Publications by authors named "Silvana Granado Nogueira da Gama"

73 Publications

Prelabor cesarean section: the role of advanced maternal age and associated factors.

Rev Saude Publica 2021 14;55. Epub 2021 Apr 14.

Universidade Federal do Espírito Santo. Departamento de Medicina Social. Vitória, ES, Brasil.

Objective: to evaluate whether advanced maternal age (AMA) is associated with prelabor cesarean section and to identify the factors associated with prelabor cesarean section in AMA women, according to the mode of type of labor financing (private or public).

Methods: Based on the Birth in Brazil survey, the research was conducted on representative sample of mothers for the country (Brazil), regions, type of hospital and location (capital or not), in 2011/2012. This study included 15,071 women from two age groups: 20-29 years and ≥ 35 years. The information was collected from interviews with puerperal woman, prenatal cards, and medical records of mothers and newborns. Multiple logistic regression modelling was used to verify the association between prelabor cesarean section and maternal, prenatal and childbirth characteristics, according to the mode of financing.

Results: Our results showed a higher use of prelabor cesarean section for AMA (≥ 35 years) women in the public service (OR = 1.63; 95%CI 1.38-1.94) and in the private service (OR = 1.44; 95%CI 1.13-1.83), compared with women aged 20-29 years. In the adjusted model, we recorded three factors associated with the prelabor cesarean section in AMA women in both, public and private sectors: the same professional in prenatal care and childbirth (OR = 4.97 and OR = 4.66); nulliparity (OR = 6.17 and OR = 10.08), and multiparity with previous cesarean section (from OR = 5.73 to OR = 32.29). The presence of obstetric risk (OR = 1.94; 95%CI .44-2.62) also contributed to the occurrence of prelabor cesarean section in women who gave birth in the public service.

Conclusions: AMA was an independent risk factor for prelabor cesarean in public and private services. In the public, prelabor cesarean in AMA was more influenced by clinical criteria. Higher chance of prelabor cesarean section in nulliparous women increases the chance of cesarean section in multiparous women, as we showed in this study, which increases the risk of anomalous placental implantation.
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http://dx.doi.org/10.11606/s1518-8787.2021055002530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023322PMC
April 2021

Different methods for assessing gestational weight gain and its association with birth weight.

Epidemiol Serv Saude 2021 ;30(1):e2020123

Fundação Instituto Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, RJ, Brasil.

Objective: To analyze association of different methods of gestational weight gain assessment with live births small for gestational age (SGA) and large for gestational age (LGA).

Methods: This was a cross-sectional study with adult women, normal prepregnancy BMI, single pregnancy and gestational age at delivery ≥28 weeks, from the "Birth in Brazil" study, between 2011 and 2012.

Results: Among the 11,000 women participating in the study, prevalence of excessive weight gain was 33.1% according to the Brandão et al. and Institute of Medicine (IOM) methods, and 37.9% according to the Intergrowth method. The chance of being born SGA in the case of insufficient weight gain was OR=1.52 (95%CI 1.06;2.19), OR=1.52 (95%CI 1.05;2.20) and OR=1.56 (95%CI 1.06;2.30) for the Brandão et al., IOM and Intergrowth methods, respectively. Likelihood of excessive weight gain using the same methods was OR=1.53 (95%CI 1.28;1.82), OR=1.57 (95%CI 1.31;1.87) and OR=1.65 (95%CI 1.40;1.96), for LGA respectively.

Conclusion: Compared to the IOM recommendations, the Intergrowth and Brandão et al. methods show themselves to be alternatives for identifying SGA and LGA.
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http://dx.doi.org/10.1590/S1679-49742021000100006DOI Listing
January 2021

Delivery care by obstetric nurses in maternity hospitals linked to the Rede Cegonha, Brazil - 2017.

Cien Saude Colet 2021 Mar 5;26(3):919-929. Epub 2020 Aug 5.

Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.

This study aimed to assess whether nurses' presence in delivery care in maternity hospitals linked to the Rede Cegonha program promotes access to best obstetric practices during labor and delivery. We conducted an evaluative study in 2017 in all 606 SUS maternity hospitals that joined this strategic policy in all Brazilian states. We collected data from maternity hospital managers and puerperae. The analysis was performed at two levels: hospital with or without a nurse in delivery care; and professionals that attended vaginal delivery, whether doctors or nurses. We used best practices and interventions for vaginal deliveries and cesarean section rates as dependent variables. We included 5.016 subjects for analyses of vaginal deliveries and 9.692 to calculate cesarean section rates. Multiple regressions were adjusted for geographic region, maternity hospital size, and puerperae skin color and parity. Maternity hospitals with nurses in delivery care used more the partograph and less oxytocin, lithotomy, episiotomy, and cesarean section. Deliveries attended by nurses had more frequent use of the partograph and a lower likelihood of lithotomy and episiotomy. The inclusion of nurses in vaginal delivery care has successfully brought women closer to a more physiological and respectful delivery.
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http://dx.doi.org/10.1590/1413-81232021263.28482020DOI Listing
March 2021

Childbirth care for adolescents and advanced maternal age in maternities linked to Rede Cegonha.

Cien Saude Colet 2021 Mar 29;26(3):847-858. Epub 2020 Jul 29.

