A completeness indicator of gestational and congenital syphilis information in Brazil.

OBJECTIVE: To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018. METHODS: Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA). RESULTS: Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90). CONCLUSION: The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.

Estimating the real burden of gestational syphilis in Brazil, 2007-2018: a Bayesian modeling study.

Background: Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Methods: Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. Findings: We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Interpretation: Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. Funding: National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.

The ß2-adrenergic receptor agonist terbutaline upregulates T helper-17 cells in a protein kinase A-dependent manner.

BACKGROUND: T helper 17 (Th17) cells produce IL-17A cytokine and can exacerbate autoimmune diseases and asthma. The ß2 adrenergic receptor is a g protein-coupled receptor that induces cAMP second messenger pathways. We tested the hypothesis that terbutaline, a ß2-adrenergic receptor-specific agonist, promotes IL-17 secretion by memory Th17 cells in a cAMP and PKA-dependent manner. METHODS: Venous peripheral blood mononuclear cells (PBMC) from healthy human participants were activated with anti-CD3 and anti-CD28 antibodies. Secreted IL-17A was measured by enzyme linked immunosorbent assay, intracellular IL-17A, and RORγ were measured using flow cytometry, and RORC by qPCR. Memory CD3+CD4+CD45RA-CD45RO+ T cells were obtained by immunomagnetic negative selection and activated with tri-antibody complex CD3/CD28/CD2. Secreted IL-17A, intracellular IL-17A, RORC were measured, and phosphorylated-serine133-CREB was measured by western blotting memory Th cells. RESULTS: Terbutaline increased IL-17A (p < 0.001), IL-17A+ cells (p < 0.05), and RORC in activated PBMC and memory Th cells. The PKA inhibitors H89 (p < 0.001) and Rp-cAMP (p < 0.01) abrogated the effects of terbutaline on IL-17A secretion in PBMC and memory T cells. Rolipram increased IL-17A (p < 0.01) to a similar extent as terbutaline. P-Ser133-CREB was increased by terbutaline (p < 0.05) in memory T cells. CONCLUSION: Terbutaline augments memory Th17 cells in lymphocytes from healthy participants. This could exacerbate autoimmune diseases or asthma, in cases where Th17 cells are considered to be pro-inflammatory.

Maternal and congenital syphilis in Indigenous Peoples: a scoping review of the worldwide literature.

BACKGROUND: Syphilis is among the most common sexually transmitted infections worldwide. When it occurs during pregnancy, it can seriously affect the fetus and newborn`s health. The scarcity of studies on maternal and congenital syphilis in Indigenous Peoples remains an obstacle to its control in these populations. This study aimed to explore the breadth of the literature, map updated evidence, and identify knowledge gaps on maternal and congenital syphilis in Indigenous Peoples worldwide. METHODS: We conducted a Scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews. In March 2021, we collected data through a priority search on PubMed, Web of Science, Embase, and SciELO. RESULTS: The strategy yielded 24 studies for analysis. Data in the articles were collected from 1989 to 2020, half from 2015 onwards. Studies were in Oceania and the Americas, mainly in South America (66.7%), particularly in Brazil (50.0%). The topics assessed were Data quality related to maternal and congenital syphilis (20.8%); Diagnosis, provision, access, and use of health services (62.5%); Disease frequency and health inequities (54.2%); Determinants of maternal syphilis and congenital syphilis (20.8%); and Outcomes of maternal and congenital syphilis in the fetus (20.8%). The results show that the available literature on maternal and congenital syphilis is sparse and concentrated in some geographic areas; the frequency of these diseases in Indigenous Peoples varies but is generally higher than in the non-indigenous counterparts; the quality of surveillance data and health information systems is poor; multiple healthcare barriers exist; and the diversity of terms to identify Indigenous Peoples is a challenge to mapping scientific outputs on Indigenous Peoples' health. CONCLUSIONS: Maternal and congenital syphilis in Indigenous Peoples is a double-neglected condition and research in this area should be given the priority and encouragement it deserves globally. Reliable data and improving access to health care are needed to reduce the burden of syphilis and correctly inform policies and health services response to mitigate ethnic-racial inequalities in maternal and congenital syphilis.

Mortality in children under 5 years of age with congenital syphilis in Brazil: A nationwide cohort study.

