Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

Benzaken, Adele Schwartz; Pereira, Gerson Fernando Mendes; Cunha, Alessandro Ricardo Caruso da; Souza, Flavia Moreno Alves de; Saraceni, Valéria

doi:10.1590/0102-311X00057219

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ARTICLE • Cad. Saúde Pública 36 (1) • 2020 • https://doi.org/10.1590/0102-311X00057219 copy

Adequacy of prenatal care, diagnosis and treatment of syphilis in pregnancy: a study with open data from Brazilian state capitals

Adequação de atendimento pré-natal, diagnóstico e tratamento da sífilis gestacional: um estudo com dados abertos de capitais brasileiras

Adecuación de la atención prenatal, diagnóstico y tratamiento de la sífilis en el embarazo: un estudio con datos abiertos en siete capitales brasileñas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

Keywords:
Prenatal Care; Syphilys; Congenital Syphilis; Health Systems

City	Did not receive prenatal care	Inadequate prenatal care	Intermediary prenatal care	Adequate prenatal care	Intensive prenatal care
Porto Velho	13.3	15.3	5.5	16.9	49.0
Rio Branco	2.7	19.8	6.5	17.4	53.6
Manaus	2.5	17.2	9.0	22.5	48.8
Boa Vista	2.5	17.2	7.3	17.2	55.8
Belém	3.9	13.3	6.4	16.7	59.7
Macapá	3.2	22.8	14.3	19.7	40.0
Palmas	0.4	8.2	4.0	14.9	72.5
São Luís	1.1	13.0	11.6	24.1	50.2
Teresina	5.6	9.3	5.5	15.3	64.3
Fortaleza	5.6	11.6	5.8	17.7	59.3
Natal	1.1	12.8	6.8	18.0	61.3
João Pessoa	1.8	10.4	6.5	16.0	65.2
Recife	1.8	13.5	6.1	17.6	61.0
Maceió	1.9	13.0	8.3	22.9	53.9
Aracaju	0.8	10.8	10.2	20.3	57.9
Salvador	4.9	13.5	5.7	18.8	57.1
Belo Horizonte	0.4	6.3	3.2	11.1	78.8
Vitória	0.5	7.4	3.4	9.6	79.1
Rio de Janeiro	1.5	9.3	2.3	9.1	77.8
São Paulo	1.0	8.0	3.2	10.3	77.5
Curitiba	0.5	6.1	1.3	3.5	88.6
Florianópolis	1.2	9.2	3.0	11.0	75.6
Porto Alegre	1.7	10.9	3.5	9.2	74.7
Campo Grande	1.3	8.7	7.1	16.6	66.3
Cuiabá	0.5	13.2	4.7	14.3	67.3
Goiânia	8.5	8.9	3.3	12.3	67.0
Brasília	2.3	10.0	3.4	10.2	74.1
Total	2.3	10.5	4.7	13.5	69.0

Characteristics	Crude OR	95%CI	p-value	Adjusted OR	95%CI	p-value
Age group (years)
≥ 20	1.00			1.00
< 20	2.10	2.07-2.13	< 0.001	2.53	2.48-2.58	< 0.001
Color
White	1.00			1.00
Other	2.38	2.34-2.42	< 0.001	1.93	1.89-1.96	< 0.001
Marital situation
With a partner	1.00			1.00
Without a partner	1.96	1.93-1.98	< 0.001	1.70	1.68-1.73	< 0.001
Schooling (years)
≥ 4	1.00			1.00
< 4	2.76	2.64-2.88	< 0.001	2.06	1.97-2.16	< 0.001
Quantity of births
None	1.00			1.00
1 or more	1.90	1.87-1.92	< 0.001	2.39	2.35-2.43	< 0.001

City	Primary care units (n)	SRT always available (%)	Benzathine penicillin available (%)	If yes, drug available in sufficient quantity (%)	Health team applies intramuscular administration benzathine penicillin (%)	Estimated population coverage of FHS (%)	Syphilis detection rate in pregnant women	Congenital syphilis incidence rate
Porto Velho	17	94.1	82.4	92.9	100.0	57.3	12.2	6.9
Rio Branco	22	36.4	90.9	95.0	100.0	57.8	32.7	2.9
Manaus	142	2.1	4.9	100.0	27.9	33.1	24.9	10.1
Boa Vista	23	69.6	4.4	100.0	45.5	59.3	15.0	1.6
Belém	44	9.1	11.4	60.0	42.9	24.3	12.5	8.0
Macapá	25	40.0	84.0	81.0	94.7	64.1	11.3	6.2
Palmas	32	9.4	12.5	100.0	25.0	84.5	9.2	5.8
São Luís	36	2.8	55.6	100.0	67.4	35.7	12.4	7.5
Teresina	9	22.2	88.9	100.0	86.7	100.0	9.5	14.5
Fortaleza	54	18.5	51.9	96.4	36.6	51.6	8.3	18.2
Natal	34	29.4	0.0	0.0	5.3	46.8	6.8	12.1
João Pessoa	98	19.4	2.0	50.0	0.0	83.1	0.9	0.8
Recife	124	14.5	62.9	91.0	74.3	52.3	7.4	21.2
Maceió	19	47.4	84.2	87.5	58.3	29.5	7.8	9.8
Aracaju	31	80.7	67.7	85.7	100.0	75.8	6.3	8.3
Salvador	55	49.1	52.7	93.1	87.5	27.2	21.3	15.9
Belo Horizonte	146	49.3	98.6	95.1	98.2	80.2	15.1	9.3
Vitória	22	27.3	100.0	100.0	100.0	73.3	34.1	13.9
Rio de Janeiro	173	94.8	94.8	99.4	99.7	44.1	35.0	16.4
São Paulo	269	3.4	90.7	93.0	99.7	31.6	19.1	6.3
Curitiba	101	1.0	82.2	90.4	98.0	42.6	18.4	5.8
Florianópolis	45	11.1	97.8	100.0	98.0	99.4	22.5	9.5
Porto Alegre	133	84.2	94.0	88.0	98.7	41.6	22.9	29.3
Campo Grande	50	97.1	94.1	96.9	100.0	34.7	27.6	9.5
Cuiabá	59	16.0	4.0	50.0	9.7	37.1	4.3	3.7
Goiânia	59	6.8	37.3	100.0	76.0	43.2	9.6	4.1
Brasília	64	67.2	54.7	100.0	73.1	30.2	7.2	4.7

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[1] Correspondence V. Saraceni Coordenação de Doenças Transmissíveis, Secretaria Municipal de Saúde. Rua Afonso Cavalcanti 455, sala 809, Rio de Janeiro, RJ 20211-901, Brasil. valsaraceni@gmail.com