Instituto Nacional de Infectologia Evandro Chagas, Fiocruz. Rio de Janeiro RJ Brasil.

Based on the Rede Cegonha guidelines that propose the strengthening of women's sexual and reproductive rights, we sought to present a brief overview of issues related to reproductive planning and to analyze obstetric practices in childbirth care for adolescents and women of advanced age in maternity hospitals linked to Rede Cegonha. Data were extracted from an assessment conducted in 2017, based on information from the interview with puerperal women and from the hospital record. For age extremes, the high proportion of unplanned pregnancies and low use of contraception means problems in accessing family planning programs. Adolescents are more exposed to the presence of a companion and less to the use of analgesia in labor. Advanced maternal age were more likely to use analgesia in labor and to give birth in the lithotomy position, being less exposed to amniotomy. Although Rede Cegonha is an excellent strategy for improving assistance to childbirth, attention is still needed to the use of potentially unnecessary or not recommended interventions, with greater incentive to good obstetric practices.
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http://dx.doi.org/10.1590/1413-81232021263.12492020DOI Listing
March 2021

Assessment of delivery and childbirth care in the maternity units of Rede Cegonha: the methodological paths.

Cien Saude Colet 2021 Mar 12;26(3):789-800. Epub 2020 Jun 12.

Departamento de Saúde Pública, Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Maranhão. São Luís MA Brasil.

This article describes the methodology used to evaluate delivery and childbirth care practices in maternity hospitals that belong to the Rede Cegonha, according to scientific evidence and rights guarantee. It shows the maternity selection criteria, the evaluated guidelines, their devices and check items, the method used to collect information and the treatment of data to obtain the results. It discusses the chosen guidelines and the strategy of returning results to managers and services and discusses their potential to foster management qualification processes and obstetric and neonatal care. This is a study of delivery and childbirth care practices of 606 maternity hospitals selected for the second evaluation cycle of the Rede Cegonha. The methodological paths stood out for the construction of tripartite co-responsibility for the process and the evaluation results, with an emphasis on its usefulness for the decision-makers and the hospital institutions involved.
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http://dx.doi.org/10.1590/1413-81232021263.10642020DOI Listing
March 2021

Twin pregnancy and perinatal outcomes: Data from 'Birth in Brazil Study'.

PLoS One 2021 11;16(1):e0245152. Epub 2021 Jan 11.

Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.

Background: Twin pregnancies account for 0.5-2.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms.

Methods: Data is from "Birth in Brazil", a national inquiry into childbirth care conducted in 2011/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders.

Results: Twins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (<34 weeks). Amongst late preterm's, twins had higher odds of jaundice (OR 2.7, 95% CI 1.8-4.2) and antibiotic use (OR 1.8, 95% CI 1.1-3.2). Amongst early-terms, twins had higher odds of oxygen therapy (OR 2.7, 95% CI 1.3-5.9), admission to neonatal intensive care unit (OR 3.1, 95% CI 1.5-6.5), transient tachypnoea (OR 3.7, 95% CI 1.5-9.2), jaundice (OR 2.8, 95% CI 1.3-5.9) and antibiotic use (OR 2.2, 95% CI 1.14.9). In relation to birth order, the second-born infant had an elevated likelihood of jaundice, antibiotic use and oxygen therapy, than the first-born infant.

Conclusion: Although strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245152PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799786PMC
January 2021

[Teenage pregnancy and prematurity in Brazil, 2011-2012].

Cad Saude Publica 2020 18;36(12):e00145919. Epub 2020 Dec 18.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

The study aims to evaluate the association between teenage pregnancy and prematurity. The data are from the Birth in Brazil study, a national survey consisting of 23,894 postpartum women and their newborn infants. The information was obtained from interviews with the mothers during their postpartum hospital stay. A matching method was established, based on propensity scores, to deal with differences between the groups due to the non-experimental design of the Birth in Brazil study. The study outcome was gestational age, considering all the premature births (gestational age < 37 weeks) and term births (gestational age 37 weeks to 41 weeks and 6 days). The study revealed social, economic, and maternal care disparities between the women according to age bracket. The highest proportions of teenage mothers were in the least developed regions of Brazil (North and Northeast) and in the poorest economic classes. After matching for socioeconomic and obstetric care characteristics, the highest odds of spontaneous prematurity were seen in younger adolescents compared to older adolescents (OR = 1.49; 95%CI: 1.07-2.06), and young adults (OR = 2.38; 95%CI: 1.82-3.12). Prematurity is still an issue in the field of maternal and child health, and the association with teenage pregnancy identified in this study is worrisome, especially because younger adolescent mothers were associated with higher odds of spontaneous prematurity.
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http://dx.doi.org/10.1590/0102-311X00145919DOI Listing
March 2021

Factors associated with neonatal near miss in Brazil.

Rev Saude Publica 2020 4;54:123. Epub 2020 Dec 4.

Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Epidemiologia em Métodos Quantitativos em Saúde. Rio de janeiro, RJ, Brasil.

Objective: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil.

Methods: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels.

Results: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss.

Conclusions: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.
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http://dx.doi.org/10.11606/s1518-8787.2020054002382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688256PMC
January 2021

Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: An analysis of data from the Birth in Brazil survey.

