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Dias Neto NM, Moura Dias VGN, Christofolini DM. Is syphilis infection a risk factor for cervicovaginal HPV occurrence? A case-control study. J Infect Public Health 2024; 17:102472. [PMID: 38901118 DOI: 10.1016/j.jiph.2024.102472] [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: 01/23/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Syphilis and human papillomavirus (HPV) are sexually transmitted infections affecting women in the same risk group. Thus, the main objective of the present study was to investigate the prevalence of HPV in a population of women with and without syphilis and observe the characteristics of HPV cervical lesions when coinfection occurs. Sociodemographic factors associated with coinfection were also evaluated. METHODS This case-control study was conducted at a Brazilian HIV/STD testing and training center. Study groups were composed of women with (case) and without syphilis (control), paired by age. The presence of HPV, HPV subtype, and lesion severity were investigated. All women were subjected to a sociodemographic interview, clinical data collection, cell collection for cytopathological analysis, and a hybrid capture test for HPV diagnosis. The chi-square test was used for statistical analysis. RESULTS The sample consisted of 176 women, 88 in each group. The prevalence of HPV was 14.8 % in the case (n = 13) and 18.1 % in the control group (n = 16), and there was no statistically significant difference between them. Illiterate individuals were more prevalent in the control group (p = 0.023). Considering women with suggestive signs of STIs, 30 % (6) of the patients and controls had high-risk HPV, and 15 % (3) had coinfection. The cytopathological assessment showed no differences between the groups concerning cellular atypia. However, ASC-US and ASC-H (atypical squamous cells of undetermined significance and high-grade) were only found in women with coinfections, with 75 % of these patients testing positive for high-risk HPV. Considering the distribution of lesions on the cervix, the HSIL (high-grade intraepithelial lesion) was assessed in high-risk HPV patients, both cases and controls. CONCLUSIONS The prevalence of HPV was not increased in patients infected with syphilis. In addition, coinfection does not seem to be an aggravating factor for the presence of precursor lesions of cervical cancer.
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Affiliation(s)
| | | | - Denise Maria Christofolini
- Postgraduate Program of Health Sciences, Centro Universitário FMABC, Santo André, SP, Brazil; Genetics Laboratory, Instituto Ideia Fértil de Saúde Reprodutiva, Instituto Idéia, São Paulo, SP, Brazil
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Cruz RFD, Ruberti JA, Mota TS, Silveira LVDA, Chiaravalloti-Neto F. Spatiotemporal Bayesian modeling of the risk of congenital syphilis in São Paulo, SP, Brazil. Spat Spatiotemporal Epidemiol 2024; 49:100651. [PMID: 38876564 DOI: 10.1016/j.sste.2024.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 06/16/2024]
Abstract
The aim of this study is to analyze the spatiotemporal risk of congenital syphilis (CS) in high-prevalence areas in the city of São Paulo, SP, Brazil, and to evaluate its relationship with socioeconomic, demographic, and environmental variables. An ecological study was conducted based on secondary CS data with spatiotemporal components collected from 310 areas between 2010 and 2016. The data were modeled in a Bayesian context using the integrated nested Laplace approximation (INLA) method. Risk maps showed an increasing CS trend over time and highlighted the areas that presented the highest and lowest risk in each year. The model showed that the factors positively associated with a higher risk of CS were the Gini index and the proportion of women aged 18-24 years without education or with incomplete primary education, while the factors negatively associated were the proportion of women of childbearing age and the mean per capita income.
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Affiliation(s)
- Renato Ferreira da Cruz
- Institute of Exact and Earth Sciences, Araguaia University Campus - Unit II, Federal University of Mato Grosso, 6390 Valdon Varjão Avenue, Barra do Garca̧s, Mato Grosso, 78605-091, Brazil.
| | | | | | - Liciana Vaz de Arruda Silveira
- Institute of Biosciences, Department of Biostatistics, São Paulo State University Júlio de Mesquita Filho, Botucatu, São Paulo, Brazil.
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Vital CL, Reis RB, Soares JFDS, Miranda DLP, Reis MG. Spatial distribution of congenital syphilis in the state of Bahia, Brazil from 2009 to 2018. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1234580. [PMID: 38516337 PMCID: PMC10956362 DOI: 10.3389/fepid.2023.1234580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/31/2023] [Indexed: 03/23/2024]
Abstract
Objective To describe the temporal trend and spatial distribution of congenital syphilis (CS) cases in the state of Bahia, Brazil between 2009 and 2018. Method Mixed ecological study conducted through the analysis of data obtained from the Notifiable Diseases Information System and the Live Birth Information System. Global Moran Index I was performed in order to analyze spatial autocorrelation of CS cases in the municipalities of Bahia and the Local Spatial Association Indicator (LISA) was used to identify the formation of spatial regimes in the GeoDA software. Results 8,786 cases of CS were registered in the period. An increasing growth in CS incidence, with a 511% increase between 2009 and 2018. Spatial autocorrelation was observed between the municipalities (I Moran = 0.452; p < 0.001) and four clusters were identified. More frequently, mothers were aged 20-29 years (50.7%); had incomplete primary education (54.9%); were Black and multiracial (93.2%); received prenatal care (82.2%); 49.0% were diagnosed with syphilis during prenatal care; 68.8% were not adequately treated, and 81.1% of their partners were not treated. Conclusion The results showed that CS consolidates as a serious public health problem in Bahia, with an incidence 8.4 times higher in the period than the WHO target of 0.5/1,000 live births, predominantly related to inadequate prenatal care and social vulnerability indicators: young mothers with low education levels, as well as individuals identified as Black and multiracial. Thus, programs aimed at women of childbearing age and pregnant women need to be intensified.
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Affiliation(s)
- Caroline Luz Vital
- Pathology and Molecular Biology Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Medicine of Bahia of Federal University of Bahia, Salvador, Bahia, Brazil
| | - Renato Barbosa Reis
- Pathology and Molecular Biology Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Post-Graduate Program in Regional and Urban Development, Salvador University, Salvador, Brazil
- National Industrial Learning Service University Center and Integrated Center for Manufacturing and Technology (SENAI CIMATEC), Salvador, Bahia, Brazil
| | - Jorgana Fernanda de Souza Soares
- Department of Preventive and Social Medicine of Faculty of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
- PhD in Public Health from the Post-Graduate Program of Collective Health at Federal University of Bahia, Salvador, Bahia, Brazil
| | - Diego Lopes Paim Miranda
- Post-Graduate Program in Medicine and Health at the Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mitermayer Galvão Reis
- Pathology and Molecular Biology Laboratory, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Medicine of Bahia of Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, United States
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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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Guedes ALDL, Guimarães DCDS, Sarkis DJ, Gabriel TT, Delgado CS, Campos AAL, Nogueira MC, Ribeiro LC. Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit. EINSTEIN-SAO PAULO 2023; 21:eAO0046. [PMID: 36946823 PMCID: PMC10010254 DOI: 10.31744/einstein_journal/2023ao0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/30/2022] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. METHODS This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. RESULTS The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). CONCLUSION Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).
