Sífilis em gestantes de um município prioritário para eliminação da transmissão vertical no Brasil: prevalência, fatores associados e análise espacial

Abstract

The aim of this study was to estimate the prevalence and factors associated with Syphilis in pregnancy in women attended at primary health care units in a priority municipality in Brazil, with an emphasis on spatial analysis of social vulnerability factors associated with the outcome. This is a cross-sectional study, carried out between July and December 2018, with data obtained from interviews using a structured questionnaire, the pregnant woman's booklet and medical records. The 399 postpartum women were eligible from admission for hospitalization for childbirth or curettage, when in physical and emotional conditions to respond to the interview, also having as a prerequisite to be in possession of the pregnant woman's booklet. The dependent variable was the diagnosis of syphilis during the prenatal period and the independent variables were grouped into blocks: sociodemographic, behavioral, obstetric and prenatal health care. Univariate and multivariate logistic regression was used to identify predictors of gestational syphilis. Spatial analyses of pregnant women were performed to assess possible clusters of positivity for syphilis and its correspondence with indicators of social vulnerability. From the final multivariate logistic regression analysis, the following factors associated with gestational syphilis were identified: not having a partner (OR 5.34; 95% CI 1,75-16,35), sexual intercourse up to 15 years (OR 3.50; 95% CI 1,25-9,79), partner's history of syphilis (OR 7.41; 95% CI 1,82-30,23), pregnant women’s history of syphilis (OR 9.47; 95% CI 1,07-83,50), use of condoms during pregnancy in less than half of the sexual intercourse, (OR 4.50; 95% CI 0,80-25,37), partner’s use of illicit drugs (OR 3.59; 95% CI 1,10-11,74 for marijuana and others, and OR 14.52; 95% CI4,18-50,49 for crack and cocaine), and having attended prenatal care at a Basic Health Unit with a Family Health Strategy model (OR 4.42; 95% CI0,99-19,74). The spatial analyses indicated two clusters of positivity for gestational syphilis in places of higher social vulnerability. There was a high prevalence of Syphilis in pregnancy associated with individual characteristics of both the pregnant women and their partners, as well as the socioeconomic context, the type of prenatal service and the spatial location of the individuals. Therefore, it is necessary to plan and restructure existing programs, with actions aimed at identified populations with greater social vulnerability.