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      Associação entre as taxas de incidência de sífilis gestacional e sífilis congênita e a cobertura de pré-natal no Estado da Bahia, Brasil Translated title: Asociación entre las tasas de incidencia de sífilis gestacional y sífilis congénita y la cobertura prenatal en el Estado de Bahía, Brasil Translated title: Association between the incidence rates for gestational syphilis and congenital syphilis and prenatal care coverage in the State of Bahia, Brazil

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          Abstract

          O objetivo deste estudo foi analisar a associação entre as taxas de incidência da sífilis gestacional e da sífilis congênita e a cobertura de pré-natal no período de 2007 a 2017 no Estado da Bahia, Brasil. Trata-se de um estudo ecológico e longitudinal, cujas unidades de análise foram os municípios do Estado da Bahia. Foram utilizados dados secundários, obtidos nas bases de dados dos Sistemas de Informação em Saúde. A análise da associação entre as taxas de incidência e a cobertura do pré-natal foi realizada por meio de dados em painel, utilizando o modelo fixo com resposta binomial negativa, controlada pelas variáveis socioeconômica, demográfica e de tempo. Nas análises multivariadas, a cobertura de pré-natal apresentou associação positiva estatisticamente significante com a taxa de incidência de sífilis gestacional, mas não foi observada associação com a taxa de incidência de sífilis congênita. Tendo como referência o grupo de municípios com cobertura pré-natal < 45%, a taxa de incidência de sífilis gestacional aumentou em 22% e 25%, respectivamente nos municípios com cobertura de pré-natal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Os achados do estudo indicam que, embora a ampliação da cobertura de atenção pré-natal nos municípios baianos tenha contribuído para a melhoria da detecção dos casos de sífilis gestacional, não houve impacto na redução da taxa de incidência de sífilis congênita. A assistência pré-natal prestada apresenta limitações, que devem ser alvo de intervenções que promovam a prevenção e o bloqueio da transmissão vertical da sífilis.

          Translated abstract

          El objetivo de este estudio fue analizar la asociación entre las tasas de incidencia de la sífilis gestacional y de la sífilis congénita con la cobertura prenatal, en el período de 2007 a 2017, en el Estado de Bahía, Brasil. Se trata de un estudio ecológico y longitudinal, cuyas unidades de análisis fueron los municipios del Estado de Bahía. Se utilizaron datos secundarios, obtenidos en las bases de datos de los Sistemas de Información en Salud. El análisis de la asociación entre las tasas de incidencia y la cobertura del cuidado prenatal se realizada mediante datos en panel, utilizando el modelo fijo con respuesta binomial negativa, controlada por las variables socioeconómica, demográfica y de tiempo. En los análisis multivariados, la cobertura prenatal presentó una asociación positiva, estadísticamente significante con la tasa de incidencia de sífilis gestacional, pero no se observó una asociación con la tasa de incidencia de sífilis congénita. Teniendo como referencia el grupo de municipios con cobertura prenatal < 45%, la tasa de incidencia de sífilis gestacional aumentó en un 22% y 25% respectivamente, en los municipios con cobertura prenatal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Los resultados del estudio indican que, a pesar de que la ampliación de la cobertura de atención prenatal en los municipios bahianos haya contribuido a la mejoría de la detección de los casos de sífilis gestacional, no presentó un impacto en la reducción de la tasa de incidencia de sífilis congénita. La asistencia prenatal prestada presenta limitaciones, que deben ser objetivo de intervenciones que promuevan la prevención y el bloqueo de la transmisión vertical de la sífilis.

          Translated abstract

          This study aimed to analyze the association between incidence rates for gestational and congenital syphilis and coverage of prenatal care from 2007 to 2017 in the State of Bahia, Brazil. This was an ecological and longitudinal study in which the units of analysis were the municipalities (counties) of the State of Bahia. Secondary data were used, obtained from the databases of the Health Information Systems. Analysis of the association between the incidence rates and prenatal coverage was performed with panel datal, using the fixed model with negative binomial response, controlled for socioeconomic, demographic, and temporal variables. In the multivariate analyses, prenatal coverage showed a statistically significant positive association with gestational syphilis incidence rate, but no association was found with congenital syphilis the incidence rate. Using municipalities with prenatal coverage < 45% as the reference group, the gestational syphilis incidence rate increased by 22% and 25%, respectively, in municipalities with prenatal coverage of 45%-64.9% (RR = 1.22; 95%CI: 1.11-1.33) and ≥ 65% (RR = 1.25; 95%CI: 1.10-1.43). The findings indicate that although the expansion of prenatal coverage in municipalities in Bahia has helped improve the detection of gestational syphilis, it did not impact the congenital syphilis incidence rate. Prenatal care as provided suffers limitations that should be the target of interventions to prevent and block vertical syphilis transmission.

