Background: Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil. Methods: This study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included. Results: The results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits. In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits. Conclusions: ANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.

Purpose: To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. Data sources: Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. Study selection: Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. Data extraction: Publication date, study design and ANC process indicators were extracted. Results of data synthesis: Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. Conclusion: Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.

This study aimed to describe fetal, neonatal, and post-neonatal mortality and associated factors in participants of the 2015 Pelotas (Brazil) birth cohort. The child mortality sub-study followed up all deaths in the first year of life. Data were collected on intrauterine fetal deaths (weight ≥ 500g and/or gestational age ≥ 20 weeks), neonatal deaths (< 28 days of life), and post-neonatal deaths (from 28 days to the end of the first year of life). Descriptive analyses using the Pearson chi-square test and a multinomial logistic regression to estimate the risk of fetal, neonatal, and post-neonatal deaths compared to live infants in the cohort (reference group) were performed. Data from 4,329 eligible births were collected, of which 54 died during the fetal period. Of the 4,275 eligible live births, 59 died in the first year of life. An association between fetal, neonatal, and post-neonatal deaths (OR = 15.60, 7.63, and 5.51 respectively) was found, as well as less than six prenatal consultations. Compared to live infants, fetal deaths were more likely to occur in non-white mothers, and neonatal deaths were 14.09 times more likely to occur in a preterm gestational age (< 37 weeks). Compared to live infants, infants that were born in a C-section delivery had 3.71 increased odds of post-neonatal death. Additionally, neonatal deaths were 102.37 times more likely to have a low Apgar score on the fifth minute after birth. These findings show the need for early interventions during pregnancy, ensuring access to adequate prenatal care.

Background: Studies 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. Methods: In 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. Results: The 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. Conclusions: Self-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.

Evaluating vaccination coverage in the infant population aged 0-23 months by cluster (locality) in Bogotá and identifying reasons for the lack of vaccination coverage. This was a descriptive, retrospective study. Sample size was calculated on target population (children aged 0-23 months), further divided into 0-1, 2-6, 7-11 and 12-23 month sub-groups by tri-stage sampling to ascertain newborn vaccination status, evaluate opportune oral polio vaccine (OPV) and pentavalent vaccine third dose vaccination and opportune measles, mumps and rubella (MMR) vaccination. 5,845 children were surveyed; 96.7% had immunisation cards, 75.3% were registered in the Social Protection System and 12.6% (713 out of 5,845) had not been vaccinated. Vaccination coverage by biological products was as follows: 99.1% BCG, 93.0% pentavalent vaccine, 93.2% OPV, 85% MMR. Vaccination opportunity was 5,328 for BCG (94.3%), 1 256 for OPV (88.6%), 1 112 for pentavalent (88.5%) and 1,702 for MMR (69.5%) with 33 vaccination errors (1.3%). Among the identified reasons for non-vaccination were confused health service logistics and coordination (59.2%), misguided parental beliefs (27.9%) and unregistered children (12.8%). Useful and timely vaccine coverage was evident with BCG; there were difficulties regarding recording pentavalent vaccination. Information, education and mass communication strategies must be developed to counteract reasons given for non-vaccination and to educate parents and tutors in its opportune application to increase triple-viral vaccine coverage.

Introduction: Since the emergence of the SARS-CoV-2, there have been efforts to develop vaccines to control the COVID-19 pandemic.Objective: The present study assessed the efficacy and safety of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-Vac rAd26-S/rAd5-S vaccines against theSARS-CoV-2.Materials and methods: We searched PubMed/MEDLINE, Google Scholar, Cochrane, and the WHO International Clinical Trials Registry Platform on March 15, 2021. The searchterms used were: “vaccine” OR “vaccination” AND “covid19” OR “coronavirus” OR “sarscov2” AND “bnt162b2” OR “chadox1-S” OR “azd1222” OR “sputnik” OR “Gam-COVID-Vac” OR“mrna” OR “mRNA-1273” . We measured the risk of bias of the studies and the quality of the evidence using GRADE profiles. A qualitative and quantitative analysis of the results of clinical trials is presented.Results: Of the 74 identified studies, 4 were finally included in this review. The efficacies of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-VacrAd26-S/rAd5-S vaccines against symptomatic COVID-19 were 95,0% (CI95% 90,3-97,6), 94,1% (CI95% 89,3-96,8), 66,7% (CI95% 57,4-74,0), and 91,1% (CI95% 83,8-95,1), respectively. There was moderate certainty of the evidence due to serious indirectness, when we measured the risk of bias of the studies and the quality of the evidence using GRADE profile. The safety profiles were acceptable, and data on serious adverse events (summary RR=0,93; CI95% 0,77-1,12; p=0,16) and deaths from all causes (summary RR=0,70; CI95% 0,33-1,50; p=0,90) showed no significant differences.Conclusion: The results of this review support the level of evidence for the efficacy and safety of the COVID-19 vaccines analysed.