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França APFDM, de Sousa CM, de Lima MSGA, Fonseca RRDS, Laurentino RV, Monteiro JC, Feitosa RNM, dos Santos LM, Oliveira-Filho AB, Machado LFA. High Prevalence of Syphilis among Young Pregnant Women in the Brazilian Amazon: A Cross-Sectional Study Based on Clinical Records in a Public Health Reference Unit in the City of Belém. Pathogens 2024; 13:686. [PMID: 39204286 PMCID: PMC11357224 DOI: 10.3390/pathogens13080686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/20/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Syphilis remains a significant global public health concern, and one of its consequences in pregnant women is the potential occurrence of congenital syphilis due to Treponema pallidum infection. This study determined the prevalence of syphilis among pregnant women undergoing prenatal care in a neighborhood on the outskirts of the city of Belém, Brazilian Amazon. METHODS This cross-sectional study used data from clinical records of 611 pregnant women who underwent prenatal care at a public health unit in 2019 and 2020. The reagent result for VDRL was used as an indicator of syphilis. Odds Ratio and chi-square tests were used to evaluate the association of information from pregnant women with syphilis. RESULTS The overall prevalence of syphilis was 5.2 % (32/611; 95 % CI: 3.5-7.0 %). Age under 23 years was identified as a risk factor for syphilis. CONCLUSIONS The prevalence of syphilis among pregnant women in the outskirts of Belém is high, especially among younger women. There is an urgent need to intensify innovative sexual and reproductive health education initiatives and emphasize the importance of consistent practice of preventive measures against syphilis and other STIs in the Amazon region, especially in the young population.
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Affiliation(s)
- Ana Paula Figueiredo de Montalvão França
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.P.F.d.M.F.); (C.M.d.S.); (M.S.G.A.d.L.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Camille Massena de Sousa
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.P.F.d.M.F.); (C.M.d.S.); (M.S.G.A.d.L.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Misma Suely Gonçalves Araújo de Lima
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.P.F.d.M.F.); (C.M.d.S.); (M.S.G.A.d.L.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Ricardo Roberto de Souza Fonseca
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Rogério Valois Laurentino
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Jacqueline Cortinhas Monteiro
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Rosimar Neris Mantins Feitosa
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
| | - Leonardo Miranda dos Santos
- Bacteriology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil;
| | - Aldemir Branco Oliveira-Filho
- Study and Research Group on Vulnerable Populations, Institute for Coastal Studies, Federal University of Pará, Bragança 68600-000, PA, Brazil;
| | - Luiz Fernando Almeida Machado
- Biology of Infectious and Parasitic Agents Post-Graduate Program, Federal University of Pará, Belém 66075-110, PA, Brazil; (A.P.F.d.M.F.); (C.M.d.S.); (M.S.G.A.d.L.)
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Belém 66075-110, PA, Brazil; (R.R.d.S.F.); (R.V.L.); (J.C.M.); (R.N.M.F.)
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Paixao ES, Ferreira AJF, Pescarini JM, Wong KLM, Goes E, Fiaccone R, Lopes de Oliveira G, Reboucas P, Cardoso AM, Smeeth L, Barreto ML, Rodrigues LC, Ichihara MY. Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil. Lancet Glob Health 2023; 11:e1734-e1742. [PMID: 37858584 DOI: 10.1016/s2214-109x(23)00405-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This study estimated ethnoracial inequalities in maternal and congenital syphilis in Brazil, understanding race as a relational category product of a sociopolitical construct that functions as an essential tool of racism and its manifestations. METHODS We linked routinely collected data from Jan 1, 2012 to Dec 31, 2017 to conduct a population-based study in Brazil. We estimated the attributable fraction of race (skin colour) for the entire population and specific subgroups compared with White women using adjusted logistic regression. We also obtained the attributable fraction of the intersection between two social markers (race and education) and compared it with White women with more than 12 years of education as the baseline. FINDINGS Of 15 810 488 birth records, 144 564 women had maternal syphilis and 79 580 had congenital syphilis. If all women had the same baseline risk as White women, 35% (95% CI 34·89-36·10) of all maternal syphilis and 41% (40·49-42·09) of all congenital syphilis would have been prevented. Compared with other ethnoracial categories, these percentages were higher among Parda/Brown women (46% [45·74-47·20] of maternal syphilis and 52% [51·09-52·93] of congenital syphilis would have been prevented) and Black women (61% [60·25-61·75] of maternal syphilis and 67% [65·87-67·60] of congenital syphilis would have been prevented). If all ethnoracial groups had the same risk as White women with more than 12 years of education, 87% of all maternal syphilis and 89% of all congenital syphilis would have been prevented. INTERPRETATION Only through effective control of maternal syphilis among populations at higher risk (eg, Black and Parda/Brown women with lower educational levels) can WHO's global health initiative to eliminate mother-to-child transmission of syphilis be made feasible. Recognising that racism and other intersecting forms of oppression affect the lives of minoritised groups and advocating for actions through the lens of intersectionality is imperative for attaining and guaranteeing health equity. Achieving health equality needs to be addressed to achieve syphilis control. Given the scale and complexity of the problem (which is unlikely to be unique to Brazil), structural issues and social markers of oppression, such as race and education, must be considered to prevent maternal and congenital syphilis and improve maternal and child outcomes globally. FUNDING Wellcome Trust, CNPq-Brazil. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Enny S Paixao
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil.
