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Sala A, Luppi CG, Wagner GA, Pinheiro Junior RVB, Carneiro Junior N. Performance of primary health care in São Paulo state, Brazil, during the period 2010-2019. CIENCIA & SAUDE COLETIVA 2024; 29:e04112023. [PMID: 38896671 DOI: 10.1590/1413-81232024296.04112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.
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Affiliation(s)
- Arnaldo Sala
- Secretaria de Estado da Saúde de São Paulo. Av. Doutor Arnaldo 351, 5º andar. 01246-901 São Paulo SP Brasil.
| | - Carla Gianna Luppi
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | - Nivaldo Carneiro Junior
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo. São Paulo SP Brasil
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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.
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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”
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Faculdade de Medicina de Botucatu
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Departamento de Saúde Pública
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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”
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Faculdade de Medicina de Botucatu
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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
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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
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Centro de Ciências Biológicas e da Saúde
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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”
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Faculdade de Medicina de Botucatu
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Departamento de Saúde Pública
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Botucatu
,
SP
,
Brazil
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Hailemeskel HS, Dagnaw FT, Demis S, Birhane BM, Azanaw MM, Chanie ES, Asferie WN, Fetene MT, Mose A, Belay DM, Kefale D, Kassaw A, Tiruneh M, Tesfaw A, Tilaye BA, Arage G, Kebede AB, Tiruneh SA. Neonatal outcomes of preterm neonates and its predictors in Ethiopian public hospitals: Multicenter prospective follow-up study. Heliyon 2023; 9:e18534. [PMID: 37576212 PMCID: PMC10412993 DOI: 10.1016/j.heliyon.2023.e18534] [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: 03/01/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors. Objective This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021. Methods A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P-value less than 0.05. Result The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (β = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (β = 0.85; 95% CI: 0.49, 1.22), body mass index (β = -1.34; 95% CI: -1.87, -0.80), non-union marital status (β = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (β = -0.66; 95% CI: -0.99-0.32), multiparous (β = 0.35; 95% CI: 0.01, 0.69), hypothermia (β = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (β = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (β = -1.23; 95% CI: -1.99,-0.46) were significant predictors. Conclusion In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births.
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Affiliation(s)
- Habtamu Shimels Hailemeskel
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye Birhane
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melkalem Mamuye Azanaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Ayenew Mose
- Department of Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Demeke Mesfin Belay
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Demewoz Kefale
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birara Aychew Tilaye
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Arage
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemwork Baye Kebede
- Neonatal Intensive Care Unit, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Pícoli RP, Cazola LHDO. Missed opportunities in preventing mother-to-child transmission of syphilis in the indigenous population in central Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract Objectives: to estimate the detection rate of syphilis in pregnant women, the occurrence of congenital syphilis, and the rate of mother-to-child transmission of syphilis, in addition to analyzing missed opportunities in the prevention of mother-to-child transmission in the indigenous population. Methods: descriptive study of cases of pregnant indigenous women with syphilis resulting or not in a case of congenital syphilis. The data were obtained from the Sistema de Informação de Agravos de Notificação (Information System of Notifable Diseases), the records of the Infecções Sexualmente Transmissíveis do Distrito Sanitário Especial Indígena (Sexually Transmitted Infections in the Special Indigenous Health District), and the medical records of pregnant indigenous women in 2015. The database and the calculation of syphilis rates in pregnant women, congenital syphilis, and mother-to-child transmission were carried out. Data on prenatal, diagnosis and treatment of syphilis during pregnancy were collected from the medical records. Results: the detection rate of syphilis in pregnant women reached 35.2/1,000 live births (LB), the occurrence of congenital syphilis encompassed 15.7/1.000 LB, and the rate of mother-to-child transmission was 44.8%. Six (24%) pregnant women started prenatal care in the first trimester and seven (28%) attended seven or more consultations. The diagnosis of syphilis was late and only nine (36%) women were properly treated. Conclusions: failures in the diagnosis and the adequate treatment of pregnant women with syphilis compromised the prevention of mother-to-child transmission of the disease.
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Lannoy LH, Santos PC, Coelho R, Dias-Santos AS, Valentim R, Pereira GM, Miranda AE. Gestational and congenital syphilis across the international border in Brazil. PLoS One 2022; 17:e0275253. [PMID: 36282795 PMCID: PMC9595568 DOI: 10.1371/journal.pone.0275253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Brazil lacks data from syphilis in its border areas. We aimed to describe the spatial and temporal distribution of acquired syphilis (AS), in pregnancy (SP) and congenital syphilis (CS) in Brazilian municipalities in the arches border contexts. METHODS An ecological, cross-sectional study was conducted from 2010 to 2020. The study was based on the cases of syphilis available in the Notifiable Diseases Information System (SINAN), and on the Primary Health Care Information System. The detection rates of AS and SP, and the incidence of CS were estimated, and the time series was analyzed. Data between the border arches were compared. RESULTS In 2020, data showed 7,603 cases of AS (detection rate 64.8/100,000 inhabitants), 3,960 cases of SP (detection rate of 21.6/1,000 live births) and 836 cases of CS (incidence of 4.6/1,000 live births) in the border region. Between 2010 and 2020, the mean annual increase of detection rate of SP was 53.4% in Brazil, 48.0% in the border region, 59.6% in the North Arch, 28.8% in the Central and 67.2% in the South. Annual variation on the incidence of CS for the same period was 31.0% in Brazil 38.4% at the border, in the North and South Arcs 18.3% and 65.7% respectively. The Central Arch showed an increase only between 2010 and 2018 (62.7%). A total of 427 (72.6%) municipalities has primary health care coverage ≥ 95% of the population. In 2019, 538 (91.8%) municipalities reported using rapid tests for syphilis, which decreased to 492 (84%) in 2020. In 2019, 441 (75.3%) municipalities reported administering penicillin, and 422 (72%) in 2020. CONCLUSION Our data show syphilis reman problem at the Brazilian border, rates in pregnant are high. It was observed a reduction in the detection rates, SP and the incidence of CS between 2018 and 2020. Syphilis should be included on the agenda of all management levels, aiming at expanding access and quality care.
