Quality of antenatal care in primary health care in Brazil: a latent class analysis (ORIGINAL ARTICLE)

Quality of antenatal care in primary health care in Brazil: a latent class analysis (ORIGINAL ARTICLE)

primary health care, quality of antenatal care, latent class analysis

Background: Adequate antenatal care (ANC) is fundamental in preventing maternal and neonatal mortality. Developing indicators for assessing
the ANC quality in Primary Health Care (PHC) is essential.
Objective: To characterize subgroups of quality of care with respect to ANC at the PHC level in Brazil.
Methods: We conducted a cross-sectional study with data from the first Brazil’s National Program for Improving Primary Care Access and Quality
(PMAQ-AB) Cycle (2011–2012). A total of 16 566 PHC teams participated in the first cycle of the PMAQ-AB, corresponding to 49.6% of the teams
active across Brazil, distributed across 69.3% of Brazilian municipalities. To assess the quality of ANC, six indicators were defined: ‘Group of
medicines,’ ‘Protocols and patient flows,’ ‘Record-keeping practices,’ ‘ANC routine tests,’ ‘Protocols for early detection of pregnant women and
ANC provision,’ and ‘Identification and ANC of low/high-risk pregnancies.’ Latent Class Analysis (LCA) was carried out to characterize the quality
of care provided by PHC teams according to these six indicators.
Results: ‘Identification and ANC of low/high-risk pregnancies’ indicator had the highest percentage of teams providing adequate care (39.5%),
while ‘ANC routine tests’ had the lowest percentage (16.8%). The LCA identified three classes, and 20.5% of PHC teams had the probability of
belonging to the class denominated ‘High adequacy.’
Conclusion: Using a national PHC-level dataset, we evaluated PHC teams’ ANC adequacy through six indicators. Brazilian PHC teams consistently show weaknesses across these indicators, particularly in essential care. This approach can guide global initiatives to evaluate the quality
of ANC.

Naiá Ortelan , Maria Del Pilar Flores-Quispe, Leandro A. da Luz , Valentina Martufi, Eduarda F. dos Anjos, Acácia M. P. de Lima, Josemir R. de Almeida, Michelle P. V. dos Passos, Ythalo H. S. Santos , Leila D.A.F. Amorim , Rosana Aquino,
Anya P. G. F. Vieira-Meyer , Maria Yury T. Ichihara
, Mauricio L. Barreto , Elzo P. Pinto-Junior

DOI:https://doi.org/10.1093/ijcoms/lyad014

Oxford University Press

22 November 2023

Sri Wahyuni

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