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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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Follow-up of infants with congenital syphilis during the penicillin shortage period. J Pediatr (Rio J) 2022; 99:302-308. [PMID: 36584977 DOI: 10.1016/j.jped.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the follow-up, in specialized outpatient clinics, of infants reported with congenital syphilis during the penicillin shortage. METHOD A cross-sectional study was carried out in ten public maternity hospitals affiliated with the Brazilian Unified Health System in the city of Fortaleza, state of Ceará. Clinical records of infants reported with congenital syphilis who were born alive in 2015 were used to describe correlates of attendance at recommended clinical follow-up appointments. RESULTS A total of 469 infants reported with CS from January 1/2015 to December 31/2015 were included in the analysis. The results show that most infants did not attend the follow-up visits (368/469, 78.5%) and the main associated factors are that the follow-up clinic is located in a different hospital from that where the infant was born (OR: 3.7; CI: 2.20-6.22; p < 0.001) and the use of illicit drugs by the mother (OR: 3.2; CI: 1.57-6.87; p = 0.002). Only 33.7% (34/101) were followed until discharge. CONCLUSION The majority of infants with reported congenital syphilis during this period did not attend the follow-up visits. Public health efforts aimed at reaching the parents of infants with CS should be a priority to ensure appropriate clinical identification and management of the associated outcomes of this vertically transmitted infection.
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Souza RT, Brasileiro M, Ong M, Delaney L, Vieira MC, Dias MAB, Pasupathy D, Cecatti JG. Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade. Int J Gynaecol Obstet 2022; 161:711-725. [PMID: 36373189 DOI: 10.1002/ijgo.14573] [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: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Melissa Ong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Louisa Delaney
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK.,Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
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Fernandes LPMR, Oliveira CNT, de Brito BB, Freire de Melo F, Souza CL, Oliveira MV. Prevalence and factors associated with non-adherence to therapy among partners of pregnant women with syphilis in a city of northeastern Brazil. World J Obstet Gynecol 2022; 11:20-32. [DOI: 10.5317/wjog.v11.i3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/30/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One of the main difficulties faced in the prevention of the vertical transmission of syphilis is the inadequate treatment of pregnant women and their partners. The disease causes serious repercussions in infected newborns.
AIM To evaluate the prevalence and factors associated with the therapeutic adhesion among partners of pregnant women with syphilis in a county in Northeastern Brazil.
METHODS This is a descriptive, analytic, quantitative, cross-sectional study that was carried out through interviews with 46 pregnant women diagnosed with syphilis between 2017 and 2018 as well as with their partners. The interviews aimed at collecting data regarding sociodemographic characteristics, obstetric variables and information about syphilis, and partners’ related variables.
RESULTS Our results showed that 73.91% of the partners did not undergo appropriate treatments, and obtaining negative results in syphilis tests was the main reason for the absence of therapies. The following factors were significantly associated with the lack of treatment among partners: Being a partner that is not the current mate of the pregnant woman, having a level of schooling inferior to 8 years [odds ratio (OR) = 10.28], and the pregnant woman undergoing up to two syphilis tests during the prenatal care (OR = 8.6). The study found a higher odds of absent treatment among partners if the pregnant woman is not white (OR = 13.88) or if the partner has less than 8 years of schooling (OR = 21.00) or has a monthly income of less than half the minimum wage (OR = 13.93).
CONCLUSION The findings of this study show a high prevalence of partners that are not adequately treated for syphilis, a phenomenon that is strongly associated with socioeconomic factors.
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Affiliation(s)
| | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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Moraes BQSD, Feitosa ADO, Wanderley RA, Machado MF. Trend analysis of clinical aspects of congenital syphilis in Brazil, 2009-2018. Rev Assoc Med Bras (1992) 2021; 67:991-996. [PMID: 34817512 DOI: 10.1590/1806-9282.20210432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Congenital syphilis is caused by the vertical transmission of bacteria, Treponema pallidum, from nontreated or inappropriately treated pregnant to the fetus. OBJECTIVE To evaluate the clinical aspects of Congenital syphilis in Brazil, between 2009-2018. METHOD It is an analytical cross-sectional study whose data were collected from the Department of Chronical Conditions and Sexually Transmitted Infections of Brazilian Health Ministry. Clinical variables were analyzed using the software Joinpoint Regression, which makes a segmented linear regression. RESULTS In the study period, 156,969 cases of Congenital syphilis and 1642 deaths by this disease were reported. The trend analysis indicates growing in diagnosis of maternal syphilis during prenatal care, appropriate treatment of pregnant, realization of prenatal care, maternal partner treatment, diagnosis of syphilis in children under seven days, and diagnosis of recent syphilis. CONCLUSIONS Although the trend analysis presents relative improvement in Congenital syphilis panorama in Brazil, the disease still related to high numbers of evitable perinatal morbidity and mortality. Therefore, the prenatal assistance with quality is fundamental to have a possible change in this field in the country.
