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Adami ADG, da Motta LR, Sperhacke RD, Kato SK, Pereira GFM, Rahmi RM. Adequacy of prenatal care and associated factors in the State of Rio Grande do Sul, Brazil. Rev Saude Publica 2023; 57:68. [PMID: 37878854 PMCID: PMC10519679 DOI: 10.11606/s1518-8787.2023057005146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE This study aims to assess the degree of adequacy of prenatal care (PNC) in the state of Rio Grande do Sul (RS) and in its 7 macro-regions considering the time of PNC initiation and the number of appointments attended. It also aims to verify the mode of delivery prevalence and the factors associated with PNC adequacy by mode of delivery. METHODS Sub analysis from a cross-sectional study conducted among 13,432 childbearing women aged 15-49 years assisted in 66 maternity hospitals of the Unified Health System (SUS) and private associated facilities from September 2017 to October 2019. A standardized form was used to collect sociodemographic data, and information about PNC and delivery from the childbearing women's prenatal cards, hospital records, and medical reports. RESULTS The PNC coverage was (98.4%), but only 57.5% of the participants had an adequate PNC defined as the one initiated until the 12th gestational week, with attendance of at least 6 appointments. The cesarean rate was 57.2%. Among women who performed vaginal delivery, multivariate analysis showed that for each 1-year increase in the age of the parturient, the chance of having an adequate PNC increased by 5%. White parturients with higher education and fewer deliveries residing in the macro-region of Valleys were more likely to have an adequate PNC when compared with non-white parturients, who were illiterate and/or had incomplete elementary school, with 3 or more deliveries and who resided in other macro-regions. During pregnancy, 96.0% of the women performed at least one anti-HIV test, 55.8% a rapid test for syphilis, and 75.0% a Venereal Disease Research Laboratory test (VDRL). CONCLUSIONS Despite the almost universal PNC coverage in RS, the PNC offered by the SUS was adequate for just half of the population, therefore public health policies targeted at women receiving care in this setting shall be revisited.
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Affiliation(s)
- Aline De Gregori Adami
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Leonardo Rapone da Motta
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Rosa Dea Sperhacke
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
| | - Sérgio Kakuta Kato
- Universidade de Caxias do SulInstituto de Pesquisas em SaúdeÁrea do Conhecimento de Ciências da VidaCaxias do SulRSBrazilUniversidade de Caxias do Sul. Instituto de Pesquisas em Saúde. Área do Conhecimento de Ciências da Vida. Caxias do Sul, RS, Brazil.
- Universidade Federal de Ciências da Saúde de Porto AlegreDepartamento de Saúde ColetivaPorto AlegreRSBrazil Universidade Federal de Ciências da Saúde de Porto Alegre. Departamento de Saúde Coletiva. Porto Alegre, RS, Brazil.
| | - Gerson Fernando Mendes Pereira
- Ministério da SaúdeSecretaria de Vigilância em SaúdeDepartamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente TransmissíveisBrasíliaDFBrazilMinistério da Saúde. Secretaria de Vigilância em Saúde. Departamento de HIV/aids, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis. Brasília, DF, Brazil.
| | - Rosa Maria Rahmi
- Universidade de Caxias do SulPrograma de Pós-graduação em Ciências da SaúdeCaxias do SulRSBrazil Universidade de Caxias do Sul. Programa de Pós-graduação em Ciências da Saúde. Caxias do Sul, RS, Brazil.
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Lopes de Oliveira G, Ferreira AJ, Teles CADS, Paixao ES, Fiaccone R, Lana R, Aquino R, Cardoso AM, Soares MA, Oliveira dos Santos I, Pereira M, Barreto ML, Ichihara MY. Estimating the real burden of gestational syphilis in Brazil, 2007-2018: a Bayesian modeling study. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100564. [PMID: 37575963 PMCID: PMC10415804 DOI: 10.1016/j.lana.2023.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
Background Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Methods Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. Findings We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Interpretation Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. Funding National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.
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Affiliation(s)
- Guilherme Lopes de Oliveira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Department of Computing, Federal Centre of Technological Education of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrêa J.F. Ferreira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- The Ubuntu Center on Racism, Global Movement, Population and Equity, School of Public Health, Drexel University, Pennsylvania, USA
| | - Carlos Antônio de S.S. Teles
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Enny S. Paixao
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemeire Fiaccone
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Statistics Department, Institute of Mathematics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Raquel Lana
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Barcelona Supercomputing Center, Catalonia, Spain
| | - Rosana Aquino
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Maria Auxiliadora Soares
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Idália Oliveira dos Santos
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Marcos Pereira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maurício L. Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
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de Oliveira GL, Ferreira AJF, Santana JG, Lana RM, Cardoso AM, Teles C, Fiaccone RL, Aquino R, Soares MAS, Paixao ES, Santos IO, Salvi L, Barreto ML, Ichihara MY. A completeness indicator of gestational and congenital syphilis information in Brazil. Rev Saude Publica 2023; 57:42. [PMID: 37556664 PMCID: PMC10355315 DOI: 10.11606/s1518-8787.2023057004789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/08/2022] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018. METHODS Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA). RESULTS Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90). CONCLUSION The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.
