Structure in Brazilian maternity hospitals: key
					characteristics for quality of obstetric and neonatal care

Bittencourt, Sonia Duarte de Azevedo; Reis, Lenice Gnocchi da Costa; Ramos, Márcia Melo; Rattner, Daphne; Rodrigues, Patrícia Lima; Neves, Dilma Costa Oliveira; Arantes, Sandra Lúcia; Leal, Maria do Carmo

doi:10.1590/0102-311X00176913

person Sonia Duarte de Azevedo Bittencourt

schoolEscola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

person Lenice Gnocchi da Costa Reis

schoolEscola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

person Márcia Melo Ramos

schoolSubsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonoses, Secretaria Municipal de Saúde, Rio de Janeiro, Brasil.

person Daphne Rattner

schoolFaculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brasil.

person Patrícia Lima Rodrigues

schoolEscola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

person Dilma Costa Oliveira Neves

schoolCentro Universitário do Estado do Pará, Belém, Brasil.

person Sandra Lúcia Arantes

schoolCentro de Ciências Biológicas, Universidade Federal de Mato Grosso do Sul, Campo Grande , Brasil.

person Maria do Carmo Leal

schoolEscola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

This study aimed to evaluate key characteristics of structure in a sample of maternity hospitals in Brazil. Structure was evaluated according to Ministry of Health criteria and included: geographic location, obstetric volume, presence of ICU, teaching activities, staff qualifications, and availability of equipment and medicines. The results showed differences in staff qualifications and availability of equipment in obstetric and neonatal care according to type of financing, region of the country, and degree of complexity. The North/Northeast and Central-West regions presented the most serious problems with structure. The public and mixed hospitals were better structured in the South/Southeast, reaching satisfactory levels on various items, similar or superior to the private hospitals. The current study contributes to the debate on quality of structure in Brazil’s hospital services and emphasizes the need to develop analytical studies considering process and results of obstetric and neonatal care.

Maternity Hospitals; Structure of Services; Quality of Health Care;

Correspondence S. A. Bittencourt Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brasil. sonia@ensp.fiocruz.br

Contributors

S. D. A. Bittencourt participated in the study project’s national coordination and collaborated in the data analysis and writing of the article. L. G. C. Reis collaborated in the elaboration of the questionnaire, data analysis, and writing of the article. M. M. Melo and P. L. Rodrigues collaborated in the elaboration of the questionnaire and writing of the article. D. Rattner, D. O. Neves and S. L. Arantes were State coordinators of the study and collaborated in the data analysis and writing of the article. M. C. Leal was the national study coordinator and collaborated in the data analysis and writing of the article.

	Public (%)			Mixed (%)			Private (%)			Brazil (%)
	N/NE	S/SE	C	N/NE	S/SE	C	N/NE	S/SE	C	Public	Mixed	Private
Located in State capital	16.9	38.7	62.8	18.4	8.1	67.6	32.4	23.0	39.1	28.8	13.4	28.3
Obstetric volume
CHigh	15.1	36.0	7.1	28.0	10.0	17.6	3.7	14.8	0.0	22.3	13.9	8.7
Medium	46.4	53.8	76.2	52.8	51.8	26.5	49.1	50.8	39.1	51.7	50.6	48.8
Low	38.5	10.2	16.7	19.2	38.3	55.9	47.2	34.4	60.9	26.0	35.5	42.5
ICU	32.9	69.2	48.8	55.6	67.2	42.4	76.1	97.6	69.6	47.7	63.7	86.2
Type of ICU
Adult ICU	29.7	3.9	23.8	57.1	38.0	14.3	0.0	15.8	0.0	15.4	40.4	8.7
Neonatal ICU	29.7	15.6	0	2.9	3.1	7.1	9.6	14.2	31.3	19.6	3.2	13.7
Adult and neonatal ICU	40.7	80.5	76.2	40.0	59.0	78.6	90.4	70.0	68.8	65.0	56.4	77.6
Teaching hospital	69.4	82.8	100.0	52.4	79.2	85.3	0.0	21.1	13.0	76.9	74.1	11.4
High-risk referral hospital	20.1	56.1	32.6	7.1	30.1	20.6	0.0	0.0	0.0	34.5	25.2	0.0

