Knowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis inMaternityHospitals in Teresina - PI, Brazil

Santos, Raquel Rodrigues dos; Niquini, Roberta Pereira; Domingues, Rosa Maria Soares Madeira; Bastos, Francisco Inácio

doi:10.1055/s-0037-1606245

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 39 (09) • Sept 2017 • https://doi.org/10.1055/s-0037-1606245 copy

Knowledge and Compliance in Practices in Diagnosis and Treatment of Syphilis inMaternityHospitals in Teresina - PI, Brazil

Conhecimento e conformidade quanto às práticas de diagnóstico e tratamento da sífilis em maternidades de Teresina - PI, Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the knowledge and compliance of health professionals regarding the diagnostic and treatment practices for syphilis in patients admitted for childbirth in public maternity hospitals in the city of Teresina, in the state of Piauí, Northeastern Brazil.

Methods

A cross-sectional study was performed in 2015 with obstetricians and nurses working in the public maternity hospitals in Teresina (n = 159) using a selfadministered questionnaire, with 5% of losses and 10% of refusals. The study used 21 evaluation criteria: 13 of them were related to knowledge (5 on serological tests and 8 on treatment adequacy); 8 were related to practices (3 on diagnosis, 4 on treatment, and 1 on post-test counseling). The knowledge of and compliance to the practices was estimated as the proportion of health professionals’ answers that were in agreement with Brazilian Ministry of Health protocols.

Results

The obstetricians were in agreement with twocriteria concerning the knowledge of serological tests, one for diagnostic practices, and one for treatment practice. Among nurses, no single match between actual procedures and guidelines was observed.

Conclusions

Low compliance with the protocols results in missed opportunities for the diagnosis and treatment of pregnant and postpartum women and their partners. Strategies for training and integrating the various professional groups, improved data recording on prenatal cards, and greater accountability of the hospital team in managing the women’s partners are needed to overcome the barriers identified in the study and to interrupt the syphilis transmission chain.

Keywords:
syphilis; congenital syphilis; health personnel; health evaluation; maternity hospitals