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Affiliation(s)
- Guilherme Lopes de Oliveira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Centro Federal de Educação Tecnológica de Minas GeraisDepartamento de ComputaçãoBelo HorizonteMGBrasilCentro Federal de Educação Tecnológica de Minas Gerais. Departamento de Computação. Belo Horizonte, MG, Brasil
| | - Andrêa JF Ferreira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Drexel UniversityDornsife School of Public HealthThe Ubuntu Center on Racism, Global Movements & Population Health EquityPhiladelphiaUSADrexel University. Dornsife School of Public Health. The Ubuntu Center on Racism, Global Movements & Population Health Equity. Philadelphia, USA
| | - José Guilherme Santana
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Drexel UniversityDornsife School of Public HealthThe Ubuntu Center on Racism, Global Movements & Population Health EquityPhiladelphiaUSADrexel University. Dornsife School of Public Health. The Ubuntu Center on Racism, Global Movements & Population Health Equity. Philadelphia, USA
| | - Raquel Martins Lana
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Centro Nacional de SupercomputaciónBarcelonaEspañaCentro Nacional de Supercomputación. Barcelona, España
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartment of Endemic Diseases Samuel PessoaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca, Department of Endemic Diseases Samuel Pessoa. Rio de Janeiro, RJ, Brasil
| | - Andrey Moreira Cardoso
- Fundação Oswaldo CruzEscola Nacional de Saúde Pública Sérgio AroucaDepartment of Endemic Diseases Samuel PessoaRio de JaneiroRJBrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca, Department of Endemic Diseases Samuel Pessoa. Rio de Janeiro, RJ, Brasil
| | - Carlos Teles
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Estadual de Feira de SantanaDepartamento de Ciências ExatasFeira de SantanaBABrasilUniversidade Estadual de Feira de Santana, Departamento de Ciências Exatas. Feira de Santana, BA, Brasil
| | - Rosemeire L. Fiaccone
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Matemática e Estatística, Salvador, BA, Brasil
| | - Rosana Aquino
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Maria Auxiliadora Santos Soares
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Enny S. Paixao
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- London School of Hygiene and Tropical MedicineLondonUnited KingdomLondon School of Hygiene and Tropical Medicine. London, United Kingdom
| | - Idália Oliveira Santos
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Leonardo Salvi
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
| | - Maurício L. Barreto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil.
| | - Maria Yury Ichihara
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasilFundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde, Salvador, BA, Brasil
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Dantas JDC, Marinho CDSR, Pinheiro YT, Ferreira MÂF, da Silva RAR. Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: An ecological study. Front Pediatr 2023; 11:1109271. [PMID: 37033177 PMCID: PMC10075361 DOI: 10.3389/fped.2023.1109271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Objective The study aimed to analyze the temporal trend of congenital syphilis in Brazil in the period from 2008 to 2018 and its spatial distribution in the Immediate Regions of Urban Articulation, and to identify spatial correlations with socioeconomic factors and prenatal care. Methods Spatial correlations between the incidence of congenital syphilis and socioeconomic conditions and access to prenatal care were assessed. This ecological study conducted a time series analysis in Brazil and spatial analysis in 482 Immediate Regions of Urban Articulation. Cases of congenital syphilis reported in the Notifiable Diseases Information System and the Live Birth Information System from January 1, 2008, to December 31, 2018 were included. Socioeconomic conditions (percentage of individuals with inadequate water supply and sanitation) were extracted from the 2010 census, whereas the Live Birth Information System provided data on access to prenatal care (percentage of live births with 1-3 prenatal care appointments). The Joinpoint Regression software performed the temporal trend analysis, while the GeoDa software assessed territorial clusters using the Moran's I and Local Spatial Association Indicator. Results The incidence of congenital syphilis showed an upward trend (annual percent change 1 = 26.96; 95% CI: 18.2-36.3; annual percent change 2 = 10.25; 95% CI: 2.7-28.4) and was unevenly distributed across Immediate Regions of Urban Articulation in Brazil (Moran's I = 0.264, p ≤ 0.05). It also presented a direct spatial correlation with the percentage of individuals with inadequate water supply and sanitation (Moran's I = 0.02, p ≤ 0.05) and the percentage of live births with 1-3 prenatal care appointments (Moran's I = 0.03, p ≤ 0.05). Conclusion Agrowth trend of congenital syphilis in Brazil was observed between 2008 and 2018. Moreover, inequalities in socioeconomic conditions and access to prenatal care influenced the spatial distribution of this disease.