Service	Public (%)			Mixed (%)			Private (%)			Brazil (%)
Service	N/NE	S/SE	C	N/NE	S/SE	C	N/NE	S/SE	C	Public	Mixed	Private
Obstetrics
Physician
Médico
Coordinator	50.4	95.7	93.0	73.6	91.9	54.6	69.4	73.8	73.9	70.6	86.3	71.8
With specialized training	85.7	100.0	100.0	82.6	100.0	88.9	100.0	100.0	100.0	94.4	96.7	100.0
Nurse
Coordinator	63.3	71.5	83.7	74.6	92.1	100.0	61.1	63.4	73.9	68.0	89.1	63.4
With specialized training	55.7	67.7	36.1	45.7	51.7	23.5	90.9	47.4	23.5	58.0	49.0	62.7
Neonatology
Physician
Coordinator	31.5	72.0	76.2	54.0	64.0	32.4	100.0	80.5	82.6	50.2	60.3	89.0
With specialized training	85.2	100.0	93.8	64.7	91.2	100.0	52.3	100.0	100.0	94.1	86.8	77.0
Nurse
Coordinator	34.9	72.0	69.0	52.0	50.7	81.8	64.2	68.0	73.9	51.4	52.6	66.9
With specialized training	47.4	79.1	55.2	32.3	43.0	18.5	61.4	75.9	54.1	64.4	39.2	71.8
All coordinators with specialized training	9.4	29.2	18.6	7.2	18.7	8.8	4.5	11.4	12.5	17.4	15.9	8.7

Emergency equipment	Public (%)			Mixed (%)			Private (%)			Brazil (%)
Emergency equipment	N/NE	S/SE	C	N/NE	S/SE	C	N/NE	S/SE	C	Public	Mixed	Private
Obstetric
Mechanical respirator/Ventilator	62.9	91.4	74.4	69.0	95.0	97.1	97.2	100.0	100.0	74.4	90.0	98.8
Laryngoscope and endotracheal tube	85.6	100.0	100.0	89.6	100.0	100.0	100.0	100.0	100.0	92.1	98.0	100.0
Manual resuscitator	94.2	100.0	100.0	98.4	100.0	100.0	100.0	100.0	100.0	96.8	99.7	100.0
All equipment	56.3	91.4	74.4	64.3	95.0	97.1	97.2	100.0	100.0	70.6	89.1	98.8
Neonatal
Laryngoscope and endotracheal tube	83.8	100.0	100.0	85.7	100.0	100.0	100.0	95.9	100.0	91.1	97.2	98.0
Valve-less neonatal suction catheters	73.2	99.5	100.0	86.5	97.2	100.0	100.0	95.9	100.0	85.3	95.2	98.0
Meconium aspirator and aspirator with manometer and O2	55.0	94.1	100.0	86.5	90.6	73.5	100.0	76.2	95.7	73.2	88.9	88.2
Material for ventilation manual resuscitator)	88.5	100.0	100.0	92.1	100.0	100.0	100.0	95.9	100.0	93.8	98.4	98.0
All equipment	44.8	93.5	100.0	64.3	87.7	73.5	100.0	75.6	95.7	67.7	82.1	87.8
Blood bank or transfusion service	62.2	77.0	74.4	47.6	83.6	58.8	56.5	74.6	75.0	68.8	75.2	66.9
Clinical pathology laboratory	91.7	89.8	100.0	69.6	87.6	97.1	79.8	91.1	95.7	91.9	84.6	86.6
Ambulance for mothers	95.3	100.0	100.0	77.0	90.9	88.2	49.5	62.6	100.0	97.4	88.1	60.6
Ambulance for newborns	64.7	63.1	100.0	60.3	46.4	87.9	28.7	8.9	0.0	67.1	51.3	16.5

