APH 1998, 56, 263-273:

Prenatal care use, perinatal and infant mortality in Portugal.  An area-level analysis.

H. Barros, and M. Tavares

Keywords: districts, ecological study, infant mortality, prenatal care, perinatal mortality, Portugal

This study describes differences in district utilization and content of prenatal care services in Portugal and its relation with perinatal and infant mortality. A sample of 1,582 deliveries in 41 public hospitals, grouped according to 19 districts of residence, was evaluated to obtain a quantitative characterization of care. Use of prenatal care was classified as no care, late care, and inadequate care and self-reported information on screening for hepatitis B surface antigen (HBsAg) was used as a surrogate for content of care. Linear regression and multiple regression analysis were performed to identify the contribution of prenatal care for the district variation in perinatal and infant mortality. Portuguese districts presented significant differences in prenatal care utilization. District perinatal mortality was related with the proportion of women without information on HBsAg screening ( = 0.11, p = 0.025) but not significantly correlated with quantitative indexes of care. After accounting for the significant effect of the proportion of women less than 19 years and with adverse obstetric history, the proportion of women with no care or without information on HBsAg screening were independent predictors of the district variation in infant ( = 0.33, p = 0.016; = 0. 10, p = 0.031, respectively) and neonatal mortality ( = 0.24, p = 0.048; = 0.10, p = 0.013, respectively). Postneonatal mortality was associated with the proportion of women with no care 0.14, p = 0.034) after adjusting for the proportion of less educated women. In Portugal, there are significant district disparities on the use and content of the freely available prenatal care services that show a relation with local rates of perinatal and infant mortality.