1
|
de Carvalho RR, Carvalho F, de Oliveira EB, Souza da Silva R, Rados DV, Mattiello R, Gonçalves MR, Umpierre RN, Giugliani C. Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. PLoS One 2024; 19:e0306192. [PMID: 38941327 PMCID: PMC11213312 DOI: 10.1371/journal.pone.0306192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/11/2024] [Indexed: 06/30/2024] Open
Abstract
This cross-sectional study aims to describe doubts regarding the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. All teleconsultations (TCs) offered through TelessaúdeRS-UFRGS to primary health care (PHC) services in the state of Rio Grande do Sul between 2018 and 2021 involving syphilis in pregnancy were included. A total of 356 (TCs) were analyzed. The main doubts about syphilis during pregnancy raised by primary care professionals were related to the need for retreatment (35%), diagnostic definition (23%) and initial treatment (16%). In addition, 95% of TCs were suitable for diagnosing and treating syphilis based on the 2020 Brazilian Ministry of Health guideline. This study suggests that TCs can identify failures in the diagnosis and treatment of public health problems and support decision making in PHC involving syphilis in pregnancy.
Collapse
Affiliation(s)
- Renata Rosa de Carvalho
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fabiana Carvalho
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elise Botteselle de Oliveira
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodolfo Souza da Silva
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Dimitris Varvaki Rados
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rita Mattiello
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Rodrigues Gonçalves
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Nunes Umpierre
- Núcleo de Telessaúde do Rio Grande do Sul (TelessaúdeRS-UFRGS), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila Giugliani
- Post Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Social Medicine Department, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
2
|
Couto CE, Castanheira ERL, Sanine PR, Mendonça CS, Nunes LO, Zarili TFT, Dias A. Congenital syphilis: performance of primary care services in São Paulo, 2017. Rev Saude Publica 2023; 57:78. [PMID: 37937652 PMCID: PMC10609639 DOI: 10.11606/s1518-8787.2023057004965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. METHODS Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. RESULTS 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. CONCLUSIONS The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.
Collapse
Affiliation(s)
- Caroline Eliane Couto
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Elen Rose Lodeiro Castanheira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
| | - Patrícia Rodrigues Sanine
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Carolina Siqueira Mendonça
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
| | - Luceime Olívia Nunes
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuPrograma de Pós-Graduação em Saúde ColetivaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Programa de Pós-Graduação em Saúde Coletiva
.
Botucatu
,
SP
,
Brazil
| | - Thais Fernanda Tortorelli Zarili
- Universidade Estadual do Oeste do ParanáCentro de Ciências Biológicas e da SaúdeCascavelPRBrazil Universidade Estadual do Oeste do Paraná
.
Centro de Ciências Biológicas e da Saúde
.
Cascavel
,
PR
,
Brazil
| | - Adriano Dias
- Universidade Estadual Paulista “Júlio de Mesquita Filho”Faculdade de Medicina de BotucatuDepartamento de Saúde PúblicaBotucatuSPBrazil Universidade Estadual Paulista “Júlio de Mesquita Filho”
.
Faculdade de Medicina de Botucatu
.
Departamento de Saúde Pública
.
Botucatu
,
SP
,
Brazil
| |
Collapse
|
3
|
Lopes de Oliveira G, Ferreira AJ, Teles CADS, Paixao ES, Fiaccone R, Lana R, Aquino R, Cardoso AM, Soares MA, Oliveira dos Santos I, Pereira M, Barreto ML, Ichihara MY. Estimating the real burden of gestational syphilis in Brazil, 2007-2018: a Bayesian modeling study. LANCET REGIONAL HEALTH. AMERICAS 2023; 25:100564. [PMID: 37575963 PMCID: PMC10415804 DOI: 10.1016/j.lana.2023.100564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
Background Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Methods Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. Findings We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Interpretation Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. Funding National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.