Clin Nutr ESPEN 2020 06 10;37:114-120. Epub 2020 Apr 10.

Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, UFRJ/RJ, Avenida Carlos Chagas Filho 373, Bloco J, 2º Andar, Rio de Janeiro, RJ, 21941-902, Brazil.

Background & Aims: Monitoring gestational weight gain (GWG) is relevant for perinatal outcomes, especially in the context of increasing obesity and overweight in the female population. This study analyses the association between GWG in Brazilian women, according to different body mass index (BMI) categories, and different outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes (GD) and caesarean section.

Methods: Data on women from all the major regions of Brazil with a single pregnancy of a gestational age of 28 weeks or more and information available for anthropometric evaluation were included in the Birth in Brazil survey. Adequacy of GWG was assessed according to the percentile distribution of GWG of women with favourable neonatal outcomes, with the median of the distribution referred to as 100% adequacy in the GWG evaluation.

Results: The study consisted of 18,953 women, 58.3% of whom were normal weight and 35.1% were overweight. The adequacy of GWG was better amongst the normal weight women (91.1%) and worse amongst those with class III obesity (46.0% with excessive GWG), with the latter showing the highest occurrence of adverse outcomes. Results of the multivariate logistic regression analysis revealed that weight gain above 200% of the median in the normal weight, overweight and obese women was positively associated with HDP and caesarean section, but not with GD.

Conclusions: The proposed ranges of appropriate GWG associated with favourable neonatal outcomes based on the data from the Birth in Brazil survey proved good predictors of HDP and caesarean section amongst the women included in the study.
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http://dx.doi.org/10.1016/j.clnesp.2020.03.009DOI Listing
June 2020

Professional who attended childbirth and breastfeeding in the first hour of life.

Rev Bras Enferm 2020 17;73(2):e20180448. Epub 2020 Feb 17.

Fundação Oswaldo Cruz. Rio de Janeiro, Rio de Janeiro, Brazil.

Objectives: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life.

Methods: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach.

Results: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn.

Conclusions: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.
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http://dx.doi.org/10.1590/0034-7167-2018-0448DOI Listing
January 2021

Prenatal care in the Brazilian public health services.

Rev Saude Publica 2020 20;54:08. Epub 2020 Jan 20.

Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública (ENSP/Fiocruz). Departamento de Epidemiologia e Métodos Quantitativos em Saúde (DEMQS). Rio de Janeiro, RJ, Brasil.

Objective: To verify regional inequalities regarding access and quality of prenatal and birth care in Brazilian public health services and associated perinatal outcomes.

Methods: Birth in Brazil was a national hospital-based survey conducted between 2011 and 2012, which included 19,117 women with public-funded births. Regional differences in socio-demographic and obstetric characteristics, as well as differences in access and quality of prenatal and birth care were tested by the χ2 test. The following outcomes were assessed: spontaneous preterm birth, provider-initiated preterm birth, low birth weight, intrauterine growth restriction, Apgar in the 5th min < 8, neonatal and maternal near miss. Multiple and non-conditional logistic regressions were used for the analysis of the associated perinatal outcomes, with the results expressed in adjusted odds ratio and 95% confidence interval.

Results: Regional inequalities regarding access and quality of prenatal and birth care among users of public services are still evident in Brazil. Pilgrimage for birth associated with all perinatal outcomes studied, except for intrauterine growth restriction. The odds ratios ranged between 1.48 (95%CI 1.23-1.78) for neonatal near miss and 1.62 (95%CI 1.27-2.06) for provider-initiated preterm birth. Among women with clinical or obstetric complications, pilgrimage for birth associated with provider-initiated preterm birth and with Apgar in the 5th min < 8, odds ratio of 1.98 (95%CI 1.49-2.65) and 2.19 (95%CI 1.31-3.68), respectively. Inadequacy of prenatal care associated with spontaneous preterm birth in both groups of women, with or without clinical or obstetric complications.

Conclusion: Improvements in the quality of prenatal care, appropriate coordination and comprehensive care at the time of birth have a potential to reduce prematurity rates and, consequently, infant morbidity and mortality rates in the country.
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http://dx.doi.org/10.11606/s1518-8787.2020054001458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961968PMC
April 2020

Advanced maternal age and factors associated with neonatal near miss in nulliparous and multiparous women.

Cad Saude Publica 2019 28;35(12):e00222218. Epub 2019 Nov 28.

Universidade Federal do Espírito Santo, Vitória, Brasil.