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Affiliation(s)
- Janmilli da Costa Dantas
- Graduate Program in Collective Health, Health Science Center, Federal University of Rio Grande Do Norte, Natal, Brazil
- Correspondence: Janmilli da Costa Dantas
| | - Cristiane da Silva Ramos Marinho
- Graduate Program in Collective Health, Faculty of Health Sciences of Trairi, Federal University of Rio Grande Do Norte, Santa Cruz, Brazil
| | - Yago Tavares Pinheiro
- Graduate Program in Collective Health, Health Science Center, Federal University of Rio Grande Do Norte, Natal, Brazil
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Morais LSD, Pimentel SVT, Kawa H, Fonseca SC. Temporal trend of congenital syphilis in the most populous municipality of metropolitan region II of Rio de Janeiro state. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021337. [PMID: 36921166 PMCID: PMC10014027 DOI: 10.1590/1984-0462/2023/41/2021337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/30/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to explore the temporal trend in congenital syphilis, according to sociodemographic and prenatal care in the city of São Gonçalo - Rio de Janeiro, from 2007 to 2018. METHODS Ecological time series study, with data from SINAN (Information System for Notifiable Diseases) and SINASC (Information System on Live Births databases). We calculated annual incidence (per 1,000 live births) according to sociodemographic and prenatal variables. For the same variables, we calculated trends by logarithmic regression (Joinpoint Regression), estimating the annual percentage change. RESULTS A total of 2,420 cases were reported from 2007 to 2018, with an increasing trend: 64.9% per year (2010-2013) and 24.9% (2013-2018). In 2018, the highest rates were in adolescents (90.6/1,000 live births), black women (87.6/1,000 live births), low-educated women (122.8/1,000 live births), and those without prenatal care (677.4/1,000 live births). The annual percentage change of these categories was, respectively, 37.3% (2010-2018), 33.5% (2012-2018), 39.9% (2014-2018), and 85.0% (2011-2015), but all categories showed a crescent trend. CONCLUSIONS We identified high congenital syphilis incidences and crescent trends, especially in more vulnerable groups, pointing to social and healthcare inequalities. Prenatal care needs to be more comprehensive and qualified, primarily for young, low-educated, and black women.
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Affiliation(s)
| | | | - Helia Kawa
- Universidade Federal Fluminense, Niterói, RJ, Brazil
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Uchôa TLDA, Araújo EDC, da Silva RAR, Valois R, de Azevedo Junior WS, Nascimento VGC, Aben-Athar CYUP, Parente AT, Botelho EP, Ferreira GRON. Determinants of gestational syphilis among women attending prenatal care programs in the Brazilian Amazon. Front Public Health 2022; 10:930150. [PMID: 36438302 PMCID: PMC9683036 DOI: 10.3389/fpubh.2022.930150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background There was a high proportion of pregnant women who were attending prenatal care who were not tested for syphilis or tested but not treated, among priority countries. The coverage for prenatal care visits, syphilis screening, and treatment are priority indicators for monitoring of the elimination of syphilis. The aim was to determine the factors associated with gestational syphilis among postpartum women who were in a prenatal care program in the Brazilian Amazon. Methods An unmatched case-control study was conducted at the hospital in Brazil. Data collection was carried out from November 2020 to July 2021 during hospitalization using a pretested structured questionnaire. The criteria for selection of cases and control followed the guidelines established by the Ministry of Health of Brazil; postpartum women with a laboratory diagnosis based on treponemal and/or nontreponemal tests, symptoms of syphilis or asymptomatic, treatment or not treated, and in a prenatal care program. Gestational syphilis cases were identified as women who tested positive for syphilis, and those who tested negative were controls, at minimally one prenatal care visit, childbirth, and/or the puerperium. The sample size encompassed 59 cases and 118 controls (1: 2 ratio of cases to controls). Data were analyzed using Minitab 20® and BioEstat 5.3® software. The odds ratio was calculated by multiple logistic regression. Results One hundred and seventy-seven postpartum women were included in the study, 59 cases and 118 controls. Among all participants, 95.5% (169) were tested for syphilis in any trimester during pregnancy and at the delivery and 4.5% (8) were tested in the maternity only, at the time childbirth and/or puerperium. The final multiple logistic regression model evidenced that cases had higher odds compared to controls if they had past history of sexually transmitted infections (AOR: 55.4; p: 0.00), difficulty talking about condom use with their sexual partner (AOR: 4.92; p: 0.01), one to six prenatal care visits (AOR: 4.93; p: 0.01), had not received a sexually transmitted infections test result in the maternity hospital (AOR: 4.09; p: 0.04), lower monthly income (AOR: 4.32; p: 0.04), or one to three miscarriages (AOR: 4.34; p: 0.01). Conclusion The sociodemographic, programmatic, obstetric, and sexual factors are associated with gestational syphilis among postpartum women.
