Sífilis em parturientes no Brasil: prevalência e fatores associados, 2010 a 2011 / Syphilis in parturient women in Brazil: prevalence and associated factors, 2010 to 2011

RESUMO

OBJETIVO:Estimar a prevalência e investigar os fatores associados à sífilis em parturientes no Brasil. MÉTODOS: Estudo transversal de base populacional, nacional, com representatividade regional, realizado com parturientes de 15 a 49 anos de idade atendidas em maternidades do sistema público de saúde e conveniadas, de janeiro de 2010 a dezembro de 2011. Para investigação da sífilis, realizou-se triagem com teste rápido treponêmico. A confirmação diagnóstica baseou-se no ensaio não treponêmico Venereal Disease Research Laboratory (VDRL) e em ensaios treponêmicos adicionais. Um questionário estruturado foi aplicado para coleta de variáveis sociodemográficas e clínicas. Informações acerca do pré-natal foram obtidas no cartão pré-natal e registros médicos. Os fatores associados foram verificados por meio da razão de prevalência, estimada pelo modelo de regressão logística. RESULTADOS: Foram analisadas informações de 36 713 parturientes. A prevalência geral da sífilis foi estimada no país em 0,89%; nas regiões Norte, Nordeste, Sudeste, Sul e Centro-Oeste, foi de 1,05%, 1,14%, 0,73%, 0,48% e 1,20%, respectivamente. A soropositividade associou-se a não realização do pré-natal, menor número de consultas e início tardio do pré-natal. Das parturientes diagnosticadas durante o pré-natal, 53,1% permaneciam infectadas no parto. As parturientes de raça/cor amarela, preta e parda e as de menor escolaridade apresentaram maior risco para sífilis do que as de raça/cor branca e as de maior escolaridade. CONCLUSÕES: Houve redução da prevalência da sífilis no Brasil. Porém, esse agravo ainda está associado a desigualdades sociais e regionais.

ABSTRACT

OBJECTIVE:To estimate the prevalence and investigate the factors associated with syphilis in parturient women in Brazil. METHOD: This nationwide cross-sectional population-based study, with regional representativeness, was carried out with parturient women aged 15 to 49 years delivering babies in public healthcare system/partner maternity facilities between January 2010 and December 2011. Syphilis screening was based on a rapid treponemal test. Diagnostic confirmation was based on the Venereal Disease Research Laboratory (VDRL) test and additional treponemal tests. A structured questionnaire was used for collection of clinical and sociodemographic variables. Information regarding pre-natal consultations was obtained from the prenatal card and medical records. The association between the variables of interest and syphilis was investigated using odds ratios and logistic regression. RESULTS: Information was obtained from 36 713 women. The overall prevalence of syphilis for the country was 0.89%; the prevalence in the North, Northeast, Southeast, South, and Mid-West regions was 1.05%, 1.14%, 0.73%, 0.48%, and 1.20% respectively. Seropositive results were associated with absence of prenatal consultations, fewer prenatal consultations, and late start of prenatal consultations. Of the women diagnosed during prenatal consultations, 53.1% were still infected at delivery. Increased risk of syphilis was observed in women of yellow, black, and brown race/skin color as well as in those with fewer years of schooling than in women of white race/skin color and more years of schooling. CONCLUSIONS: A reduction in the prevalence of syphilis in Brazil was recorded. However, this disease is still associated with social and regional inequality.