Avaliação das ações de controle da transmissão de mãe para filho da sífilis na assistência pré-natal, na Atenção Primária à Saúde, no município de Juiz de Fora- MG

Abstract

The aim of this study was to evaluate the implementation of actions to prevent mother-to-child transmission of syphilis in prenatal care, in Primary Health Care in the municipality of Juiz de Fora – Minas Gerais, with a view to improving the program. Initially, an evaluability study was carried out and then an implementation evaluation as part of a collaborative evaluative research. A cross-sectional study was carried out in 2018 and 2019. The degree of implementation was estimated through structured interviews with women who underwent prenatal care in Primary Health Care (399), semi-structured interviews with women diagnosed with syphilis (32) , interviews with supervisors of the Basic Health Units (60), a checklist in the Basic Health Units (58) and research of secondary data. Two levels of analysis were taken into account: women and territory. To assess the degree of implementation, Ministry of Health regulations, parameters, relevance and judgment matrices and descriptive statistics were used. Points were assigned to the selected variables, the sum of which classified the degree of implementation of congenital syphilis control actions in the municipality of Juiz de Fora as: acceptable, unsatisfactory and critical. To analyze the interaction of the implementation with the outcome of gestational syphilis and with the intervention environment: external context (individual and social vulnerabilities of women, and social vulnerability in the territory of Basic Health Units), organization of services (adherence of teams to the third party cycle of the National Program for Improvement of Access and Quality of Primary Care) and use of prenatal services (early access and minimum of six consultations), descriptive statistics and bivariate analyzes were used. Thematic content analysis of the semi-structured interviews complemented the assessments of the degree of implementation and the interaction of the implementation with the intervention environment and the outcome of gestational syphilis. The third stage included the analysis of facilitating factors and barriers to implementation. The main results were that the SC prevention program has an “unsatisfactory” degree of implementation with regard to the set of its components. We can say that prenatal care in Primary Health Care in the city of Juiz de Fora is inadequate in its most basic components advocated by the Humanization Program in Prenatal and Birth and Previne Brazil Program, related to early initiation and / or realization minimum of six consultations. This data may partially explain the persistence of unfavorable perinatal results. We reaffirm the findings of other studies that are women with higher education, higher per capita income, with a partner, aged 25 years or more, without risk behaviors for Sexually Transmitted Infections, those who had greater implementation of the control actions of congenital syphilis. This reveals inequities in the use of prenatal services and in actions to control congenital syphilis.