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Affiliation(s)
| | - Alexya de Oliveira Feitosa
- Universidade Federal de Alagoas, Nucleus of Studies in Social and Preventive Medicine - Arapiraca (AL), Brazil
| | | | - Michael Ferreira Machado
- Universidade Federal de Alagoas, Nucleus of Studies in Social and Preventive Medicine - Arapiraca (AL), Brazil
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Besen E, Paiva KM, Hillesheim D, Cigana LB, Haas P. Congenital syphilis associated with hearing screening failure in southern Brazilian newborns. Braz J Otorhinolaryngol 2021; 88 Suppl 3:S20-S24. [PMID: 34716107 DOI: 10.1016/j.bjorl.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To estimate the association between congenital syphilis and neonatal hearing screening failure in the state of Santa Catarina between 2017 and 2019. METHODS This is a cross-sectional, retrospective, analytical study with secondary data of neonates from the state of Santa Catarina born between January 2017 and December 2019. We used logistic regression analysis to estimate the association between the main exposure (congenital syphilis) and the study outcome (failure in the Neonatal Hearing Screening). RESULTS The study included 21,434 newborns evaluated in a Brazilian hearing health care service. A total of 351 (1.6%) newborns failed the Neonatal Hearing Screening, and 364 (1.7%) had congenital syphilis. In the adjusted analysis, newborns with congenital syphilis were 3.25 times as likely to fail the Neonatal Hearing Screening as neonates without this disease (95% CI: 2.01; 5.26). As for maternal age, the sample had a higher prevalence (53.5%) of mothers aged 20-29 years. CONCLUSION There was an association between congenital syphilis and failure in Universal Neonatal Hearing Screening in the sample studied. There is a need for investments in public policies to value and strengthen the hearing screening program in the state to provide early diagnosis and intervention. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Eduarda Besen
- Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Karina Mary Paiva
- Universidade Federal de Santa Catarina (UFSC), Departamento de Fonoaudiologia, Florianópolis, SC, Brazil
| | - Danúbia Hillesheim
- Universidade Federal de Santa Catarina (UFSC), Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brazil
| | - Luciana B Cigana
- Instituto Otovida - Clínica de Audição, Voz, Fala e Linguagem, Florianópolis, SC, Brazil
| | - Patrícia Haas
- Universidade Federal de Santa Catarina (UFSC), Curso de Fonoaudiologia, Florianópolis, SC, 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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High Incidence of Congenital Syphilis after Implementation of the Brazilian Ministry of Health Ordinances Related to Maternal Diagnostics. Pathogens 2021; 10:pathogens10050606. [PMID: 34063357 PMCID: PMC8156733 DOI: 10.3390/pathogens10050606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
The increasing rates of maternal and congenital syphilis (CS) infections are public health concerns and need further investigation in order to provide better assistance in epidemiological surveillance and new strategies for the assistance and prevention of CS. In December 2011, the Brazilian Ministry of Health (BMH) implemented ordinance number 3.242, reinforced in 2012 by ordinance number 77, aiming to improve the quality of the syphilis diagnosis system using rapid tests. Here, we evaluate the incidence, lethality, and possible factors associated with CS in Salvador, Bahia, in the pre-resolution period (2007 to 2011) and post-resolution (2012 to 2016). An observational, ecological time-series study is conducted using secondary data collected from the National Notifiable Diseases Information System (SINAN). Linear regression analysis to estimate increases or reductions in the mean incidence over time is also performed. A total of 5470 CS cases are analyzed. The incidence ranges from 2.1 cases per 1000 live births in 2007 to 17.1 cases per 1000 live births in 2019, showing a progressive increase in incidence over the years and reduction of lethality in the post-resolution period. The number of CS cases reported prior to the implementation of the ordinances (2007–2011) does not reveal a significant increase in the incidence. However, in the post-ordinances period (2012–2019), there is an average increase of the number of CS cases by three times over the years, with an average increase of 1.8 new cases annually. Our findings highlight the importance of diagnosis and support information in strategies for CS prevention. Furthermore, these data show a positive impact of resolutions on the diagnosis and evolution of the disease.
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Santana RDS, Kerr L, Mota RMS, Kendall C, Justa Neto RD, Macena HM, Seal D, Sousa AFL, McFarland W. Syphilis Testing Among Female Prisoners in Brazil: Results of a National Cross-sectional Survey. J Assoc Nurses AIDS Care 2021; 32:140-150. [PMID: 32889965 DOI: 10.1097/jnc.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Brazil has the third largest prison population in the world and is also experiencing a high and rising rate of syphilis infection. To establish the gaps in syphilis testing, we examined data from a nationally representative sample of incarcerated women in Brazil. Data originated from a cross-sectional survey designed to represent all regions of Brazil (N = 1,327). Data were collected by Audio Computer-Assisted Self-Interview, including variables in several blocks or domains. 49.2% had a lifetime history of being tested for syphilis. Increased likelihood of syphilis testing was significantly associated with completed elementary education (odds ratio ajustado [AOR] 1.75, 95% confidence interval [CI] 1.28-2.40), completed high school or more (AOR 2.04, 95% CI 1.36-3.06), income below minimum wage (AOR 1.46, 95% CI 1.10-1.94), homelessness (AOR 1.83, 95% CI 1.21-2.76), having heard of the female condom (AOR 1.92, 95% CI 1.25-2.95), received a condom in prison (AOR 1.56, 95% CI 1.11-2.21) or in public health services (AOR 1.50, 95% CI 1.13-1.98), lifetime history of pregnancy (AOR 2.55, 95% CI 1.67-3.89), had a gynecological examination (AOR 1.73, 95% CI 1.05-2.83), and perceived they had some chance (AOR 1.61, 95% CI 1.17-2.20) or a big chance (AOR 1.89, 95% CI 1.31-2.73) that they were likely to have been infected with HIV before entering prison.
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Affiliation(s)
- Rosane da Silva Santana
- Rosane da Silva Santana, RN, MS (Adult and Child Health), is a PhD Student, Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil. Ligia Kerr, MD, PhD, is a Professor, Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil. Rosa Maria Salani Mota, MD, PhD, is a Professor, Department of Statistics and Applied Mathematics, Federal University of Ceará, Fortaleza, Ceará, Brazil. Carl Kendall, PhD, is a Professor, Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA. Roberto da Justa Neto, MD, PhD, is an Associate Professor, Department of Physiotherapy, Federal University of Ceará, Fortaleza, Ceará, Brazil. Hermelinda Maia Macena, RN, PhD, is a Professor, Department of Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil. David Seal, PhD, is a Professor, Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA. Alvaro Francisco Lopes Sousa, RN, PhD, is a Postdoctoral Fellow, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil, and Research in Global Health and Tropical Medicine (GHMT), Instituto de Higiene e Medicina Tropical, Lisboa, Portugal. Willi McFarland, MD, PhD, is a Professor, Global Health Sciences, University of California, San Francisco, USA
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Araujo RS, Souza ASSD, Braga JU. Who was affected by the shortage of penicillin for syphilis in Rio de Janeiro, 2013-2017? Rev Saude Publica 2020; 54:109. [PMID: 33146299 PMCID: PMC7593023 DOI: 10.11606/s1518-8787.2020054002196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the shortage of benzathine penicillin G (BPG), characterizing its temporal evolution and spatial distribution in the city of Rio de Janeiro from 2013 to 2017. METHODS This ecological study used gestational and congenital syphilis notifications, BPG distribution records, and sociodemographic data from the population of Rio de Janeiro. To quantify the shortage, a BPG supply indicator was estimated per quarter for each neighborhood between 2013 and 2017. Thematic maps were created to identify areas and periods with greater BPG shortage, described according to sociodemographic factors, health services network, and epidemiological features in the incidence of syphilis. RESULTS BPG shortage in Rio de Janeiro from 2013 to 2017 was not homogeneous in space nor in time. The temporal evolution and spatial distribution of BPG scarcity shows that the shortage affected the inhabitants of the municipality in different ways. Shortage was lower in 2013 and 2016 and more severe in 2014, 2015, and 2017, particularly in neighborhoods within the programmatic areas PA3 and PA5, poorer and with higher prevalence rates of gestational and congenital syphilis. CONCLUSIONS Analyzing BPG shortage and its temporal evolution and spatial distribution in Rio de Janeiro allowed us to realize that the inhabitants are affected in different ways. Understanding this process contributes to the planning of actions to face shortage crises, minimizing possible impacts on the management of syphilis and reducing inequality in access to treatment.