The early neonatal period accounts for approximately half of the deaths of young children under one year of age, and the neonatal near miss can recognize factors causing this high number of deaths. Thus, the aim of this study is to determine whether advanced maternal age increases the chance of neonatal near miss, in addition is to identify which factors are associated with the neonatal near miss, stratified by parity. Data are from the 2011-2012 Birth in Brazil study, which used a national population-based sample of 15,092 newborns of women between 20-29 and 35 years of age or more (advanced maternal age). Multiple logistic regression was performed to test the association between neonatal near miss and prenatal and childbirth variables, pre-gestational diseases, obstetric history and socioeconomic characteristics, stratified by parity. Advanced maternal age was to be statistically associated with neonatal near miss in nulliparous (OR = 1.62; 95%CI: 1.05-2.50) and multiparous (OR = 1.51; 95%CI: 1.20-1.91) when compared to women 20-29 years of age. For nulliparous women, the main variables statistically associated with neonatal near miss were multiple gestation (OR = 8.91) and hypertensive disease (OR = 2.57), whereas forceps-assisted vaginal delivery (OR = 7.19) and multiple gestation (OR = 4.47) were the variables associated for multiparous women. Neonatal near miss has been shown to be connected with access to health services for childbirth, gestational complications and maternal characteristics, mainly advanced maternal age. Therefore, to properly monitor and classify maternal gestational risk, to control gestational complications during prenatal care, and to correctly refer these women to childbirth care should be priority strategies for healthcare services.
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http://dx.doi.org/10.1590/0102-311X00222218DOI Listing
June 2020

Gestational risk and social inequalities: a possible relationship?

Cien Saude Colet 2019 Dec 17;24(12):4633-4642. Epub 2018 Apr 17.

Departamento de Medicina Social, Universidade Federal do Espírito Santo. Av. Marechal Campos 1.468, Maruípe. 29040-090  Vitória  ES  Brasil.

This study aims to analyze the association between social inequalities and gestational risk in administrative regions of the state of Espírito Santo. This is a cross-sectional study based on two administrative regions of the state of Espírito Santo. The sample consisted of 1,777 women who underwent prenatal care in the municipalities of the Greater Vitória Metropolitan Region (RMGV-ES) and São Mateus Microregion (MRSM) and were admitted to the public health facilities at the time of delivery between 2010 and 2012/2013. The multivariate logistic regression was performed to test the association between social and gestational risk variables. Variables with a significance level < 0.20 in the Chi-square test were adopted for the final model, and only those variables with a p-value < 0.05 remained. An association was found between high gestational risk and women's dwelling place in the RMGV-ES (OR = 1.74; CI95% 1.32-2.28), women as head of households (OR = 3.03; CI95% 1.64-5.61), head of household with less than five years of schooling (OR = 1.58; CI95% 1.14-2.20) and receipt of social benefit "Bolsa Família" (Family Grant) (OR = 1.46; CI95% 1.04-2.03). While some social variables underpin the classification of gestational risk, other social factors have been shown to produce this risk.
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http://dx.doi.org/10.1590/1413-812320182412.31422017DOI Listing
December 2019

Prevalence of spontaneous, induced labour or planned caesarean section and factors associated with caesarean section in low-risk women in southern Brazil.

Midwifery 2019 Dec 16;79:102530. Epub 2019 Aug 16.

Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil. Electronic address:

Objectives: This study aimed to examine the prevalence of spontaneous labour, induced labour and planned caesarean section in low-risk women; to identify the contribution of each group to the overall caesarean section rate; and to estimate factors associated with caesarean section in low-risk women according to spontaneous labour, induced labour and planned caesarean section.

Design: Cross-sectional hospital-based study of postpartum women and newborns, using data from the survey Birth in Brazil, Southern region. In the sample of 2,668 low-risk women, a descriptive analysis was undertaken and a Multinomial Logistic Regression model was applied to verify associations among caesarean section and spontaneous labour, induced labour and planned caesarean section in comparison with vaginal birth.

Measurements And Findings: The results showed the prevalence of spontaneous labour (48.0%), induced labour (14.0%) and planned caesarean sections (38.0%); these frequencies contributed to an overall caesarean section rate of 50.5%. Obstetric characteristics like previous vaginal birth or previous caesarean section were differentially associated with caesarean section, independently of the labour. Caesarean section without labour was significantly associated with age ≥ 35 years (ORadj 5.45 95%CI 3.16-9.39), economic class A and B (ORadj 3.10 95%CI 1.92-4.99), pregnancy between 37 and 38 weeks (ORadj 1.65 95%CI 1.22-2.24), same obstetrician in prenatal and childbirth (ORadj 13.83 95%CI 8.85-21.61) and private payment source at birth (ORadj 11.50 95%CI 6.64-19.93).

Key Conclusion: For low-risk women in Southern Brazil, the results identify high planned caesarean section rates, not associated with socioeconomic, obstetric, institutional or prenatal factors that justify these rates.
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http://dx.doi.org/10.1016/j.midw.2019.102530DOI Listing
December 2019

Progress in childbirth care in Brazil: preliminary results of two evaluation studies.

Cad Saude Publica 2019 07 22;35(7):e00223018. Epub 2019 Jul 22.

Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, Brasil.

This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.
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http://dx.doi.org/10.1590/0102-311X00223018DOI Listing
July 2019

Completeness and reliability of the National Mortality Information System for perinatal deaths in Brazil, 2011-2012: a descriptive study.

Epidemiol Serv Saude 2019 03 21;28(1):e2018093. Epub 2019 Mar 21.

Fundação Instituto Oswaldo Cruz, Escola Nacional de Saúde Pública, Rio de Janeiro, RJ, Brasil.

Objective: to analyze the completeness and reliability of data on perinatal deaths held on Brazil's Mortality Information System (SIM) in 2011-2012.