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Affiliation(s)
- Leonor H. Lannoy
- Post-Graduation Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Patrícia C. Santos
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Ronaldo Coelho
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Adriano S. Dias-Santos
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Ricardo Valentim
- Laboratory of Technological Innovation in Health (LAIS), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Gerson M. Pereira
- Department of Chronic Diseases and Sexually Transmitted Infections, Secretary of Health Surveillance, Brazilian Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Angelica E. Miranda
- Post-Graduation Program in Infectious Diseases, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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de Brito Pinto TK, da Cunha-Oliveira ACGDP, Sales-Moioli AIL, Dantas JF, da Costa RMM, Silva Moura JP, Gómez-Cantarino S, Valentim RADM. Clinical Protocols and Treatment Guidelines for the Management of Maternal and Congenital Syphilis in Brazil and Portugal: Analysis and Comparisons: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10513. [PMID: 36078229 PMCID: PMC9518460 DOI: 10.3390/ijerph191710513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/13/2022] [Accepted: 08/20/2022] [Indexed: 05/18/2023]
Abstract
(1) Background: Maternal syphilis (MS) and congenital syphilis (CS) are serious public health problems worldwide due to their high morbidity and mortality rates. (2) Objective: Evaluating the applicability of Clinical Protocols and Treatment Guidelines on case incidence trends in Brazil and Portugal. (3) Methods: The review was done through bibliographic research in two public databases and government websites from both countries, published between 2007 and 2022. All guidelines that contained CS and MS were selected. (4) Results and discussion: After evaluation, we found that Brazil and Portugal have adequate protocols for screening and treating congenital and maternal syphilis. (5) Conclusion: The results suggest that CS and MS incidence are notably higher in Brazil than in Portugal due to economic, cultural, and social disparities and the differences in territory size. Therefore, these demographic and socioeconomic factors could strongly influence efforts to fight against syphilis and thus control the infection.
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Affiliation(s)
- Talita Katiane de Brito Pinto
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
| | - Aliete Cristina Gomes Dias Pedrosa da Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3001-901 Coimbra, Portugal
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | | | - Jane Francinete Dantas
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
| | - Rosângela Maria Morais da Costa
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Center for Interdisciplinary Studies of the 20th Century (CEIS-20), University of Coimbra, 3000-186 Coimbra, Portugal
- Municipal Health Department, Natal City Hall, Natal 59014-030, Brazil
| | - José Paulo Silva Moura
- Doctor Daniel de Matos Maternity, Coimbra Hospital and University Center, 3000-157 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
| | - Sagrario Gómez-Cantarino
- Faculty of Physiotherapy and Nursing, Toledo Campus, University of Castilla-La Mancha, 45071 Toledo, Spain
| | - Ricardo Alexsandro de Medeiros Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal 59010-090, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
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Amorim EKR, Matozinhos FP, Araújo LA, Silva TPRD. Trend in cases of gestational and congenital syphilis in Minas Gerais, Brazil, 2009-2019: an ecological study. ACTA ACUST UNITED AC 2021; 30:e2021128. [PMID: 34644777 DOI: 10.1590/s1679-49742021000400006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the trend of notifications of gestational and congenital syphilis in Minas Gerais, Brazil, from 2009 to 2019. METHODS This was an ecological time series study which took the state of Minas Gerais as its unit of analysis, based on data reported on the Notifiable Health Conditions Information System (SINAN). The Prais-Winsten autoregressive model was used to verify trends. RESULTS 20,348 cases of gestational syphilis and 11,173 cases of congenital syphilis were reported. Average percentage annual increase was 36.7% (95%CI 32.5;41.0), for gestational syphilis incidence rates, and 32.8% (95%CI 28.0;37.8) for congenital syphilis incidence rates (p<0.001). CONCLUSION The temporal trend analysis showed that gestational and congenital syphilis incidence rates had significant increasing trends, which may be related to inadequate treatment or failure to treat syphilis during pregnancy.
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Affiliation(s)
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais, Departamento de Enfermagem Materno-Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
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de Cerqueira BGT, da Silva EP, Gama ZADS. Improvement of quality of care for gestational syphilis in the municipality of Rio de Janeiro. Rev Saude Publica 2021; 55:34. [PMID: 34133619 PMCID: PMC8225322 DOI: 10.11606/s1518-8787.2021055002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care. METHODS This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality. RESULTS After the intervention, there was a total absolute improvement of 6.7% (64.4% versus 71.0%) and relative of 28.8% (p > 0.05). Eight of the ten quality criteria had an improvement, which was significant in four of them (p < 0.05). The monthly indicator of adequate treatment also improved (p < 0.05), but maintained low performance throughout the project. The increase in the compliance of the treatment scheme with the protocol (91.4% versus 99.1%) positively stood out, but the main opportunities for improvement were testing (42.8% versus 48.5%) and treatment of sexual partnerships (42.8% versus 44.2%). Regulatory pressures to improve the monthly indicator and the political-economic crisis experienced by the municipality modulated the effect of the intervention. CONCLUSION The project was useful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
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Affiliation(s)
- Brena Gabriella Tostes de Cerqueira
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdePrograma de Pós-Graduação em Gestão da Qualidade em Serviços de SaúdeNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Programa de Pós-Graduação em Gestão da Qualidade em Serviços de Saúde. Natal, RN, Brasil
| | - Eliane Pereira da Silva
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Medicina ClínicaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Medicina Clínica. Natal, RN, Brasil
| | - Zenewton André da Silva Gama
- Universidade Federal do Rio Grande do NorteCentro de Ciências da SaúdeDepartamento de Saúde ColetivaNatalRNBrasilUniversidade Federal do Rio Grande do Norte. Centro de Ciências da Saúde. Departamento de Saúde Coletiva. Natal, RN, Brasil
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Fernandes LPMR, Souza CL, Oliveira MV. Missed opportunities in treating pregnant women’s sexual partners with syphilis: a systematic review. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to compile studies in the literature that deal with missed opportunities related in treating pregnant women’s partners with syphilis Methods: this is a systematic review from SciELO, PUBMED, Lilacs and BVS databases, using articles published between 2008 and 2018. The research was carried out between April and August 2019 and followed PRISMA guideline recommendation Results: 56,686 titles were identified and 53 were extracted in which addressed aspects related intreating pregnant women’s partners with syphilis. Most studies were National, representing 60.7% of the researched articles. 51% of them used the Sistemas de Informação de Agravos Notificados (SINAN) (Notified Diseases Information System) as a database, followed by the use of Questionnaires / Interviews (33.9%) and consulted patients’ files (15.1%). The factors most associated with the non-treatment of the pregnant women’s partners with syphilis were: structuring /quality in the services from the aspect related to failures in prenatal care, characteristics of pregnant women that interfere in their treatment and aspects related to the cultural particularities that involvemen's healthcare. Conclusion: in all continents, the main aspect related to failures in the treatment of the partners/pregnant women with syphilis is associated with low quality in prenatal care.