BACKGROUND: Congenital syphilis (CS) is a major and avoidable cause of neonatal death worldwide. In this study, we aimed to estimate excess all-cause mortality in children under 5 years with CS compared to those without CS. METHODS AND FINDINGS: In this population-based cohort study, we used linked, routinely collected data from Brazil from January 2011 to December 2017. Cox survival models were adjusted for maternal region of residence, maternal age, education, material status, self-declared race and newborn sex, and year of birth and stratified according to maternal treatment status, non-treponemal titers and presence of signs and symptoms at birth. Over 7 years, a total of 20 057 013 live-born children followed up (through linkage) to 5 years of age, 93 525 were registered with CS, and 2 476 died. The all-cause mortality rate in the CS group was 7·84/1 000 person-years compared with 2·92/1 000 person-years in children without CS, crude hazard ratio (HR) = 2·41 (95% CI 2·31 to 2·50). In the fully adjusted model, the highest under-five mortality risk was observed among children with CS from untreated mothers HR = 2·82 (95% CI 2·63 to 3·02), infants with non-treponemal titer higher than 1:64 HR = 8·87 (95% CI 7·70 to 10·22), and children with signs and symptoms at birth HR = 7·10 (95% CI 6·60 to 7·63). Among children registered with CS, CS was recorded as the underlying cause of death in 33% (495/1 496) of neonatal, 11% (85/770) of postneonatal, and 2·9% (6/210) of children 1 year of age. The main limitations of this study were the use of a secondary database without additional clinical information and the potential misclassification of exposure status. CONCLUSIONS: This study showed an increased mortality risk among children with CS that goes beyond the first year of life. It also reinforces the importance of maternal treatment that infant non-treponemal titers and the presence of signs and symptoms of CS at birth are strongly associated with subsequent mortality. TRIAL REGISTRATION: Observational study.

A completeness indicator of gestational and congenital syphilis information in Brazil

ABSTRACT OBJECTIVE To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018. METHODS Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA). RESULTS Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90). CONCLUSION The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.

Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017. / Completude e caracterização dos registros de sífilis gestacional e congênita na Bahia, 2007-2017.

OBJECTIVE: To describe the completeness and characteristics of reported gestational syphilis and congenital syphilis cases in the state of Bahia, Brazil, between 2007 and 2017. METHODS: This was an ecological study using data retrieved from the Notifiable Health Conditions Information System (SINAN). Incidence rates at the macro-regional and state levels and percentage completeness were calculated. RESULTS: 15,050 gestational syphilis cases and 7,812 congenital syphilis cases were identified. The incidence rate varied from 1.3 to 15.1 cases in pregnant women/1,000 live births and from 0.5 to 6.7 cases in infants under 1 year old/1,000 live births. Completeness of 'clinical classification' of gestational syphilis varied from 58.2% to 67.2% in the periods studied. CONCLUSION: The study showed an increase in incidence rates, flaws in report form completion and the need to implement routine information quality evaluation.

Completeness and characterization of gestational and congenital syphilis records in Bahia, Brazil, 2007-2017 / Completitud y caracterización de los registros de sífilis gestacional y congénita en Bahia, Brasil, 2007-2017 / Completude e caracterização dos registros de sífilis gestacional e congênita na Bahia, 2007-2017

Objective: To describe the characteristics and completeness of notifications of gestational and congenital syphilis across the state of Bahia, Brazil, in the period 2007-2017. Methods: This ecological study with data obtained from Notifiable Diseases Information System (Sinan). Incidence rates at the macro-regional and state levels and percentage of completeness were calculated. Results: 15.050 cases of gestacional syphilis and 7.812 of congenital syphilis were identified. The incidence rate varied from 1.3 to 15.1 cases in pregnant women/1,000 live births and from 0.5 to 6.7 cases in infants under one year/1,000 live births. The completeness of variable clinical classification of gestacional syphilis varied from 58.2% to 67.2% in the studied periods. Conclusion: The study showed an increase in the incidence rates, failure to fill out notifications and the need to the implementation of a routine information quality assessment.

