Rosendo Tatyana Souza, Roncalli Angelo Giuseppe, Azevedo George Dantas de
Departament of Collective Health, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
Departament of Odontology, Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
Rev Bras Ginecol Obstet. 2017 Nov;39(11):587-595. doi: 10.1055/s-0037-1606246. Epub 2017 Aug 23.
To identify the prevalence of maternal morbidity and its socioeconomic, demographic and health care associated factors in a city in Northeastern Brazil. A cross-sectional and population-based study was conducted, with a design based on multi-stage complex sampling. A validated questionnaire was applied to 848 women aged between 15 and 49 years identified in 8,227 households from 60 census tracts of Natal, the capital of the state of Rio Grande do Norte (RN), Brazil. The main outcome measure was maternal morbidity. The Poisson regression analysis, with 5% significance, was used for the analysis of the associated factors. The prevalence of maternal morbidity was of 21.2%. A bivariate analysis showed the following variables associated with an increased number of obstetric complications: non-white race (prevalence ratio [PR] =1.23; 95% confidence interval [95%CI]: 1.04-1.46); lower socioeconomic status (PR = 1.33; 95%CI: 1.12-1.58); prenatal care performed in public services (PR = 1.42; 95%CI: 1.16-1.72): women that were not advised during prenatal care about where they should deliver (PR = 1.24; 95%CI: 1.05-1.46); delivery in public services (PR = 1.63; 95%CI: 1.30-2.03); need to search for more than one hospital for delivery (PR = 1.22; 95%CI: 1.03-1.45); and no companion at all times of delivery care (PR = 1.25, 95%CI: 1.05-1.48). The place where the delivery occurred (public or private) and the socioeconomic status remained significant in the final model. Women in a worse socioeconomic situation and whose delivery was performed in public services had a higher prevalence of maternal morbidity. Such an association reinforces the need to strengthen public policies to tackle health inequalities through actions focusing on these determinants.
确定巴西东北部某城市孕产妇发病情况及其社会经济、人口统计学和医疗保健相关因素。开展了一项基于人群的横断面研究，采用多阶段复杂抽样设计。对从巴西北里奥格兰德州首府纳塔尔60个人口普查区的8227户家庭中识别出的848名年龄在15至49岁之间的女性应用了经过验证的问卷。主要结局指标是孕产妇发病情况。采用显著性水平为5%的泊松回归分析来分析相关因素。孕产妇发病患病率为21.2%。双变量分析显示以下变量与产科并发症数量增加相关：非白人种族（患病率比[PR]=1.23；95%置信区间[95%CI]：1.04 - 1.46）；社会经济地位较低（PR = 1.33；95%CI：1.12 - 1.58）；在公共服务机构进行产前检查（PR = 1.42；95%CI：1.16 - 1.72）：产前检查时未被告知应在何处分娩的女性（PR = 1.24；95%CI：1.05 - 1.46）；在公共服务机构分娩（PR = 1.63；95%CI：1.30 - 2.03）；需要为分娩寻找不止一家医院（PR = 1.22；95%CI：1.03 - 1.45）；以及分娩护理期间始终无陪伴（PR = 1.25，95%CI：1.05 - 1.48）。分娩地点（公立或私立）和社会经济地位在最终模型中仍然具有显著性。社会经济状况较差且在公共服务机构分娩的女性孕产妇发病患病率较高。这种关联强化了通过关注这些决定因素的行动来加强公共政策以解决健康不平等问题的必要性。