	Obstetricians(n= 59)		Nurses(n= 100)		Total(n= 159)
Variables	n	% (95%CI)*	n	% (95%CI)*	n	% (95%CI)*
Sex
Female	20	34 (22.4 - 47. 5)	86	86 (77.2–91.8)	106	67 (58.7–73.8)
Male	39	66 (52.5–77.6)	14	14 (8.1–22.7)	53	33 (26.2–41.3)
Age group (years)
< 30	4	7 (2.2–17.3)	39	39 (29.5–49.3)	43	27 (20.4–34.8)
30–39	25	42 (29.8–55.9)	35	35 (25.9–45.2)	60	38 (30.3–45.8)
40–49	13	22 (12.7–35.0)	14	14 (8.1–22.7)	27	17 (11.7–23.9)
≥ 50	16	27 (16.7–40.5)	9	9 (4.4–16.3)	25	16 (10.6–22.5)
Time since graduation
< 10 years	15	25 (15.4–38.7)	70	70 (59.9–78.5)	85	53 (45.4–61.3)
≥ 10 years	43	73 (59.5–83.2)	29	29 (20.6–39.1)	72	45 (37.4–53.3)
Time working in the maternity hospital
< 10 years	26	44 (31.4–57.5)	87	87 (78.4–92.6)	113	71 (63.3–77.8)
≥ 10 years	32	54 (40.8–67.1)	9	9 (4.4–16.8)	41	26 (19.3–33.4)
Employment relationship in maternity hospital
Stable/public servant	49	83 (70.6–91.1)	69	69 (58.8–77.7)	118	74 (66.6–80.7)
Temporary	10	17 (8.8–29.4)	30	30 (21.4–40.1)	40	25 (18.8–32.8)
Graduate training
Yes	59	100 (92.4–100.0)	81	81 (71.7–87.9)	140	88 (81.7–92.5)
No	0	0 (0.0–7.6)	17	17 (10.5–26.1)	17	11 (6.5–16.8)
Most recent types of graduate training
Specialization/residency	53	90 (78.5–95.8)	68	68 (57.8–76.8)	121	76 (68.6–82.3)
Master's	2	3 (0.6–12.7)	13	13 (7.4–21.6)	15	9 (5.5–15.3)
PhD	3	5 (1.3–15.0)	0	0 (0.0–4.6)	3	2 (0.5–5.9)
Other	1	2 (0.1–10.3)	0	0 (0.0–4.6)	1	1 (0.0–4.0)
Most recent type of specialization/residency(*)
Maternal and child health	47	89 (76.3–95.3)	18	26 (16.8 - 38.8)	65	54 (44.4–62.7)
ICU/urgency and emergency	1	2 (0.1–11.4)	18	26 (16.8 - 38.8)	19	16 (10.0–23.7)
Family health /public health	0	0 (0.0–8.4)	10	15 (7.6–25.8)	10	8 (4.2–15.0)
Other	6	11 (4.7–23.7)	19	28 (18.1–40.3)	25	21 (14.0–29.2)
Participation in training on syphilis
Yes	22	37 (25.3–50.9)	40	40 (30.5–50.3)	62	39 (31.5–47.1)
No	36	61 (47.4–73.2)	57	57 (46.7–66.7)	93	58 (50.4–66.2)
Most recent training***
< 1 year	0	0(0.0–18.5)	3	8 (1.9–21.5)	3	5 (1.2–14.4)
1 to 5 years	13	59 (36.7–78.5)	30	75 (58.5–86.7)	43	69 (56.2–80.1)
> 5 years	9	41 (21.5–63.3)	6	15 (6.2–30.5)	15	24 (14.6–37.0)
Knows MoH manual
Yes	31	52 (39.2–65.5)	71	71 (60.9–79.4)	102	64 (56.1–71.5)
No	26	44 (31.4–57.5)	25	25 (17.1–34.8)	51	32 (25.0–40.0)
Last time consulting the MoH manual***
< 1 year	4	13 (4.2–30.8)	12	17 (9.4–28.0)	16	16 (9.5–24.5)
1 to 5 years	23	74 (55.1–87.4)	48	68 (55.3–77.9)	71	70 (59.6–78.1)
> 5 years	2	6 (1.1–22.8)	9	13 (6.3–23.2)	11	11 (5.8–18.9)
Read MoH manual ***
Yes, entirely	13	42 (25.1–60.7)	11	16 (8.3–26.4)	24	23 (15.9–33.1)
Yes, partially	16	52 (33.4–69.4)	57	80 (68.8–88.4)	73	72 (61.6–79.8)
No	2	6 (1.1–22.8)	3	4 (1.1–12.7)	5	5 (1.8–11.6)

