Sífilis congênita em uma região de saúde do ceará: um estudo ecológico

Abstract

The Congenital Syphilis (CS) remains as a challenge and its occurrence showing fails on the health care service, particularly in the prenatal assistance, because early diagnosis and the syphilis treatment in a pregnant woman are simple and effective actions to its prevention. This study has a goal to verify relation between the incidence of congenital syphilis (SC), in the counties from the 11 Health Regional coordinating from Ceará (CE), with the maternal variables, sociodemographic indicators and the health service cover according with the geographic location. It is a study with a quantitative approach, of the kind ecological mixed analytical. The population studied in this research was compose with every case of CS occurred in the counties from the 11 CRES, on the period of 2010 and 2017. It was calculated the incidence rate of CS (dependent variable) for each county and studied year, as well as the survey from the independent variables, processed and analyzed with the use of the software Statistical Package for the Social Sciences (SPSS) version 23. The descriptive statistics approach was performed. Applied the Kolmogorov-Smirnov Normality Test, and Qui-square tests and Likelihood Ratio. The statistics tests were developed with a significance level of p < 0.05. It was represented firstly the spatial exploratory analysis, being utilized the software ArcGis version free trial. It was utilized the software R version 3.5.1 in the method of independent variables selection for the regression model, and the software GeoDa to generate autocorrelation analysis and spatial modeling. In the years of 2010 to 2017 there were registered 522 cases of CS. It was identified a historical ascendant series on the percentual cases of CS until 2013. In 2014, 2015, 2016 and 2017 there were a decrease in the cases. In relation to the socioeconomic and clinical characteristics from the mothers of children diagnosed with CS, the average age was 23 years, 92% considered themselves brown, 75.7% were housewife and 44.1% possessed education between 5 and 8 degree series incomplete. About the prenatal, 94.6% from the women were followed during pregnancy, but, only 46.9% has received diagnostic of syphilis in the same period. In the percentual of confirmatory tests performed, 78% from the women did not perform the treponemal test. More than a half (55.6%) received inappropriate treatment for the syphilis, as well as, 66.1% from the partners did no do the treatment at the same time with the pregnant women. It was verified a statistical significance with the time series: “Education”, “diagnosis of maternal syphilis”, “treatment regimen” and “partner (s) treated concomitantly with the pregnant woman”. It was observed as well, what disrespect the clinical features from the mothers with children that have CS and the prenatal, statistical significance with the "diagnosis of maternal syphilis" and "treatment regimen". Analyzing the spatial distribution of the incidence rate of CS, it was identified that the counties of Massape e Forquilha presented the highest rates. The Global Index Moran got it a positive spatial Association (I=0.22). Built it the maps of Lisa and Moran. The counties of Senador Sa, Alcantaras, Reriutaba, Sobral e Hidrolandia presented statistically significant spatial dependence with the incidence rate of SC. Regarding the regression model, the autoregressive spatial coefficient was significant (CS incidence rate), as like the variables " Rate of illiteracy from people over 15 years", “Diagnosis of maternal syphilis during prenatal care”, “Untreated treatment schedule” and “Estimated annual ESF population coverage average”, being this variables distributed spatially. The information’s are favorable in the planning and monitoring of the grievance under study, with the goal to improve the epidemiological picture of CS, once it is a health care public problem yet.