Mortalidade com sífilis congênita no município de São Paulo
Data
2022-09-02
Autores
Soares, Roberta de Almeida 
Orientadores
Luppi, Carla Gianna
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A sífilis congênita (SC) é uma doença evitável mediante detecção precoce e tratamento adequado e oportunamente instituído para a sífilis em gestantes (SG). O acompanhamento adequado no pré-natal (PN), parto e puerpério é a melhor prevenção contra a transmissão vertical da doença. Em decorrência da dificuldade de manejo de casos de SG, podem ocorrer graves consequências. Assim, conhecer sistematicamente fatores associados à mortalidade com SC e propor medidas de prevenção e controle da doença pode auxiliar em sua redução e de seus efeitos. Objetivo: investigar os casos de SC e os seus desfechos no município de São Paulo (MSP) nos anos de 2016 a 2018. Método: estudo quantitativo, transversal, observacional e analítico com o universo de dados secundários do projeto Mortalidade por sífilis congênita no estado de São Paulo, tendo todos os casos notificados com SC residentes no MSP. A fonte de dados utilizada foi a base de dados aprimorada do Sinan. Realizou-se a descrição dos dados desagregados segundo ano e evolução com SC (óbito infantil; óbito perinatal; desfechos desfavoráveis (DD) - aborto; natimorto; óbito infantil); descreveram-se as respectivas taxas de mortalidade: infantil com SC (TMISC) por 1.000 nascidos vivos (NV); perinatal com SC (TMPSC) por 1.000 nascimentos totais (NT); e por desfechos desfavoráveis com SC (TMDDSC) por 1.000 NT. Empregaram-se fatores associados aos DD com SC por meio de análise bivariada e elaboração de modelo múltiplo por regressão logística; utilizou-se o odds ratio e intervalo de confiança (IC) de 95%. Resultados: dos 3.434 casos notificados de SC no MSP, a evolução foi de 82,47% de casos vivos, 9,03% de abortos, 5,59% de natimortos, 1,08% de óbitos infantis com SC e 1,31% de óbitos por outras causas. Encontrou-se elevação de casos de SC e de seus DD no MSP de 2016 a 2018, de forma heterogênea, segundo local de residência, características maternas e infantis e assistência ao ciclo gravídico-puerperal. Observou-se elevação das TMISC, TMPSC e TMDDSC no MSP, de formas diferentes, segundo região de residência dos casos. Os 36 óbitos infantis com SC ocorreram mais frequentemente nos casos com maiores títulos do teste não treponêmico (TNT) materno no parto (3,59% com título de 1/128 ou mais) e no sangue periférico da criança (5,00% com título de 1/128 ou mais); local de moradia, com maior frequência nas Coordenadorias Regionais de Saúde (CRS) Sudeste (2,14%) e Leste (1,82%); não realização de PN (2,38%); esquema de tratamento da criança não realizado (11,94%); e outras. Os 233 óbitos perinatais ocorridos foram mais frequentes de acordo com as seguintes características: títulos de TNT maternos elevados (28,24% com títulos de 1/128 ou mais); local de moradia com destaque para as CRS Leste (9,76%) e Sul (7,93%); não realização de PN (13,41%); e outras. Identificaram-se os seguintes fatores independentemente associados aos DD com SC: ano de diagnóstico 2018 (OR=1,53; IC95% 1,17–1,98); vulnerabilidade individual: faixa etária materna de 35 a 39 anos (OR=0,59; IC95% 0,36–0,97); título elevado do TNT 1/16 a 1/64 (OR=1,76 (IC95% 1,40–2,23) e 1/128 ou mais (OR=3,21; IC 95% 2,33–4,42); vulnerabilidade social: local de residência CRS Sul (OR=1,71; IC95% 1,01–2,89) e leste (OR=1,71; IC95% 1,01–2,89); vulnerabilidade programática: não realização de PN (OR=3,14; IC95% 2,38–4,14); diagnóstico de SM no momento do parto/curetagem (OR=2,28; IC95% 1,68–3,08); esquema de tratamento materno não realizado (OR=7,97; IC 95% 1,91–33,21) ou inadequado (OR=6,52; IC 95% 1,58–26,91). Conclusão: Houve aumento de casos de sífilis congênita, óbito infantil, óbito perinatal e desfechos desfavoráveis no período analisado. Regiões com maior vulnerabilidade no município de São Paulo (leste e sul) apresentaram mais chances de desfechos desfavoráveis, reforçando a importância da detecção e do tratamento precoces da sífilis gestacional e do pré-natal adequado, com ações mais intensivas direcionadas às populações moradoras dessas regiões.