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Affiliation(s)
- Rachel Sarmeiro Araujo
- Universidade do Estado do Rio de Janeiro . Instituto de Medicina Social . Programa de Pós-graduação em Saúde Coletiva . Rio de Janeiro , RJ , Brasil
| | - Ana Sara Semeão de Souza
- Universidade do Estado do Rio de Janeiro . Instituto de Medicina Social . Programa de Pós-graduação em Saúde Coletiva . Rio de Janeiro , RJ , Brasil
| | - José Ueleres Braga
- Universidade do Estado do Rio de Janeiro . Instituto de Medicina Social . Departamento de Epidemiologia . Rio de Janeiro , RJ , Brasil.,Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sergio Arouca . Departamento de Epidemiologia . Rio de Janeiro , RJ , Brasil
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Pires CDP, Fernandes CO, Oliveira EFD, Freitas SLFD, Almeida RGDS. Syphilis notifications among pregnant women in Campo Grande, state of Mato Grosso do Sul, Brazil, 2011 to 2017. Rev Soc Bras Med Trop 2020; 53:e20200024. [PMID: 32935779 PMCID: PMC7491558 DOI: 10.1590/0037-8682-0024-2020] [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: 01/28/2020] [Accepted: 05/28/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Syphilis is a sexually transmitted infection caused by Treponema pallidum. Considering the high rates of syphilis in pregnancy and congenital syphilis reported in Brazil in the past, and their serious consequences, this study described the epidemiological and clinical profile of pregnant women with a confirmed diagnosis of syphilis in Campo Grande, in the state of Mato Grosso do Sul, Brazil, from 2011 to 2017. METHODS: This is a descriptive study, based on syphilis notifications among pregnant women reported to the Sistema de Informação de Agravos de Notificação (National System of Disease Notification of Brazil). RESULTS: Over the study period, 2,056 confirmed cases of syphilis in pregnancy were reported, resulting in a crude cumulative incidence of 144.76 cases per 1,000 live-born babies. The incidence increased from 9.97 cases per 1,000 live-born babies in 2011 to 36.10 cases per 1,000 live-born babies in 2017. It was more prevalent in women who were young, of mixed race, with low educational attainment. Over one third of women were diagnosed in the first trimester of pregnancy; therefore, they were at risk of reinfection if they or their sexual partners were inadequately treated. Furthermore, syphilis was not well classified according to its clinical stage, which led to inappropriate treatments. CONCLUSIONS: Despite efforts to reduce the incidence of syphilis, syphilis during pregnancy remains a public health problem, reflecting possible inadequacies in antenatal care, especially in vulnerable populations. It is important to include sexual partners in syphilis treatment during pregnancy to prevent reinfection.
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Affiliation(s)
- Cássia de Paula Pires
- Universidade Federal de Mato Grosso do Sul, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Campo Grande, MS, Brasil
| | - Caroliny Oviedo Fernandes
- Universidade Federal de Mato Grosso do Sul, Programa de Residência em Enfermagem Obstétrica, Campo Grande, MS, Brasil
| | - Everton Falcão de Oliveira
- Universidade Federal de Mato Grosso do Sul, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Campo Grande, MS, Brasil.,Universidade Federal de Mato Grosso do Sul, Instituto Integrado de Saúde, Campo Grande, MS, Brasil
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de Souza CDF, Machado MF, Correia DS, do Carmo RF, Cuevas LE, Santos VS. Spatiotemporal clustering, social vulnerability and risk of congenital syphilis in northeast Brazil: an ecological study. Trans R Soc Trop Med Hyg 2020; 114:657-665. [PMID: 32537650 DOI: 10.1093/trstmh/traa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/07/2020] [Accepted: 04/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil. METHODS This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS. RESULTS The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability. CONCLUSIONS CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability.
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Affiliation(s)
| | - Michael F Machado
- Department of Medicine, Federal University of Alagoas, Arapiraca, Brazil
| | | | - Rodrigo F do Carmo
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Luis E Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Victor S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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Oliveira VDS, Rodrigues RL, Chaves VB, Dos Santos TS, de Assis FM, Ternes YMF, de Aquino ÉC. [High-risk clusters and temporal trends in congenital syphilis infection in Brazil]. Rev Panam Salud Publica 2020; 44:e75. [PMID: 32818032 PMCID: PMC7425818 DOI: 10.26633/rpsp.2020.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022] Open
Abstract
Objetivo. Determinar a existência de aglomerados de municípios (clusters) com alto risco para sífilis congênita (SC) no Brasil e descrever a tendência temporal da doença no país, comparando a população de crianças cujas mães realizaram o pré-natal com aquelas cujas mães não realizaram esse controle. Métodos. Este estudo ecológico utilizou dados do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informações sobre Nascidos Vivos (SINASC). Para a análise de aglomerados, a estatística de varredura Kulldorff foi aplicada à população de risco. A significância estatística foi determinada pelo logaritmo da razão de verossimilhança utilizando a distribuição discreta de Poisson. Para a análise das tendências das taxas de detecção do agravo, utilizou-se a regressão de Prais-Winsten. A análise foi realizada com os programas SatScan 9.4 e Stata 14.0. Resultados. Clusters com taxas de detecção de 41,3, 44,4 e 188,1 casos/10 000 nascidos vivos foram identificados em 2001, 2009 e 2017, respectivamente. Em 2001, as taxas foram 8 vezes maiores nos clusters do que no restante do país; em 2009, foram 3,3 vezes maiores; e, em 2017, 2,5. Detectou-se uma tendência crescente na infecção por SC em todas as regiões e unidades da federação. As taxas foram 8,53 vezes maiores nos neonatos cujas mães não realizaram pré-natal (243,3 casos/1 000 nascidos vivos vs. 28,4 casos/1 000 nascidos vivos em mães com pré-natal). Conclusões. A identificação de aglomerados de municípios com alto risco para SC e de tendências crescentes de infecção por SC em todo o país, mesmo na presença de pré-natal, indicam a necessidade de melhoria nas ações de saúde pública para o combate dessa doença.