Collapse
Affiliation(s)
- Guilherme Lopes de Oliveira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Department of Computing, Federal Centre of Technological Education of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andrêa J.F. Ferreira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- The Ubuntu Center on Racism, Global Movement, Population and Equity, School of Public Health, Drexel University, Pennsylvania, USA
| | - Carlos Antônio de S.S. Teles
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| | - Enny S. Paixao
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rosemeire Fiaccone
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Statistics Department, Institute of Mathematics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Raquel Lana
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Barcelona Supercomputing Center, Catalonia, Spain
| | - Rosana Aquino
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Maria Auxiliadora Soares
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Idália Oliveira dos Santos
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Marcos Pereira
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maurício L. Barreto
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Centre of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fiocruz, Salvador, Bahia, Brazil
| |
Collapse
|
4
|
Borba KB, Maurici da Silva R. Sociodemographic risk factors for gestational syphilis in a maternity hospital in Santa Catarina, Brazil. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i4.1326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective: to identify risk factors for the acquisition of gestational syphilis. Methods: Coorte study. The participants will perform rapid tests to detect syphilis during pregnancy and hospitalization. Data referring to age, ethnicity, education, and family income were collected in the interview. To investigate factors associated with syphilis infection in the gestational period, binary logistic regression models were run to analyze the crude and adjusted odds ratios for sociodemographic and economic variables. The statistical significance level of 5% was adopted. Results: There was a statistically significant association between syphilis infection and the social class of the patient [χ2 9.821 (4 df); p = 0.05]. The logistic regression model showed that black women had a higher chance of syphilis infection (OR = 2.582; 95% CI 1.068 – 6.243). Conclusion: Low social class and black ethnicity are risk factors for acquiring syphilis during pregnancy.
Collapse
|
5
|
Seabra I, Ferreira GRON, Sorensen W, Oliveira C, Parente AT, Gir E, Reis RKK, Ferrari RAP, Botelho E. Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study. BMJ Open 2022; 12:e058270. [PMID: 35443962 PMCID: PMC9021778 DOI: 10.1136/bmjopen-2021-058270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques. DESIGN Ecological study. SETTINGS This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study. PRIMARY OUTCOME MEASURES The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan. RESULTS From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk. CONCLUSION This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.
Collapse
Affiliation(s)
- Iaron Seabra
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - William Sorensen
- Health & Kinesiology Department, University of Texas at Tyler, Tyler, Texas, USA
| | - Carmem Oliveira
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - Elucir Gir
- College of Nursing, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Eliã Botelho
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| |
Collapse
|
6
|
Reis ARDP, Duarte G, Menegueti MG, Reis RK, Silva ACRE, Gir E. Reactive treponemal and non-treponemal tests in pregnant women and associated factors. Rev Esc Enferm USP 2022; 56:e20220146. [PMID: 36427270 PMCID: PMC10081588 DOI: 10.1590/1980-220x-reeusp-2022-0146en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Objective: to identify the rate of reactive treponemal and non-treponemal tests in pregnant women during childbirth and to analyze the factors associated with this seroreactivity. Method: this is a cross-sectional, quantitative study with secondary sources of sociodemographic and clinical data on 2,626 pregnant women treated at a public maternity hospital in the interior of São Paulo, in 2020. For statistical analysis, Fisher’s exact test, Mann-Whitney test and the logistic regression model were used. A difference of p < 0.05 was considered statistically significant. Results: the rate of seropositivity for syphilis among pregnant women in this series was 2.74%. Among the groups with positive and non-reactive tests, marital status, occupation, place of residence and use of licit drugs indicated significant differences, but, in the final model, only unmarried marital status was associated with reactive tests (Odds Ratio: 0.169; Confidence Interval: 0.04–0.72; and p: 0.016). Conclusion: in this study, unmarried marital status was the only independent factor associated with seroreactivity for syphilis. Therefore, it is necessary to create strategies aimed at women in this condition, potentially reducing the rate of congenital syphilis.
Collapse
|
7
|
Reis ARDP, Duarte G, Menegueti MG, Reis RK, Silva ACRE, Gir E. Testes treponêmicos e não treponêmicos reagentes em gestantes e fatores associados. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0146pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RESUMO Objetivo: identificar a taxa de testes treponêmicos e não treponêmicos reagentes em gestantes no período do parto e analisar os fatores associados a essa sororreatividade. Método: estudo transversal, quantitativo, com fontes secundárias de dados sociodemográficos e clínicos de 2.626 gestantes atendidas em uma maternidade pública do interior paulista, em 2020. Para a análise estatística, foram utilizados os Testes Exato de Fisher, de Mann-Whitney e o modelo de regressão logística. Considerou-se diferença com significância estatística valores de p < 0,05. Resultados: a taxa de soropositividade para sífilis entre gestantes nesta casuística foi de 2,74%. Entre os grupos com testes reagentes e não reagentes à situação maritária, ocupação, local da residência e uso de drogas lícitas indicaram diferenças significantes, mas, no modelo final, apenas a situação marital não casada apresentou associação com os testes reagentes (Odds Ratio: 0,169; Intervalo de Confiança: 0,04–0,72; e p: 0,016). Conclusão neste estudo, a situação maritária não casada foi o único fator independente associado à sororreatividade para a sífilis. Por isso, faz-se necessária a criação de estratégias voltadas para mulheres nessa condição, potencialmente reduzindo a taxa de sífilis congênita.
Collapse
|