Tendência temporal e aspectos epidemiológicos da sífilis em gestante e congênita em municípios de médio porte do estado do Paraná, 2007-2017

Abstract

The incidence of congenital and gestational syphilis has increased in Brazil, although the diseases present well-established prevention, diagnosis and treatment during pregnancy and the cost of preventive intervention is low. The aim of the present study is to describe the temporal trend and epidemiological aspects of the reported cases of gestational and congenital syphilis in residents of medium-sized cities in the State of Paraná between 2007 and 2017. This is a descriptive and analytical epidemiological study of time series type with secondary data obtained in the DATASUS of the Information System of Notification Diseases, the Mortality Information System and the Information System on Live Births. In order to verify the associations of epidemiological aspects, the simulated Chi-square test was used. To verify the rate trend of syphilis detection in pregnant women and the incidence rate of congenital syphilis, a mixed effects model with random effect in the intercept and also in the inclination was adjusted. Negative Binomial Regression and the Maximum Likelihood method were also used. In cases of syphilis in pregnant women, 73,1% were aged between 20 and 39 years old; 39,4% had incomplete primary education; 69,6% were of white race/color; 57,6% had primary clinical classification; 22,8% did not undergo the treponemal test. There was a significant influence of time on the rate of syphilis detection in pregnant women, with an increase of 31% in syphilis rate (IC 95% 23-39, p <0.001) each year. There was a significant influence (p<0.005) of per capita income on the number of gestational syphilis cases, every 100 units added in per capita income, the number of cases of gestational syphilis decreases by an average of 49%. In congenital syphilis, 95,8% were aged up to 6 days; 1,5% died from the disease; 40,4% of the mothers had incomplete primary education; 92,4% underwent prenatal care; 18,6% maternal diagnosis was at child-birth and 63% of the partners did not carry out concomitant treatment with the pregnant woman. The analysis of the trend of congenital syphilis showed an increase of 25% (IC 95% 17-34, p <0.001) in the syphilis rate. There was a significant association of the HDI on congenital syphilis, with an increase of 0.01 units in the HDI, the number of congenital syphilis cases decrease, on average, 27%. It is concluded that public maternal and child health policies on maternal and child have not yet ensured the reduction of cases of congenital syphilis in the medium-sized cities of the state.