalisys (13.8 versus 29.8%). As a result, there was significant (p < 0.001) improvement of the adequacy between 2002 and 2004: 27.6 versus 44.8% (level 1); 7.8 versus 15.4% (level 2); 1.1 versus 4.5% (level 3). This trend was also noted in care provided by the majority of the municipal services/teams. CONCLUSIONS: the persistence of low adequacy, despite good coverage and PHPN implementation, confirmed the need to increase health managers, professionals and users' compliance with the rules and routines of care, including the institutionalization of a monitoring program of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(10):717-724
DOI 10.1590/S0100-72032003001000004
PURPOSE: to evaluate the adequacy of the prenatal care process offered to users of the Unified Health Care System (SUS) in Juiz de Fora-MG and to compare the municipal services. METHODS: a transversal study with auditing was carried out on the records of 370 pregnant women, selected by systematic sampling among women who carried their pregnancies to term and gave birth using SUS services in the first semester of 2002, with prenatal care given in Juiz de Fora. For statistical analysis the c² test was used to compare the municipal services (level of significance: 5%). The evaluation followed a three-tiered complementary sequence, using: the utilization of prenatal care (Kessner index: beginning and frequency of care) at level 1; the utilization of prenatal care and basic laboratory tests, according to the Humanization Program of Prenatal Care and Birth (ABO-Rh, hemoglobin/hematocrit, VDRL, glycemia and urinalysis), at level 2; and the utilization of prenatal care, the basic laboratory tests and the obligatory clinical-obstetric procedures during a prenatal visit (assessment of blood pressure, weight, edema, uterine fundal height, gestational age, fetal heart rate and fetal presentation), at level 3. RESULTS: the observed adequacy of the process was only 26.7% (level 1), 1.9% (level 2) and 1.1% (level 3). We also observed a prenatal coverage of 99.04%, an average of 6.4 visits per pregnant woman, and an average gestational age of 17.4 weeks at the time of the first prenatal visit. There were no significant differences between the municipal services. CONCLUSIONS: prenatal care offered to SUS users in Juiz de Fora should be reviewed from a qualitative standpoint, and periodic evaluations as necessary instruments of improvement are recommendable. Managers and professionals should undertake actions aimed at increasing compliance with norms/routines of the program - principally the request/recording of basic complementary tests - and which guarantee increased utilization of prenatal care.