Knowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis in Maternity Hospitals in Teresina - PI, Brazil

Abstract

Objective To assess the knowledge and compliance of health professionals regarding the diagnostic and treatment practices for syphilis in patients admitted for childbirth in public maternity hospitals in the city of Teresina, in the state of Piauí, Northeastern Brazil. Methods A cross-sectional study was performed in 2015 with obstetricians and nurses working in the public maternity hospitals in Teresina (n ¼ 159) using a selfadministered questionnaire, with 5% of losses and 10% of refusals. The study used 21 evaluation criteria: 13 of them were related to knowledge (5 on serological tests and 8 on treatment adequacy); 8 were related to practices (3 on diagnosis, 4 on treatment, and 1 on post-test counseling). The knowledge of and compliance to the practices was estimated as the proportion of health professionals' answers that were in agreement with Brazilian Ministry of Health protocols. Results The obstetricians were in agreement with two criteria concerning the knowledge of serological tests, one for diagnostic practices, and one for treatment practice. Among nurses, no single match between actual procedures and guidelines was observed. Conclusions Low compliance with the protocols results in missed opportunities for the diagnosis and treatment of pregnant and postpartum women and their partners. Strategies for training and integrating the various professional groups, improved data recording on prenatal cards, and greater accountability of the hospital team in managing the women's partners are needed to overcome the barriers identified in the study and to interrupt the syphilis transmission chain.

Conhecimento técnico dos profissionais de saúde quanto ao manejo da sífilis e a sua relação com a Educação Permanente em Saúde

“…Feliz et al (2016) afirmam que poucos são os estudos sobre seguimento de sífilis adquirida. Faz-se necessário capacitação dos profissionais para que estejam habilitados a atender todos os casos expostos e cumprir todas as etapas do seguimento da sífilis até a sua cura (Domingues, Lauria, Saraceni & Leal, 2013b;Costa et al, 2018;Dos Santos, Niquini, Domingues & Bastos, 2017).…”

“…Muitos profissionais desconhecem a correta definição e uso dos testes sorológicos para diagnóstico oportuno (Dos Santos et al, 2017;Dos Santos, Machado, Sampaio, De Abreu & Bezerra, 2019a). Em Fortaleza/CE, dentre os profissionais atuantes da Estratégia de Saúde da Família, apenas 30,5% consideraram corretamente o RPR e o VDRL como testes não treponêmicos enquanto pouco mais da metade (55,1%) conhecem corretamente o intervalo de seguimento pós-terapêutico (Silva et al, 2014).…”

“…A escolha de antibiótico alternativo para o tratamento de gestantes alérgicas à penicilina também foi erroneamente respondida em duas regiões do território nacional (Dos Santos et al, 2017;Costa et al, 2018). No sudoeste do Paraná 34,8% dos pré-natalistas relataram que escolheriam fármacos teratogênicos como alternativas ao tratamento de gestantes alérgicas à penicilina (Costa et al, 2018), fato também identificado em estudo realizado em Teresina/PI (Dos Santos et al, 2017), onde apenas 32% dos médicos obstetras e enfermeiros atuantes em maternidade sabiam o manejo correto da gestante nesta situação.…”

“…Com relação aos treinamentos realizados pelos profissionais de saúde, em Fortaleza/CE, 39% afirmaram ter participado de atividades educativas sobre o manejo da sífilis (Dos Santos et al, 2017), enquanto em Teresina/PI este percentual foi um pouco maior, atingindo a marca de 54% dos participantes (Dos Santos et al, 2019b). No estudo de Costa et al (2018) 86% dos profissionais de saúde do sudoeste do Paraná apontaram a educação permanente como uma estratégia de melhoria da qualidade assistencial.…”

A survey of syphilis knowledge among medical providers and students in Rhode Island

“…[13][14][15] While a small number of syphilis knowledge surveys have previously been developed, many have been limited in scope, as either secondary to HIV knowledge questionnaires or part of a broader STI survey, or otherwise focused on at-risk individuals rather than providers. [16][17][18][19][20][21] Work that more closely mirrors our own has been performed in Brazil with respect to maternal and congenital syphilis by Dos Santos et al 22,23 The two 2015 studies targeted obstetricians/nurses and pediatricians, respectively, in municipal maternity hospitals in Brazil in an area with a high incidence of congenital syphilis. The studies used guidance from the Brazilian Ministry of Health to develop a survey assessing knowledge of testing and compliance with management guidelines, though it is notable that some of the items were specific to practice guidelines such as recording of data or providing post-test counseling.…”