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Affiliation(s)
| | | | | | - Rubenilson Valois
- Program of Post-Graduation in Nursing, State University of Pará, Belém, Brazil
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Lannoy LH, Santos PC, Coelho R, Dias-Santos AS, Valentim R, Pereira GM, Miranda AE. Gestational and congenital syphilis across the international border in Brazil. PLoS One 2022; 17:e0275253. [PMID: 36282795 PMCID: PMC9595568 DOI: 10.1371/journal.pone.0275253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Brazil lacks data from syphilis in its border areas. We aimed to describe the spatial and temporal distribution of acquired syphilis (AS), in pregnancy (SP) and congenital syphilis (CS) in Brazilian municipalities in the arches border contexts. METHODS An ecological, cross-sectional study was conducted from 2010 to 2020. The study was based on the cases of syphilis available in the Notifiable Diseases Information System (SINAN), and on the Primary Health Care Information System. The detection rates of AS and SP, and the incidence of CS were estimated, and the time series was analyzed. Data between the border arches were compared. RESULTS In 2020, data showed 7,603 cases of AS (detection rate 64.8/100,000 inhabitants), 3,960 cases of SP (detection rate of 21.6/1,000 live births) and 836 cases of CS (incidence of 4.6/1,000 live births) in the border region. Between 2010 and 2020, the mean annual increase of detection rate of SP was 53.4% in Brazil, 48.0% in the border region, 59.6% in the North Arch, 28.8% in the Central and 67.2% in the South. Annual variation on the incidence of CS for the same period was 31.0% in Brazil 38.4% at the border, in the North and South Arcs 18.3% and 65.7% respectively. The Central Arch showed an increase only between 2010 and 2018 (62.7%). A total of 427 (72.6%) municipalities has primary health care coverage ≥ 95% of the population. In 2019, 538 (91.8%) municipalities reported using rapid tests for syphilis, which decreased to 492 (84%) in 2020. In 2019, 441 (75.3%) municipalities reported administering penicillin, and 422 (72%) in 2020. CONCLUSION Our data show syphilis reman problem at the Brazilian border, rates in pregnant are high. It was observed a reduction in the detection rates, SP and the incidence of CS between 2018 and 2020. Syphilis should be included on the agenda of all management levels, aiming at expanding access and quality care.
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Affiliation(s)
- Leonor H. Lannoy
- Post-Graduation Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Patrícia C. Santos
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Ronaldo Coelho
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Adriano S. Dias-Santos
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Ricardo Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Gerson M. Pereira
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Angelica E. Miranda
- Post-Graduation Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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Saes MDO, Duro SMS, Gonçalves CDS, Tomasi E, Facchini LA. Assessment of the appropriate management of syphilis patients in primary health care in different regions of Brazil from 2012 to 2018. CAD SAUDE PUBLICA 2022; 38:EN231921. [PMID: 35584428 DOI: 10.1590/0102-311xen231921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/03/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the presence of adequate infrastructure and work process in primary health care for the diagnosis, management, and treatment of syphilis in Brazil in 2012, 2014, and 2018. This is a cross-sectional, nationwide study with data from the three cycles of the Program for Improvement of Access and Quality of Basic Healthcare (PMAQ-AB): 2012 (Cycle I), 2014 (Cycle II), and 2018 (Cycle III). Two outcomes were assessed: adequate infrastructure and work process. The independent variables were macroregion, municipality size, Municipal Human Development Index (HDI-M), and coverage of the Family Health Strategy (FHS). Variance-weighted least squares regression was used to estimate annual changes in percentage. In total, 13,842 primary basic health units (UBS) and 17,202 professional health care teams were assessed in Cycle I; 24,055 UBS and 29,778 teams in Cycle II, and 28,939 UBS and 37,350 teams in Cycle III. About 1.4% of UBS had adequate infrastructure in Cycle I; 17.5% had in Cycle II; and 42.7% had in Cycle III. Adequate work process also increased in the three cycles, ranging from 47.3% in Cycle I to 45.5% in Cycle II and 75.4% in Cycle III. However, inequities are observed, considering that richer regions and larger municipalities, with higher HDI-M and lower FHS coverage improved the most. The low prevalence of adequate infrastructure and work process for the care of patients with syphilis in Brazil reflects a significant weakness in the Brazilian health system.
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Spatiotemporal dynamics of syphilis in pregnant women and congenital syphilis in the state of São Paulo, Brazil. Sci Rep 2022; 12:585. [PMID: 35022472 PMCID: PMC8755837 DOI: 10.1038/s41598-021-04530-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to estimate the occurrence of syphilis in pregnant women (SPW) and congenital syphilis (CS) in the municipalities of the state of São Paulo (SP) and evaluate their relationship with socioeconomic, demographic, and health care variables. We developed an ecological study based on secondary data of SPW and CS with spatiotemporal components from 645 municipalities in SP including data from 2007 to 2018. We modeled the data in a Bayesian context, considered spatial and temporal random effects, and used binomial negative probability distributions. We found a continuous increase in the relative temporal risk of SPW, from 2007 to 2018, and CS, from 2007 to 2017, when their incidences increased by 8.6 and 6.6 times, respectively. This increase occurred en bloc in practically all municipalities of SP. The increase in SPW was associated with teenage pregnancy, municipalities with a large number of inhabitants, and acquired immunodeficiency syndrome (AIDS) incidence. The increase in CS was associated with municipalities with a large number of inhabitants, incomplete antenatal care, and AIDS incidence. Although actions to control these diseases are required in all municipalities of SP, the identification of high-risk areas points to priority regions for development.