	Public (%)			Mixed (%)			Private (%)			Brazil (%)
	N/NE	S/SE	C	N/NE	S/SE	C	N/NE	S/SE	C	Public	Mixed	Private
Medicines
Anti-hypertensives	100.0	99.5	100.0	100.0	100.0	100.0	92.7	89.4	100.0	99.8	100.0	92.1
Anxiolytics/Hypnotics	97.1	94.7	88.4	92.9	95.8	100.0	92.7	87.7	100.0	95.7	95.5	90.9
Steroids	97.1	100.0	100.0	93.6	100.0	100.0	97.2	89.4	100.0	98.4	98.8	94.1
Oxytocin	100.0	100.0	100.0	100.0	100.0	100.0	90.7	89.4	100.0	100.0	100.0	90.9
Uterine contractility inhibitors	100.0	97.3	100.0	98.4	97.7	100.0	97.2	89.4	100.0	99.0	98.0	94.1
Magnesium sulfate	100.0	98.4	95.3	100.0	97.7	100.0	97.2	89.4	100.0	99.0	98.3	94.1
Surfactant	58.6	88.2	83.3	39.2	73.7	64.7	97.2	87.0	87.0	71.6	66.6	91.3
Coagulants/Hemostatic drugs for woman	87.5	70.4	76.2	92.9	89.2	100.0	97.2	85.2	95.7	80.3	90.5	91.3
Coagulants/Hemostatic drugs for newborn	98.6	100.0	100.0	100.0	100.0	100.0	97.2	89.4	100.0	99.2	100.0	94.1
Solution for prevention of neonatal conjunctivitis	87.8	81.7	88.4	96.0	93.3	100.0	97.2	84.6	100.0	85.8	94.2	91.7
Anti-D immunoglobulin	74.8	95.7	88.4	96.0	93.3	100.0	97.2	84.6	100.0	83.6	93.6	79.5
All medicines	37.3	48.1	53.5	34.9	64.2	64.7	66.1	71.8	83.3	42.6	58.6	70.6

	Neonatal ICU with six or more beds and adult ICU (%)
	Public		Mixed		Private
	No	Yes	No	Yes	No	Yes
Location in State capital	13.6	63.6	9.9	20.3	25.0	30.7
Obstetric volume
High	14.7	39.6	10.2	22.1	4.8	12.0
Medium	50.5	54.6	41.3	69.7	23.8	66.0
Low	34.8	5.8	48.5	8.2	71.4	22.0
Total	100.0	100.0	100.0	100.0	100.0	100.0
Teaching hospital	70.3	91.6	67.4	88.0	2.9	17.3
High-risk referral hospital	12.7	84.4	5.8	65.7	0.0	0.0
Head physician and head nurse with specialized training	5.4	45.5	5.1	38.5	4.8	12.0
Obstetric emergencies
All equipment	53.3	100.0	76.1	94.2	97.1	100.0
Neonatal emergencies
All equipment	61.8	90.9	87.3	92.3	87.5	88.7
Availability
Blood bank or transfusion service	57.2	94.8	65.8	94.7	71.4	63.3
Clinical pathology laboratory	89.0	98.7	83.6	86.5	73.1	96.0
Ambulance for mothers	96.3	100.0	87.8	88.9	61.9	59.3
Ambulance for newborns	70.8	58.4	48.8	56.9	34.3	4.0
Medicines
All medicines	32.6	66.0	48.1	80.3	46.2	88.0

[tfn01t01_en] C: Central; N: North; NE: Northeast; S: South; SE: Southeast; ICU: intensive care unit. * Values weighted according to sampling plan.

Structure in Brazilian maternity hospitals: key characteristics for quality of obstetric and neonatal care