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