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Reis ARDP, Duarte G, Menegueti MG, Reis RK, Silva ACRE, Gir E. Reactive treponemal and non-treponemal tests in pregnant women and associated factors. Rev Esc Enferm USP 2022; 56:e20220146. [PMID: 36427270 PMCID: PMC10081588 DOI: 10.1590/1980-220x-reeusp-2022-0146en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Objective: to identify the rate of reactive treponemal and non-treponemal tests in pregnant women during childbirth and to analyze the factors associated with this seroreactivity. Method: this is a cross-sectional, quantitative study with secondary sources of sociodemographic and clinical data on 2,626 pregnant women treated at a public maternity hospital in the interior of São Paulo, in 2020. For statistical analysis, Fisher’s exact test, Mann-Whitney test and the logistic regression model were used. A difference of p < 0.05 was considered statistically significant. Results: the rate of seropositivity for syphilis among pregnant women in this series was 2.74%. Among the groups with positive and non-reactive tests, marital status, occupation, place of residence and use of licit drugs indicated significant differences, but, in the final model, only unmarried marital status was associated with reactive tests (Odds Ratio: 0.169; Confidence Interval: 0.04–0.72; and p: 0.016). Conclusion: in this study, unmarried marital status was the only independent factor associated with seroreactivity for syphilis. Therefore, it is necessary to create strategies aimed at women in this condition, potentially reducing the rate of congenital syphilis.
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Reis ARDP, Duarte G, Menegueti MG, Reis RK, Silva ACRE, Gir E. Testes treponêmicos e não treponêmicos reagentes em gestantes e fatores associados. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0146pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RESUMO Objetivo: identificar a taxa de testes treponêmicos e não treponêmicos reagentes em gestantes no período do parto e analisar os fatores associados a essa sororreatividade. Método: estudo transversal, quantitativo, com fontes secundárias de dados sociodemográficos e clínicos de 2.626 gestantes atendidas em uma maternidade pública do interior paulista, em 2020. Para a análise estatística, foram utilizados os Testes Exato de Fisher, de Mann-Whitney e o modelo de regressão logística. Considerou-se diferença com significância estatística valores de p < 0,05. Resultados: a taxa de soropositividade para sífilis entre gestantes nesta casuística foi de 2,74%. Entre os grupos com testes reagentes e não reagentes à situação maritária, ocupação, local da residência e uso de drogas lícitas indicaram diferenças significantes, mas, no modelo final, apenas a situação marital não casada apresentou associação com os testes reagentes (Odds Ratio: 0,169; Intervalo de Confiança: 0,04–0,72; e p: 0,016). Conclusão neste estudo, a situação maritária não casada foi o único fator independente associado à sororreatividade para a sífilis. Por isso, faz-se necessária a criação de estratégias voltadas para mulheres nessa condição, potencialmente reduzindo a taxa de sífilis congênita.
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Roncalli AG, Rosendo TMSDS, Santos MMD, Lopes AKB, Lima KCD. Effect of the coverage of rapid tests for syphilis in primary care on the syphilis in pregnancy in Brazil. Rev Saude Publica 2021; 55:94. [PMID: 34910026 PMCID: PMC8621623 DOI: 10.11606/s1518-8787.2021055003264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/29/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: To analyze the effect of rapid tests coverage in Primary Care on syphilis detection rate in pregnant women in Brazil, in municipalities with more than 100,000 inhabitants. METHODS: The dependent variable was the syphilis detection rate in pregnant women between 2012 and 2018. As the main independent variables, the methods for measuring the coverage of rapid tests for syphilis in Primary Care were used and, as adjustment variables, some indicators of health services and socioeconomic. We opted for a linear regression model for panel data (panel data analysis), considering the municipality as the unit of analysis and the year as the time variable. RESULTS: From the results of the final model, we can infer that, for a given municipality, as the rate of rapid tests increases by one point for every thousand live births, the detection rate of syphilis in pregnant women increases by an average of 0.02 cases per thousand live births (p < 0.001). This value is adjusted for Family Health coverage, proportion of health facilities per inhabitant, per capita expenditure on health and the Human Development Index. CONCLUSIONS: There was a substantial improvement in the amount of rapid tests available, as well as a significant increase in the number of tests performed in pregnant women, which predicts an increase in syphilis rates in pregnant women. However, a worrying hypothesis is that the number of tests performed on pregnant women during the analyzed period may have been insufficient to detect the progress of the epidemic in this population.