Methods: this was a study evaluating the quality of completeness of data on perinatal deaths reported on SIM compared to data from the 'Birth in Brazil' survey for the same period; to evaluate reliability, we used the Kappa coefficient, the intraclass correlation coefficient (ICC) and the Bland-Altman plot method.

Results: completeness was greater than 80%, and agreement was 0.61 for 10 of the 12 evaluated fields; aggregated gestation length (Kappa coefficient=0.542) and continuous gestation length (ICC=0.448) for early neonatal deaths and fetal deaths, respectively, had regular agreement; graphical evaluation of gestation length showed that the fetal death metric was underestimated and that early neonatal deaths were overestimated by between 25 and 35 weeks of gestation.

Conclusion: the information analyzed available on SIM for perinatal deaths is complete and reliable for the period analyzed.
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http://dx.doi.org/10.5123/S1679-49742019000100007DOI Listing
March 2019

[Obstetric care models in the Southern Region of Brazil and associated factors].

Cad Saude Publica 2019 03 25;35(3):e00093118. Epub 2019 Mar 25.

Universidade Federal de Santa Catarina, Florianópolis, Brasil.

The study sought to identify obstetric care models for low-risk pregnancies in the Southern Region of Brazil and to estimate factors associated with these models and maternal and neonatal outcomes. This is a cross-sectional, hospital-based study using data from the Birth in Brazil survey regarding puerperae and newborns. We identified 2,668 low-risk pregnant women. We carried out an exploratory analysis using the proportion of practices per hospital, among them inducing labor, presence of a companion, cesarean section and skin-to-skin contact, in order to obtain the care models we called Best Practice, Interventionist I and Interventionist II. We then carried out an inferential analysis of the associated characteristics. Results show that access to public or private funding, cultural factors and actions taken by health professional are associated with the care models. Public care had different contexts, one based on public policies and evidence-based practices; and another, that suggests the intentionality of vaginal delivery without considering humanization principles. Private care, on the other hand, is standardized and centered on the medical professional, with higher intervention levels. We conclude there is a predominance of interventionist obstetric care models in the Southern Region of Brazil, a type of care that goes against the best evidence, and that women who receive care in public hospitals have greater chances of benefiting from good practices.
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http://dx.doi.org/10.1590/0102-311X00093118DOI Listing
March 2019

Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis.

Cad Saude Publica 2018 Feb 19;34(2):e00206116. Epub 2018 Feb 19.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

This study aimed to investigate the existence and magnitude of the association between advanced maternal age (AMA) and occurrence of placenta praevia (PP) and placental abruption (PA) among nulliparous and multiparous women, by a systematic review and meta-analysis. We searched articles published between January 1, 2005 and December 31, 2015, in any language, in the following databases: PubMed, Scopus, Web of Science, and LILACS. Women were grouped into two age categories: up to 34 years old and 35 years or older. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of the studies. A meta-analysis was conducted for the PP and PA outcomes, using a meta-regression model to find possible covariates associated with heterogeneity among the studies and Egger's test to assess publication bias. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) system (CRD42016045594). Twenty-three studies met the criteria and were included in the meta-analysis. For both outcomes, an increase in age increased the magnitude of association strength, and PP (OR = 3.16, 95%CI: 2.79-3.57) was more strongly associated with AMA than PA (OR = 1.44, 95%CI: 1.35-1.54). For parity, there was no difference between nulliparous and multiparous women considered older for the PP and PA outcomes. Our review provided very low-quality evidence for both outcomes, since it encompasses observational studies with high statistical heterogeneity, diversity of populations, no control of confounding factors in several cases, and publication bias. However, the confidence intervals were small and there is a dose-response gradient, as well as a large magnitude of effect for PP.
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http://dx.doi.org/10.1590/0102-311X00206116DOI Listing
February 2018

Burden of early-term birth on adverse infant outcomes: a population-based cohort study in Brazil.

BMJ Open 2017 12 27;7(12):e017789. Epub 2017 Dec 27.

Department of Epidemiology and Quantitative Methods in Health, Women's, Children's and Adolescents' Research Group, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Objectives: To estimate the national rate of early-term live births in Brazil and to evaluate the effect of birth at 37 and 38 weeks' gestation, as compared with 39 and 40 weeks' gestation on infant outcomes according to precursors of birth and the existence of maternal/fetal medical conditions.

Design: National perinatal population-based cohort study.

Setting: 266 maternity services located in the five Brazilian macroregions.

Participants: 18 652 singleton live newborns from 37 0/7 to 40 6/7 weeks of gestation.

Main Outcome Measures: Resuscitation in delivery room, oxygen therapy, transient tachypnoea, admission to neonatal intensive care unit (NICU), hypoglycaemia, use of antibiotics, phototherapy, phototherapy after hospital discharge, neonatal death and breastfeeding.

