National Vaccine Coverage Survey 2020: methods and operational aspects.

OBJECTIVE: The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. METHODS: A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. RESULTS: Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. CONCLUSION: There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.

[Inadequacy of the content of prenatal care and associated factors in a cohort in the northeast of Brazil]. / Inadequação do conteúdo da assistência pré-natal e fatores associados em uma coorte no nordeste brasileiro.

The scope of this study was to analyze the content of prenatal care in São Luís, Maranhão, Brazil, and the factors associated with its inadequacy. A cross-sectional study was conducted based on data from the birth cohort of São Luís in 2010. The content of prenatal care was defined as inadequate when it did not meet the criteria of the Program for Humanization of Prenatal and Delivery Care, which establishes early initiation of prenatal care, minimum number of medical consultations, basic laboratory tests, tetanus vaccination and obstetric procedures. Poisson regression was used to observe associations of the variables with the outcome. The inadequacy rate was high (60.2%). The variables associated with inadequacy were: class C socioeconomic status (PR = 1.39; CI = 1.26-1.55); class D/E socioeconomic status (PR = 1.60; CI = 1.43-1.79); unqualified/unemployed mother (PR = 1.24; CI = 1.11-1.37); 5-8 years of schooling (PR = 1.12; CI = 1.06-1.19); 0-4 years of schooling (PR = 1.13; CI = 1.01-1.26); not being religious (PR = 1.10; CI = 1.04-1.17); alcohol use during pregnancy (PR = 1.13; CI = 1.06-1.20), and being attended by the public service (PR = 1.75; CI = 1.54-2.00). The results showed inadequacy and inequality of prenatal care, revealing that women of lower socioeconomic status received lower quality care.

Inadequação do conteúdo da assistência pré-natal e fatores associados em uma coorte no nordeste brasileiro / Inadequacy of the content of prenatal care and associated factors in a cohort in the northeast of Brazil

Resumo O objetivo desta pesquisa foi analisar o conteúdo da assistência pré-natal em São Luís e os fatores associados com sua inadequação. Realizou-se estudo transversal baseado em dados da coorte de nascimento de São Luís em 2010. O conteúdo da assistência pré-natal foi classificado como inadequado quando não atendeu aos critérios do Programa de Humanização no Pré-Natal e Nascimento (PHPN) que estabelece o início precoce, o número mínimo de consultas, os exames laboratoriais básicos, a vacinação antitetânica e os procedimentos obstétricos. Regressão de Poisson foi utilizada para observar associações das variáveis com o desfecho. A taxa de inadequação foi de 60,2%. O pré-natal inadequado foi associado à classe econômica C (RP = 1,39; IC = 1,26-1,55), à D/E (RP = 1,60; IC = 1,43-1,79), à ocupação da mãe não qualificada/desempregada (RP = 1,24; IC = 1,11-1,37), à escolaridade de 5-8 anos (RP = 1,12; IC = 1,06-1,19) e de 0-4 anos (RP = 1,13; IC = 1,01-1,26), a não ter religião (RP = 1,10; IC = 1,04-1,17), ao uso de álcool durante a gestação (RP = 1,13; IC = 1,06-1,20) e ao atendimento no serviço público (RP = 1,75; IC = 1,54-2,00). Os resultados demonstraram inadequação e iniquidade da assistência pré-natal, evidenciando que mulheres de pior condição socioeconômica foram as que receberam assistência de menor qualidade.

Abstract The scope of this study was to analyze the content of prenatal care in São Luís, Maranhão, Brazil, and the factors associated with its inadequacy. A cross-sectional study was conducted based on data from the birth cohort of São Luís in 2010. The content of prenatal care was defined as inadequate when it did not meet the criteria of the Program for Humanization of Prenatal and Delivery Care, which establishes early initiation of prenatal care, minimum number of medical consultations, basic laboratory tests, tetanus vaccination and obstetric procedures. Poisson regression was used to observe associations of the variables with the outcome. The inadequacy rate was high (60.2%). The variables associated with inadequacy were: class C socioeconomic status (PR = 1.39; CI = 1.26-1.55); class D/E socioeconomic status (PR = 1.60; CI = 1.43-1.79); unqualified/unemployed mother (PR = 1.24; CI = 1.11-1.37); 5-8 years of schooling (PR = 1.12; CI = 1.06-1.19); 0-4 years of schooling (PR = 1.13; CI = 1.01-1.26); not being religious (PR = 1.10; CI = 1.04-1.17); alcohol use during pregnancy (PR = 1.13; CI = 1.06-1.20), and being attended by the public service (PR = 1.75; CI = 1.54-2.00). The results showed inadequacy and inequality of prenatal care, revealing that women of lower socioeconomic status received lower quality care.