Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

Abstract

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

CORRELAÇÃO ENTRE A NOTIFICAÇÃO DE SÍFILIS, DISPONIBILIDADE DE PENICILINA E TESTE RÁPIDO: Uma análise a partir do sistema Retratos da Atenção Primária à Saúde

“…466/2012 do Conselho Nacional de Saúde. 2017;BENZAKEN et al, 2019). Para a variável III.13.7.3 verifica-se que a resposta "Não se aplica", de código 998, apresenta coeficientes que indicam correlação forte com o número de notificações para as três classificações da infecção, o que pode apontar a influência exercida por usuários do sexo masculino ou que nunca engravidaram nas respostas aos questionários.…”

“…Ademais, apenas 28.78% das equipes mineiras afirmam ter os testes sempre disponíveis, sendo este o pior índice no país para a variável, o que reforça a hipótese citada anteriormente. O Brasil apresenta diferenças regionais em vários aspectos, inclusive no acesso à saúde e perfil dos usuários (GOUVEIA et al, 2005;GUIBU et al, 2017), a situação não é diferente em relação aos casos de sífilis (SARACENI et al, 2017;BENZAKEN et al, 2019).…”

Outcomes of infants born to pregnant women with syphilis: A nationwide study in Korea

“…5 Also, a higher incidence of gestational syphilis was observed in women of lower socioeconomic status and women with lower education. 17,18 In this study, socioeconomic data were not included, and only trends by region could be seen.…”

Syphilis in Pregnant Women and Congenital Syphilis: Spatio-temporal Dynamics and Covariates in the Middle-income Country – São Paulo, Brazil

“…In 2019, of the 12,650 cases of SPW registered in SP, 4,013 evolved to CS, approximately 72% of CS cases were avoided. Of those who progressed to CS, 28% had maternal reinfections close to delivery, even after adequate treatment, including a change of partner or untreated partner, and 14% of cases were diagnosed with syphilis only in the third trimester of pregnancy 32 .…”