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Ueleres Braga J, Araujo RS, de Souza ASS. The Shortage of Benzathine Penicillin and Its Impact on Congenital Syphilis Incidence: An Ecologic Study in the City of Rio de Janeiro. Clin Infect Dis 2021; 72:e79-e87. [PMID: 33197933 DOI: 10.1093/cid/ciaa1716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Pan American Health Organization indicates that increased incidence of congenital syphilis (CS) can be attributed to the lack of penicillin. This study aimed to analyze the relationship between the benzathine penicillin shortage and the significant increase in the incidence of congenital syphilis in the city of Rio de Janeiro from 2013 to 2017. METHODS We used a mixed ecologic study design (temporal and multiple groups). Analysis units were the neighborhoods (spatial) and quarters (temporal) during those years. The study population consisted of CS patients who were living in the city of Rio de Janeiro. The benzathine penicillin supply measure for use in gestational syphilis considered the ratio between (1) the number of bottles dispensed to health facilities in each neighborhood and (2) the number of bottles necessary to treat pregnant women diagnosed with syphilis and their respective partners residing in each neighborhood. To evaluate the association between shortages and a significant increase in CS incidence, the negative-inflated zero-binomial regression model (longitudinal model) was used. RESULTS During the study period, the incidence rate of CS in Rio de Janeiro neighborhoods was on average 19.6 per 1000 live births. In the simple analysis, shortage was associated with a 2.17-fold increase in the risk of a significant increase in CS incidence. After adjustment for the sufficient minimum set, the strength of association increased to 2.23 (95% confidence interval, 1.15-4.30). CONCLUSIONS We conclude that the benzathine penicillin shortage had an impact on the increase in the incidence of CS in Rio de Janeiro.
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Affiliation(s)
- José Ueleres Braga
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rachel Sarmeiro Araujo
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Canto SVE, Araújo MAL, Almeida RLFD, Cutrim BEC. Hospitalization costs for congenital syphilis in the state of Ceará. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000100016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: this study aimed to describe direct medical-hospital costs of hospitalizations for Congenital Syphilis (CS) in children under one year of age, users of the public health network in the state of Ceará, Brazil, from 2012 to 2017. Methods: this is a cross-sectional study that used the DATASUS Hospital Information System database, built from the information registered in the Inpatient Hospital Authorizations (IHA), organized in a Microsoft Office Excel 2010 spreadsheet and analyzed in SPSS, version 23. Results: there were 4,085 hospitalizations registered for CS (16.6% of total hospital admissions for infectious and parasitic diseases) at a cost of US$ 927,726.84, representing an annual average of US$ 234.73 per child. A slight decrease in approved IHA for infectious and parasitic diseases (5.5%) was verified when compared with CS, which increased by 36.4%> over the evaluated years. Conclusion: high treatment costs for CS in the state of Ceará were identified, a situation that could be avoided if pregnant women with syphilis were diagnosed and treated during prenatal care.
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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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Figueiredo DCMMD, Figueiredo AMD, Souza TKBD, Tavares G, Vianna RPDT. [Relationship between the supply of syphilis diagnosis and treatment in primary care and incidence of gestational and congenital syphilis]. CAD SAUDE PUBLICA 2020; 36:e00074519. [PMID: 32215510 DOI: 10.1590/0102-311x00074519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
Brazil has reported an increase in the incidence of both gestational and congenital syphilis, posing a serious public health problem in the country. The study aimed to analyze the relationship between the supply of syphilis diagnosis and treatment in primary care and the incidence rates of gestational and congenital syphilis. An ecological study analyzed these incidence rates and the coverage of diagnostic and therapeutic measures in primary care. The study sample consisted of municipalities (counties) with population over 20,000, with coverage by primary care over 50%, and where the majority of the teams were assessed in the second cycle of the National Program for Improvement of Access and Quality of Basic Care. Analysis of the effectiveness of detection and treatment measures was based on the development of the Index of Variation in Vertical Syphilis Transmission. The administration of penicillin and application of the rapid test in these municipalities showed median rates of 41.9% and 67.14%, respectively, with regional differences. Median incidence of gestational syphilis was 6.24 (IQR: 2.63-10.99) in municipalities with a higher supply of the rapid test and 3.82 (IQR: 0.00-8.21) in those with a lower supply, indicating an increase in detection capacity. Municipalities with a reduction in vertical transmission showed higher median rates of teams with supply of rapid testing and (83.33%; IQR: 50.00-100.00) and administration of penicillin (50.00%; IQR: 11.10-87.50), demonstrating a relationship between these measures and the reduction in congenital syphilis. The findings indicate the need to expand these services and to reinforce the importance of reducing vertical transmission.
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Affiliation(s)
| | | | - Tanise Kely Bezerra de Souza
- Universidade Federal da Paraíba, João Pessoa, Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Graziela Tavares
- Programa de Pós-graduação em Políticas Públicas em Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Rodrigo Pinheiro de Toledo Vianna
- Universidade Federal da Paraíba, João Pessoa, Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Fundação Oswaldo Cruz, Brasília, Brasil
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Anugulruengkitt S, Yodkitudomying C, Sirisabya A, Chitsinchayakul T, Jantarabenjakul W, Chaithongwongwatthana S, Puthanakit T. Gaps in the elimination of congenital syphilis in a tertiary care center in Thailand. Pediatr Int 2020; 62:330-336. [PMID: 31886919 DOI: 10.1111/ped.14132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The World Health Organization has set a goal to eliminate mother-to-child transmission of syphilis to a target of <50 cases per 100 000 live births. This study aimed to determine the rate of congenital syphilis and identify gaps in prevention. METHODS A retrospective chart review was conducted in a tertiary care center in Bangkok, Thailand. The study included all pregnant women with positive syphilis serology and their infants. All congenital syphilis cases were categorized according to Centers for Disease Control criteria. RESULTS From 2013 to 2017, 69 syphilis-infected pregnant women were included, with 30 congenital syphilis cases. The rate of congenital syphilis was 115 cases (95% CI 78-164) per 100 000 live births. The median (interquartile range) maternal age was 21 (18-32) years and 12 (17%) women had human immunodeficiency virus co-infection. Regarding maternal treatment, 28 (41%) women had inadequate treatment due to 13 cases (19%) of late or no antenatal care, six cases (8%) of recent infection near delivery, five cases (7%) of failure of treatment provision, and four (6%) others. There were three syphilitic stillbirths who were prematurely born to untreated pregnant women and 67 live births (one set of twins) of which 27 met definitions of probable congenital syphilis. They received complete treatment with penicillin and had non-reactive rapid plasma reagin within the first 6 months of life, with the exception of one who had non-reactive rapid plasma reagin at the age of 7 months. CONCLUSIONS Congenital syphilis remains a problem in our setting. Nearly half of pregnant women who had syphilis had inadequate treatment. There is an urgent need to strengthen diagnosis and the treatment cascade of syphilis during antenatal care.
