Syphilis in pregnant women and congenital syphilis: spatial pattern and relationship with social determinants of health in Mato Grosso

Abstract

Introduction: The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. The spatial approach to diseases with social indicators improves knowledge of health situations. Herein, we aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. Methods: This is an ecological study with data from different health information systems. After data procedure linkage, we analyzed the Bayesian incidences of triennial infections during specific periods. We performed SATSCAN screenings to identify spatiotemporal clusters. Further, we verified the differences between the clusters and indicators using Pearson's chi-square test. Results: The variations in PS incidence were 0.9-20.5/1,000 live births (LB), 0.6-46.3/1,000 LB, and 2.1-23.2/1,000 LB in the first, second, and last triennium, respectively; for CS, the variations were 0-7.1/1,000 LB, 0-7.5/1,000 LB, and 0.3-10.8/1,000 LB in the first, second, and last triennium, respectively. Three clusters each were identified for PS (RR=2.02; RR=0.30; RR=21.45, p<0.0001) and CS (RR=3.55; RR=0.10; RR=0.26, p<0.0001). The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of LB mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling. Conclusions: The increase in the spatiotemporal evolution of PS and CS incidences and the extension of areas with persistent infections indicate the need for monitoring, especially of priority areas in the state.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

“…In addition to chronic diseases, the increase in infectious diseases during pregnancy has been documented in recent years. The rates of syphilis incidence in pregnant women have also increased in Brazil in recent years 36 , 37 , with great regional differences 38 . Studies show that the H1N1 pandemic showed an impact on the MMR, with an increase of 6% between 2008 and 2009 14 , 39 .…”

Geospatial Social Determinants of Health Correlate with Disparities in Syphilis and Congenital Syphilis Cases in California

“…Fewer studies have geospatially analyzed syphilis/CS morbidity, and none (to our knowledge) have previously used the variety of SDH indicators that make up the CA HPI. Researchers in the Brazilian state of Mato Grosso used six metrics to estimate SDH and describe a municipality-level correlation between the incidence of CS and structural challenges such as poor sanitary conditions and less than eight years of schooling [ 9 ]. In the U.S.A., state-level analyses have shown that states with higher percentages of impoverished residents have higher rates of P&S syphilis among MSM [ 35 ].…”

“…We hypothesized that social determinants of health (SDH), encompassing the personal, social, economic, and environmental factors that influence health [ 7 ]—and often varying by geographic location [ 5 , 8 , 9 ] —contribute to these observed health inequities in syphilis/CS. Because SDH are often unmeasured and un/underreported in traditional public health disease investigations, we leveraged an existing metric, the CA Healthy Places Index (HPI), to geospatially describe syphilis/CS in the context of community-level SDH.…”

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

“…This increase was also in uenced by the decreased use of condoms and loss of opportunity for treatment when penicillin was not administered in primary health care (PHC), as well as the global crisis supply shortages between 2014 and 2016 9 . This evidence was consistent with the results of this research, which showed a positive association between SPW and the proportion of live births to adolescent mothers, municipalities with a large number of inhabitants, and the incidence rate of aids.…”

“…However, few ecological studies with spatial or space-time designs for investigating SPW and CS have been conducted in Brazil. We conducted a search in PubMed, Web of Science, and Scopus for studies published from 2010 to 2020 and found only four studies conducted in Brazil on this theme [9][10][11][12] , highlighting the existence of a knowledge gap as none of the studies used space-time modeling, few focused lowincome countries, and none used SP as a study area. Thus, we aimed to estimate the occurrence of SPW and CS in the municipalities of SP and evaluate their relationships with socioeconomic, demographic, and health care variables.…”