Sífilis na gestação e puerpério: oportunidades estratégicas para a sua prevenção e controle, Brasil, 2000

Abstract

Despite the new and the more developed efforts, congenital syphilis is still an important issue in the public health. Once the Treponema pallidum infection is identified in the woman and it is appropriately treated before or during pregnancy this disease can be prevented. The present work aims to study the relevant aspects of the syphilis during the pregnancy and the puerperal, using: 1) Evaluations of health services that provide prenatal care, labor attendance and curettage; 2) Analysis of the missed prevention opportunities (MPO) for congenital syphilis and the HIV infection, perceived by the VDRL and the anti-HIV exams not realized during the prenatal care and 3) Analysis of the factors associated to the persistence of the VDRL positivy on puerperal women. A cross-sectional study was elaborated and the random probabilistic sample included3233 puerperal that were attended by 24 maternity registered in the National STD/AIDS Program and called Investigation Groups of Congenital Syphilis Cases. Two questionnaires were applied. The first one was related to the characteristics of the maternities and it was answered by the coordinator of GICSC. The second was related to the characteristics of the population studied and it was answered by the puerperal women. A VDRL exam was also realized for all puerperalwomen and a FTA-Abs exam was realized for those whose VDRL was positive. The results showed a reasonable structure of the maternities, which are 73.9% publics, 76.9% having prenatal care and 86,9% possessing their own laboratory. The results also showed a greater vulnerability of women who are single, have low schooling (= 8 years of study) and have low income ( < 3 minimum wages ). The results pointed to a high prevalence of MPO related to each test, representing 41.2% for VDRL tests and 56.0% for anti-HIV tests. They still pointed a highpositivy of syphilis (1.7%) in the studied population. The achieved results revealed some fails related to the development of the preventable actions and the controlling of syphilis, of congenital syphilis and of the vertical transmition of HIV across the country. During the whole process of prenatal care and the labor/curettage, it was noticed missed opportunities of realizations of exams and appropriately treatment for the pregnant and their partners, even when talking about servicesespecially registered and capcited for that objective. It shows it is necessary to move forward on the organization of the health services and to extend the access and linkages between pregnants and the prenatal care.