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Affiliation(s)
- Vinícius da Silva Oliveira
- Universidade Federal de Goiás (FM-UFG) Faculdade de Medicina Goiânia (GO) Brasil Universidade Federal de Goiás (FM-UFG), Faculdade de Medicina, Goiânia (GO), Brasil
| | - Roberta Luiza Rodrigues
- Universidade Federal de Goiás (FM-UFG) Faculdade de Medicina Goiânia (GO) Brasil Universidade Federal de Goiás (FM-UFG), Faculdade de Medicina, Goiânia (GO), Brasil
| | - Vinícius Barros Chaves
- Universidade Federal de Goiás (FM-UFG) Faculdade de Medicina Goiânia (GO) Brasil Universidade Federal de Goiás (FM-UFG), Faculdade de Medicina, Goiânia (GO), Brasil
| | - Thiago Soares Dos Santos
- Universidade Federal de Goiás (FM-UFG) Faculdade de Medicina Goiânia (GO) Brasil Universidade Federal de Goiás (FM-UFG), Faculdade de Medicina, Goiânia (GO), Brasil
| | - Flaviane Marques de Assis
- Universidade Federal de Goiás (FM-UFG) Faculdade de Medicina Goiânia (GO) Brasil Universidade Federal de Goiás (FM-UFG), Faculdade de Medicina, Goiânia (GO), Brasil
| | - Yves Mauro Fernandes Ternes
- Universidade Federal de Goiás (IPTSP-UFG) Instituto de Patologia Tropical e Saúde Pública Goiânia (GO) Brasil Universidade Federal de Goiás (IPTSP-UFG), Instituto de Patologia Tropical e Saúde Pública, Goiânia (GO), Brasil
| | - Érika Carvalho de Aquino
- Universidade Federal de Goiás (IPTSP-UFG) Instituto de Patologia Tropical e Saúde Pública Goiânia (GO) Brasil Universidade Federal de Goiás (IPTSP-UFG), Instituto de Patologia Tropical e Saúde Pública, Goiânia (GO), Brasil
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Marques dos Santos M, Lopes AKB, Roncalli AG, de Lima KC. Trends of syphilis in Brazil: A growth portrait of the treponemic epidemic. PLoS One 2020; 15:e0231029. [PMID: 32271807 PMCID: PMC7145144 DOI: 10.1371/journal.pone.0231029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
Syphilis is a chronic infectious disease with its prevalence being described since the 15th century. Although its etiological agent and also the treatment measures are widely known, syphilis is still a great public health problem worldwide, mainly in countries with limited resources associated to low investments in health primary care. The aim of the present study was to analyze the trend and regional distribution of syphilis in Brazil between 2007 and 2017. This is an ecological study using secondary data from the Brazilian notification system. The Ministry of Health selected 100 municipalities which presented the worse outcomes related to syphilis from the 5,570 Brazilian municipalities as a target for a comprehensive project in order to tackle the prevalence of syphilis, called the "No Syphilis Project". These priority municipalities represent 57.7% of syphilis cases and about one third of the Brazilian population. They were compared with other 189 non-priority municipalities with more than 100 thousand inhabitants among the Brazilian regions (North, Northeast, Southeast, South and Center-West). Polynomial regression methods and Joinpoint analyses were used to analyze the trend, from which the Annual Average Percent Change (AACP) for each time period was calculated. There was a significant growth trend in all regions for the main three forms of syphilis (in pregnancy, congenital and acquired), especially in the South. The ratio between syphilis in pregnancy and congenital syphilis increased in both priority (AAPC: 8.54%; p<0.001) and non-priority municipalities (AAPC: 2.61%; p = 0.005), as well as in the regions, except the Center-West. High growth trends in syphilis prevalence were found in all municipalities, as well as all five regions between 2007 and 2017, showing that the challenge to reduce or even eliminate syphilis in Brazil is still difficult.
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Affiliation(s)
- Marquiony Marques dos Santos
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Doutorado em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- * E-mail:
| | - Ana Karla Bezerra Lopes
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Doutorado em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Laboratório de Microbiologia, Maternidade Escola Januário Cicco, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Angelo Giuseppe Roncalli
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kenio Costa de Lima
- Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Programa de pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Heringer ALDS, Kawa H, Fonseca SC, Brignol SMS, Zarpellon LA, Reis AC. [Inequalities in congenital syphilis trends in the city of Niterói, Brazil, 2007-2016Desigualdades en la tendencia de sífilis congénita en la ciudad de Niterói, Brasil, 2007-2016]. Rev Panam Salud Publica 2020; 44:e3. [PMID: 32038724 PMCID: PMC7001125 DOI: 10.26633/rpsp.2020.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/07/2019] [Indexed: 12/15/2022] Open
Abstract
Objetivo. Descrever a distribuição temporal e as características epidemiológicas da sífilis congênita (SC) em Niterói, Sudeste do Brasil, de 2007 a 2016. Métodos. Este estudo descritivo de série temporal da incidência de SC utilizou os dados do Sistema de Informação de Agravos de Notificação (SINAN) e do Sistema de Informações sobre Nascidos Vivos (SINASC). A amostra incluiu todos os casos notificados. Além disso, foi realizado um relacionamento probabilístico entre SINAN e SINASC para recuperar informações ignoradas. A série temporal foi estimada por regressão logarítmica, de acordo com variáveis sociodemográficas e de pré-natal. Resultados. Identificaram-se 754 casos de SC no período estudado (incidência média de 11,9 casos/1 000 nascidos vivos). A incidência foi mais elevada em jovens (10 a 19 anos; 20 a 24 anos), participantes de cor preta e naquelas com baixa escolaridade e sem pré-natal. Do total de mulheres, apenas 57,6% obtiveram o diagnóstico de sífilis durante o pré-natal. O tratamento foi inadequado em 87,7% das mulheres. Apenas 12,2% dos parceiros foram tratados. Houve tendência crescente do agravo (16%/ano), que atingiu 23,2 casos/1 000 nascidos vivos em 2016. O crescimento foi mais acentuado em adolescentes do sexo feminino (25,2%/ano), raça/cor parda (16,8%/ano), indivíduos com baixa escolaridade (57,1%/ano) e mulheres que realizaram pré-natal (17,3%/ano); e, no período de 2012 a 2016, em mulheres com informação ignorada para a cor da pele. Conclusões. As iniquidades sociais se destacaram na ocorrência de SC, com incidência crescente em jovens. É necessária a capacitação dos profissionais de saúde para o manejo da sífilis gestacional e uma atuação efetiva das políticas públicas sobre os determinantes sociais da sífilis.