Results: Early terms accounted for 35% (95% CI 33.4% to 36.7%) of all live births. Among provider-initiated births in women without medical conditions, infants of 37 and 38 weeks' gestation had higher odds of oxygen therapy (adjusted OR (AOR) 2.93, 95% CI 1.72 to 4.98 and AOR 1.92 95% CI 1.18 to 3.13), along with admission to NICU (AOR 2.01, 95% CI 1.18 to 3.41 and AOR 1.56, 95% CI 1.02 to 2.60), neonatal death (AOR 14.40, 95% CI 1.94 to 106.69 and AOR 13.76,95% CI 2.84 to 66.75), hypoglycaemia in the first 48 hours of life (AOR 7.86, 95% CI 1.95 to 31.71 and AOR 5.76, 95% CI 1.63 to 20.32), transient tachypnoea (AOR 2.98, 95% CI 1.57 to 5.65 and AOR 2.12, 95% CI 1.00 to 4.48) and the need for phototherapy within the first 72 hours of life (AOR 3.59, 95% CI 1.95 to 6.60 and AOR 2.29, 95% CI 1.49 to 3.53), yet lower odds of breastfeeding up to 1 hour after birth (AOR 0.67, 95% CI 0.53 to 0.86 and AOR 0.87, 95% CI 0.76 to 0.99) and exclusive breastfeeding during hospital stay (AOR 0.68, 95% CI 0.51 to 0.89 and AOR 0.84, 95% CI 0.71 to 0.99).

Conclusion: Birth at 37 and 38 weeks' gestation increased the risk of most adverse infant outcomes analysed, especially among provider-initiated births and should be avoided before 39 weeks' gestation in healthy pregnancies.
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http://dx.doi.org/10.1136/bmjopen-2017-017789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770827PMC
December 2017

Validity of self-reported weight, height, and BMI in mothers of the research Birth in Brazil.

Rev Saude Publica 2017 Dec 4;51:115. Epub 2017 Dec 4.

Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Epidemiologia e Métodos Quantitativos em Saúde. Rio de Janeiro, RJ, Brasil.

Objective: To evaluate the accuracy of information on pre-gestational weight, height, pre-gestational body mass index, and weight at the last prenatal appointment, according to maternal characteristics and sociodemographic and prenatal variables.

Methods: The study was developed using data from the face-to-face questionnaire and prenatal card (gold standard) of the study "Birth in Brazil, 2011-2012". To evaluate the differences between the measured and self-reported anthropometric variables, we used the the Kruskal-Wallis test for the variables divided into quartiles. For the continuous variables, we used the Wilcoxon test, Bland-Altman plot, and average difference between the information measured and reported by the women. We estimated sensitivity and the intraclass correlation coefficient.

Results: In the study, 17,093 women had the prenatal card. There was an underestimation of pre-gestational weight of 1.51 kg (SD = 3.44) and body mass index of 0.79 kg/m2 (SD = 1.72) and overestimation of height of 0.75 cm (SD = 3.03) and weight at the last appointment of 0.22 kg (SD = 2.09). The intraclass correlation coefficients (ICC) obtained for the anthropometric variables were: height (ICC = 0.89), pre-gestational weight (ICC = 0.96), pre-gestational body mass index (ICC = 0.92), and weight at the last appointment (ICC = 0.98).

Conclusions: The results suggest that the mentioned anthropometric variables were valid for the study population, and they may be used in studies of populations with similar characteristics.
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http://dx.doi.org/10.11606/S1518-8787.2017051006775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5708269PMC
December 2017

Prevalence of physical intimate partner violence in the first six months after childbirth in the city of Rio de Janeiro, Brazil.

Cad Saude Publica 2017 Aug 21;33(8):e00141116. Epub 2017 Aug 21.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

The aim of the study was to estimate the prevalence of physical intimate partner violence in the first six months after childbirth among women attending primary care clinics (UBS) for the infant's follow-up in Rio de Janeiro, Brazil. This is the first study on the theme using a representative sample of primary care clinics in the city of Rio de Janeiro. The study used a cross-sectional design from June to September 2007 and included 927 mothers/infants seen at 27 UBS, selected by complex sampling, geographically representative of the city. The information was collected in face-to-face interviews by a previously trained team, using a structured questionnaire. History of physical intimate partner violence from the child's birth to the date of the interview was obtained with the Brazilian version of the Revised Conflict Tactics Scales (CTS2). Thirty percent (95%CI: 26.2-33.8) of mothers reported having experienced some form of physical intimate partner violence in the postpartum and 14% (95%CI: 11.0-17.0) reported severe physical violence. The physical abuse occurred especially among black teenage mothres, in unfavorable socioeconomic situation, that did not live with the partner and that had received inadequate or no prenatal care and reported difficulties in breastfeeding and use of healthcare services. The widespread occurrence of physical intimate partner violence emphasizes the urgent need to deal with the problem. Primary healthcare services must be linked to other support networks and health professionals need to be prepared to deal with the problem.
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http://dx.doi.org/10.1590/0102-311X00141116DOI Listing
August 2017

The color of pain: racial iniquities in prenatal care and childbirth in Brazil.