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Affiliation(s)
- Suvaporn Anugulruengkitt
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Chatnapa Yodkitudomying
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
| | - Anongnart Sirisabya
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaninee Chitsinchayakul
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand.,Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Surasith Chaithongwongwatthana
- Division of Infectious Diseases, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn, Bangkok, Thailand
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Félix ICG, Oliveira TFD, Souza CDFD, Machado MF. Análise de tendência da sífilis congênita no estado da Bahia de 2008 a 2017. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i1.873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objetivo: A sífilis, causada pelo Treponema pallidum, de transmissão sexual ou vertical, é responsável pela sífilis congênita. Destaca-se por seus números expressivos e por se tratar de doença evitável, de tratamento simples e de baixo custo. O presente trabalho tem como objetivo análise de tendência da sífilis congênita, no estado da Bahia de 2008 a 2017, relacionando os dados obtidos com a implantação de ações governamentais no âmbito da saúde materno-infantil. Métodos: Trata-se de um estudo observacional descritivo retrospectivo, no qual foi analisada a tendência dos casos de sífilis congênita no Estado da Bahia contidos em documentos oficiais.Resultados: Dentre os indivíduos diagnosticados com sífilis congênita, 69,5% das mães haviam realizado o pré-natal em 2008, enquanto esta porcentagem subiu para 78% em 2017. Neste período, apenas 4,2% das gestantes diagnosticadas com sífilis realizaram o tratamento adequadamente, enquanto 77,3% não realizaram ou realizaram inadequadamente. O tratamento dos parceiros ocorreu em somente 12% dos casos. Conclusão: O expressivo número de casos associado às graves consequências em decorrência desta infecção estrutura-se como um alerta à qualidade da assistência prestada à mulher, principalmente no pré-natal. Para que esta assistência ocorra de maneira adequada é necessário que haja melhoria em relação à cobertura da atenção básica, disponibilidade de exames e medicamentos para o tratamento, assim como o tratamento dos parceiros.
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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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Cavalcante ANM, Araújo MAL, Nobre MA, Almeida RLFD. Factors associated with inadequate follow-up of children with congenital syphilis. Rev Saude Publica 2019; 53:95. [PMID: 31644773 PMCID: PMC6802946 DOI: 10.11606/s1518-8787.2019053001284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/10/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.
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Affiliation(s)
- Ana Nery Melo Cavalcante
- Universidade de Fortaleza. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
| | - Maria Alix Leite Araújo
- Universidade de Fortaleza. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
| | - Marina Arrais Nobre
- Universidade de Fortaleza. Curso graduação em Medicina. Fortaleza, CE, Brasil
| | - Rosa Lívia Freitas de Almeida
- Universidade de Fortaleza. Centro de Ciências da Saúde. Programa de Pós-Graduação em Saúde Coletiva. Fortaleza, CE, Brasil
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Freitas CHSDM, Forte FDS, Roncalli AG, Galvão MHR, Coelho AA, Dias SMF. Factors associated with prenatal care and HIV and syphilis testing during pregnancy in primary health care. Rev Saude Publica 2019; 53:76. [PMID: 31553379 PMCID: PMC6752686 DOI: 10.11606/s1518-8787.2019053001205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with HIV and syphilis testing during pregnancy in Brazil. METHODS This was an ecological study covering all Brazilian municipalities evaluated by the second cycle of the National Program for Access and Quality Improvement in Primary Care, 2013-2014. The dependent variables were based on prenatal care access: prenatal care appointments, and HIV and syphilis tests during prenatal care. The independent variables were compared with demographic and social characteristics. Bivariate analysis was performed assessing the three outcomes with the independent variables. Variables with significant associations in this bivariate analysis were fit in a Poisson multiple regression analysis with robust variance to obtain adjusted estimates. RESULT Poisson regression analysis showed a statistically significant association with the variables “less than eight years of study” [prevalence ratio (PR) = 1.31; 95%CI 1.19–1.45; p < 0.001] and “participants of the cash transfer program” (PR = 0.80; 95%CI 0.72–0.88; p < 0.001) for the outcome of “having less than six prenatal care appointments” and individual variables. A statistically significant association was found for “participants of the cash transfer program” (PR = 1.43; 95%CI 1.19–1.72; p < 0.001) regarding the outcome from the comparison between HIV testing absence during prenatal care and demographic and social characteristics. The absence of syphilis testing during prenatal care, and demographic and social characteristics presented a statistically significant association for the education level variable “less than eight years of study” (PR =1.75; 95%CI 1.56–1.96; p < 0.001) and “participants of the cash transfer program” (PR = 1.21, 95%CI 1.07–1.36; p < 0.001). CONCLUSIONS The individual factors were associated with prenatal care appointments and HIV and syphilis tests in Brazilian pregnant women. They show missed opportunities for diagnosing HIV and syphilis infection during prenatal care and indicate weaknesses in the quality of maternal health care services to eliminate mother-to-child transmission.
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Affiliation(s)
| | | | - Angelo Giuseppe Roncalli
- Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil
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Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4562385. [PMID: 31392211 PMCID: PMC6662498 DOI: 10.1155/2019/4562385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/20/2019] [Accepted: 06/27/2019] [Indexed: 11/23/2022]
Abstract
Objective Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design Systematic review and meta-analysis. Data Sources Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.
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Teixeira SAM, Taquette SR, Monteiro DLM. Violence and sexually transmitted infections in pregnancy. ACTA ACUST UNITED AC 2019; 65:475-484. [PMID: 30994850 DOI: 10.1590/1806-9282.65.3.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/04/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To synthesize the knowledge produced in studies about the association between violence and STI during pregnancy. METHODS In this systematic review, we conducted basic activities of identification, compilation, and registration of the trials. The instruments of data collection were studies that investigated, explicitly, relationships between violence, gestation, and STI, from July 2012 to July 2017, using PubMed, Cochrane Library, SciELO, and LILACS. RESULTS In all, 26 articles were chosen to form the basis of the analysis of this study. The relationship between violence and STI was observed in 22 of the 26 studies, and in eight of them, the violence was practiced during the gestation period. In two studies, there was no evidence of this relationship. In one study, the lack of care for STI was attributed to the unpreparedness of health professionals. Mental disorders were cited as resulting from STI in three articles and in another as a result of violence. One study found more frequent violence against adolescents, while two others cited gestation as a protective factor. CONCLUSIONS IPV combines characteristics that have a different expression when the woman is in the gestational period. The literature points to a relationship between IPV against women and the presence of STI. The monitoring of pregnancy, whether in the prenatal or postpartum period, offers unique opportunities for the health professional to identify situations of violence and thus provide assistance.