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Affiliation(s)
- Andressa Lohan Dos Santos Heringer
- Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva Departamento de Epidemiología e Bioestatística Niterói (RJ) Brasil Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Departamento de Epidemiología e Bioestatística, Niterói (RJ), Brasil
| | - Helia Kawa
- Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva Departamento de Epidemiología e Bioestatística Niterói (RJ) Brasil Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Departamento de Epidemiología e Bioestatística, Niterói (RJ), Brasil
| | - Sandra Costa Fonseca
- Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva Departamento de Epidemiología e Bioestatística Niterói (RJ) Brasil Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Departamento de Epidemiología e Bioestatística, Niterói (RJ), Brasil
| | - Sandra Mara Silva Brignol
- Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva Departamento de Epidemiología e Bioestatística Niterói (RJ) Brasil Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Departamento de Epidemiología e Bioestatística, Niterói (RJ), Brasil
| | - Loren Angelica Zarpellon
- Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva Departamento de Epidemiología e Bioestatística Niterói (RJ) Brasil Universidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Departamento de Epidemiología e Bioestatística, Niterói (RJ), Brasil
| | - Ana Cristina Reis
- Escola Politécnica de Saúde Joaquim Venâncio (EPSJV/FIOCRUZ) Laboratório de Educação Profissional em Informações e Registros em Saúde Rio de Janeiro (RJ) Brasil Escola Politécnica de Saúde Joaquim Venâncio (EPSJV/FIOCRUZ), Laboratório de Educação Profissional em Informações e Registros em Saúde, Rio de Janeiro (RJ), Brasil
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22
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Bezerra MLDMB, Fernandes FECV, de Oliveira Nunes JP, de Araújo Baltar SLSM, Randau KP. Congenital Syphilis as a Measure of Maternal and Child Healthcare, Brazil. Emerg Infect Dis 2019; 25:1469-1476. [PMID: 31310223 PMCID: PMC6649332 DOI: 10.3201/eid2508.180298] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Syphilis is a sexually transmitted infection that has direct adverse effects on maternal and infant health through vertical Treponema pallidum transmission during early pregnancy. We evaluated congenital syphilis as a predictor of the quality of basic maternal and child healthcare in Brazil during 2010–2015. We investigated case rates and correlations with epidemiologic and socioeconomic indicators. We observed rising congenital syphilis incidence rates and increasing syphilis-associated perinatal and infant mortality rates in all regions. Case rates were highest in the Northeast, Southeast, and South, and congenital syphilis infant mortality rates were highest in the Northeast and Southeast. We observed correlations between congenital syphilis rates and infant death, spontaneous abortion (miscarriage), and stillbirth rates. We also noted correlations between rates of stillbirth caused by syphilis and inadequate prenatal care. Our study suggests gaps in basic healthcare for pregnant women and indicates the urgent need for measures to increase early diagnosis and appropriate treatment.
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23
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Cabrera S, Silveira MF, Visconti A, García F, Aguirre R, Ponce de Leon RG, Quian J, Serruya SJ. Lessons about the reliability of congenital syphilis and vertical HIV transmission data learned from case reviews in Uruguay: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:400. [PMID: 31684892 PMCID: PMC6827247 DOI: 10.1186/s12884-019-2516-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Uruguay it is mandatory to review all cases of positive HIV or reactive syphilis tests in pregnancy and peripartum. We compared the rates of mother-to-child transmission of syphilis and HIV detected by case reviews to those obtained from the usual surveillance system and described the characteristic of vertical transmission cases. Methods This is a cross-sectional study performed with secondary data obtained from official government sources, for all the country cases of maternal to child transmission of HIV and syphilis from 2012 to 2017, with descriptive analyses. For congenital syphilis analyses, the following pregnancy characteristics were investigated: number of antenatal checks, gestational age at pregnancy diagnosis, gestational age at syphilis test and diagnosis, adequate treatment, and treatment of partners. Sociodemographic characteristics included type of health care (public/private), maternal age, distribution of ethnic minorities, maximum educational attainment, presence of partner, planned pregnancy, drug and alcohol use, domestic violence, previous maternal diagnosis of syphilis, and previous children with congenital syphilis. Results Coverage of syphilis case reviews increased from 82% in 2014 to 97.4% in 2017. For HIV, this coverage reached 100% in 2017 and elimination of mother to child transmission was achieved. A marked decline in congenital syphilis was noted in the public health care sector, especially in the capital Montevideo, whereas the private sector has remained below the elimination target. Variables related with congenital syphilis in exposed children were late pregnancy diagnosis, < 5 antenatal checks, delayed diagnosis of gestational syphilis, lower rate of correct treatment for gestational syphilis, untreated partner, low maternal schooling, unplanned pregnancy, history of syphilis, and having other children with syphilis. Conclusion The use of case reviews provided knowledge regarding the accurate number of mother-to-child transmission cases and the evolution of elimination of mother to child transmission in the country. The results suggest that rates must be adjusted, providing an opportunity to improve the reliability of surveillance data, and point the need to address specific gaps in order to improve the quality of care during pregnancy, delivery, and the neonatal period.
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Affiliation(s)
- Susana Cabrera
- STI-HIV/AIDS Program Area, Public Health Ministry, Montevideo, Uruguay
| | | | - Ana Visconti
- Sexual and Reproductive Health Program Area, Public Health Ministry, Montevideo, Uruguay
| | - Fabian García
- Sexual and Reproductive Health Program Area, Public Health Ministry, Montevideo, Uruguay
| | - Rafael Aguirre
- Women's Health Program Area, Public Health Ministry, Montevideo, Uruguay
| | | | | | - Suzanne J Serruya
- Latin American Center of Perinatology, Women and Reproductive Health, Montevideo, Uruguay
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24
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Falavina LP, Lentsck MH, Mathias TADF. Trend and spatial distribution of infectious diseases in pregnant women in the state of Paraná-Brazil. Rev Lat Am Enfermagem 2019; 27:e3160. [PMID: 31432916 PMCID: PMC6703098 DOI: 10.1590/1518-8345.2838.3160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 03/03/2019] [Indexed: 12/01/2022] Open
Abstract
Objective to analyze the trend and spatial distribution of some diseases that require
compulsory notification in pregnant women. Method ecological study, with data from the National Notifiable
Diseases Surveillance System, of the incidence
of the six most frequent diseases that, require compulsory notification, in
pregnant women. The Prais-Winsten model was used to analyze the trend
classified as stable, decreasing and increasing, according to macro-regions.