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Affiliation(s)
- Angelo Giuseppe Roncalli
- Universidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasils
| | | | | | - Ana Karla Bezerra Lopes
- Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Ciências da Saúde. Natal, RN, Brasil
| | - Kenio Costa de Lima
- Universidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasils
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de Araújo Veras AAC, Arruda Vidal S, Costa de Macêdo V, de Carvalho Lima M, Cabral de Lira PI, da Fonseca Lima EJ, Batista Filho M. Prevalence, Trends and Conditions for the DTP3 Vaccine: A 25-Year Historical Perspective. Risk Manag Healthc Policy 2021; 14:4301-4310. [PMID: 34703341 PMCID: PMC8524252 DOI: 10.2147/rmhp.s312263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022] Open
Abstract
Background The aim was to verify the prevalence of vaccination coverage, tendency and factors of the third dose of the vaccine against diphtheria, tetanus and pertussis-DTP3 in surveys over the period of 25 years in a state of the Northeast of Brazil. Methods Cross-sectional and temporal series, utilizing ad hoc database, were extracted from the Health and Nutrition State Research 1991, 1997, 2006 and 2015/2016. Children from 12 to 23 months of age with proof in the vaccination card were included. The vaccination coverage (outcome) of each year was calculated, the tendency throughout the period was analyzed and the associations through Pearson chi-squared were tested. The results of the first and last survey were compared with a significance level of 5%. The reasons of the crude prevalence and confidence intervals of 95% were estimated. Results The vaccination coverage in 1991, 1997, 2006 and 2015/2016 was 77.6%, 82.7%, 89.7% and 72.9%, respectively, with an increasing tendency from 1991 to 2006 (p<0.001) and decreasing between 2006 and 2015/2016 (p<0.001). Factors in 1991: low socioeconomic conditions; lack of access to health service and pre-natal care, nutritional deficit and diarrhea in children (p<0.005). In 2015/2016, low socioeconomic conditions and diarrhea persisted and a larger family size, black, negative self-perception of happiness, both from the mother (p<0.05), were identified. Conclusion The factors of the recent decrease of vaccination coverage are complex, multifactorial, dependent of context and even on subjective aspects of the maternal perception. Its identification contributed to the understanding of inadequate vaccination at the state level.
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Affiliation(s)
- Ana Amélia Corrêa de Araújo Veras
- Programa de Pós-graduação em Medicina Integral, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Suely Arruda Vidal
- Programa de Pós-graduação em Medicina Integral, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Vilma Costa de Macêdo
- Departamento de Enfermagem, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marília de Carvalho Lima
- Programa de Pós-graduação em Saúde da Criança e Adolescente, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Pedro Israel Cabral de Lira
- Programa de Pós-graduação em Saúde da Criança e Adolescente, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Eduardo Jorge da Fonseca Lima
- Programa de Pós-graduação em Medicina Integral, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | - Malaquias Batista Filho
- Programa de Pós-graduação em Medicina Integral, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
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de Cerqueira BGT, da Silva EP, Gama ZADS. Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro. Rev Saude Publica 2021; 55:34. [PMID: 34133619 PMCID: PMC8225322 DOI: 10.11606/s1518-8787.2021055002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
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Affiliation(s)
- Brena Gabriella Tostes de Cerqueira
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdePrograma de Pós-Graduação em Gestão da Qualidade em Serviços de SaúdeNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Gestão da Qualidade em Serviços de Saúde. Natal, RN, Brasil
| | - Eliane Pereira da Silva
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Medicina ClínicaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Medicina Clínica. Natal, RN, Brasil
| | - Zenewton André da Silva Gama
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Saúde ColetivaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Natal, RN, Brasil
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Garcia JFB, Aun MV, Motta AA, Castells M, Kalil J, Giavina-Bianchi P. Algorithm to guide re-exposure to penicillin in allergic pregnant women with syphilis: Efficacy and safety. World Allergy Organ J 2021; 14:100549. [PMID: 34093957 PMCID: PMC8165434 DOI: 10.1016/j.waojou.2021.100549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/27/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Gestational syphilis is underdiagnosed and undertreated, leading to stillbirth, prematurity, low birthweight, neonatal death, and congenital syphilis. Most patients who label as allergic to penicillin are misdiagnosed. Objective To assess the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and reporting allergy to the antibiotic. Methods We performed a prospective study assessing pregnant women with syphilis and labeled as allergic to penicillin. Based on clinical history, patients were divided in two groups: high-risk and low-risk to penicillin allergy. Low-risk patients with negative skin testing and negative serum specific IgE to penicillin underwent drug provocation test. The remaining patients underwent desensitization. Results Ninety-one patients were enrolled. Allergy to penicillin was confirmed in 7.69% of pregnant women with syphilis and clinical history of allergy to penicillin; in all cases the diagnosis was made through intradermal testing, which predicted 100% of the breakthrough reactions observed during rapid drug desensitization (p < 0.001). Risk stratification based on the initial clinical reaction and skin testing to guide penicillin re-introduction through drug challenge or desensitization was safe (97.8%) and effective (97.8%). Conclusion We developed and showed the efficacy and safety of an algorithm to guide re-exposure to penicillin in pregnant women with syphilis and labeled as allergic to this drug. Intradermal test is an excellent biomarker in the diagnosis of immediate hypersensitivity reaction to penicillin and to predict breakthrough reaction during rapid drug desensitization. Further studies may confirm the greater safety of the intravenous protocol compared to the oral protocol.