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Affiliation(s)
- Sérgio Araujo Martins Teixeira
- Department of Post-Graduation in Medical Sciences, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil.,Institute of Education and Research Teixeira Ramos, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Stella R Taquette
- Department of Post-Graduation in Medical Sciences, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Denise Leite Maia Monteiro
- Department of Post-Graduation in Medical Sciences, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil.,Department of Obstetrics and Gynecology - University Center Serra dos Órgãos, Teresópolis, Rio de Janeiro, Brasil
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Elarrat Canto SV, Leite Araújo MA, Espinosa Miranda A, Paulo Cardoso AR, Freitas de Almeida RL. Fetal and infant mortality of congenital syphilis reported to the Health Information System. PLoS One 2019; 14:e0209906. [PMID: 30608958 PMCID: PMC6319744 DOI: 10.1371/journal.pone.0209906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Congenital syphilis (CS) is a major cause of mortality in several countries, especially in Latin America and the Caribbean. This study aimed to analyze fetal and infant mortality of CS reported to the Health Information System in a State in Northeastern Brazil. Methods and results This was a cross-sectional study that analyzed the deaths of CS from 2010 to 2014 through the linkage of the Mortality Information System (SIM) and the Notifiable Diseases Information System (Sinan). The Statistical Package for the Social Sciences (SPSS) version 23.0 was used to calculate the rates of Fetal, Perinatal, Neonatal (early and late), and Postneonatal Mortality. Simple linear regression was performed. Fisher's exact test or Pearson's chi-square test were used for comparison of proportions and Student's t-test was used for comparison of means. Of the 414 cases reported to the SIM as deaths possibly caused by CS, 44 (10.6%) presented CS as the underlying cause. From 2010 to 2014 the Infant Mortality Rate of CS was 16.3 per 100,000 live births (y = 0.65x + 14.33, R2 = 0.2338, p = 0.003). There was an 89.4% underreporting of deaths. Perinatal deaths and fetal deaths of CS accounted for 87.7% and 73.9% of total deaths, respectively. Conclusions The results of the study revealed a significant Fetal and Infant Mortality rate of CS and demonstrated the importance of using the linkage method in studies that involve the analysis of secondary data obtained from mortality and disease reporting systems. The underreporting of CS as a cause of fetal and infant mortality leads to unawareness of the reality of deaths from this disease, hindering the development of public policies aimed at its prevention.
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Affiliation(s)
| | - Maria Alix Leite Araújo
- Collective Health Post Graduation Program, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Angélica Espinosa Miranda
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Ana Rita Paulo Cardoso
- Department of Health Surveillance, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil
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22
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Reis GJD, Barcellos C, Pedroso MDM, Xavier DR. [Intraurban differentials in congenital syphilis: a predictive analysis by neighborhood in the city of Rio de Janeiro, Brazil]. CAD SAUDE PUBLICA 2018; 34:e00105517. [PMID: 30208175 DOI: 10.1590/0102-311x00105517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
The study aimed to characterize notified cases of congenital syphilis from 2011 to 2014 in the city of Rio de Janeiro and to analyze possible associations between congenital syphilis and living conditions in the city's neighborhoods. Cases of congenital syphilis were characterized according to biological and socioeconomic variables and health services use. At the aggregate level, regression tree technique was used for the data analysis, with mean incidence rate (2011-2014) of congenital syphilis as the dependent variable and housing quality, schooling, income, teenage pregnancy, poverty density, access to prenatal care, and skin color as independent variables. The dependent variable was mapped to identify spatial patterns. The SINAN, SINASC, and IBGE databases were used for notifiable diseases, live births, and census data, respectively. A total of 6,274 cases of congenital syphilis were reported, which represents an incidence rate of 17.3 cases/1,000 live births. Cases were distributed in the central, northern peripheral, and western zones of the city, with a high proportion of cases in infants of black mothers with low schooling. There was also a high proportion of pregnant women with late diagnosis of syphilis and inadequate treatment. At the aggregate level, the most relevant variable for explaining the problem was the low proportion of pregnant women with at least 7 prenatal visits. The analysis allowed the identification of marginalized population segments and can help direct public health resources more effectively.
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Affiliation(s)
- Gilson Jácome Dos Reis
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Christovam Barcellos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Marcel de Moraes Pedroso
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Diego Ricardo Xavier
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Cardoso ARP, Araújo MAL, Cavalcante MDS, Frota MA, Melo SPD. Analysis of cases of gestational and congenital syphilis between 2008 and 2010 in Fortaleza, State of Ceará, Brazil. CIENCIA & SAUDE COLETIVA 2018; 23:563-574. [PMID: 29412414 DOI: 10.1590/1413-81232018232.01772016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/09/2016] [Indexed: 02/07/2023] Open
Abstract
This study analyzes the reported cases of syphilis in pregnant women and the possible outcomes for fetuses and the newborn in Fortaleza, Ceará. It is a cross-sectional study that analyzed 175 reported cases of syphilis in pregnant women matched with the corresponding reports of congenital syphilis during the years 2008-2010. Descriptive statistics with absolute and relative frequencies, central tendency and dispersion measures, and the Pearson's chi-square test were used to analyze the statistical significance using the p-value <0.05. Sociodemographic variables of pregnant/postpartum women, the assistance provided to newborns and the outcome of cases were analyzed. The results showed the occurrence of syphilis in young women with more than 85% of inappropriate treatment, 62.9% of untreated sexual partners or lack of statistics and high percentages of non-realization of the recommended tests for congenital syphilis investigation in children. Among the fetuses, five were stillborn, one miscarried and there were three neonatal deaths. The lack of adequate treatment of pregnant women may be associated with morbidity and mortality of fetuses, maintaining this infection as a burden on the list of public health problems.
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Affiliation(s)
- Ana Rita Paulo Cardoso
- Centro de Ciências da Saúde, Universidade de Fortaleza. Av. Washington Soares 1321, Edson Queiroz. 60811-341 Fortaleza CE Brasil.
| | - Maria Alix Leite Araújo
- Centro de Ciências da Saúde, Universidade de Fortaleza. Av. Washington Soares 1321, Edson Queiroz. 60811-341 Fortaleza CE Brasil.
| | - Maria do Socorro Cavalcante
- Núcleo de Vigilância Epidemiológica do Hospital Geral Dr. César Cals, Secretaria de Saúde do Estado do Ceará. Fortaleza CE Brasil
| | - Mirna Albuquerque Frota
- Centro de Ciências da Saúde, Universidade de Fortaleza. Av. Washington Soares 1321, Edson Queiroz. 60811-341 Fortaleza CE Brasil.
| | - Simone Paes de Melo
- Centro de Ciências da Saúde, Universidade de Fortaleza. Av. Washington Soares 1321, Edson Queiroz. 60811-341 Fortaleza CE Brasil.
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Fernandes Nascimento DDS, Da Silva RC, Tártari DDO, Cardoso ÉK. Relato da dificuldade na implementação de teste rápido para detecção de sífilis em gestantes na Atenção Básica do SUS em um município do Sul do Brasil. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2018. [DOI: 10.5712/rbmfc13(40)1723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Relatar o processo de implementação dos testes rápidos na Atenção Básica no Município de Tubarão. Métodos: Relato de experiência baseado nas vivências dos autores e em entrevistas bimestrais aos enfermeiros responsáveis pelas unidades de Estratégia de Saúde da Família e um hospital através de questionário semi-estruturado, com duração de oito meses. Resultados: No ano de 2014, os enfermeiros das unidades de Estratégia de Saúde da Família e de outros serviços de saúde receberam capacitação para execução dos testes rápidos para sífilis em gestantes e consideraram satisfatória. No entanto, apenas um hospital e uma unidade de Estratégia de Saúde da Família implantaram os testes rápidos, as demais justificaram a não implantação principalmente pela falta de infraestrutura e recursos humanos limitados. Conclusão: Este estudo demonstrou que a implantação de testes rápidos para sífilis ainda está em andamento, e exige um grande esforço de vários departamentos do Ministério da Saúde e da prefeitura em parceria.
