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Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal : Results from the IMAgiNE EURO study

Costa, Raquel ; Barata, Catarina ; Dias, Heloísa ; Rodrigues, Carina ; Santos, Teresa ; Mariani, Ilaria ; Covi, Benedetta ; Valente, Emanuelle Pessa ; Lazzerini, Marzia and Ćerimagić, Amira , et al. (2022) In International Journal of Gynecology and Obstetrics 159(S1). p.137-153
Abstract

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall... (More)

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
childbirth, COVID-19, IMAgiNE EURO, maternal care, newborn care, Portugal, quality of care, respectful maternity care
in
International Journal of Gynecology and Obstetrics
volume
159
issue
S1
pages
17 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:36530002
  • scopus:85144292506
ISSN
0020-7292
DOI
10.1002/ijgo.14507
language
English
LU publication?
yes
id
43b69e92-1f33-4392-82f7-e8dc9c1e6a7f
date added to LUP
2023-01-07 14:57:12
date last changed
2024-04-15 13:25:48
@article{43b69e92-1f33-4392-82f7-e8dc9c1e6a7f,
  abstract     = {{<p>Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.</p>}},
  author       = {{Costa, Raquel and Barata, Catarina and Dias, Heloísa and Rodrigues, Carina and Santos, Teresa and Mariani, Ilaria and Covi, Benedetta and Valente, Emanuelle Pessa and Lazzerini, Marzia and Ćerimagić, Amira and Drandić, Daniela and Kurbanović, Magdalena and Virginie, Rozée and de La Rochebrochard, Elise and Löfgren, Kristina and Miani, Céline and Batram-Zantvoort, Stephanie and Wandschneider, Lisa and Morano, Sandra and Chertok, Ilana and Hefer, Emek and Artzi-Medvedik, Rada and Pumpure, Elizabete and Rezeberga, Dace and Jansone-Šantare, Gita and Jakovicka, Dārta and Knoka, Anna Regīna and Vilcāne, Katrīna Paula and Liepinaitienė, Alina and Kondrakova, Andželika and Mizgaitienė, Marija and Juciūtė, Simona and Arendt, Maryse and Tasch, Barbara and Nedberg, Ingvild Hersoug and Kongslien, Sigrun and Vik, Eline Skirnisdottir and Baranowska, Barbara and Tataj-Puzyna, Urszula and Węgrzynowska, Maria and Linden, Karolina and Zaigham, Mehreen and Mueller, Antonia N}},
  issn         = {{0020-7292}},
  keywords     = {{childbirth; COVID-19; IMAgiNE EURO; maternal care; newborn care; Portugal; quality of care; respectful maternity care}},
  language     = {{eng}},
  number       = {{S1}},
  pages        = {{137--153}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{International Journal of Gynecology and Obstetrics}},
  title        = {{Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal : Results from the IMAgiNE EURO study}},
  url          = {{http://dx.doi.org/10.1002/ijgo.14507}},
  doi          = {{10.1002/ijgo.14507}},
  volume       = {{159}},
  year         = {{2022}},
}