Sífilis materna no estado de Goiás: análise de série histórica de 2007 a 2017

Abstract

BACKGROUND: Maternal syphilis is an important public health problem in Brazil and worldwide, responsible for high rates of intrauterine and postnatal morbidity and mortality. In the last decades there has been an increase in the number of cases in Goiás, which requires epidemiological studies on the behavior of the disease in pregnant women OBJECTIVES: Analyze trends in incidence, clinical and laboratory aspects of maternal syphilis, in the state of Goiás, between 2007 and 2017. METHODS: Time series study, using data from compulsory notification of syphilis during pregnancy, in the state of Goiás, between the years 2007 to 2017. The incidence of maternal syphilis was calculated by dividing the number of reported cases by the population of live births each year, times a thousand live births. The analysis of the average annual percentage variation and the incidence by municipality size were calculated using a linear model with first order autoregressive errors (AR), via Prais Winsten's transformation, in the R software, and for this, the number of inhabitants 2010 CENSUS was considered. The spatial correlation was measured using the Moran Index (I). The clinical and sociodemographic variables were analyzed descriptively. The Cochran-Armitage test was used to verify trends in proportions. RESULTS: Between 2007 and 2017, 7,774 cases of maternal syphilis were recorded in Goiás. The age of pregnant women with syphilis varied between 12 and 49 years, with an average of 24.8 years (SD 6.5). The incidence was higher in the second trimester of pregnancy, in those with a lower level of education and brown skin, and the most frequent clinical form was the primary. The annual incidence rate of syphilis during pregnancy ranged between 2.9 and 15.6 cases per thousand live births, with an average annual growth of 1.21 cases per year from 2007 to 2017 (95% CI: 0.78-1, 65). The annual percentage change (APC) increased by 17.8% (95% CI: 16.9-18.8) in the period studied, with a statistically significant spatial correlation (p = 0.0035). The size of the municipality was not significant to explain the variation in incidence. Between 2007 and 2017, there was an increasing trend in the percentage of reports of latent syphilis (14.1% to 30.7%), secondary (5.2% to 19.0%) and tertiary (4.4% to 11, 4%) and treatment with benzathine penicillin at a dose of 7.2 million (19.3% to 59.6%). A decreasing trend was observed in the percentages of data without information (from 10.0% in 2007 to 8.8% in 2017) or ignored (from 22.9% in 2007 to 8.0% in 2017). CONCLUSION: There was a linear increase in the incidence of syphilis during pregnancy in Goiás in recent years, with a statistically significant spatial correlation, however, the size of the municipality was not significant to explain the variation in incidence. The increase in reports of latent syphilis and the use of penicillin in the appropriate dose for this classification, associated with the reduction of ignored or unfilled data, suggest an improvement in the notification process.