Sífilis em gestante e sífilis congênita em Mato Grosso : avaliação da qualidade das informações e análise espaço-temporal de casos, de 2008 a 2016

Abstract

The syphilis presents a serious Public Health problem in Brazil. In Mato Grosso (MT), detection rates of pregnant syphilis (PS) and incidence of congenital syphilis (CS) in 2016 increased by 157% and 208%, respectively, compared to 2008. The spatial approach allows identifying differentials in the pattern of disease presentation, contributing to the planning and execution of specific strategic actions, essential in situation epidemic. This study aimed: to evaluate the quality of PS and CS information in Information System on Diseases of Compulsory Declaration (Sinan) MT; to verify the spatiotemporal distribution of PS and CS rates in MT municipalities and analyzing the relationship with social determinants of health; to identify spatiotemporal clusters of CS and PS and to analyze the differences in the epidemiological cases profile in relation to their formation. A descriptive study of incompleteness, duplicity and inconsistency of information was performed after data linkage and time series of incompleteness, with Prais-Winsten Regression, 2008-2016 (article 1); and another, mixed (ecological and cross-sectional) with PS and CS data from different health information systems. Bayesian infection rates by triennium and period (2008-2010; 2011-2013; 2014-2016; 2008-2016) were calculated and correlated with sociodemographic indicators with Pearson’s correlation and Spearman’s correlation. SATSCAN scans for identification of spatiotemporal clusters were performed and the differences in the epidemiological profile of the cases in relation to their formation were analyzed using Pearson's x2 test (article 2). We found 7.6% of duplicity, 50% of the notification fields with bad average annual incompleteness, and 75% of excellent inconsistency ratios for PS; and 4.9% of duplicate notifications, 57.1% of fields with bad incompleteness and 83.3% of inconsistent relationships, excellent for CS. There was a progressive increase in the rates of PS and CS in most municipalities. Rates of PS and CS ranged from 0.9- 20.5/1,000NV, 0.6-46.3/1,000NV, 2.1-23,2/1,000NV; and zero-7.1/1,000NV, zero- 7.5/1,000NV, and 0.3-10.8/1,000NV in the first, second and last triennium, respectively. Statistically significant clusters were identified for PS (RR=2.02; RR=0.30; RR=21.45, p<0.0001) and CS (RR=3.55; RR=0.10; RR=0.26, p<0.0001). Clusters with higher occurrence of PS and CS were overlapped. Bayesian CS incidence rates showed a negative weak correlation between Gini Index (r = - 0.23; p=0.007), average proportion of pregnant women with less than 8 years of schooling (r = - 0.37; p=0.000) and average proportion of adolescent pregnant women (r = - 0.22; p=0.008), and positive weak correlation between unemployment rate of population 18 years of age and older (r = 0.28; p=0.001) and average proportion of live births of non-white race (r= 0.19; p=0.024). There was no statistically significant correlation between Bayesian PS detection rates and sociodemographic determinants. The high-risk cluster for PS and CS was characterized by pregnant women/mothers with high education (p=0.006). For CS, the high-risk cluster consisted of mothers with non-white race/color (p=0.000), high education (p=0.010), nontreponemal test titration at delivery > 1:8 (p=0.024) and have had inadequate or unmet maternal treatment regimen (p=0.000). The incompleteness of PS and CS information is still large in MT. Training and encouragement to fill out notifications about PS and CS to the primary care and hospital health teams is needed, as well as the improvement of mechanisms to track and continuum evaluate the quality of the information produced. The increasing spatiotemporal evolution by rates of PS and CS besides on the persistence of areas with higher occurrences for these infections, the underreporting and unexpected find out in relation to sociodemographic determinants demonstrate the requirements for ostensive monitoring of these infections and to guarantee quality prenatal care in the State, in order to avoid the vertical transmission of syphilis.