Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016

Abstract

Background Congenital syphilis occurs when a pregnant woman with syphilis is not diagnosed or treated and the infection is passed in utero, causing severe infant morbidity and mortality. Congenital syphilis is easily prevented if women receive timely and adequate prenatal care. Cases of congenital syphilis are considered indicators of problems in the safety net. However, maternal social and behavioral factors can impede women’s care, even when providers follow guidelines. Methods We reviewed case interviews and maternal records for 23 congenital syphilis cases reported to CDC from Indiana between 2014 and 2016. We used qualitative methods to analyze narrative notes from maternal interviews to learn more about factors that potentially contributed to CS cases. Results All providers followed CDC and state recommendations for screening and treatment of pregnant women with syphilis. Twenty-one of 23 women had health insurance. The number of prenatal care visits women had was suboptimal; more than one third of women had no prenatal care. Nearly one third of women’s only risk factor was sex with a primary male sex partner. The majority of women suffered social vulnerabilities, including homelessness, substance abuse, and incarceration. Conclusions Despite provider adherence to guidelines and health insurance availability, some pregnant women with syphilis are unlikely to receive timely diagnosis and treatment. Pregnant women at high risk for syphilis may need additional social and material support to prevent a CS case. Additional efforts are needed to reach the male partners of vulnerable females with syphilis.

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

“…In accordance with the Stork Network, 79.3% of women start prenatal care by the 12th week. The median maternal age was 27 years old (interquartile range: [22][23][24][25][26][27][28][29][30][31][32][33]. Regarding the adequacy of prenatal care (adequate and intensive), the mean value for the 27 cities was 79.7% (SD = 7.3), varying from Curitiba (92.1%) to Macapá (59.7%).…”

“…The vulnerability of women receiving inadequate prenatal care and, even worse, when infected with syphilis, shows the need of a closer approach on this population, in order to compensate its vulnerability. Other factors associated with vulnerability, such as poverty, violence, and inequality may be present in different degrees among Brazilian cities, prompting the need of strategies designed to reach those women 23,24 . The FHS could play a positive role in this situation, as long as health teams are inside the poorer communities.…”

Relação entre oferta de diagnóstico e tratamento da sífilis na atenção básica sobre a incidência de sífilis gestacional e congênita

“…Nos Estados Unidos, os casos de sífilis congênita estão associados ao início tardio ou ausência de pré-natal, ocorrendo, sobretudo, nas gestantes negras e hispânicas no sul do país 32,33 . Um trabalho realizado com 23 gestantes americanas revelou exemplos como a instabilidade de moradia (mulheres que viviam em abrigos, moravam com os pais ou haviam sido despejadas recentemente), parceiros privados de liberdade ou as gestantes tinham vivenciado período de encarceramento 34 . Assim, percebe-se que a pobreza, o isolamento social, a instabilidade no controle da vida pessoal e profissional, bem como questões relacionadas à moradia, alimentação, educação, entre outros, são condições que estão relacionadas ao aumento do risco de sífilis congênita 35 .…”

Desigualdades na tendência da sífilis congênita no município de Niterói, Brasil, 2007 a 2016

“…A ocorrência de sífilis e SC em gestantes tem sido associada a fatores sociais, econômicos, de infraestrutura e de acesso aos serviços de saúde, acometendo, muitas vezes, populações de maior vulnerabilidade social (2,11,20). Sendo assim, a explicação para os resultados deste estudo pode ser o aumento de iniquidades sociais.…”