For the spatial analysis, the incidences distributed in percentiles, in
choropleth maps, by Health Regions were calculated. Results the most frequent infections were syphilis, dengue, Human Immunodeficiency
Virus, influenza, hepatitis and toxoplasmosis. Incidence increased by 30.8%,
30.4%, 15.4% and 2.6%, on average, for syphilis, toxoplasmosis, dengue and
Human Immunodeficiency Virus, respectively. On average, the incidence of
syphilis increased by 40.5% in Macro-regional North and 38% in
Macro-regional Northwest. The spatial analysis showed, in the last four
years, high incidence of dengue, syphilis and infection by Human
Immunodeficiency Virus, which reached 180.2, 141.7 and 100.8 cases per
10,000 live births, respectively. Conclusion there were increased incidences of infection in pregnant women due to
syphilis, toxoplasmosis and Human Immunodeficiency Virus, with differences
in their spatial distribution, indicating that these diseases should be a
priority in the care of pregnant women in more affected regions.
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Affiliation(s)
| | - Maicon Henrique Lentsck
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brasil.,Universidade Estadual do Centro-Oeste, Departamento de Enfermagem, Guarapuava, PR, Brasil
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25
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Marinho de Souza J, Giuffrida R, Ramos APM, Morceli G, Coelho CH, Pimenta Rodrigues MV. Mother-to-child transmission and gestational syphilis: Spatial-temporal epidemiology and demographics in a Brazilian region. PLoS Negl Trop Dis 2019; 13:e0007122. [PMID: 30789909 PMCID: PMC6383870 DOI: 10.1371/journal.pntd.0007122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022] Open
Abstract
Syphilis is a Sexually Transmitted Infection (IST) with significant importance to public health, due to its impact during pregnancy (Gestational Syphilis-GS); especially because syphilis can affect fetus and neonates' development (mother-to-child transmission-MTCT of syphilis), by increasing susceptibility to abortion, premature birth, skeletal malformations, meningitis and pneumonia. Measures to control and eliminate MTCT of syphilis have failed on the last few years in Brazil and this research aimed to identify the seasonality of notified cases of syphilis in a region of São Paulo state. The studied region, Pontal do Paranapanema, comprises 32 cities located in the West of São Paulo state, in Brazil. Data collected from the National System of Aggravations and Notification (SINAN) website was used to calculate the incidence rate of GS and MTCT. The incidence rate of GS was acquired dividing number of cases by number of women in each municipality and MTCT using number of live births in each year (from 2007 to 2013) in each municipality. This result was then, standardized multiplying incidence rate by 10,000 and expressed as incidence/10,000 women or live births, for GS and MTCT, respectively. To identify possible endemic/epidemic periods, a control diagram was performed using the standard deviation (SD) of incidence rate. Thematic maps representing the spatial distribution of incidence rates were constructed using a Geographic Information System software (GIS, based on cartographic vector available on the Brazilian Institute of Geography and Statistics (IBGE) website. Eighty cases of GS and 61 cases of MTCT were notified in the studied region. An increase of GS notification was detected in the Pontal do Paranapanema in 2011 followed by an increase in number of MTCT cases in the subsequent year, suggesting inefficacy in the treatment during gestational period. Most of those cases were reported on February and November which suggested seasonality for this IST in the region. The control diagram, based on the inputs collected from SINAN, showed no endemic period; however, the most susceptible month to happen an endemic event of GS and MTCT was February. Our study provided a new methodology to understand the syphilis dynamics as a potential tool to improve the success of future measures to control and possibly eliminate MTCT of syphilis.
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Affiliation(s)
- Joyce Marinho de Souza
- Faculdade de Ciências da Saúde, Biomedicina, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
- Laboratório de Biologia Molecular de Microrganismos, Universidade Estadual Paulista, Londrina, PR, Brazil
| | - Rogério Giuffrida
- Programa de pós-graduação em Meio Ambiente e Desenvolvimento Regional, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
- Programa de pós-graduação em Ciência Animal, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
| | - Ana Paula Marques Ramos
- Programa de pós-graduação em Meio Ambiente e Desenvolvimento Regional, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
| | - Glilciane Morceli
- Faculdade de Ciências da Saúde, Biomedicina, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
- Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
| | - Camila H. Coelho
- Laboratory of Malaria Immunology and Vaccinology, DIR, NIAID, NIH, Bethesda, MD, United States of America
| | - Marcus Vinícius Pimenta Rodrigues
- Faculdade de Ciências da Saúde, Biomedicina, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
- Programa de pós-graduação em Meio Ambiente e Desenvolvimento Regional, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
- Mestrado em Ciências da Saúde, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil
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26
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Rocha AFB, Araújo MAL, Miranda AE, de Leon RGP, da Silva Junior GB, Vasconcelos LDPG. Management of sexual partners of pregnant women with syphilis in northeastern Brazil - a qualitative study. BMC Health Serv Res 2019; 19:65. [PMID: 30678672 PMCID: PMC6344990 DOI: 10.1186/s12913-019-3910-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there are public policies for eradicating congenital syphilis, they do not seem to be a routine in most health services. The objective of this study was to evaluate the management of sexual partners of pregnant women with syphilis in primary health care in northeastern Brazil. METHODS This is a qualitative assessment carried out from February to October 2014 in the city of Fortaleza, Ceará, northeastern region of Brazil, through the observation of six primary health care centers and interviews with 21 professionals, six coordinators, nine women diagnosed with syphilis during antenatal care and four sexual partners. The data were submitted to thematic content analysis. RESULTS Important flaws were identified at the primary health centers studied regarding the management of syphilis during pregnancy. Accessing testing and treatment is difficult, and there are no standardized strategies to notify the partner. The responsibility for notifying them is transferred to the women, and counseling does not offer proper guidance nor sufficient emotional support to help them. CONCLUSION The management of pregnant women and their sexual partners in our region does not comply with global recommendations. Professional qualification, sensitization, and standardization of health professionals' conduct are necessary. Offering support to health professionals on their clinical practices by means of a supervision process may contribute to the adoption of the recommended guidelines and to the promotion of care based on privacy, respect, confidentiality of information, and awareness of the problems faced by women as a result of syphilis diagnosis.