Congenital syphilis (CS) is a preventable disease, through early detection, adequate and timely treatment for syphilis in pregnant women (GS). Adequate follow-up during prenatal care (PC), childbirth and the postpartum period is the best prevention against vertical transmission of the disease. Due to the difficulty in managing GS cases, serious consequences can occur. Therefore, systematically knowing factors associated with CS mortality and proposing CS prevention and control measures can help to reduce CS and its effects. Objective: The objective of this study was to investigate cases of congenital syphilis and their outcomes in the city of São Paulo (MSP) in the years 2016 to 2018. Methodology: quantitative, cross-sectional, observational and analytical study with the universe of secondary data from the Mortality by congenital syphilis in the state of São Paulo Project, all reported cases with SC residing in the MSP. Data source: Sinan Enhanced DB. Data disaggregated according to year and evolution with CS were described (infant death; perinatal death; unfavorable outcomes (UO) - abortion; stillbirth; infant death); The respective mortality rates were described: infant with CS (TMISC) per 1,000 live births (LB); perinatal with SC (TMPSC) per 1,000 total births (TB); and by unfavorable outcomes with SC (TMDDSC) per 1,000 TB. Factors associated with UO with CS were used through bivariate analysis and elaboration of a multiple model by logistic regression; the odds ratio and 95% confidence interval (CI) were used. Results: of the 3,434 reported cases of CS in the MSP, the evolution was: 82.47% live cases, 9.03% abortions, 5.59% stillbirths, 1.08% infant deaths with CS, 1.31% deaths from other causes. An increase in CS cases and their UO was found in the MSP from 2016 to 2018, in a heterogeneous way according to: place of residence; maternal and child characteristics; assistance to the pregnancy-puerperal cycle. Elevation of TMISC, TMPSC and TMDDSC was observed in the MSP, in different ways according to the region of residence of the cases. The 36 infant deaths with CS occurred more frequently in cases with: higher maternal non-treponemal test (TNT) titers at delivery (3.59% with titers of 1/128 or more) and in the child's peripheral blood (5.00% with a titer of 1/128 or more); place of residence, more frequently in the southeast (2.14%) and east (1.82%) regional health coordination (CRS); non-performance of PC (2.38%), child treatment scheme not performed (11.94%) and others. The 233 perinatal deaths occurred more frequently according to the following characteristics: high maternal TNT titers (28.24% with titers of 1/128 or more); place of residence, with emphasis on CRS east (9.76%) and CRS south (7.93%); non-performance of PC (13.41%); and others. The following factors were identified independently associated with UO with CS: year of diagnosis 2018 (OR= 1.53; 95% CI 1.17-1.98); individual vulnerability: maternal age group 35 to 39 years (OR= 0.59; 95% CI 0.36-0.97); high titer of TNT 1/16 to 1/64 (OR= 1.76 (95% CI 1.40-2.23) and 1/128 or more (OR= 3.21; 95% CI 2.33-4 .42); social vulnerability: place of residence CRS south (OR= 1.71; 95% CI 1.01-2.89) and east (OR=1.71; 95% CI 1.01-2.89) ; programmatic vulnerability: non-performance of PC (OR=3.14; 95% CI 2.38-4.14); diagnosis of GS at delivery/curettage (OR= 2.28; 95% CI 1.68- 3.08); maternal treatment regimen not performed (OR= 7.97; 95% CI 1.91-33.21) or inadequate (OR= 6.52; 95% CI 1.58-26.91). Conclusion: There was an increase in cases of congenital syphilis, infant death, perinatal death and unfavorable outcomes in the analyzed period. Regions with greater vulnerability in the city of São Paulo (east and south) had a greater chance of unfavorable outcomes, reinforcing the importance of early detection and treatment of gestational syphilis and adequate prenatal care, with more intensive actions aimed at populations living in these regions.
