Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil

Abstract

Resumo: O objetivo foi estimar a incidência de sífilis congênita ao nascimento e verificar os fatores associados à transmissão vertical da sífilis. Estudo nacional, de base hospitalar, realizado em 2011-2012 com 23.894 puérperas, por meio de entrevista hospitalar, dados de prontuário e cartão de pré-natal. Realizada regressão logística univariada para verificar os fatores associados à sífilis congênita. Estimada incidência de sífilis congênita de 3,51 por mil nascidos vivos (IC95% 2,29-5,37) e taxa de transmissão vertical de 34,3% (IC95%: 24,7-45,4). Casos de sífilis congênita estiveram associados à menor escolaridade materna, cor da pele preta e maior proporção de fatores de risco para prematuridade, bem como ao início mais tardio do pré-natal, menor número de consultas e menor realização de exames sorológicos. A mortalidade fetal foi seis vezes superior nos casos de sífilis congênita, e recém-natos com sífilis congênita apresentaram maior frequência de internação. A sífilis congênita persiste como problema de saúde pública, estando associada à maior vulnerabilidade social e falhas na assistência pré-natal.

Gestational and congenital syphilis: maternal, neonatal characteristics and outcome of cases

“…24 The measures and interventions for syphilis converge in a single gestational sense: prevent congenital syphilis. After a year of child monitoring,12 cases of congenital syphiliswere identified, which corroborates with other studies, 8,18,25 who consider unsatisfactory quality of prenatal care as responsible for the direct vertical transmission.…”

“…[8][9][10][11][12][13][14][15][16][17][18]19 In this regard, it was found that the majority of pregnant women (55%) studied did only oneVDRL test, indicating non-compliance with the Protocol of attention to prenatal care.…”

Adhesion to the monitoring of newborns from VDRL positive mothers

“…Studies of similar shape and objectives conducted in maternity hospitals in different regions of Brazil, reported congenital syphilis rates varying from 1.3% to 14.5%. [17][18][19][20][21][22] Domingues et al, 23 in a national hospital based study in a sample of 450 newly delivered The monitoring of newborns from VDRL Lopes ID 21 Based on the 2012 guidelines of the Scientific Department of Nutrology, 28 86.8% of newborns in this study gained weight daily in their first month of life, greater than 15g per day. Only 14.2% gained less than 15g daily.…”

Classificações de evitabilidade dos óbitos infantis: diferentes métodos, diferentes repercussões?

“…In 2013, the congenital syphilis rate for Brazil as a whole was 4.7 per 1,000 live births, while in Espírito Santo State the rate was 2.4 per 1,000 live births during the same period 36 . Although congenital syphilis is highly preventable in the prenatal period, it is a persistent challenge in Brazil due to the services' limited capacity to intervene to reduce vertical transmission by adequately diagnosing and treating pregnant women and their partners 37 .…”

“…Additional problems include delays in turnaround and communication of the test result for syphilis, which is only available months after the test is ordered; lack of health teams' preparedness to deal with a positive diagnosis; lack of the male partner's treatment compliance; and lack of clinical and serological follow-up of the disease by the healthcare system make congenital syphilis a public calamity in Brazil 37 . It is thus crucial to change the health services' strategy, especially in primary healthcare services, through training, investigation, and active uptake of congenital syphilis cases.…”