Cad Saude Publica 2017 Jul 24;33Suppl 1(Suppl 1):e00078816. Epub 2017 Jul 24.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

Few studies on the influence of race/color on pregnancy and birthcare experiences have been carried out in Brazil. Additionally, none of the existing studies are of national scope. This study sought to evaluate inequities in prenatal and childbirth care according to race/color using propensity score matching. The data comes from the study Birth in Brazil: National Survey into Labor and Birth, a national population study comprised of interviews and revisions of medical records that included 23,894 women in 2011/2012. We used logistic regressions to estimate odds ratios (OR) and respective 95% confidence intervals (95%CI) of race/color associated with the outcomes were analyzed. When compared with white-skinned women, black-skinned women were more likely to have inadequate prenatal care (OR = 1.6; 95%CI: 1.4-1.9), to not be linked to a maternity hospital for childbirth (OR = 1.2 95%CI: 1.1-1.4), to be without a companion (OR = 1.7; 95%CI: 1.4-2.0), to seek more than one hospital for childbirth (OR =1.3; 95%CI: 1.2-1.5), and less likely to receive local anesthesia for an episiotomy (OR = 1.5; 95%CI: 1.1-2.1). Brown-skinned women were also more likely to have inadequate prenatal care (OR = 1.2; 95%CI: 1.1-1.4) and to lack a companion (OR = 1.4; 95%CI: 1.3-1.6) when compared with white-skinned women. We identified racial disparities in care during pregnancy and childbirth, which displayed a gradient going from worst to best care provided to black, brown and white-skinned women.
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http://dx.doi.org/10.1590/0102-311X00078816DOI Listing
July 2017

Regional and social inequalities in the performance of Pap test and screening mammography and their correlation with lifestyle: Brazilian national health survey, 2013.

Int J Equity Health 2016 11 17;15(1):136. Epub 2016 Nov 17.

Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.

Background: Mass population screening for the early detection of cervical and breast cancer has been shown to be a safe and effective strategy worldwide and has reduced the incidence and mortality rates of these diseases. The aim of this study is to analyse the reach of screening tests for cervical and breast cancer according to sociodemographic variables and to analyse their correlation with a healthy lifestyle.

Methods: We have analysed data collected from 31.845 women aged 18 and over, who were interviewed for the Brazilian National Health Survey, a nationwide household inquiry, which took place between August 2013 and February 2014. The Pap tests performed in the last 3 years in women aged between 25 and 64 and screening mammogram performed in the last 2 years in women aged between 50 and 69 were considered adequate. We identified habits that constitute a healthy lifestyle, such as the consumption of five or more daily servings of fruits and vegetables, 30 min or more of leisurely physical activity and not smoking.

Results: We observed that the Pap test (78.8 %) was more widespread than the screening mammogram (54.5 %), with significant geographical and social differences concerning access to health care. Access for such screening was higher for women living in more developed regions (Southeast and South), who were white-skinned, better educated, living with a partner and, especially, who were covered by private health insurance. Those who underwent the tests according to established protocols also had a healthy lifestyle, which corroborates the healthy behaviour pattern of damage prevention.

Conclusion: Despite the progress made, social disparity still defines access to screening tests for cervical and breast cancer, with women covered by private health insurance tending to benefit the most. It is necessary to reduce social and regional inequalities and ensure a more uniform provision and access to the tests, especially for socially disadvantaged women, in order to reduce the incidence and mortality rate resulting from the aforementioned diseases.
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http://dx.doi.org/10.1186/s12939-016-0430-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112710PMC
November 2016

Good practices according to WHO's recommendation for normal labor and birth and women's assessment of the care received: the "birth in Brazil" national research study, 2011/2012.

Reprod Health 2016 Oct 17;13(Suppl 3):124. Epub 2016 Oct 17.

National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Background: The World Health Organization recommends good practices for the conduct of uncomplicated labor and birth, with the aim of improving the quality of and assessment by women of childbirth care. The aim of this study was to evaluate the association between adoption of good practices according to WHO's recommendation for normal labor and birth and assessment by women of the care received.

Methods: Birth in Brazil is a national hospital-based study with countrywide representation consisting of 23,894 mothers and their newborns, conducted between February 2011 and October 2012. The present study analysed a subsample of this national survey. Postpartum women classified as low risk during pregnancy who had experienced either spontaneous or induced labor were included in this study, totalling 4102 mothers. To estimate the association between assessment by women of the childbirth care received (dependent variable) and good practices according to WHO's recommendation during normal labor and birth (independent variables), a multinomial logistic regression analysis was used and crude and adjusted odds ratios calculated with their 95 % confidence intervals.

Results: The good practices associated with positive assessment of the care received by women during labor and birth included the partner's presence, privacy in the birthing place, time available to ask questions, clarity of information received, and empathic support from caregivers during labor and birth. Freedom of movement, free nutrition offered, choice of companions, nonpharmacological analgesia, skin-to-skin contact and breastfeeding in the childbirth room were not associated with the assessment by women of the care received.

Conclusions: Our findings reveal the importance to mothers of their relationship with the team of caregivers during labor and birth. Therefore, caregiver teams must be qualified within a more humanistic vision of childbirth health care.
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http://dx.doi.org/10.1186/s12978-016-0233-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073993PMC
October 2016

Labor and birth care by nurse with midwifery skills in Brazil.

Reprod Health 2016 Oct 17;13(Suppl 3):123. Epub 2016 Oct 17.

National School of Public Health, Oswaldo Cruz Foundation (ENSP/Fiocruz), Rio de Janeiro, Brazil.

Background: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.

Methods: Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.

Results: 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.