Objetivo: Descrever a completude e as características das notificações de sífilis gestacional e congênita no estado da Bahia, Brasil, no período 2007-2017. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação (Sinan). Foram calculadas as taxas de incidência para a Bahia e suas macrorregiões de saúde, e o percentual da completude dos dados. Resultados: Foram identificados 15.050 casos de sífilis gestacional e 7.812 de sífilis congênita, no período analisado. A taxa de incidência variou de 1,3 para 15,1 casos em gestantes/1 mil nascidos vivos, e de 0,5 para 6,7 casos em menores de um ano/1 mil nascidos vivos. A completude da 'classificação clínica' dos casos de sífilis gestacional apresentou preenchimento variável, entre 58,2 e 67,2%, entre 2007 e 2017. Conclusão: Evidenciou-se aumento nas taxas de incidência, falha no preenchimento das notificações e necessidade de implementação de uma rotina de avaliação da qualidade das informações

[Association between the incidence rates for gestational syphilis and congenital syphilis and prenatal care coverage in the State of Bahia, Brazil]. / Associação entre as taxas de incidência de sífilis gestacional e sífilis congênita e a cobertura de pré-natal no Estado da Bahia, Brasil.

This study aimed to analyze the association between incidence rates for gestational and congenital syphilis and coverage of prenatal care from 2007 to 2017 in the State of Bahia, Brazil. This was an ecological and longitudinal study in which the units of analysis were the municipalities (counties) of the State of Bahia. Secondary data were used, obtained from the databases of the Health Information Systems. Analysis of the association between the incidence rates and prenatal coverage was performed with panel datal, using the fixed model with negative binomial response, controlled for socioeconomic, demographic, and temporal variables. In the multivariate analyses, prenatal coverage showed a statistically significant positive association with gestational syphilis incidence rate, but no association was found with congenital syphilis the incidence rate. Using municipalities with prenatal coverage < 45% as the reference group, the gestational syphilis incidence rate increased by 22% and 25%, respectively, in municipalities with prenatal coverage of 45%-64.9% (RR = 1.22; 95%CI: 1.11-1.33) and ≥ 65% (RR = 1.25; 95%CI: 1.10-1.43). The findings indicate that although the expansion of prenatal coverage in municipalities in Bahia has helped improve the detection of gestational syphilis, it did not impact the congenital syphilis incidence rate. Prenatal care as provided suffers limitations that should be the target of interventions to prevent and block vertical syphilis transmission.

O objetivo deste estudo foi analisar a associação entre as taxas de incidência da sífilis gestacional e da sífilis congênita e a cobertura de pré-natal no período de 2007 a 2017 no Estado da Bahia, Brasil. Trata-se de um estudo ecológico e longitudinal, cujas unidades de análise foram os municípios do Estado da Bahia. Foram utilizados dados secundários, obtidos nas bases de dados dos Sistemas de Informação em Saúde. A análise da associação entre as taxas de incidência e a cobertura do pré-natal foi realizada por meio de dados em painel, utilizando o modelo fixo com resposta binomial negativa, controlada pelas variáveis socioeconômica, demográfica e de tempo. Nas análises multivariadas, a cobertura de pré-natal apresentou associação positiva estatisticamente significante com a taxa de incidência de sífilis gestacional, mas não foi observada associação com a taxa de incidência de sífilis congênita. Tendo como referência o grupo de municípios com cobertura pré-natal < 45%, a taxa de incidência de sífilis gestacional aumentou em 22% e 25%, respectivamente nos municípios com cobertura de pré-natal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Os achados do estudo indicam que, embora a ampliação da cobertura de atenção pré-natal nos municípios baianos tenha contribuído para a melhoria da detecção dos casos de sífilis gestacional, não houve impacto na redução da taxa de incidência de sífilis congênita. A assistência pré-natal prestada apresenta limitações, que devem ser alvo de intervenções que promovam a prevenção e o bloqueio da transmissão vertical da sífilis.

El objetivo de este estudio fue analizar la asociación entre las tasas de incidencia de la sífilis gestacional y de la sífilis congénita con la cobertura prenatal, en el período de 2007 a 2017, en el Estado de Bahía, Brasil. Se trata de un estudio ecológico y longitudinal, cuyas unidades de análisis fueron los municipios del Estado de Bahía. Se utilizaron datos secundarios, obtenidos en las bases de datos de los Sistemas de Información en Salud. El análisis de la asociación entre las tasas de incidencia y la cobertura del cuidado prenatal se realizada mediante datos en panel, utilizando el modelo fijo con respuesta binomial negativa, controlada por las variables socioeconómica, demográfica y de tiempo. En los análisis multivariados, la cobertura prenatal presentó una asociación positiva, estadísticamente significante con la tasa de incidencia de sífilis gestacional, pero no se observó una asociación con la tasa de incidencia de sífilis congénita. Teniendo como referencia el grupo de municipios con cobertura prenatal < 45%, la tasa de incidencia de sífilis gestacional aumentó en un 22% y 25% respectivamente, en los municipios con cobertura prenatal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Los resultados del estudio indican que, a pesar de que la ampliación de la cobertura de atención prenatal en los municipios bahianos haya contribuido a la mejoría de la detección de los casos de sífilis gestacional, no presentó un impacto en la reducción de la tasa de incidencia de sífilis congénita. La asistencia prenatal prestada presenta limitaciones, que deben ser objetivo de intervenciones que promuevan la prevención y el bloqueo de la transmisión vertical de la sífilis.