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25
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Analysis of conditions sensitive to primary care in a successful experience of primary healthcare expansion in Brazil, 1998-2015. Public Health 2018; 162:32-40. [PMID: 29957336 DOI: 10.1016/j.puhe.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/15/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze trends in expansion of coverage of the family health strategy and hospitalization for conditions sensitive to primary care (CSPC) in a successful experience of primary healthcare expansion in Brazil. STUDY DESIGN Ecological study with data from the Brazilian National Health Information System. METHODS CSPC were analyzed between 1998 and 2015 in Rio de Janeiro, Brazil, by cause groups. Trends, variation, and correlation between indicators in the period were evaluated. RESULTS Most of the cause groups showed a reduction in hospitalization rate, particularly cardiovascular diseases and asthma, but an increase was seen for obstetric causes. The main causes of hospitalization were heart failure, cerebrovascular diseases, and bacterial pneumonia. The contribution of vaccine-preventable diseases, cardiovascular diseases, diabetes, nutritional deficiencies, and chronic lung diseases to the total number of hospitalizations was seen to decrease. CONCLUSIONS Analysis demonstrates that the family health strategy, as access to the healthcare system, decreases the majority of CSPC hospitalization rates.
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26
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Domingues RMSM, Saraceni V, Leal MDC. Reporting of HIV-infected pregnant women: estimates from a Brazilian study. Rev Saude Publica 2018; 52:43. [PMID: 29668812 PMCID: PMC5933940 DOI: 10.11606/s1518-8787.2018052017439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE: To estimate the coverage of the reporting of cases of HIV-infected pregnant women, to estimate the increase in the coverage of the reporting with the routine search of data in other Brazilian health information systems, and to identify missed opportunities for identification of HIV-infected pregnant women in Brazilian maternity hospitals. METHODS: This is a descriptive study on the linkage of Brazilian databases with primary data from the “Nascer no Brasil” study and secondary database collection from national health information systems. The “Nascer no Brasil” is a national-based study carried out in 2011–2012 with 23,894 pregnant women, which identified HIV-infected pregnant women using prenatal and medical records. We searched for cases of HIV-infected pregnant women identified in the “Nascer no Brasil” study in the Information System of Notifiable Diseases, the Control System for Laboratory Tests of the National CD4+/CD8+ Lymphocyte Count and HIV Viral Load Network, and the Logistics Control System for Medications. We used the OpenRecLink software for the linkage of databases. We estimated the notification coverage, with the respective confidence interval, of the evaluated Brazilian health information systems. RESULTS: We estimated the coverage of the reporting of HIV-infected pregnant women in the Information System of Notifiable Diseases as 57.1% (95%CI 42.9–70.2), and we located 89.3% of the HIV-infected pregnant women (95%CI 81.2–94.2) in some of the Brazilian health information systems researched. The search in other national health information systems would result in an increase of 57.1% of the reported cases. We identified no missed opportunities for the diagnosis of HIV+ in pregnant women in the maternity hospitals evaluated by the “Nascer no Brasil” study. CONCLUSIONS: The routine search for information in other Brazilian health information systems, a procedure carried out by the Ministry of Health for cases of AIDS in adults and children, should be adopted for cases of HIV in pregnancy.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Valéria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Maria do Carmo Leal
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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27
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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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28
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Prevalence of Curable Sexually Transmitted Infections in Pregnant Women in Low- and Middle-Income Countries From 2010 to 2015: A Systematic Review. Sex Transm Dis 2017; 43:450-8. [PMID: 27322048 DOI: 10.1097/olq.0000000000000460] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current literature comparing the prevalence rates of curable sexually transmitted infections (STIs) in pregnant women in various global regions is limited. As a result, antenatal screening practices for curable STIs in pregnant women, specifically Treponema pallidum (syphilis), Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) vary around the world, differing by country and particular STI. METHODS We conducted a systematic review of publications on STI prevalence among pregnant women in 30 different low- and middle-income countries. We searched PubMed for studies reporting prevalence of syphilis, CT, NG, and TV in pregnant women. English language studies published between January 1, 2010, and March 1, 2015, were included. The adjusted mean STI prevalence by region was calculated via multivariable linear regression adjusting for health care setting, women's mean age, study sample size, and sensitivity of diagnostic test. RESULTS We identified 75 studies that met inclusion criteria, providing 116 point prevalence estimates for curable STIs among 3,489,621 pregnant women. Adjusted mean prevalence for NG ranged from 1.2% (95% confidence interval [CI], 1.0-1.3) in Latin America to 4.6% (95% CI, 4.0-5.2) in Southern Africa; syphilis prevalence ranged from 1.1% (95% CI, 0.5-1.6) in Asia to 6.5% (95% CI, 4.7-6.3) in Southern Africa; CT ranged from 0.8% (95% CI, 0.4-1.1) in Asia to 11.2% (95% CI, 6.0-16.4) in Latin America; and TV ranged from 3.9% (95% CI, 2.2-5.6) in Latin America to 24.6% (95% CI, 17.9-31.4) in Southern Africa. CONCLUSIONS Although we observed a wide variation in STI burden in pregnancy after adjusting for age, test, and health care setting, further valid comparison may depend on adjustment for access to care and screening practices.
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29
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Hebmuller MG, Fiori HH, Lago EG. Subsequent pregnancies in women with previous gestational syphilis. CIENCIA & SAUDE COLETIVA 2017; 20:2867-78. [PMID: 26331518 DOI: 10.1590/1413-81232015209.20332014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study included data on syphilis-positive pregnant women seen for delivery or miscarriage, between 1997 and 2004, in Sao Lucas Hospital, Porto Alegre, RS. Their subsequent obstetric outcomes were studied, until December 2011, to see if the disease recurred. From 450 pregnant women with positive syphilis serology, seen from 1997 to 2004, 166 had at least one more obstetric attendance until December 2011, with 266 new obstetric outcomes. Congenital syphilis (CS) was demonstrated in 81.9% of the initial pregnancies and in 68.4% of the subsequent ones. The main causes of CS in subsequent pregnancies were a negative VDRL that turned positive at delivery, and undocumented treatment. VDRL titers were higher than 1:4 in 50.4% of the initial and 13.3% of the subsequent pregnancies (p < 0.01). Perinatal mortality rate was 119/1000 in initial and 41/1000 in subsequent pregnancies (p < 0.01). CS recurrence was frequent in subsequent pregnancies of women who tested positive for syphilis in a preceding pregnancy. No or inadequate prenatal care was the main risk factor for CS, both in initial and in subsequent pregnancies. These data suggest that non-infected neonates could have been defined as CS cases because of insufficient information about the mother's history.
