Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve?

Abstract

The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil’s National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests—HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures—all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.

Indicadores de desempenho da Atenção Primária do Programa Previne Brasil

“…Seguindo essa evolução, observa-se um aumento relativo (16) , e baixo acompanhamento odontológico (24,5% das gestantes realizaram algum acompanhamento no cenário estudado) (17) . Além disso, 24% dos municípios brasileiros apresentaram um pré-natal razoável, com fragilidades quanto à estrutura, aos aspectos operacionais, ao acesso, à promoção, à prevenção e ao seguimento da assistência (18) .…”

Gestational and congenital syphilis across the international border in Brazil

“…These data are in agreement with the sociodemographic characteristics described in other studies [ 13 , 27 – 29 ]. However, the expansion of primary health care in Brazil led to an increase in prenatal coverage and the coverage of prenatal screening exams, a measure that expanded access and service as well as improved the diagnosis and notification of syphilis cases in the country [ 30 – 32 ].…”

Indicadores de desempeño de la Atención Primaria del Programa Previne Brasil

“…en los indicadores de calidad de la atención prenatal, con una reducción en el número de consultas durante el embarazo, de 2012 a 2018 (16) , y bajo seguimiento odontológico (24,5% de las gestantes realizaron algún seguimiento en el escenario estudiado) (17) . Además, el 24% de los municipios brasileños tenían atención prenatal razonable, con debilidades en términos de estructura, aspectos operativos, acceso, promoción, prevención y seguimiento (18) .…”