Criteria	Obstetricians(n= 59)		Nurses(n= 100)		Total(n= 159)
	n	% (95%CI)*	N	% (95%CI)*	n	% (95%CI)*
The VDRL test is non-treponemal
In agreement	54	92 (80.6–96.8)	72	72 (62.0–80.3)	126	79 (71.9–85.1)
Not in agreement/not informed	5	8 (3.1–19.4)	28	28 (19.7–38.0)	33	21 (14.9–28.1)
The rapid syphilis test is treponemal
In agreement	28	48 (34.5–60.8)	51	51 (40.9–61.0)	79	50 (41.7–57.7)
Not in agreement/not informed	31	52 (39.2–65.5)	49	49 (38.9–59.1)	80	50 (43.3–58.3)
The TPHA and FTA-Abs test are treponemal
In agreement	54	92 (80.6–96.8)	69	69 (58.8–77.7)	123	77 (69.9–83.4)
Not in agreement/not informed	5	8 (3.1–19.4)	31	31 (22.3–41.1)	36	23 (16.5–30.1)
Characteristics of the VDRL test**
1. Qualitative test	18	31 (19.5–44.0)	33	33 (24.1–43.2)	51	32 (25.0–40.0)
2. Can become non-reactive after adequate treatment	41	70 (56.0–80.4)	47	47 (37.0–57.2)	88	55 (47.3–63.1)
3. Can be used to control the cure	46	78 (64.9–87.3)	43	43 (33.2–53.3)	89	56 (47.9–63.8)
4. Cross-reactive with other infections	51	86 (74.5–93.5)	28	28 (19.7–38.0)	79	50 (41.7–57.7)
5. Does not know how to interpret the test	0	0 (0.0–7.6)	8	8 (3.8 - 15.6)	8	5 (2.3–10.0)
In agreement (with items 1,2,3, and 4)	9	15 (7.6–27.4)	1	1 (0.1–6.2)	10	6 (3.2–11.6)
Not in agreement / Not informed	50	85 (72.5–92.4)	99	99 (93.8–99.9)	149	94 (88.4–96.8)
Characteristics of the treponemal tests**
1. Qualitative tests	39	66 (52.5–77.6)	49	49 (38.9–59.1)	88	55 (47.3–63.1)
2. Can become non-reactive after adequate treatment	21	36 (23.9–49.2)	29	29 (20.6–39.1)	50	31 (24.4–39.3)
3. Can be used to control the cure	26	44 (31.4–57.5)	19	19 (12.1–28.3)	45	28 (21.6–36.1)
4. Cross-reactive with other infections	7	12 (5.3–23.5)	11	11 (5.9–19.2)	18	11 (7.0–17.5)
5. Does not know how to interpret the tests	0	0 (0.0–7.6)	19	19 (12.1–28.3)	19	12 (7.5–18.3)
In agreement (only with item 1)	20	34 (22.4–47.5)	26	26 (18.0–35.9)	46	29 (22.2–36.7)
Not in agreement/Not informed	39	66 (52.5–77.6)	74	74 (64.1–82.0)	113	71 (63.3–77.8)

Criteria	Obstetricians(n= 59)		Nurses(n= 100)		Total(n= 159)
Criteria	n	% (95%CI)*	n	% (95%CI)*	n	% (95%CI)*
(I) Pregnant woman allergic to penicillin
In agreement	24	41 (28.3–54.2)	27	27 (18.8–37.0)	51	32 (25.0–40.0)
Not in agreement/not informed	35	59 (45.8–71.7)	73	73 (63.0–81.2)	108	68 (60.0–75.0)
(II) Low titer (1:2) at childbirth, no diagnosis, or prior treatment
In agreement	44	75 (61.3–84.6)	56	56 (45.7–65.8)	100	63 (54.8–70.3)
Not in agreement/not informed	15	25 (15.4–38.7)	44	44 (34.2–54.3)	59	37 (29.7–45.2)
(III) Treatment dose
In agreement	51	86 (74.5–93.5)	70	70 (59.9–78.5)	121	76 (68.6–82.3)
Not in agreement/not informed	8	14 (6.4–25.5)	30	30 (21.4–40.1)	38	24 (17.6–31.4)
(IV)Time elapsed between the conclusion of the treatment and delivery
In agreement	11	19 (10.1–31.3)	22	22 (14.6–31.6)	33	21(14.9–28.0)
Not in agreement/not informed	48	81 (68.7–89.9)	78	78 (68.4–85.4)	126	79 (71.9–85.1)
(V) Serological scar
In agreement	50	85 (72.5–92.4)	60	60 (49.7–69.5)	110	69 (61.3–76.1)
Not in agreement/not informed	9	15 (7.6–27.5)	40	40 (30.5–50.3)	49	31 (23.9–38.7)
(VI) Persistent titer after treatment
In agreement	24	41 (28.3–54.2)	42	42 (32.3–52.3)	66	41 (33.8–49.6)
Not in agreement/not informed	35	59 (45.8–71.7)	58	58 (47.7–67.7)	93	59 (50.4–66.2)
(VII) Partner not treated
In agreement	52	88 (76.4–94.7)	67	67 (56.8–75.9)	119	75 (67.2–81.2)
Not in agreement/not informed	7	12 (5.3–23.5)	33	33 (24.1–43.2)	40	25 (18.8–32.8)
(VIII) Interval between treatment doses
In agreement	38	64 (50.8–76.1)	39	39 (29.5–49.3)	77	48 (40.4–56.4)
Not in agreement/not informed	21	36 (23.9–49.2)	61	61 (50.7–70.4)	82	52 (43.6–59.5)