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Affiliation(s)
- Marjorie Garlow Hebmuller
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
| | - Humberto Holmer Fiori
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
| | - Eleonor Gastal Lago
- Departamento de Pediatria, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, BR,
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30
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Macêdo VCD, Lira PICD, Frias PGD, Romaguera LMD, Caires SDFF, Ximenes RADA. Risk factors for syphilis in women: case-control study. Rev Saude Publica 2017; 51:78. [PMID: 28832758 PMCID: PMC5559218 DOI: 10.11606/s1518-8787.2017051007066] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/05/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors. CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.
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Affiliation(s)
- Vilma Costa de Macêdo
- Programa de Pós-Graduação em Saúde da Criança e Adolescente. Departamento de Enfermagem. Universidade Federal de Pernambuco. Recife, PE, Brasil
| | | | - Paulo Germano de Frias
- Grupo de Estudos de Avaliação em Saúde. Diretoria de Ensino e Pesquisa. Instituto de Medicina Integral Prof. Fernando Figueira. Recife, PE, Brasil
| | - Luciana Maria Delgado Romaguera
- Programa de Pós-Graduação em Medicina Tropical. Unidade de Neonatologia do Hospital das Clínicas. Universidade Federal de Pernambuco. Recife, PE, Brasil
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31
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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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32
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Domingues RMSM, Leal MDC. [Incidence of congenital syphilis and factors associated with vertical transmission: data from the Birth in Brazil study]. CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000605002. [PMID: 27333146 DOI: 10.1590/0102-311x00082415] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The objectives were to estimate incidence of congenital syphilis and verify factors associated with vertical transmission. A national hospital-based study was performed in 2011-2012 with 23,894 postpartum women using an in-hospital interview and data from patient charts and prenatal cards. Univariate logistic regression was performed to verify factors associated with congenital syphilis. Estimated incidence of congenital syphilis was 3.51 per 1,000 live births (95%CI: 2.29-5.37) and vertical transmission rate was 34.3% (95%CI: 24.7-45.4). Congenital syphilis was associated with lower maternal schooling, black skin color, higher rate of risk factors for prematurity, late initiation of prenatal care, fewer prenatal visits, and lower rate of prenatal serological testing. Fetal mortality was six times higher in congenital syphilis, and newborns with congenital syphilis showed higher hospital admission rates. Congenital syphilis is a persistent public health problem in Brazil and is associated with greater social vulnerability and gaps in prenatal care.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil., Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro , Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil., Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro , Brazil
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33
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Lazarini FM, Barbosa DA. Educational intervention in Primary Care for the prevention of congenital syphilis. Rev Lat Am Enfermagem 2017; 25:e2845. [PMID: 28146181 PMCID: PMC5288867 DOI: 10.1590/1518-8345.1612.2845] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/23/2016] [Indexed: 11/24/2022] Open
Abstract
Objectives: to evaluate the efficiency of educational interventions related to the knowledge
of health care professionals of Primary Care and to verify the impact on the
vertical transmission rates of congenital syphilis. Method: a quasi-experimental study conducted in the city of Londrina, Paraná, between 2013
and 2015. An educational intervention on diagnosis, treatment and notification was
carried out with 102 professionals with knowledge measurement before and after the
intervention. Incidence and mortality data from congenital syphilis were taken
from the system for notifiable diseases (SINAN) and the Mortality Information
System (SIM). Excel tabulation and statistical analysis was done in the
Statistical Package for Social Sciences, version 2.1. A descriptive and
inferential analysis was performed. Results: the mean number of correct responses increased from 53% to 74.3% after the
intervention (p < 0.01). The adherence to professional training was 92.6%.
There was a significant reduction in the vertical transmission rate of syphilis
from 75% in 2013 to 40.2% in 2015. In 2014 and 2015 there were no records of
infant mortality from this condition. Conclusion: the educational intervention significantly increased the knowledge of health
professionals about syphilis and collaborated to reduce the rate of vertical
transmission of the disease.
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Affiliation(s)
- Flaviane Mello Lazarini
- PhD, Assistant Professor, Departamento de Saúde Coletiva, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Dulce Aparecida Barbosa
- PhD, Associate Professor, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Cardoso ARP, Araújo MAL, Andrade RFV, Saraceni V, Miranda AE, Dourado MIC. Underreporting of Congenital Syphilis as a Cause of Fetal and Infant Deaths in Northeastern Brazil. PLoS One 2016; 11:e0167255. [PMID: 27941983 PMCID: PMC5152812 DOI: 10.1371/journal.pone.0167255] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/12/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Of all syphilis-related pregnancy outcomes, fetal death is certainly the most common one, being directly related to the availability, accessibility and quality of prenatal care. The present study aimed to analyze the underreporting of fetal and infant deaths and other maternal factors associated with congenital syphilis (CS) death. Methods This cross-sectional study integrated data of infants that were diagnosed and/or died of CS from the Sistema de Informação de Agravos de Notificação–Sinan (Notifiable Diseases Information System) and the Sistema de Informação de Mortalidade–SIM (Mortality Information System) in Fortaleza, Northeastern Brasil to identify unreported cases of congenital syphilis. We assessed data during the period from 2007 to 2013. Results The underreporting of CS as a cause of fetal or infant death increased from 41 to 415 cases (90.1%) during 2007–2013. Exactly 3,209 cases of CS were identified in Sinan and 6,578 deaths in SIM. After database linkage, we identified 382 cases that were reported in the SIM and SINAN databases consisting of 309 fetal deaths and 73 infant deaths related to CS. From the children notified at Sinan that born alive, 3.0% (78/2,542) died; Out of these, 39 (50.0%) were early and 25 (32.1%) were late neonatal deaths. The proportion of death by CS increased from 0.62 to 5.8 from 2007 to 2013. At logistic regression, the variable that maintained statistical significance with fetal and infant death outcomes was the presence of CS signs and/or symptoms at birth (OR = 3.20; IC 95% 1.54–6.62; p = 0.002). Conclusions Neonatal and Infant deaths following CS-associated live births are underreported in Northeastern Brazil. Data base linkage identified unreported fetal and neonatal deaths due to CS leading to an increased awareness of fetal/infant mortality due to this infection.