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Affiliation(s)
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Antonio Abilio Motta
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Kalil
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Domingues CSB, de Lannoy LH, Saraceni V, da Cunha ARC, Pereira GFM. Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance. Rev Soc Bras Med Trop 2021; 54:e2020549. [PMID: 34008715 PMCID: PMC8210489 DOI: 10.1590/0037-8682-549-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published. sexually transmitted infections are among the most common diseases in the world. They affect people's health and life, impact reproductive and child health, contribute to infertility and complications during pregnancy and birth.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
| | | | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Gerson Fernando Mendes Pereira
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
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Araújo MAL, Esteves ABB, Rocha AFB, Silva Junior GBD, Miranda AE. Factors associated with prematurity in reported cases of congenital syphilis. Rev Saude Publica 2021; 55:28. [PMID: 34008782 PMCID: PMC8102023 DOI: 10.11606/s1518-8787.2021055002400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: To analyze the factors associated with prematurity in reported cases of congenital syphilis in the city of Fortaleza, Ceará, Brazil. METHODS: Cross-sectional study conducted in ten public maternity hospitals in Fortaleza, Ceará, Brazil. A total of 478 reported cases of congenital syphilis were included in 2015, and data were collected from notification forms, from mothers’ and babies’ medical records and from prenatal cards. For the bivariate analysis, Pearson’s chi-squared and Fisher’s exact tests were used, considering p < 0.05. Multiple logistic regression was conducted, presenting odds ratio (OR) with a 95% confidence interval. RESULTS: We found 15.3% prematurity in pregnant women with syphilis. The titration of the VDRL test > 1:8 at delivery (OR 2.46; 95%CI: 1.33–4.53; p = 0.004) and the non-treatment of the pregnant women or treatment with drugs other than penicillin during prenatal care (OR 3.52; 95%CI: 1.74–7.13; p< 0.001) were associated with higher chances of prematurity. CONCLUSION: The prematurity due to congenital syphilis is a preventable condition, provided that pregnant women with syphilis are treated appropriately. Weaknesses in prenatal care are associated with this outcome, which highlights the importance of public policies oriented to improve the quality of prenatal care.
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Affiliation(s)
- Maria Alix Leite Araújo
- Universidade de Fortaleza. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
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Domingues CSB, Lannoy LHD, Saraceni V, Cunha ARCD, Pereira GFM. [Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance]. ACTA ACUST UNITED AC 2021; 30:e2020549. [PMID: 33729398 DOI: 10.1590/s1679-4974202100002.esp1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022]
Abstract
This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that forms part of the Clinical Protocol and Treatment Guidelines (PDCT) for Comprehensive Care for People with STI 2020), published by the Health Surveillance Secretariat of the Ministry of Health of Brazil. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women and congenital syphilis. The PCDT-IST 2020 was developed based on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, as well as guidelines for health service managers regarding programmatic and operational management of these diseases, guidelines for health professionals on screening, diagnosing and treating people with STIs and their sex partners, in addition to strategies for surveillance, prevention and control actions.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brasil
| | | | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Sanine PR, Dias A, Machado DF, Zarili TFT, Carrapato JFL, Placideli N, Nunes LO, Mendonça CS, Castanheira ERL. [Influence of municipal management on the organization of children's healthcare in primary care services in the interior of the State of São Paulo, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00242219. [PMID: 33566991 DOI: 10.1590/0102-311x00242219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
The aim was to assess the association between the organizational quality of children's healthcare in primary care services and variables in the management context. An evaluative survey in 151 primary care services in 40 municipalities (counties) in the interior of the State of São Paulo, Brazil, answered the QualiAB in 2014. Services were scored according to 41 children's health indicators which comprised quality groups distributed by quartiles and were associated with 17 management indicators. The following were not associated with the quality groups: participation in the More Doctors Program/Provab-Médico (p = 0.102), availability of social services (p = 0.315), and high-risk pregnancy (p = 0.814). The association was significant for all the others. Although for some variables, groups G1 and G2 were similar to the more polar groups (G0 and G3), the latter showed differences in all the variables. The services belonging to the group considered as having the best quality (G3) were mostly organized in the Family Health Unit/Mixed model (p = 0.018), administered under outsourced management (p < 0.001), regularly supplied prenatal care (p < 0.001), had a general practitioner or family physician available on a 24/7 basis (p = 0.009), and had a support network consisting mainly of CAPSi and CAPSAd III and children's health services (p < 0.001). They also reported holding weekly team meetings (p < 0.001), studying cases of spontaneous demand (p < 0.001), and changing the management and organization of care based on the evaluative process (p = 0.004). In conclusion, organizational quality does not depend only on practices by health professionals, but also on administrators' decisions.