Criteria	Obstetricians		Nurses		Total
Criteria	n	% (95%CI)	n	% (95%CI)	n	% (95%CI)
Diagnostic practices
(A) Recording the test results**		Obstetricians(n= 55)		Nurses(n= 68)		Total(123)
In agreement (test results recorded)	40	73 (58.8–83.4)	51	75 (62.8–84.4)	91	74 (65.2–81.3)
Not in agreement /not informed	15	27 (16.5–41.2)	17	25 (15.6–37.2)	32	26 (18.7–34.8)
(B) “Syphilis serology” ordered		Obstetricians(n= 59)		Nurses(n= 100)		Total(159)
(1) For all women admitted for childbirth, but not for curettage	1	2 (0.1–10.3)	4	4 (1.3–10.5)	5	3 (1.2–7.6)
(2) Only other criteria*	0	0(0.0–7.6)	4	4 (1.3–10.5)	4	2 (0.8–6.7)
(3) Does not order	1	2 (0.1–10.3)	47	47 (37.0–57.2)	48	30 (23.3–38.0)
(4) Not allowed to order tests	0	0 (0.0–7.6)	36	36 (26.8–46.3)	36	23 (16.5–30.1)
In agreement (for all women admitted for childbirth or curettage)	57	96 (87.2–99.4)	7	7 (3.1–14.4)	64	40 (32.6–48.3)
Not in agreement /not informed	2	4 (0.6–12.7)	93	93 (85.6–96.9)	95	60 (51.7–67.3)
(C)Management of partner
In agreement (treatment of partner at the maternity hospital)	25	42 (29.8–55.9)	34	34 (25.0–44.2)	59	37 (29.7–45.1)
Other approaches	31	53 (39.2–65.5)	47	47 (37.1–57.2)	78	49 (41.1–57.1)
No management of partner or not informed	3	5 (1.3–15.1)	19	19 (12.1–28.3)	22	14 (9.1–20.4)
Treatment practices
(A)Recording the treatments performed**		Obstetricians(n= 55)		Nurses(n= 68)		Total(123)
In agreement	46	84 (70.7–91.8)	55	81 (69.2–89.0)	101	82 (73.9–88.2)
Not in agreement	9	16 (8.2–29.3)	13	19 (10.9–30.8)	22	18 (11.8–26.0)
(B)Treatment of primary syphilis		Obstetricians(n= 59)		Nurses(n= 100)		Total(159)
Not allowed to prescribe	0	0 (0.0–7.6)	58	58 (47.7–67.7)	58	36 (29.1–44.5)
In agreement (Penicillin G Benzathine 2,400,000 IU)	39	66 (52.5–77.6)	29	29 (20.6–39.1)	68	43 (35.0–50.8)
Does not know how to treat/not informed	20	34 (22.4- 47.5)	13	13 (7.4–21.6)	33	21 (14.9–28.0)
(C)Treatment of secondary syphilis
Not allowed to prescribe	0	0 (0.0–7.6)	58	58 (47.7–67.7)	58	36 (29.1–34.5)
In agreement (Penicillin G Benzathine 4,800,000 IU)	31	52 (39.2–65.5)	26	26 (18.0–35.9)	57	36 (28.5–43.9)
Does not know how to treat/not informed	28	48 (34.5–60.8)	16	16 (9.7–25.0)	44	28 (21.0–35.4)
(D)Treatment of syphilis of unknown duration
Not allowed to prescribe	0	0 (0.0–7.6)	58	58 (47.7–67.7)	58	37 (29.1–34.5)
In agreement (Penicillin G Benzathine 7,200,000 IU)	56	95 (84.9–98.7)	32	32 (23.2–42.2)	88	55 (47.3–63.2)
Does not know how to treat/not informed	3	5 (1.3–15.0)	10	10 (5.2–18.0)	13	8 (4.6–13.9)
Post-test counseling
(1) Always provides orientation on the risks of the disease for the pregnant woman with diagnosis of syphilis and her child	55	93 (82.7–97.8)	81	81 (71.7–87.9)	136	86 (78.9–90.4)
(2) Always provides orientation on the importance of the partner's treatment to avoid reinfection	57	97 (87.2–99.4)	90	91 (82.0–94.8)	147	92 (86.9–95.9)
(3) Always provides orientation on the importance of condom use to avoid reinfection	48	81 (68.7–89.9)	81	81 (71.7–87.9)	129	81 (74.0–86.7)
In agreement (with items 1, 2, and 3)	46	78 (64.9–87.3)	70	70 (59.9 - 78.5)	116	73 (65.2–80.0)
Not in agreement /not informed	13	22 (12.7 - 35.1)	30	30 (21.4 - 40.1)	43	27 (20.4–34.8)

