Indicadores de saúde materna e infantil em uma capital do nordeste brasileiro: Uma análise de séries temporais

Abstract

Introduction: Maternal and child health problems remain significant worldwide, especially in low- and middle-income countries. In Brazil, regional inequalities still hinder the achievement of the Sustainable Development Goals (SDGs), with the Northeast region facing major challenges. In this context, monitoring maternal and child health through indicators available in health information systems enables the continuous evaluation of service performance and implemented actions, particularly within the scope of care during the first 1,000 days. Objective: To analyze the temporal trend of maternal and child health indicators in Primary Health Care (PHC) in the city of São Luís, capital of Maranhão, from 2017 to 2024. Methods: This is an ecological time-series study using secondary data from the Primary Health Care Information System (SISAB). Six indicators related to women’s health were analyzed [number of pregnant women with prenatal care initiated up to 12 weeks of gestational age (GA); number of pregnant women with exams performed up to 20 weeks of GA; number of pregnant women with six or more prenatal visits; number of collective educational activities with pregnant women; number of home visits by community health workers (CHWs) to pregnant women; number of home visits by CHWs to postpartum women], and four indicators related to child health [number of home visits by CHWs to newborns (NB); number of children in exclusive breastfeeding; number of children in complementary breastfeeding; and number of children with up-to-date vaccination]. All indicators were expressed as ratios per 100 live births. Trends were estimated using Joinpoint regression, calculating semiannual percent changes (SPC), considering a 5% significance level. For each indicator, the number of joinpoints was selected based on the lowest Bayesian Information Criterion (BIC). Results: Descriptive analysis showed wide variability across indicators, with high coefficients of variation, reflecting irregularity in the provision of PHC actions. In the temporal trend analysis (Joinpoint model), high variability was also observed, with the highest coefficients of variation found in the indicators “number of collective educational activities with pregnant women” (CV=90%) and “number of pregnant women with six or more prenatal visits” (CV=81%). Significant increasing trends were identified for early initiation of prenatal care (SPC=14.77%; p<0.001), completion of six or more prenatal visits (SPC=20.06%; p<0.001), and exams up to 20 weeks between 2017 and 2023 (SPC=15.20%; p=0.003), with a non-significant inflection in the final period. Educational activities showed a significant decrease between 2019 and 2021, followed by growth thereafter (SPC=36.74%; p=0.002). Exclusive breastfeeding (SPC=16.58%; p<0.001) and complementary breastfeeding from 2020 onward (SPC=21.50%; p=0.024) also showed significant increases. In contrast, oscillatory behavior was observed in home visits and in indicators related to vaccination and child followup. Conclusion: The temporal trend of maternal and child health indicators in Primary Health Care in São Luís showed a heterogeneous pattern from 2017 to 2024. Consistent improvements were observed in indicators related to timely access to prenatal care and breastfeeding practices, whereas indicators related to home visits, vaccination, and child follow-up showed instabilities, suggesting weaknesses in the continuity and regularity of care actions.