Completude e caracterização dos registros de sífilis gestacional e congênita na Bahia, 2007-2017 / Completitud y caracterización de los registros de sífilis gestacional y congénita en Bahia, Brasil, 2007-2017 / Completeness and characterization of gestational syphilis and congenital syphilis records in Bahia, Brazil, 2007-2017

Objetivo: Descrever a completude e as características das notificações de sífilis gestacional e congênita no estado da Bahia, Brasil, no período 2007-2017. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação (Sinan). Foram calculadas as taxas de incidência para a Bahia e suas macrorregiões de saúde, e o percentual da completude dos dados. Resultados: Foram identificados 15.050 casos de sífilis gestacional e 7.812 de sífilis congênita, no período analisado. A taxa de incidência variou de 1,3 para 15,1 casos em gestantes/1 mil nascidos vivos, e de 0,5 para 6,7 casos em menores de 1 ano/1 mil nascidos vivos. A completude da 'classificação clínica' dos casos de sífilis gestacional apresentou preenchimento variável, entre 58,2% e 67,2%, entre 2007 e 2017. Conclusão: Evidenciou-se aumento nas taxas de incidência, falha no preenchimento das notificações e necessidade de implementação de uma rotina de avaliação da qualidade das informações.

Objetivo: Describir las características y la completitud de las notificaciones de sífilis gestacional y congénita en el estado de Bahia, Brasil, para el período 2007-2017. Métodos: Estudio ecológico con datos del Sistema de Información de Agravamiento de Notificación (Sinan). Se calcularon las tasas de incidencia por macrorregión y estado y el porcentaje de la completitud de los datos. Resultados: Se identificaron 15.050 casos de sífilis gestacional y 7.812 de sífilis congénita. La tasa de incidencia varió de 1,3 a 15,1 casos en gestante/1.000 nacidos vivos y de 0,5 a 6,7 casos en menores de 1 año/1.000 nacidos vivos. La completitud de la variable ´clasificación clínica´ de casos de sífilis gestacional varió de 58,2% a 67,2% en los períodos. Conclusión: El estudio reveló un aumento en las tasas de incidencia, falla en la completitud de las notificaciones y la necesidad de la implementación de una rutina de evaluación de la calidad de las informaciones.

Objective: To describe the completeness and characteristics of reported gestational syphilis and congenital syphilis cases in the state of Bahia, Brazil, between 2007 and 2017. Methods: This was an ecological study using data retrieved from the Notifiable Health Conditions Information System (SINAN). Incidence rates at the macro-regional and state levels and percentage completeness were calculated. Results: 15,050 gestational syphilis cases and 7,812 congenital syphilis cases were identified. The incidence rate varied from 1.3 to 15.1 cases in pregnant women/1,000 live births and from 0.5 to 6.7 cases in infants under 1 year old/1,000 live births. Completeness of 'clinical classification' of gestational syphilis varied from 58.2% to 67.2% in the periods studied. Conclusion: The study showed an increase in incidence rates, flaws in report form completion and the need to implement routine information quality evaluation.

