Sandra Valongueiro Alves

Qualidade da atenção ao aborto no Sistema Único de Saúde do Nordeste brasileiro: o que dizem as mulheres?

Abortion is a serious health problem in Brazil and complications can be avoided by adequate and timely care. The article evaluates the quality of care given to women admitted for abortion in hospitals operated by the Unified Health System, in Salvador, Recife and Sao Luis, the benchmarks being Ministry of Health norms and user satisfaction. The article analyzes 2804 women admitted to hospital for abortion complications in 19 hospitals, between August and December 2010. Four dimensions were defined: reception and guidance; inputs and physical environment; technical quality and continuity of care. There was a closer fit to norms on reception and guidance. Social support and the right to information were not well rated in all three cities. The technical quality of care was rated poor. With respect to inputs and physical environment, cleanliness was the least adequate criterion. Continuity of care was the most critical situation in all three cities, due to the lack of scheduled follow-up appointments, information about care available after hospital discharge, the risk of further pregnancy and family planning. Abortion care falls short of that advocated under Brazilian norms and by international agencies.

Causas externas e mortalidade materna: proposta de classificacao

OBJECTIVE To analyze deaths from external causes and undefined causes in women of childbearing age occurring during pregnancy and early postpartum. METHODS The deaths of 399 women of childbearing age, resident in Recife, Northeastern Brazil, in the period 2004 to 2006, were studied. The survey utilized the Reproductive Age Mortality Survey method and a set of standardized questionnaires. Data sources included reports from the Institute of Legal Medicine, hospital and Family Health Strategy records and interviews with relatives of the deceased women. External causes of death during pregnancy were classified according to the circumstance of death, using the O93 code (ICD) and maternal mortality ratios before and after the classification were calculated. RESULTS Eighteen deaths during pregnancy were identified. The majority were aged between 20 and 29, had between 4 and 7 years of schooling, were black and single parents. Fifteen deaths were classified using the O93 code as pregnancy related death (13 for homicide - code 93.7; 2 by suicide - code 93.6) and three were classified as indirect obstetric maternal deaths (one homicide - code 93.7 and two by suicide - code 93.6). There was an average increment of 35% in the RMM after classification. CONCLUSIONS Deaths from undefined causes in and in early postpartumdid not occur by chance and their exclusion from the calculations of maternal mortality indicators only increases levels of underreporting.OBJECTIVE To analyze deaths from external causes and undefined causes in women of childbearing age occurring during pregnancy and early postpartum. METHODS The deaths of 399 women of childbearing age, resident in Recife, Northeastern Brazil, in the period 2004 to 2006, were studied. The survey utilized the Reproductive Age Mortality Survey method and a set of standardized questionnaires. Data sources included reports from the Institute of Legal Medicine, hospital and Family Health Strategy records and interviews with relatives of the deceased women. External causes of death during pregnancy were classified according to the circumstance of death, using the O93 code (ICD) and maternal mortality ratios before and after the classification were calculated. RESULTS Eighteen deaths during pregnancy were identified. The majority were aged between 20 and 29, had between 4 and 7 years of schooling, were black and single parents. Fifteen deaths were classified using the O93 code as pregnancy related death (13 for homicide – code 93.7; 2 by suicide – code 93.6) and three were classified as indirect obstetric maternal deaths (one homicide – code 93.7 and two by suicide – code 93.6). There was an average increment of 35% in the RMM after classification. CONCLUSIONS Deaths from undefined causes in and in early postpartumdid not occur by chance and their exclusion from the calculations of maternal mortality indicators only increases levels of underreporting.

Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess womens psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Postpartum depression among women with unintended pregnancy

OBJECTIVE To analyze the association between unintended pregnancy and postpartum depression. METHODS This is a prospective cohort study conducted with 1,121 pregnant aged 18 to 49 years, who attended the prenatal program devised by the Brazilian Family Health Strategy, Recife, PE, Northeastern Brazil, between July 2005 and December 2006. We interviewed 1,121 women during pregnancy and 1,057 after childbirth. Unintended pregnancy was evaluated during the first interview and postpartum depression symptoms were assessed using the Edinburgh Postnatal Depression Screening Scale. The crude and adjusted odds ratios for the studied association were estimated using logistic regression analysis. RESULTS The frequency for unintended pregnancy was 60.2%; 25.9% presented postpartum depression symptoms. Those who had unintended pregnancies had a higher likelihood of presenting this symptoms, even after adjusting for confounding variables (OR = 1.48; 95%CI 1.09;2.01). When the Self Reporting Questionnaire (SRQ-20) variable was included, the association decreased, however, remained statistically significant (OR = 1.42; 95%CI 1.03;1.97). CONCLUSIONS Unintended pregnancy showed association with subsequent postpartum depressive symptoms. This suggests that high values in Edinburgh Postnatal Depression Screening Scale may result from unintended pregnancy.

Atenção ao aborto no Sistema Único de Saúde no Nordeste Brasileiro: a estrutura dos serviços

Objectives: to assess the structure of maternity hospitals that provide care for woman undergoing abortions in the Brazilian National Health Service in the cities of Salvador, Recife and Sao Luis. Methods: three maternity hospitals were selected in each State capital. The data were obtained by way of interviews with the service manager or team of directors and direct observation. The interviews involved 120 questions divided into six sections - physical infrastructure, material resources, human resources, consumable materials, health education and management tools, covering four areas of evaluation - materials/physical environment; technical quality and care management; reception/guidance and continuity of care. The results were presented as a percentage of the maximum possible score: adequate (B80%); average (50% - 79%); inadequate (< 50%). Results: the highest scoring sections were physical infrastructure, material resources and consumable materials. Health education and management tools received the worst scores. No unit was deemed to have attained an adequate level of care. Seven were classified as average and two as inadequate. Conclusions: the units studied did not have an adequate structure for the intended abortion care model. There is a need for intervention to improve the structure of abortion care services and to promote the humanization of care.

Avaliação da qualidade da atenção ao aborto: protótipo de questionário para usuárias de serviços de saúde

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Evaluación de la calidad en la atención al aborto: cuestionario prototipo para usuarias de los servicios de salud

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.

Quality assessment of treatment associated with abortion: a prototype questionnaire for health services users

No Brasil, sao escassas as pesquisas sobre a qualidade da atencao ao aborto inseguro. O presente artigo visa a apresentar a primeira etapa da construcao de instrumento para estudo sobre a assistencia hospitalar prestada pelo Sistema Unico de Saude em tres cidades. Foram definidas quatro dimensoes essenciais da atencao – acolhimento e orientacao, qualidade tecnica do cuidado, continuidade da atencao, insumos/ambiente fisico – e respectivos criterios. Procedeu-se a adaptacao transcultural de conjunto de itens propostos pela Organizacao Mundial da Saude. Para dar conta de dimensoes e criterios nao contemplados pelo conjunto original de perguntas, optou-se por adaptar questoes de outros estudos e adicionar outras elaboradas pela propria equipe. O questionario foi pre-testado em 52 usuarias, nas tres cidades, para avaliar a aceitacao e compreensao, o tempo de aplicacao e ajustes finais. O instrumento totalizou 55 itens, organizados segundo os momentos assistenciais, cujo uso mais amplo depende de avaliacoes psicometricas em desenvolvimento e que se seguirao em outros artigos.Little research in Brazil has focused on the quality of care following unsafe abortion. This article presents the first step in the development of an instrument to assess hospital care provided by the Brazilian Unified National Health System in three cities of Brazil. Along with related criteria, four key dimensions of care were defined: wellcome and guidance, technical quality of care, continuity of care, and supplies and physical environment. The authors performed a cross-cultural adaptation of a set of items proposed by the World Health Organization. Following an assessment of the dimensions and criteria not captured by this set, the researchers decided to adapt questions from related studies and to add others developed by the research team itself. The questionnaire was pretested in 52 patients from three cities to assess the acceptance, understanding, and time of application and to make final adjustments. The instrument totaled 55 items organized according to different stages of care. Its expanded use depends on subsequent psychometric assessments, currently underway.