Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil

Abstract

BackgroundStudies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil.MethodsIn a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests.ResultsThe self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector.ConclusionsSelf-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

Can women’s reports of client exit interviews be used to measure and track progress of antenatal care quality? Evidence from a facility assessment census in Malawi

“…Worth to be noted however is that the Assaf study only focused on the counselling aspect of maternal and child care interventions and did not include the observable components of ANC. In Brazil, Morón-Duarte et al (31) also reported moderate to high agreement on indicators of service utilization, clinical examination and diseases during pregnancy but poor agreement on indicators of counselling. Bessinger and Bertrand (18) conducted a study in Ecuador, Uganda and Zimbabwe to examined the comparability of reports from direct observations and exit interviews at health facilities.…”

“…In Brazil, Morón-Duarte et al (31) examined the agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card also reported low reporting accuracy of counselling indicators. On the other hand, a recall study of maternal and newborn interventions received in the postnatal period in Kenya and eSwatini found that some indicators of physical examination had higher reporting accuracy (32).…”

“…In this study, we found that at an individual level, women who were younger than 25 years, with primiparous status and those whose ANC visit was the first had significantly higher agreement. A possible explanation could be because of their perceived low experience, women in these categories are likely to be more attentive and seek clarification where possible unlike women who are older or have other kids may think they already know so much from experience and miss out on the new information from the provider (31). A study by Morón-Duarte et al (31) reports similar findings that higher maternal age and pregnant women with ≥2 children were associate with a lower probability of high agreement between the antenatal card and the selfreported questionnaire.…”

“…Worth to be noted however is that the Assaf study only focused on the counselling aspect of maternal and child care interventions and did not include the observable components of ANC. In Brazil, Morón-Duarte et al(31)…”

Factors associated with maternal tetanus vaccination in Myanmar: An analysis of Demographic and Health Survey data

“…In common with other DHS surveys, maternal tetanus vaccination is self-reported and subject to inaccurate recall. However, a previous study from Brazil showed that self-reported uptake of maternal TT vaccination can be higher compared with information in medical records [29]. In addition, ethnicity and religion could be important determinants of maternal vaccination [30].…”