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Affiliation(s)
- Ana Fátima Braga Rocha
- University of Fortaleza-UNIFOR. Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil.
| | - Maria Alix Leite Araújo
- University of Fortaleza-UNIFOR. Av. Washington Soares, 1321, Edson Queiroz, Fortaleza, Ceará, CEP 60.811-905, Brazil
| | - Angélica Espinosa Miranda
- , Department of Infectious Diseases - Federal University of Espírito Santo. Av. Marechal Campos, 1468, Maruípe, Vitória, Espírito Santo, CEP 29040-091, Brazil
| | - Rodolfo Gómez Ponce de Leon
- Latin American Center for Perinatology/Women and Reproductive Health (CLAP/WR), Pan American Health Organization (PAHO - WHO), Av Brasil 2679, Montevideo, Uruguay
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27
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Padovani C, Oliveira RRD, Pelloso SM. Syphilis in during pregnancy: association of maternal and perinatal characteristics in a region of southern Brazil. Rev Lat Am Enfermagem 2018; 26:e3019. [PMID: 30110097 PMCID: PMC6091379 DOI: 10.1590/1518-8345.2305.3019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/06/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: To analyze the prevalence of syphilis in during pregnancy and its association
with socioeconomic characteristics, reproductive history, prenatal and labor
care, and newborn characteristics. Method: A retrospective, cross-sectional study based on gestational and congenital
syphilis reports. A (records) linkage was performed in the Brazilian
databases: “Information System for Notifiable Diseases” (Sistema de
Informação de Agravos de Notificação - SINAN);
“Live Births Information System” (Sistema de Informação sobre
Nascidos Vivos - SINASC); and “Mortality
Information System” (Sistema de Informação sobre
Mortalidade - SIM). Results: The prevalence of gestational syphilis was 0.57%. The following associations
of syphilis in pregnancy were found: non-white skin color/ethnicity (PR=4.6,
CI=3.62-5.76); low educational level (PR=15.4; CI=12.60-18.86); and absence
of prenatal care (PR=7.4, CI=3.68-14.9). The perinatal outcomes associated
with gestational syphilis were prematurity (PR=1.6 CI=1.17-2.21) and low
birth weight (PR=1.6; CI=1.14-2.28). Two deaths from congenital syphilis,
one death from another cause and five stillbirths were reported. Conclusion: The results signify a long way until reaching the World Health Organization’s
goal of eradicating congenital syphilis.
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Affiliation(s)
- Camila Padovani
- MSc, RN, Hospital e Maternidade Santa Rita, Maringá, PR, Brazil
| | - Rosana Rosseto de Oliveira
- Post-doctoral fellow, Universidade Estadual de Maringá, Maringá, PR, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Sandra Marisa Pelloso
- PhD, Full Professor, Departamento de Enfermagem, Universidade Estadual de Maringá, Maringá, PR, Brazil
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Cerqueira LRPD, Monteiro DLM, Taquette SR, Rodrigues NCP, Trajano AJB, Souza FMD, Araújo BDM. The magnitude of syphilis: from prevalence to vertical transmission. Rev Inst Med Trop Sao Paulo 2017; 59:e78. [PMID: 29267586 PMCID: PMC5738763 DOI: 10.1590/s1678-9946201759078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/28/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction: In 2013, the World Health Organization (WHO) reported that 1.9 million pregnant women were infected with syphilis worldwide, of which 66.5% had adverse fetal effects in cases of untreated syphilis. Congenital syphilis contributes significantly to infant mortality, accounting for 305,000 perinatal deaths worldwide annually. Aim: To estimate the prevalence of syphilis in parturients, the incidence of congenital syphilis and the vertical transmission rate. Material and methods: a cross-sectional study with data collected from 2041 parturients who had undergone treatment between 2012 and 2014 in the maternity section of the Pedro Ernesto Hospital of the State University of Rio de Janeiro, in the metropolitan area of Rio de Janeiro. The inclusion criterion was positive VDRL and treponemal test in a hospital environment. Results: the prevalence of syphilis in pregnant women was 4.1% in 2012, 3.1% in 2013 and 5% in 2014, with official reporting of 15.6%, 25.0% and 48.1%, respectively. The incidence of congenital syphilis (CS) was 22/1,000 in live births (LB) in 2012; 17/1,000 LB in 2013 and 44.8/1,000 LB in 2014. CS underreporting during the period was 6.7%. Vertical transmission occurred in 65.8% of infants from infected mothers. It was concluded that, in 34.6% of the CS cases, maternal VDRL titers were = 1/4. Conclusion: Results demonstrate the magnitude of the disease, fragility of the reporting system in the assessment of the actual prevalence, impact on perinatal outcomes, and they are a warning about the real situation of syphilis, which is still underestimated in the State.
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Affiliation(s)
| | - Denise L M Monteiro
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil.,Centro Universitário Serra dos Órgãos, Teresópolis, Rio de Janeiro, Brazil
| | - Stella R Taquette
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nádia C P Rodrigues
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil.,Escola Nacional de Saúde Pública Sergio Arouca, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre J B Trajano
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil.,Universidade do Grande Rio, Duque de Caxias, Rio de Janeiro, Brazil
| | - Flavio Monteiro de Souza
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bianca De Melo Araújo
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, Rio de Janeiro, Brazil
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Nazareth JV, de Souza KV, Beinner MA, Barra JS, Brüggemann OM, Pimenta AM. Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards. Midwifery 2017; 53:42-48. [PMID: 28750275 DOI: 10.1016/j.midw.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/01/2017] [Accepted: 07/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. DESIGN This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level. FINDINGS At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics. KEY CONCLUSIONS The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.
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Affiliation(s)
| | | | - Mark Anthony Beinner
- School of Nursing, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brazil.
| | - Juliana Silva Barra
- School of Medicine, Universidade Federal de Minas Gerais - UFMG, Belo Horizonte, Brazil
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30
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Dos Santos RR, Niquini RP, Bastos FI, Domingues RMSM. Diagnostic and Therapeutic Knowledge and Practices in the Management of Congenital Syphilis by Pediatricians in Public Maternity Hospitals in Brazil. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 49:322-342. [PMID: 28735562 DOI: 10.1177/0020731417722088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The study aimed to assess conformity with Brazil's standard protocol for diagnostic and therapeutic practices in the management of congenital syphilis by pediatricians in public maternity hospitals. A cross-sectional study was conducted in 2015 with 41 pediatricians working in all the public maternity hospitals in Teresina, the capital of Piauí State, Northeast Brazil, through self-completed questionnaires. The study assessed the conformity of knowledge and practices according to the Brazilian Ministry of Health protocols. The study has made evident low access to training courses (54%) and insufficient knowledge of the case definition of congenital syphilis (42%) and rapid tests for syphilis (39%). Flaws were observed in the diagnostic workup and treatment of newborns. Requesting VDRL (88%) and correct treatment of neurosyphilis (88%) were the practices that showed the highest conformity with standard protocols. Low conformity with protocols leads to missed opportunities for identifying and adequately treating congenital syphilis. Based on the barriers identified in the study, better access to diagnostic and treatment protocols, improved recording on prenatal cards and hospital patient charts, availability of tests and medicines, and educational work with pregnant women should be urgently implemented, aiming to reverse the currently inadequate management of congenital syphilis and to curb its spread.
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Affiliation(s)
| | - Roberta Pereira Niquini
- 2 Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Inácio Bastos
- 3 Instituto de Comunicação e Informação Científica e Tecnológica em Súde, Rio de Janeiro, Brazil
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