| | - Andrêa J F Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; The Ubuntu Center on Racism, Global Movements & Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Julia M Pescarini
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Kerry L M Wong
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuelle Goes
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Rosemeire Fiaccone
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme Lopes de Oliveira
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil; Centro Federal de Educação Tecnológica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Poliana Reboucas
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | | | - Liam Smeeth
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, Bahia, Brazil
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Spatiotemporal distribution analysis of syphilis in Brazil: Cases of congenital and syphilis in pregnant women from 2001-2017. PLoS One 2022; 17:e0275731. [PMID: 36201505 PMCID: PMC9536537 DOI: 10.1371/journal.pone.0275731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
In Brazil, the notification of congenital (CS) and syphilis in pregnant women (SiP) is compulsory. Notification data provided by the Ministry of Health in combination with the mapping of vulnerable geographic areas is essential to forecasting possible outbreaks and more effectively combating infection through monitoring. We aim to evaluate the spatiotemporal distribution and epidemiological aspects of reported cases of CS and SiP in Brazil. A retrospective ecological study was carried out using secondary surveillance data obtained from the Brazilian National Notifiable Diseases Information System (SINAN) database, considering all reported cases of CS and SiP between 2001 to 2017. Epidemiological characteristics and time trends were analyzed using joinpoint regression models and spatial distribution, considering microregions or states/macroregions as units of analysis. A total of 188,630 (359/100,000 birth lives) CS and 235,895 of SiP (6.3/100,000 inhabitants) were reported during the period studied. In general, the epidemiologic profile of Brazil indicates most reported CS cases occurred in "mixed-race" newborns who were diagnosed within seven days of birth and whose mothers had received prenatal care, but the epidemiologic profile varies by Brazilian macroregion. Regarding SiP, most cases were among women who self-reported 'mixed-race', were aged 20-39 years, had up to eight years of formal education and were diagnosed with primary or latent syphilis. Approximately 549 (98.4%) and 558 (100%) microregions reported at least one case of CS and SiP, respectively. From 2012 to 2016, CS cases increased significantly in almost all Brazilian states, most notably in the South, Southeast, and Central-West macroregions, from 2001-2017 and the relative risk (RR) of SiP increased around 400% (RR: 1,00 to 445,50). Considering the epidemiological scenario of the infection in Brazil, it is necessary to enhance preventive, control and eradication measures.
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Seabra I, Ferreira GRON, Sorensen W, Oliveira C, Parente AT, Gir E, Reis RKK, Ferrari RAP, Botelho E. Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study. BMJ Open 2022; 12:e058270. [PMID: 35443962 PMCID: PMC9021778 DOI: 10.1136/bmjopen-2021-058270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques. DESIGN Ecological study. SETTINGS This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study. PRIMARY OUTCOME MEASURES The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan. RESULTS From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk. CONCLUSION This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.
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Affiliation(s)
- Iaron Seabra
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - William Sorensen
- Health & Kinesiology Department, University of Texas at Tyler, Tyler, Texas, USA
| | - Carmem Oliveira
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - Elucir Gir
- College of Nursing, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Eliã Botelho
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
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