Conclusions: The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.
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http://dx.doi.org/10.1186/s12978-016-0236-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073910PMC
October 2016

Factors associated with unintended pregnancy in Brazil: cross-sectional results from the Birth in Brazil National Survey, 2011/2012.

Reprod Health 2016 Oct 17;13(Suppl 3):118. Epub 2016 Oct 17.

Department of Epidemiology and Quantitative Methods on Health, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.

Background: Unintended pregnancy, a pregnancy that have been either unwanted or mistimed, is a serious public health issue in Brazil. It is reported for more than half of women who gave birth in the country, but the characteristics of women who conceive unintentionally are rarely documented. The aim of this study is to analyse the prevalence and the association between unintended pregnancy and a set of sociodemographic characteristics, individual-level variables and history of obstetric outcomes.

Methods: Birth in Brazil is a cross-sectional study with countrywide representation that interviewed 23,894 women after birth. The information about intendedness of pregnancy was obtained after birth at the hospital and classified into three categories: intended, mistimed or unwanted. Multinomial regression analysis was used to estimate the associations between intendedness of a pregnancy, and sociodemographic and obstetric variables, calculating odds ratios and 95 % confidence intervals. All significant variables in the bivariate analysis were included in the multinomial multivariate model and the final model retaining variables that remained significant at the 5 % level.

Results: Unintended pregnancy was reported by 55.4 % of postpartum women. The following variables maintained positive and significant statistical associations with mistimed pregnancy: maternal age < 20 years (OR = 1.89, 95 % CI: 1.68-2.14); brown (OR = 1.15, 95 % CI: 1.04-1.27) or yellow skin color (OR = 1.56, 95 % CI: 1.05-2.32); having no partner (OR = 2.32, 95 % CI: 1.99-2.71); having no paid job (OR = 1.15, 95 % CI: 1.04-1.27); alcohol abuse with risk of alcoholism (OR = 1.25, 95 % CI: 1.04-1.50) and having had three or more births (OR = 2.01, 95 % CI: 1.63-2.47). The same factors were associated with unwanted pregnancy, though the strength of the associations was generally stronger. Women with three or more births were 14 times more likely to have an unwanted pregnancy, and complication in the previous pregnancies and preterm birth were 40 % and 19 % higher, respectively. Previous neonatal death was a protective factor for both mistimed (OR = 0.61, 95 % CI: 0.44-0.85) and unwanted pregnancy (OR = 0.44, 95 % CI: 0.34-0.57).

Conclusions: This study confirms findings from previous research about the influence of socioeconomic and individual risk factors on unintended pregnancy. It takes a new approach to the problem by showing the importance of previous neonatal death, preterm birth and complication during pregnancy as risk factors for unintended pregnancy.
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http://dx.doi.org/10.1186/s12978-016-0227-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5073899PMC
October 2016

[Translation and adaptation of the Children with Special Health Care Needs Screener to Brazilian Portuguese].

Cad Saude Publica 2016 Jun;32(6)

Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil., Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro , Brazil.

This study aimed to elaborate the Brazilian version of the Children with Special Health Care Needs Screener to assess internal consistency and inter-observer agreement. The stages included translation, back-translation, expert committee review, and pretest. Participation included 140 family members of children 0-12 years of age at health services in southern Brazil. Reliability was assessed with kappa statistic and Cronbach's alpha. In the assessment of clarity with health professionals, 80% rated the questions very clear. Prevalence of children with special health needs was 36%. Mean time for applying the instrument was 3.5 minutes. The process identified difficulties in understanding question number two. The instrument showed satisfactory internal consistency and perfect agreement. Future research should add to the psychometric analyses of the instrument's adequacy for the Brazilian context, thereby contributing to a standardized definition of this young age group's epidemiological profile within the public health scenario in Brazil.
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http://dx.doi.org/10.1590/0102-311X00130215DOI Listing
June 2016

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil.

Rev Saude Publica 2016 24;50:23. Epub 2016 May 24.

Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.

Objective: To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil.

Methods: Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson's Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed.

Results: Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care.

Conclusions: Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.
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http://dx.doi.org/10.1590/S1518-8787.2016050005396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902090PMC
December 2016

Obstetric, Sociodemographic, and Psychosocial Problems of Postpartum Adolescents of Huambo, Angola.

Clin Med Insights Womens Health 2016 19;9:13-9. Epub 2016 May 19.

Fernandes Figueira Institute (IFF)-FIOCRUZ, Rio de Janeiro, Brazil.

This study aims to establish a profile of teenage pregnancy (<20 years) at a hospital in Huambo, Angola. Subjects were categorized into two age groups, 10-16 and 17-19 years. We interviewed 381 mothers in the postpartum maternity ward of the Central Hospital of Huambo. Statistical analysis then followed two stages, a descriptive analysis of the study population and analysis through a bivariate 2 × 2 table, using a chi-squared test to evaluate the hypothesis of homogeneity of proportions with a significance level of 5%. Comparing the two groups revealed a more frequent occurrence of problems among mothers under 17 years of age, including a higher frequency of involvement with unemployed parents, more often not living with parents, and fewer prenatal consultations.
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http://dx.doi.org/10.4137/CMWH.S27161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874740PMC
May 2016