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Affiliation(s)
- Patricia Rodrigues Sanine
- Faculdade de Medicina, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil.,Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | - Adriano Dias
- Faculdade de Medicina, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Dinair Ferreira Machado
- Faculdade de Medicina, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | | | | | - Nádia Placideli
- Faculdade de Medicina, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Luceime Olivia Nunes
- Faculdade de Medicina, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
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Weaknesses in primary health care favor the growth of acquired syphilis. PLoS Negl Trop Dis 2021; 15:e0009085. [PMID: 33544722 PMCID: PMC7891733 DOI: 10.1371/journal.pntd.0009085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 02/18/2021] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Acquired syphilis is a sexually transmitted infection that affects the general population and has been growing in recent years in many countries. A study was developed aiming to analyze the trends of acquired syphilis associated with sociodemographic aspects and primary health care in Brazil, in the period from 2011 to 2019. This study used secondary data from the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as socioeconomic and municipal demographic indicators. The trends of acquired syphilis at the municipal level were calculated from the log-linear regression, crossing them with variables of primary health care and sociodemographic indicators. Finally, a multiple model was built from logistic regression. 724,310 cases of acquired syphilis have been reported. In primary care units, 47.8% had partial coverage and 74.1% had health teams with poor or regular scores. 52.6% had rapid test for syphilis partially available. Male and female condoms are available in 85.9% and 62.9% respectively and 54.4% had penicillin available in the health facility. The increase in trends of acquired syphilis was associated with better availability of the rapid test; lower availability of male condoms; lower availability of female condoms; lower availability of benzathine penicillin; partial coverage of the teams in primary health care; limited application of penicillin in primary health care; higher proportion of teams classified as Poor/Regular in primary health care; higher proportion of women aged 10 to 17 years who had children; higher HDI; higher proportion of people aged 15 to 24 years who do not study, do not work and are vulnerable; and population size with more than 100,000 inhabitants. The following variables remained in the multiple model: not all primary health care teams apply penicillin; higher proportion of primary health care teams with poor/regular scores; population size >100000 inhabitants; partially available female condom. Thus, the weakness of primary health care linked to population size may have favored the growth of the acquired syphilis epidemic in Brazilian cities. Acquired syphilis is a sexually transmitted infection that continues to impact health services around the world. For decades, studies and public health policies in the fight against syphilis have focused on syphilis in pregnant women and congenital, mainly because of their importance in the health of women and children. However, the behavior of the epidemic in people aged over 13 years shows that the epidemic is comprehensive and challenging. The exponential increase in the syphilis epidemic in the general population is one of the most neglected in many parts of the world. Primary health care plays a fundamental role in the control of syphilis, but few studies have sought to analyze the impact of primary health care on the growth of acquired syphilis. Our work used two large databases of the national notification systems of the 5570 Brazilian cities and a database of 37,350 primary health care teams, as well as municipal sociodemographic indicators. Our results demonstrated several indicators that influence the growth of acquired syphilis, especially the most neglected, which can guide more effective strategies to fight the syphilis epidemic in several countries.
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Lim J, Yoon SJ, Shin JE, Han JH, Lee SM, Eun HS, Park MS, Park KI. Outcomes of infants born to pregnant women with syphilis: a nationwide study in Korea. BMC Pediatr 2021; 21:47. [PMID: 33478429 PMCID: PMC7821395 DOI: 10.1186/s12887-021-02502-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/12/2021] [Indexed: 01/25/2023] Open
Abstract
Background Despite the expansion of antenatal syphilis screening programs, congenital syphilis (CS) remains a concern. Purpose This study aimed to analyze the manifestation and progress of CS, including treatment and follow-up, based on a nationwide study. Methods From the Korean National Health Insurance Service database, a total of 548 infants were examined for CS during their first year of life from 2013 to 2018. Neurosyphilis and complications were investigated using the International Classification of Diseases-10 codes. Results The birth rate of infants from mothers with syphilis was 2.8 per 10,000 live births for 5 years, which is not indicative of a decreasing trend. Overall, 148 infants were proven or highly probable or possible of having CS with treatment for 10 days; 66 infants were possible or less likely of having CS with only 1-day treatment. Jaundice (56 %) was common, followed by hearing impairment (14 %), renal disease (8 %), and mental retardation (8 %). Fourteen cases of neurosyphilis occurred. Infants with complications, including mental retardation, eye involvement, hearing impairment, or renal disease, were significantly associated with neurosyphilis (OR 8.49, P < 0.0001). Of 250 patients who received treatment, 92.8 % were treated with one medication: benzathine penicillin was used in 73 % of patients. Only four patients were re-treated due to treatment failure. In addition to the treponemal test, fluorescent treponemal antibody-absorption was the most utilized tool for diagnosis and follow-up. Conclusions Establishing standardized guidelines for the evaluation of CS, as well as the establishment of treatment regimens and follow up-plans for the disease, at a national level would help improve maternal and neonatal care and facilitate the eradication of CS in Korea.
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Affiliation(s)
- Joohee Lim
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - So Jin Yoon
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jeong Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Jung Ho Han
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea.
| | - Ho Seon Eun
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, 03722, Seoul, Republic of Korea
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