Rua Marechal Deodoro, Pelotas, RS, Brazil.
Health Policy Plan. 2010 Jul;25(4):253-61. doi: 10.1093/heapol/czp065. Epub 2010 Feb 1.
Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private providers.
Quality of care for women giving birth in 2004 in Pelotas, Brazil, was assessed by measuring how many of 11 procedures recommended by the Ministry of Health were performed. Information on family income, self-assessed skin colour, parity and type of provider were collected.
Antenatal care was used by 98% of the 4244 women studied (mean number of visits 8.3), but the number of consultations was higher among better-off and white women, who were also more likely to start antenatal care in the first trimester. The quality of antenatal care score ranged from 0 to 11, with an overall mean of 8.3 (SD 1.7). Mean scores were 8.9 (SD 1.5) in the wealthiest and 7.9 (SD 1.8) in the poorest quintiles (P < 0.001), 8.4 (SD 1.6) in white and 8.1 (SD 1.9) in black women (P < 0.001). Adjusted analyses showed that these differences seemed to be due to attendance patterns rather than discrimination. Mean quality scores were higher in the private 9.3 (SD 1.3) than in the public sector 8.1 (SD 1.6) (P < 0.001); these differences were not explained by maternal characteristics or by attendance patterns.
Special efforts must be made to improve quality of care in the public sector. Poor and black women should be actively encouraged to start antenatal care early in pregnancy so that they can fully benefit from it. There is a need for regular monitoring of antenatal attendances and quality of care with an equity lens, in order to assess how different social groups are benefiting from progress in health care.
社会经济不平等在母婴健康方面普遍存在，但在中低收入国家，关于医疗质量根据财富或种族差异而变化的信息有限。此外，关于公私提供者之间质量差异的信息也很少。
通过测量卫生部推荐的 11 项程序中有多少项得到执行，评估了 2004 年在巴西佩洛塔斯分娩的妇女的护理质量。收集了家庭收入、自我评估肤色、产次和提供者类型的信息。
4244 名研究妇女中（平均就诊次数为 8.3 次），98%的人接受了产前护理，但经济条件较好和肤色较浅的妇女就诊次数更多，她们也更有可能在妊娠早期开始产前护理。产前护理质量评分范围从 0 到 11，平均得分为 8.3（标准差 1.7）。最富裕的五分位数（0.001）平均得分为 8.9（标准差 1.5），最贫穷的五分位数平均得分为 7.9（标准差 1.8），白人和黑人妇女分别为 8.4（标准差 1.6）和 8.1（标准差 1.9）（P<0.001）。调整后的分析表明，这些差异似乎是由于就诊模式而不是歧视造成的。私人部门的平均质量评分（9.3[标准差 1.3]）高于公共部门（8.1[标准差 1.6]）（P<0.001）；这些差异不能用产妇特征或就诊模式来解释。
必须特别努力提高公共部门的护理质量。应积极鼓励贫困和黑人妇女在妊娠早期开始产前护理，以便使她们充分受益。需要从公平的角度定期监测产前就诊和护理质量，以评估不同社会群体如何受益于医疗保健的进步。
