Prevalence of syphilis in pregnancy and prenatal
					syphilis testing in Brazil: Birth in Brazil study

Domingues, Rosa Maria Soares Madeira; Szwarcwald, Celia Landmann; Souza Junior, Paulo Roberto Borges; Leal, Maria do Carmo

doi:10.1590/S0034-8910.2014048005114

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Original Articles • Rev. Saúde Pública 48 (5) • Oct 2014 • https://doi.org/10.1590/S0034-8910.2014048005114 copy

Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: Birth in Brazil study

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil.

METHODS

This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units.

RESULTS

Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units.

CONCLUSIONS

The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Syphilis Serodiagnosis; Pregnant Women; Prenatal Care; Socioeconomic Factors; Health Inequalities; Infectious Disease Transmission, Vertical

Maternal profile	n	%
Region of residence
North	2,296	9.6
Northeast	6,904	28.9
Southeast	10,155	42.5
South	2,984	12.5
Midwest	1,555	6.5
Maternal age (years)
12 to 19	4,570	19.1
20 to 34	16,807	70.4
≥ 35	2,509	10.5
Years of education
0 to 7	6,322	26.6
8 to 10	6,085	25.6
11 to 14	9,263	39.0
≥ 15	2,109	8.9
Self-reported skin color
White	8,079	33.8
Black	2,051	8.6
Mixed	13,403	56.1
East Asian	257	1.1
Indigenous	99	0.4
Type of prenatal care service
No prenatal care	319	1.3
Public	17,575	73.6
Private	5,971	25.0
Type of child delivery care service
Public	9,836	41.2
Mixed	10,596	44.3
Private	3,462	14.5
Total	23,894	100.0

Maternal profile	n	Prenatal care (N = 23,894)		Received prenatal care cards (N = 23,555)		Brought the prenatal card at hospital admission (N = 23,555)		Result of the first serological test for syphilis (N = 16,899)		Result of the second serological test for syphilis (N = 16,899)
Maternal profile	n	%	p	%	p	%	p	%	p	%	p
Region			0.006				< 0.001		< 0.001		< 0.001
North	2,296	97.5		97.9	0.130	64.2		79.5		29.2
Northeast	6,904	98.5		94.9		67.9		84.8		31.0
Southeast	10,155	98.8		96.3		77.5		91.8		44.5
South	2,984	99.5		97.1		79.7		94.9		56.7
Midwest	1,555	98.7		94.2		45.1		86.1		42.8
Maternal age (years)			0.497		< 0.001		< 0.001		< 0.001		< 0.001
12 to 19	4,570	98.5		98.7		74.7		85.8		36.8
20 to 34	16,807	98.7		95.8		71.7		89.6		42.0
≥ 35	2,509	98.7		92.4		65.9		92.0		44.1
Years of education			< 0.001		< 0.001		< 0.001		< 0.001		< 0.001
0 to 7	6,322	96.9		98.9		76.2		84.8		33.3
8 to 10	6,085	98.8		98.0		74.5		88.6		41.8
11 to 14	9,263	99.5		95.7		71.0		91.8		45.7
≥ 15	2,109	100		83.2		52.7		93.7		45.6
Self-reported skin color			0.001		< 0.001		0.422		< 0.001		< 0.001
White	8,079	99.2		94.2		70.3		91.9		45.4
Black	2,051	98.1		98.4		73.4		85.1		38.4
Mixed	13,403	98.5		96.8		72.1		88.1		39.2
East Asian	257	98.3		93.5		73.9		83.6		34.2
Indigenous	99	95.0		98.2		80.1		91.3		38.4
Type of prenatal care service					< 0.001		< 0.001		0.001		0.756
Public	17,575			99.3		76.3		88.4		41.0
Private	5,971			86.3		58.0		91.9		41.8
Type of child delivery care service			< 0.001		< 0.001		< 0.001		0.001		0.004
Public	9,836	97.8		99.0		73.9		86.6		36.8
Mixed	10,596	99.1		97.8		77.0		90.6		44.6
Private	3,462	99.9		82.2		49.2		91.8		43.2
Total	23,894	98.7		96.0		71.6		89.1		41.1

Maternal profile	n	Prevalence of syphilis during pregnancy	95%CI	PR	95%CI
Region
North	2,296	0.76	0.42;1.35	1
Northeast	6,904	1.08	0.71;1.63	1.49	0.70;3.15
Southeast	10,155	1.03	0.75;1.41	1.44	0.72;2.89
South	2,984	1.10	0.75;1.60	1.53	0.74;3.17
Midwest	1,555	0.96	0.46;2.00	1.35	0.51;3.54
Maternal age (years)
12 to 19	4,570	0.90	0.64;1.28	1
20 to 34	16,807	1.06	0.83;1.35	1.16	0.77;1.76
≥ 35	2,509	1.02	0.60;1.75	1.14	0.62;2.11
Years of education
0 to 7	6,322	1.74	1.25;2.41	3.24	1.47;7.12
8 to 10	6,085	1.09	0.83;1.43	2.01	0.96;4.21
11 to 14	9,263	0.58	0.43;0.79	1.08	0.49;2.35
≥ 15	2,109	0.54	0.26;1.12	1
Self-reported skin color
White	8,079	0.59	0.42;0.83	1
Black	2,051	1.81	1.18;2.75	3.17	1.78;5.65
Mixed	13,403	1.16	0.89;1.51	1.99	1.30;3.06
East Asian	257	1.45	0.28;7.06	2.52	0.46;13.86
Indigenous	99	0.55	0.07;3.95	0.96	0.12;7.35
Type of prenatal care service
No prenatal care	319	2.50	1.12;5.50	6.07	2.34;15.75
Public	17,575	1.20	0.98;1.47	2.85	1.75;4.64
Private	5,971	0.42	0.26;0.67	1
Type of child delivery care service
Public	9,836	1.37	1.03;1.81	4.24	2.07;8.69
Mixed	10,596	0.93	0.70;1.25	2.94	1.44;6.03
Private	3,462	0.32	0.17;0.61	1
Total	23,894	1.02	0.84;1.25

First serological test/Second serological test or hospitalization	Second serological test				Syphilis diagnosis (gestation + hospitalization)
	Non reactive		Reactive		No		Yes
	n	%	n	%	n	%	n	%
Non reacrive	6,870	99.7	18	0.3	14,799	99.6	61	0.4
Reactive	29	43.3	38	56.7	0	0	116	100.0

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[1] Correspondence: Rosa Maria Soares Madeira Domingues. Laboratório de Pesquisa Clínica em DST e Aids. Instituto Nacional de Infectologia Evandro Chagas. Fundação Oswaldo Cruz. Av. Brasil, 4365 Manguinhos. 21040-360 Rio de Janeiro, RJ, Brasil. E-mail: rosa.domingues@ini.fiocruz.br