Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

Autor: Menezes MAS; Postgraduate Programme in Health Science, Sergipe Federal University, Aracaju, Brazil., Gurgel R; Postgraduate Programme in Health Science, Sergipe Federal University, Aracaju, Brazil., Bittencourt SDA; Department of Epidemiology and Quantitative Methods in Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil., Pacheco VE; Postgraduate Programme in Epidemiology and Public Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil., Cipolotti R; Postgraduate Programme in Health Science, Sergipe Federal University, Aracaju, Brazil., Leal MDC; Department of Epidemiology and Quantitative Methods in Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: BMJ open [BMJ Open] 2018 Dec 31; Vol. 8 (12), pp. e021431. Date of Electronic Publication: 2018 Dec 31.
DOI: 10.1136/bmjopen-2017-021431
Abstrakt: Objectives: To assess the use of the WHO's Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.
Design: A cross-sectional observational health facility assessment.
Setting: This is a secondary analysis of the 'Birth in Brazil' study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).
Participants: Data on 23 894 postnatal women and their newborn babies were analysed.
Main Outcome Measures: The facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers' sociodemographic characteristics.
Results: The utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (OR adj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (OR adj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (OR adj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (OR adj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (OR adj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (OR adj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (OR adj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (OR adj 2.55; 95% CI 2.21 to 2.96).
Conclusions: The coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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