Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019

Madeiro, Alberto; Rufino, Andréa Cronemberger; Nunes, Maria das Dores Sousa; Martins, Victor Manfrinni Magalhães Lima; Barbosa, Clara Maria; Sousa, Alessandra Maria Cerqueira de; Acaqui, Raiza Farnochia

doi:10.1590/1806-9304202200020005

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 22 (2) • Apr-Jun 2022 • https://doi.org/10.1590/1806-9304202200020005 copy

Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate the structure and adequacy of maternal healthcare facilities in Piauí.

Methods:

cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher’s chi-square/exact tests were used to assess differences in adequacy of structure.

Results:

only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031).

Conclusions:

Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.

Key words:
Structure of services; Maternity hospitals; Maternal healthcare; Quality of health care

Characteristic	N	%
Location
Capital	06	23.1
Countryside	20	76.9
Funding
Public	23	88.5
Private	03	11.5
Number of deliveries/year
<1000	05	19.2
1000 a 2999	17	65.4
≥ 3000	04	15.4
Adult ICU
Yes	03	11.5
No	23	88.5
Neonatal ICU
Yes	05	19.2
No	21	80.8
Clinical Laboratory
Yes	19	73.1
No	07	26.9
Blood bank/transfusion agency
Yes	12	46.2
No	14	53.8
Ambulance
Yes	18	69.2
No	08	30.8

Parameter	Capital		Countryside		Public		Private		All
Parameter	n	%	n	%	n	%	n	%	n	%
Physical infrastructure
Reception/welcoming room	6	100.0	20	100.0	23	100.0	3	100.0	26	100.0
Examination/Intake room	6	100.0	17	85.0	20	86.9	3	100.0	23	88.5
PPP Room	3	50.0	9	45.0	11	47.8	1	33.3	12	46.2
Walking area	5	83.3	15	75.0	17	73.9	3	100.0	20	76.9
Surgical delivery room/curettage	6	100.0	17	85.0	20	86.9	3	100.0	23	88.5
Human resources
24-hour obstetrician	6	100.0	16	80.0	19	82.6	3	100.0	22	84.6
24-hour pediatrician	6	100.0	13	65.0	16	69.6	3	100.0	19	73.1
24-hour anesthesiologist	6	100.0	10	50.0	13	56.5	3	100.0	16	61.5
24-hour nurse	6	100.0	19	95.0	22	95.7	3	100.0	25	96.2
Equipment
Laryngoscope/adult orotracheal tube	6	100.0	19	95.0	22	95.7	3	100.0	25	96.2
Laryngoscope/neonatal orotracheal tube	6	100.0	17	85.0	20	86.9	3	100.0	23	88.5
Mechanical fan	6	100.0	19	95.0	22	95.7	3	100.0	25	96.2
Hand Resuscitator	6	100.0	20	100.0	23	100.0	3	100.0	26	100.0
Grab bar	4	66.7	10	50.0	13	56.5	1	33.3	14	53.8
Obstetrical ‘horse-type’ seat	4	66.7	10	50.0	13	56.5	1	33.3	14	53.8
Swiss ball	4	66.7	10	50.0	13	56.5	1	33.3	14	53.8
Drugs
Magnesium sulfate	6	100.0	14	70.0	17	73.9	3	100.0	20	76.9
Misoprostol	6	100.0	14	70.0	17	73.9	3	100.0	20	76.9
Oxytocin	6	100.0	14	70.0	17	73.9	3	100.0	20	76.9
Antihypertensives	6	100.0	20	100.0	23	100.0	3	100.0	26	100.0
Uterine contractility inhibitors	6	100.0	16	100.0	19	82.6	3	100.0	22	84.6
Anti-D immunoglobulin	6	100.0	13	65.0	16	69.6	3	100.0	19	73.1
Antihemorrhagic	6	100.0	18	90.0	21	91.3	3	100.0	24	92.3
Antibiotics	6	100.0	20	100.0	23	100.0	3	100.0	26	100.0
Surfactant	6	100.0	10	50.0	13	56.5	3	100.0	16	61.5
Corticosteroids	6	100.0	20	100.0	23	100.0	3	100.0	26	100.0

Parameter	Capital		Countryside		p	Public		Private		p
Parameter	n	%	n	%	p	n	%	n	%	p
Physical infrastructure					0.073					0.068
Appropriate	2	33.3	8	40.0		9	39.1	1	33.3
Partially appropriate	4	66.7	11	55.0		13	56.5	2	66.7
Inappropriate	0	-	1	5.0		1	4.4	0	-
Human resources					0.021^* * p<0.05.					0.035^* * p<0.05.
Appropriate	6	100.0	9	45.0		12	52.2	3	100.0
Partially appropriate	0	-	8	40.0		8	34.8	0	-
Inappropriate	0	-	3	15.0		3	13.0	0	-
Equipment					0.063					0.078
Appropriate	4	66.7	10	50.0		13	56.5	1	33.3
Partially appropriate	2	33.3	8	40.0		8	34.8	2	66.7
Inappropriate	0	-	2	10.0		2	8.7	0	-
Drugs					0.001^* * p<0.05.					0.015^* * p<0.05.
Appropriate	6	100.0	8	40.0		11	47.8	3	100.0
Partially appropriate	0	-	7	35.0		7	30.4	0	-
Inappropriate	0	-	5	25.0		5	21.8	0	-
Global adequacy					0.034^* * p<0.05.					0.031^* * p<0.05.
Appropriate	2	33.3	4	20.0		5	21.8	1	33.3
Partially appropriate	3	50.0	8	40.0		9	39.1	2	66.7
Inappropriate	1	16.7	8	40.0		9	39.1	0	-

Instituto de Medicina Integral Prof. Fernando Figueira Rua dos Coelhos, 300. Boa Vista, 50070-550 Recife PE Brasil, Tel./Fax: +55 81 2122-4141 - Recife - PR - Brazil
E-mail: revista@imip.org.br

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[1] Authors’ contribution

Madeiro A and Rufino AC contributed to the study design, data analysis and interpretation, and manuscript writing. Nunes MDS, Martins VML, Barbosa CM, Sousa AMC and Acaqui RF collaborated in the study design, data interpretation and relevant critical review of the manuscript’s intellectual content. All authors approved the final version and are responsible for all aspects of the work, ensuring its accuracy and integrity.

The authors declare no conflicts of interest.