Abstract
BackgroundStudies 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.MethodsIn 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.ResultsThe 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.ConclusionsSelf-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.
Highlights
Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data
Agreement between Antenatal Care (ANC) card indicators and questionnaire information From the 21 indicators in the ANC card we observed that agreement strength with self-reported questionnaire information was poor in 1 indicator (K < 0.00), slight for
When we compared the antenatal card with self-report as the gold standard, we found that the specificity and sensitivity were > 80% for 60% (13/21) and 25% (5/21) of ANC indicators respectively
Summary
Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reduction of maternal mortality remains a priority under “Goal 3: Ensure healthy lives and promote wellbeing for all at all ages” in the new Sustainable Development Goals (SDGs) agenda through 2030 [2]. In this context, information on maternal and child health is fundamental to ensure antenatal care quality and reduction of maternal and perinatal mortality. The card is a tool included in the Prenatal and Birth Humanization Program, part of the Ministry of Health medical record systems, and its use is mandatory to ensure that healthcare for pregnant women meets the national minimum quality standards. The systematic collection of data during each consultation can be used to provide optimal health services at any point of care
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