Sífilis gestacional e congênita: evolução e relação com estratégia saúde da família no sul e extremo sul baiano / Gestational and congenital syphilis: evolution and relationship with the family health strategy in Southern Bahia / Sífilis gestacional y congénita: evolución y relación con la estrategia de salud familiar sur/extremo sur de Bahia

RESUMO

Sífilis em gestantes e sífilis congênita representam importantes problemas de saúde pública no Brasil. Este estudo descreve a situação epidemiológica dos casos de sífilis em gestantes e sífilis congênita na região sul/extremo sul baiana e compara a evolução das taxas de detecção dessas doenças com a ampliação da cobertura da Estratégia Saúde da Família (ESF). Este é um estudo observacional e descritivo do período de 2009-2019. Foram analisados municípios agrupados em diferentes portes populacionais e casos analisados, segundo características maternas e assistenciais. Foram correlacionadas taxas de detecção e incidência com a cobertura da Estratégia Saúde da Família utilizando o coeficiente de correlação de postos de Spearman. Os dados foram coletados do Painel de Indicadores Epidemiológicos do Ministério da Saúde. O grupo com população inferior a 20 mil habitantes foi excluído pela precariedade de registros. Foram notificados um total de 3.028 casos de sífilis em gestantes e 1.454 de sífilis congênita, nos 22 municípios selecionados, que formaram três grupos. Todos os grupos apresentaram aumento nas taxas de detecção e incidência e, quando correlacionadas com a cobertura da Estratégia de Saúde da Família, mostraram resultados positivos, sendo os mais fortes para o de menor população. Em todos os grupos prevaleceram casos de mulheres jovens, com baixa escolaridade, em sua maioria negras e que realizaram pré-natal, mas com diagnóstico de sífilis primária no terceiro trimestre gestacional. O tratamento da gestante e do parceiro foi inadequado ou não realizado na maioria dos grupos. O desafio atual está em qualificar o pré-natal, controlar desigualdades e barrar a transmissão vertical.

ABSTRACT

Gestational and congenital syphilis is a serious public health issue in Brazil. This study describes the epidemiological situation of gestational and congenital syphilis cases in southern Bahia, comparing the evolution of the detection rates of these diseases with the expanded coverage of the Family Health Strategy (FHS). An observational and descriptive research was conducted for the period of 2009-2019, in municipalities grouped by population sizes, analyzing cases according to maternal and care characteristics. Detection and incidence rates were correlated with the Family Health Strategy coverage using Spearman's rank correlation coefficient. Data were collected from the Epidemiological Indicators Panel of the Ministry of Health. The group with a population of less than 20,000 inhabitants was excluded due to poor records. A total of 3028 cases of gestational syphilis and 1454 cases of congenital syphilis were reported in the 22 selected municipalities divided into three groups. All groups presented increased detection and incidence rates and showed positive correlations with the coverage of the Family Health Strategy, stronger for the smallest population. Results show a prevalence of cases involving mostly young black women, with low schooling level, who received prenatal care, with a diagnosis of primary syphilis in the third gestational trimester. Treatment of the pregnant woman and her partner was inadequate or not performed in most groups. The current challenge is to qualify prenatal care, control inequalities, and stop vertical transmission.

RESUMEN

Gestational and congenital syphilis is a serious public health issue in Brazil. This study describes the epidemiological situation of gestational and congenital syphilis cases in southern Bahia, comparing the evolution of the detection rates of these diseases with the expanded coverage of the Family Health Strategy (FHS). An observational and descriptive research was conducted for the period of 2009-2019, in municipalities grouped by population sizes, analyzing cases according to maternal and care characteristics. Detection and incidence rates were correlated with the Family Health Strategy coverage using Spearman's rank correlation coefficient. Data were collected from the Epidemiological Indicators Panel of the Ministry of Health. The group with a population of less than 20,000 inhabitants was excluded due to poor records. A total of 3028 cases of gestational syphilis and 1454 cases of congenital syphilis were reported in the 22 selected municipalities divided into three groups. All groups presented increased detection and incidence rates and showed positive correlations with the coverage of the Family Health Strategy, stronger for the smallest population. Results show a prevalence of cases involving mostly young black women, with low schooling level, who received prenatal care, with a diagnosis of primary syphilis in the third gestational trimester. Treatment of the pregnant woman and her partner was inadequate or not performed in most groups. The current challenge is to qualify prenatal care, control inequalities, and stop vertical transmission.