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Affiliation(s)
- Ana Rita Paulo Cardoso
- Collective Health Post Graduation Program. University of Fortaleza, Fortaleza, Brazil
- * E-mail:
| | | | | | - Valéria Saraceni
- Rio de Janeiro Municipal Secretary of Health, Rio de Janeiro, Brazil
| | - Angelica E. Miranda
- Department of Social Medicine. Federal University of Espírito Santo, Vitória, Brazil
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Dallé J, Baumgarten VZ, Ramos MC, Jimenez MF, Acosta L, Bumaguin DB, Antonello VS. Maternal syphilis and accomplishing sexual partner treatment: still a huge gap. Int J STD AIDS 2016; 28:876-880. [PMID: 27810981 DOI: 10.1177/0956462416678710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital syphilis (CS) is a preventable epidemic disease for which control is hindered by socioeconomic and health system issues. Inadequately treated maternal syphilis (MaS) commonly has serious adverse obstetric outcomes. This study - which is a cross-sectional study in a Brazilian large urban public Mother and Child hospital, making use of secondary data - evaluated the occurrence of treatment of sexual partners (SP) among women with MaS. The results showed that 771 MaS cases were identified from 2007 to 2014. No information on SP treatment was available in 570 (73.9%) cases. Of the 201 cases presenting information, 25 (12.4%) SP were treated. Out of 164 women having six or more prenatal visits, 25 (15.2%) SP received treatment. Data analyzed biennially have shown a growing trend of cases without collected information, ranging from 27.2% in 2007-2008 to 87.5% in 2013-2014. No linear trend in proportions of treated SP (maximum 7.4% SP treated) was found. Thus, in this study, it has been concluded that the proportion of SP adequately treated was consistently low, and the quality of information deteriorated during the studied period. Prenatal care per se, as provided, was not effective in delivering adequate treatment of SP. Creative integrated services with SP active participation are greatly needed if CS is to be controlled.
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Affiliation(s)
- Jessica Dallé
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Z Baumgarten
- 3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil
| | | | - Mirela F Jimenez
- 2 Post-graduate Program in Obstetrics and Gynecology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,3 Department of Gynecology and Obstetrics, Hospital Fêmina, Porto Alegre, Brazil.,5 Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lisiane Acosta
- 6 Surveillance Health Department of Porto Alegre, Brazil
| | - Daniela B Bumaguin
- 7 Statistics Advisory Center, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vicente S Antonello
- 1 Department of Prevention and Infection Control, Hospital Fêmina, Porto Alegre, Brazil.,4 Department of STDs and AIDS, Porto Alegre, Brazil
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Lago EG. Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis. Cureus 2016; 8:e525. [PMID: 27081586 PMCID: PMC4829408 DOI: 10.7759/cureus.525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 03/09/2016] [Indexed: 12/21/2022] Open
Abstract
This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.
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Affiliation(s)
- Eleonor G Lago
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS ; Edipucrs University Publisher, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS
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The burden of infectious diseases in the Brazilian Southern state of Santa Catarina. J Infect Public Health 2015; 9:181-91. [PMID: 26608780 DOI: 10.1016/j.jiph.2015.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 11/21/2022] Open
Abstract
Infectious diseases are still significant causes of deaths in Brazil. The objective of this study was to estimate the burden of selected infectious diseases in the Brazilian Southern state of Santa Catarina in 2011. An ecological study was conducted. The infectious diseases included were HIV/AIDS, tuberculosis, hepatitis B, hepatitis C, Chagas disease, diarrheal diseases and other infectious diseases. Data were collected from official health information systems. Disability Adjusted Life Years (DALY) were estimated by the sum of Years of Life Lost (YLL) and Years Lived with Disability (YLD). 45,237.33 DALYs were estimated, with a rate of 685.46 DALYs per 100,000 population. 92.9% was due to YLL and 7.1% to YLD. Men and the age range of 0-4 years presented higher burden. The highest burden was attributed to HIV/AIDS. There was a high concentration of burden rates in the coast regions of the state. It could be concluded that more than 90% of the burden was attributed to the early mortality component. The highest burden was observed among men, children under 5 years of age and at the coast regions of the state. The highest levels of burden were due to HIV/AIDS.
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Prevalence of syphilis, human immunodeficiency virus, hepatitis B virus, and human T-lymphotropic virus infections and coinfections during prenatal screening in an urban Northeastern Brazilian population. Int J Infect Dis 2015; 39:10-5. [PMID: 26255887 DOI: 10.1016/j.ijid.2015.07.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/18/2015] [Accepted: 07/25/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate prevalences of Treponema pallidum, human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), and hepatitis B virus (HBV) infections and coinfections during prenatal screening in an urban Northeastern Brazilian population through a large dataset. METHODS Secondary data were obtained from the Maceió (Alagoas, Brazil) municipal prenatal screening program from June 2007 to May 2012. Dried blood serum tests from 54,813 pregnant women were examined to determine prevalences of T. pallidum, HIV, HTLV, and HBV infections and coinfections, and the seroconversion rates for syphilis and HIV infection. Socio-demographic variables associated with syphilis and HIV infection were identified. RESULTS The prevalences of syphilis, HIV, HTLV, and HBV infections were 2.8%, 0.3%, 0.2%, and 0.4%, respectively. Pregnant women infected with T. pallidum had a 4.62-fold greater risk of HIV coinfection, and pregnant women infected with HIV had a 5.71-fold greater risk of T. pallidum coinfection. Seroconversion for syphilis and HIV during pregnancy occurred in 0.5% and 0.06% of women, respectively. Among the women carrying HTLV, 4.2% also had an HBV infection. CONCLUSIONS Syphilis was twice as prevalent among pregnant women in Maceió, compared to the national average, and coinfections with syphilis/HIV and HTLV/HBV were significantly associated among these pregnant women.
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Domingues RMSM, Szwarcwald CL, Souza Junior PRB, Leal MDC. Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: birth in Brazil study. Rev Saude Publica 2015; 48:766-74. [PMID: 25372167 PMCID: PMC4211581 DOI: 10.1590/s0034-8910.2014048005114] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 03/24/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. METHODS This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. RESULTS Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95% CI 0.84; 1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. CONCLUSIONS The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.
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Araujo MAL, Barros VLD, Moura HJD, Rocha AFB, Guanabara MAO. Prevenção da sífilis congênita em Fortaleza, Ceará: uma avaliação de estrutura e processo. ACTA ACUST UNITED AC 2014. [DOI: 10.1590/1414-462x201400030012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo: Avaliar a estrutura e o processo de trabalho dos profissionais de saúde para desenvolver as ações de prevenção e controle da sífilis congênita em Fortaleza, Ceará. Métodos: Pesquisa avaliativa desenvolvida de julho a outubro de 2011 em 89 unidades primárias. Foram avaliados os componentes de estrutura física, materiais e insumos, recursos humanos e estrutura organizacional e as unidades foram classificadas como satisfatórias e insatisfatórias. Resultados: Na classificação geral, descobriu-se que somente 47,2% das unidades foram consideradas insatisfatórias. A sala de coleta de sangue estava presente em 68,5%, profissional capacitado para atender casos de sífilis em 21,3% e apenas 16,9% das unidades aplicavam a penicilina benzatina em gestantes. Conclusão: No geral, as unidades primárias de saúde não se encontravam em condições estruturais e processuais para contribuir para o controle da sífilis congênita.
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