Congenital syphilis (CS) is a preventable disease, through early detection, adequate and timely treatment for syphilis in pregnant women (GS). Adequate follow-up during prenatal care (PC), childbirth and the postpartum period is the best prevention against vertical transmission of the disease. Due to the difficulty in managing GS cases, serious consequences can occur. Therefore, systematically knowing factors associated with CS mortality and proposing CS prevention and control measures can help to reduce CS and its effects. Objective: The objective of this study was to investigate cases of congenital syphilis and their outcomes in the city of São Paulo (MSP) in the years 2016 to 2018. Methodology: quantitative, cross-sectional, observational and analytical study with the universe of secondary data from the Mortality by congenital syphilis in the state of São Paulo Project, all reported cases with SC residing in the MSP. Data source: Sinan Enhanced DB. Data disaggregated according to year and evolution with CS were described (infant death; perinatal death; unfavorable outcomes (UO) - abortion; stillbirth; infant death); The respective mortality rates were described: infant with CS (TMISC) per 1,000 live births (LB); perinatal with SC (TMPSC) per 1,000 total births (TB); and by unfavorable outcomes with SC (TMDDSC) per 1,000 TB. Factors associated with UO with CS were used through bivariate analysis and elaboration of a multiple model by logistic regression; the odds ratio and 95% confidence interval (CI) were used. Results: of the 3,434 reported cases of CS in the MSP, the evolution was: 82.47% live cases, 9.03% abortions, 5.59% stillbirths, 1.08% infant deaths with CS, 1.31% deaths from other causes. An increase in CS cases and their UO was found in the MSP from 2016 to 2018, in a heterogeneous way according to: place of residence; maternal and child characteristics; assistance to the pregnancy-puerperal cycle. Elevation of TMISC, TMPSC and TMDDSC was observed in the MSP, in different ways according to the region of residence of the cases. The 36 infant deaths with CS occurred more frequently in cases with: higher maternal non-treponemal test (TNT) titers at delivery (3.59% with titers of 1/128 or more) and in the child's peripheral blood (5.00% with a titer of 1/128 or more); place of residence, more frequently in the southeast (2.14%) and east (1.82%) regional health coordination (CRS); non-performance of PC (2.38%), child treatment scheme not performed (11.94%) and others. The 233 perinatal deaths occurred more frequently according to the following characteristics: high maternal TNT titers (28.24% with titers of 1/128 or more); place of residence, with emphasis on CRS east (9.76%) and CRS south (7.93%); non-performance of PC (13.41%); and others. The following factors were identified independently associated with UO with CS: year of diagnosis 2018 (OR= 1.53; 95% CI 1.17-1.98); individual vulnerability: maternal age group 35 to 39 years (OR= 0.59; 95% CI 0.36-0.97); high titer of TNT 1/16 to 1/64 (OR= 1.76 (95% CI 1.40-2.23) and 1/128 or more (OR= 3.21; 95% CI 2.33-4 .42); social vulnerability: place of residence CRS south (OR= 1.71; 95% CI 1.01-2.89) and east (OR=1.71; 95% CI 1.01-2.89) ; programmatic vulnerability: non-performance of PC (OR=3.14; 95% CI 2.38-4.14); diagnosis of GS at delivery/curettage (OR= 2.28; 95% CI 1.68- 3.08); maternal treatment regimen not performed (OR= 7.97; 95% CI 1.91-33.21) or inadequate (OR= 6.52; 95% CI 1.58-26.91). Conclusion: There was an increase in cases of congenital syphilis, infant death, perinatal death and unfavorable outcomes in the analyzed period. Regions with greater vulnerability in the city of São Paulo (east and south) had a greater chance of unfavorable outcomes, reinforcing the importance of early detection and treatment of gestational syphilis and adequate prenatal care, with more intensive actions aimed at populations living in these regions.
Descrição
Citação
SOARES, Roberta de Almeida. Mortalidade com sífilis congênita no município de São Paulo. 2022. 180 f. Dissertação (Mestrado Profissional em Saúde da Família (ProfSaúde)) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.