Associação entre as taxas de incidência de sífilis gestacional e sífilis congênita e a cobertura de pré-natal no Estado da Bahia, Brasil / Association between the incidence rates for gestational syphilis and congenital syphilis and prenatal care coverage in the State of Bahia, Brazil / Asociación entre las tasas de incidencia de sífilis gestacional y sífilis congénita y la cobertura prenatal en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar a associação entre as taxas de incidência da sífilis gestacional e da sífilis congênita e a cobertura de pré-natal no período de 2007 a 2017 no Estado da Bahia, Brasil. Trata-se de um estudo ecológico e longitudinal, cujas unidades de análise foram os municípios do Estado da Bahia. Foram utilizados dados secundários, obtidos nas bases de dados dos Sistemas de Informação em Saúde. A análise da associação entre as taxas de incidência e a cobertura do pré-natal foi realizada por meio de dados em painel, utilizando o modelo fixo com resposta binomial negativa, controlada pelas variáveis socioeconômica, demográfica e de tempo. Nas análises multivariadas, a cobertura de pré-natal apresentou associação positiva estatisticamente significante com a taxa de incidência de sífilis gestacional, mas não foi observada associação com a taxa de incidência de sífilis congênita. Tendo como referência o grupo de municípios com cobertura pré-natal < 45%, a taxa de incidência de sífilis gestacional aumentou em 22% e 25%, respectivamente nos municípios com cobertura de pré-natal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Os achados do estudo indicam que, embora a ampliação da cobertura de atenção pré-natal nos municípios baianos tenha contribuído para a melhoria da detecção dos casos de sífilis gestacional, não houve impacto na redução da taxa de incidência de sífilis congênita. A assistência pré-natal prestada apresenta limitações, que devem ser alvo de intervenções que promovam a prevenção e o bloqueio da transmissão vertical da sífilis.

This study aimed to analyze the association between incidence rates for gestational and congenital syphilis and coverage of prenatal care from 2007 to 2017 in the State of Bahia, Brazil. This was an ecological and longitudinal study in which the units of analysis were the municipalities (counties) of the State of Bahia. Secondary data were used, obtained from the databases of the Health Information Systems. Analysis of the association between the incidence rates and prenatal coverage was performed with panel datal, using the fixed model with negative binomial response, controlled for socioeconomic, demographic, and temporal variables. In the multivariate analyses, prenatal coverage showed a statistically significant positive association with gestational syphilis incidence rate, but no association was found with congenital syphilis the incidence rate. Using municipalities with prenatal coverage < 45% as the reference group, the gestational syphilis incidence rate increased by 22% and 25%, respectively, in municipalities with prenatal coverage of 45%-64.9% (RR = 1.22; 95%CI: 1.11-1.33) and ≥ 65% (RR = 1.25; 95%CI: 1.10-1.43). The findings indicate that although the expansion of prenatal coverage in municipalities in Bahia has helped improve the detection of gestational syphilis, it did not impact the congenital syphilis incidence rate. Prenatal care as provided suffers limitations that should be the target of interventions to prevent and block vertical syphilis transmission.

El objetivo de este estudio fue analizar la asociación entre las tasas de incidencia de la sífilis gestacional y de la sífilis congénita con la cobertura prenatal, en el período de 2007 a 2017, en el Estado de Bahía, Brasil. Se trata de un estudio ecológico y longitudinal, cuyas unidades de análisis fueron los municipios del Estado de Bahía. Se utilizaron datos secundarios, obtenidos en las bases de datos de los Sistemas de Información en Salud. El análisis de la asociación entre las tasas de incidencia y la cobertura del cuidado prenatal se realizada mediante datos en panel, utilizando el modelo fijo con respuesta binomial negativa, controlada por las variables socioeconómica, demográfica y de tiempo. En los análisis multivariados, la cobertura prenatal presentó una asociación positiva, estadísticamente significante con la tasa de incidencia de sífilis gestacional, pero no se observó una asociación con la tasa de incidencia de sífilis congénita. Teniendo como referencia el grupo de municipios con cobertura prenatal < 45%, la tasa de incidencia de sífilis gestacional aumentó en un 22% y 25% respectivamente, en los municipios con cobertura prenatal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Los resultados del estudio indican que, a pesar de que la ampliación de la cobertura de atención prenatal en los municipios bahianos haya contribuido a la mejoría de la detección de los casos de sífilis gestacional, no presentó un impacto en la reducción de la tasa de incidencia de sífilis congénita. La asistencia prenatal prestada presenta limitaciones, que deben ser objetivo de intervenciones que promuevan la prevención y el bloqueo de la transmisión vertical de la sífilis.