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          Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016

          Abstract Objective To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15–49 years, in 2016. Methods For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. Findings For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3–4.5); gonorrhoea 0.9% (95% UI: 0.7–1.1); trichomoniasis 5.3% (95% UI:4.0–7.2); and syphilis 0.5% (95% UI: 0.4–0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9–3.7); gonorrhoea 0.7% (95% UI: 0.5–1.1); trichomoniasis 0.6% (95% UI: 0.4–0.9); and syphilis 0.5% (95% UI: 0.4–0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1–165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6–123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4–231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5–7.1 million) syphilis cases. Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016–2021.
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            Assistência pré-natal no Brasil

            O estudo tem por objetivo analisar a assistência pré-natal oferecida às gestantes usuárias de serviços de saúde públicos e/ou privados utilizando dados da pesquisa Nascer no Brasil, realizada em 2011 e 2012. As informações foram obtidas por meio de entrevista com a puérpera durante a internação hospitalar e dados do cartão de pré- natal. Os resultados mostram cobertura elevada da assistência pré-natal (98,7%) tendo 75,8% das mulheres iniciado o pré-natal antes da 16a semana gestacional e 73,1% compareceram a seis ou mais consultas. O pré-natal foi realizado, sobretudo, em unidades básicas (89,6%), públicas (74,6%), pelo mesmo profissional (88,4%), em sua maioria médicos (75,6%), e 96% receberam o cartão de pré-natal. Um quarto das gestantes foi considerado de risco. Do total das entrevistadas, apenas 58,7% foram orientadas sobre a maternidade de referência, e 16,2% procuraram mais de um serviço para a admissão para o parto. Desafios persistem para a melhoria da qualidade dessa assistência, com a realização de procedimentos efetivos para a redução de desfechos desfavoráveis.
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              Global burden of maternal and congenital syphilis and associated adverse birth outcomes—Estimates for 2016 and progress since 2012

              Background In 2007 the World Health Organization (WHO) launched the global initiative to eliminate mother-to-child transmission of syphilis (congenital syphilis, or CS). To assess progress towards the goal of <50 CS cases per 100,000 live births, we generated regional and global estimates of maternal and congenital syphilis for 2016 and updated the 2012 estimates. Methods Maternal syphilis estimates were generated using the Spectrum-STI model, fitted to sentinel surveys and routine testing of pregnant women during antenatal care (ANC) and other representative population data. Global and regional estimates of CS used the same approach as previous WHO estimates. Results The estimated global maternal syphilis prevalence in 2016 was 0.69% (95% confidence interval: 0.57–0.81%) resulting in a global CS rate of 473 (385–561) per 100,000 live births and 661,000 (538,000–784,000) total CS cases, including 355,000 (290,000–419,000) adverse birth outcomes (ABO) and 306,000 (249,000–363,000) non-clinical CS cases (infants without clinical signs born to un-treated mothers). The ABOs included 143,000 early fetal deaths and stillbirths, 61,000 neonatal deaths, 41,000 preterm or low-birth weight births, and 109,000 infants with clinical CS. Of these ABOs– 203,000 (57%) occurred in pregnant women attending ANC but not screened for syphilis; 74,000 (21%) in mothers not enrolled in ANC, 55,000 (16%) in mothers screened but not treated, and 23,000 (6%) in mothers enrolled, screened and treated. The revised 2012 estimates were 0.70% (95% CI: 0.63–0.77%) maternal prevalence, and 748,000 CS cases (539 per 100,000 live births) including 397,000 (361,000–432,000) ABOs. The estimated decrease in CS case rates between 2012 and 2016 reflected increased access to ANC and to syphilis screening and treatment. Conclusions Congenital syphilis decreased worldwide between 2012 and 2016, although maternal prevalence was stable. Achieving global CS elimination, however, will require improving access to early syphilis screening and treatment in ANC, clinically monitoring all women diagnosed with syphilis and their infants, improving partner management, and reducing syphilis prevalence in the general population by expanding testing, treatment and partner referral beyond ANC.
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                Author and article information

                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro, RJ, Brazil )
                0102-311X
                1678-4464
                2021
                : 37
                : 7
                : e00209520
                Affiliations
                [1] Salvador Bahia orgnameSecretaria Municipal de Saúde de Salvador Brazil
                [2] Salvador Bahia orgnameUniversidade Federal da Bahia orgdiv1Instituto de Saúde Coletiva Brazil
                Article
                S0102-311X2021000705002 S0102-311X(21)03700705002
                10.1590/0102-311x00209520
                34259750
                7d2cc42a-50f2-4605-89f1-81739dede6d8

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 23 November 2020
                : 16 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 32, Pages: 0
                Product

                SciELO Public Health

                Categories
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                Sífilis Congênita,Pregnancy,Prenatal Care,Congenital Syphilis,Embarazo,Atención Prenatal,Sífilis Congénital,Gravidez,Cuidado Pré-Natal

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