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International Notes Pregnancy Risk Factor Assessment -- North Area of Santiago, Chile, 1982-1983

To guide public health programs in the north area of metropolitan Santiago, Chile, and to estimate the prevalence of pregnancy risk factors, the University of Chile School of Public Health surveyed 220 women in 1982-1983. All had delivered single live-born infants at a hospital in the area. Home interviews of randomly selected mothers were conducted by senior medical students, with all selected mothers being interviewed. Mothers were asked about prenatal activities, such as smoking and drinking, their previous contraceptive practices, and other perinatal and postnatal questions (1,2). Only data on prenatal risk factors are presented here.

When compared with the fathers, mothers were younger, less well educated, and less likely to work outside the home (Table 6). Seventy-one percent of women were married, and 19% were living in consensual union. The selected infant was the mother's first live birth for 42% of the women; the second or third live birth for 42%; and the fourth or more for 16%. Of these mothers, 18% reported having had at least one prior abortion, and 5% had experienced the death of at least one child. Regarding contraceptive use during the time of conception, 86% of the mothers had not used a birth control method, and 14% had used an intrauterine device, birth control pills, or some other method.

The behavioral risk factors that were measured included alcohol consumption, smoking, prenatal care, and medications taken during pregnancy. Alcohol use was reported by 25% of the women, with one-third reporting that they had been "drunk on an infrequent basis." Wine was the preferred beverage, although other beverages were consumed. Forty-nine percent reported smoking cigarettes during pregnancy: 18% of these occasionally smoked; 71% smoked fewer than 10 cigarettes per day; 5% smoked 10-20 cigarettes per day; and 6% smoked more than 20 cigarettes per day. A large majority of the mothers sought prenatal care during their most recent pregnancy. In terms of medication usage, 67% of mothers reported taking multivitamins; 22% took iron; 11% took calcium; and 51% took some other medication. Reported by A Kirschbaum, MD, A Salomon, E Parker MD, V Abarca, L Contreras, M Chomali, R Dinator, L Escobar, V Fabre, M Gelman, V Gutierrez, M Hazbun, V Murillo, A Opazo, T Riveros, M Samman, School of Public Health, University of Chile, Santiago; Pregnancy Epidemiology Br, Div of Reproductive Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: When directing reproductive health programs, rapid assessment of the needs of the population being served is essential. Assessment of program clientele can easily be incorporated, but assessment of those not participating can be difficult. In select areas, the above study proposes a simple, repeatable methodology to measure the prevalence of risk factors in women giving birth, regardless of their program participation. The method requires four conditions: (1) that the program area have a high proportion of in-hospital deliveries; (2) that most hospitals handling program area deliveries be included; (3) that program area deliveries be distinguishable from deliveries not in the program area; and (4) that a systematic or random method to select mothers for interview be available. This sampling frame can also be modified to include all registered births. The National Center for Health Statistics uses this methodology when conducting the periodic National Natality Survey. However, the sample selected by either method will not represent all pregnancies, since women with miscarriages, induced abortions, and fetal deaths are not included.

This survey had two major accomplishments. The first, obtaining information about the prevalence of selected risk factors among mothers and their newborns in the area north of Santiago, resulted in an immediate benefit: prenatal-care practitioners in the outpatient clinic were notified of the low percentage of mothers taking iron during pregnancy (22%). The second accomplishment, teaching medical students community-based epidemiologic study methods, resulted in a practical public health experience. Moreover, the community's respect for the medical students was the reason attributed for the survey's 100% response rate. As demonstrated by these accomplishments, this survey method provides one way to complete the programmatic assessment needed to help attain the goal of the World Health Organization of "Health for All by the Year 2000" (3).

References

  1. CDC. A technique for rapid epidemiologic assessment--Nevada. MMWR 1982;31:61-3.

  2. Ravenholt RT, Ravenholt OT, Payne D, Arrington H. One thousand birth epidemiological surveys. In: Magee ML, Cauthen H, eds. Energy, health and the environment: program and abstracts. Los Angeles, California: American Public Health Association, 1981:270 (abstract #3007).

  3. World Health Organization. Formulating strategies for health for all by the year 2000: guiding principles and essential issues/document of the World Health Organization. Geneva: World Health Organization, 1979.



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