Barriers	Obstetricians(n= 59)		Nurses(n= 100)		Total(n= 159)
	n	% (95%CI)	n	% (95%CI)	n	% (95%CI)
(1) No record of the diagnosis on the prenatal card	33	56 (42.5–68.6)	47	47 (37.0–57.2)	80	50 (42.3–58.3)
(2) No record of the treatments on the prenatal card	44	75 (61.3–84.6)	60	60 (49.7–69.5)	104	65 (57.4–72.6)
(3) Women's lack of information on treatments received during prenatal care	42	71 (57.7–81.9)	59	59 (48.7–68.6)	101	64 (55.5–70.9)
(4) Other health professionals in the maternity hospital do not record relevant information on syphilis on the patient's chart	17	29 (18.1–42.2)	20	20 (12.9–29.4)	37	23 (17.1–30.7)
(5) Other health professionals in the maternity hospital do not order necessary tests for diagnosis and treatment	5	9 (3.2–19.4)	5	5 (1.8–11.8)	10	6 (3.2–11.6)
(8) Delay in the turnaround time of the results of the tests ordered in the maternity hospital	16	27 (16.7–40.5)	16	16 (9.7–25.0)	32	20 (14.4–27.4)
(9) Difficulty in interpreting the test results	2	3 (0.6–12.7)	11	11 (5.9–19.2)	13	8 (4.6–13.9)
(10) Women's resistance to the waiting time in the postpartum period to receive the test result	12	20 (11.4–33.2)	18	18 (11.3–17.2)	30	19 (13.3–26.0)
(11) Lack of medicines for treatment	2	3 (0.6–12.7)	1	1 (0.0–6.2)	3	2 (0.5–5.8)
(12)Difficulty in conversing with the women's partners	37	63 (49.1–74.6)	42	42 (32.3–52.3)	79	50 (41.7–57.7)
(13)Difficulty in conversing with the women about the possible forms of syphilis infection	12	20 (11.4–33.2)	29	29 (20.6–39.1)	41	26 (19.3–33.4)
(14)Difficulty in informing the women about the consequences of syphilis for her and the infant	7	12 (5.3–23.5)	24	24 (16.3–33.8)	31	20 (13.8–26.7)
(15)Difficulty in explaining the test result to the women	10	17 (8.8–29.4)	41	41 (31.4–51.3)	51	32 (25.0–40.0)
(16)Difficulty in orienting the women on treatment	5	9 (3.2–19.4)	26	26 (18.0–35.9)	31	19 (13.8–26.7)
(17)Difficulty in orienting the women on condom use	7	12 (5.3–23.5)	19	19 (12.1–28.3)	26	16 (11.1–23.2)
No difficulties	2	3 (0.5–12.7)	7	7 (3.1–14.4)	9	6 (2.8–10.8)
Not informed	2	3 (0.5–12.7)	4	4 (1.3–10.5)	6	4 (1.5–8.4)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Roberta Pereira Niquini, PhD, Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ) - Campus Realengo, Rua Carlos Wenceslau, n° 343, Realengo, 21715- 000 - Rio de Janeiro, RJ, Brazil (e-mail: roberta.niquini@ifrj.edu.br).