Associação entre as taxas de incidência de sífilis gestacional e sífilis congênita e a cobertura de pré-natal no Estado da Bahia, Brasil / Association between the incidence rates for gestational syphilis and congenital syphilis and prenatal care coverage in the State of Bahia, Brazil / Asociación entre las tasas de incidencia de sífilis gestacional y sífilis congénita y la cobertura prenatal en el Estado de Bahía, Brasil

O objetivo deste estudo foi analisar a associação entre as taxas de incidência da sífilis gestacional e da sífilis congênita e a cobertura de pré-natal no período de 2007 a 2017 no Estado da Bahia, Brasil. Trata-se de um estudo ecológico e longitudinal, cujas unidades de análise foram os municípios do Estado da Bahia. Foram utilizados dados secundários, obtidos nas bases de dados dos Sistemas de Informação em Saúde. A análise da associação entre as taxas de incidência e a cobertura do pré-natal foi realizada por meio de dados em painel, utilizando o modelo fixo com resposta binomial negativa, controlada pelas variáveis socioeconômica, demográfica e de tempo. Nas análises multivariadas, a cobertura de pré-natal apresentou associação positiva estatisticamente significante com a taxa de incidência de sífilis gestacional, mas não foi observada associação com a taxa de incidência de sífilis congênita. Tendo como referência o grupo de municípios com cobertura pré-natal < 45%, a taxa de incidência de sífilis gestacional aumentou em 22% e 25%, respectivamente nos municípios com cobertura de pré-natal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Os achados do estudo indicam que, embora a ampliação da cobertura de atenção pré-natal nos municípios baianos tenha contribuído para a melhoria da detecção dos casos de sífilis gestacional, não houve impacto na redução da taxa de incidência de sífilis congênita. A assistência pré-natal prestada apresenta limitações, que devem ser alvo de intervenções que promovam a prevenção e o bloqueio da transmissão vertical da sífilis.

This study aimed to analyze the association between incidence rates for gestational and congenital syphilis and coverage of prenatal care from 2007 to 2017 in the State of Bahia, Brazil. This was an ecological and longitudinal study in which the units of analysis were the municipalities (counties) of the State of Bahia. Secondary data were used, obtained from the databases of the Health Information Systems. Analysis of the association between the incidence rates and prenatal coverage was performed with panel datal, using the fixed model with negative binomial response, controlled for socioeconomic, demographic, and temporal variables. In the multivariate analyses, prenatal coverage showed a statistically significant positive association with gestational syphilis incidence rate, but no association was found with congenital syphilis the incidence rate. Using municipalities with prenatal coverage < 45% as the reference group, the gestational syphilis incidence rate increased by 22% and 25%, respectively, in municipalities with prenatal coverage of 45%-64.9% (RR = 1.22; 95%CI: 1.11-1.33) and ≥ 65% (RR = 1.25; 95%CI: 1.10-1.43). The findings indicate that although the expansion of prenatal coverage in municipalities in Bahia has helped improve the detection of gestational syphilis, it did not impact the congenital syphilis incidence rate. Prenatal care as provided suffers limitations that should be the target of interventions to prevent and block vertical syphilis transmission.

El objetivo de este estudio fue analizar la asociación entre las tasas de incidencia de la sífilis gestacional y de la sífilis congénita con la cobertura prenatal, en el período de 2007 a 2017, en el Estado de Bahía, Brasil. Se trata de un estudio ecológico y longitudinal, cuyas unidades de análisis fueron los municipios del Estado de Bahía. Se utilizaron datos secundarios, obtenidos en las bases de datos de los Sistemas de Información en Salud. El análisis de la asociación entre las tasas de incidencia y la cobertura del cuidado prenatal se realizada mediante datos en panel, utilizando el modelo fijo con respuesta binomial negativa, controlada por las variables socioeconómica, demográfica y de tiempo. En los análisis multivariados, la cobertura prenatal presentó una asociación positiva, estadísticamente significante con la tasa de incidencia de sífilis gestacional, pero no se observó una asociación con la tasa de incidencia de sífilis congénita. Teniendo como referencia el grupo de municipios con cobertura prenatal < 45%, la tasa de incidencia de sífilis gestacional aumentó en un 22% y 25% respectivamente, en los municipios con cobertura prenatal entre 45%-64,9% (RR = 1,22; IC95%: 1,11-1,33) e ≥ 65% (RR = 1,25; IC95%: 1,10-1,43). Los resultados del estudio indican que, a pesar de que la ampliación de la cobertura de atención prenatal en los municipios bahianos haya contribuido a la mejoría de la detección de los casos de sífilis gestacional, no presentó un impacto en la reducción de la tasa de incidencia de sífilis congénita. La asistencia prenatal prestada presenta limitaciones, que deben ser objetivo de intervenciones que promuevan la prevención y el bloqueo de la transmisión vertical de la sífilis.