Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit

ABSTRACT Objective To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. Methods This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman’s booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. Results The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). Conclusion Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men’s Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

摘要
目的 估算在公立妇产医院就诊并于基层医疗卫生机构接受产前保健的女性群体中，梅毒的患病率及其相关影响因素。
方法 本项横断面研究（cross-sectional study）共纳入399名产后妇女。通过访谈及提取孕妇手册、病历与纸质检验报告中的相关数据完成资料收集。以妊娠期梅毒（gestational syphilis）诊断作为因变量，将自变量划分为社会人口学、行为特征、生殖健康及产前保健四大组别。计算患病率、患病率比及95%置信区间（95%CI），同时开展卡方检验（χ² test，p≤0.05），并采用泊松回归模型（Poisson regression models）进行多因素分析。
结果 妊娠期梅毒患病率为9.61%（95%CI：7.14~12.83）。本研究明确了以下校正后患病率比对应的相关影响因素：性传播感染（sexually transmitted infections）病史（2.3）、首次性交年龄≤15岁（2.42）、伴侣有梅毒病史（5.98）、伴侣吸食快克/可卡因（6.42）及大麻等其他毒品（3.02）、无伴侣（3.07）、低收入（2.85）、死胎（stillbirth）病史（5.21）、妊娠晚期（third trimester）才启动产前保健（3.15），以及在未配备家庭健康策略（Family Health Strategy）团队的基层医疗卫生机构接受产前保健（0.35）。
结论 个体特征与产前保健相关因素均与妊娠期梅毒存在关联。为控制先天性梅毒，需开展针对性干预措施以管控成人人群梅毒流行：扩大优质产前保健服务覆盖范围，识别梅毒感染风险并衔接预防与治疗举措；推行以早期性教育为核心的干预策略；建立有效的双方参与式产前保健模式；以及切实落实《国家男性健康综合关怀政策》（PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens）。