Sífilis congênita como marcadora da qualidade da assistência pré-natal na atenção primária à saúde da região Oeste Mato-Grossense (2012-2018)

Abstract

INTRODUCTION: According to 2016 data from the World Health Organization, approximately one million pregnant women were infected with syphilis, with which 661,000 cases resulted in congenital syphilis, and 355,000 cases of congenital syphilis had adverse birth outcomes. Syphilis in pregnancy and congenital syphilis are public health problems, with syphilis in pregnancy resulting from the spread of Treponema pallidum in a pregnant woman and congenital syphilis, as a consequence of a pregnant woman with syphilis not treated or inadequately treated for her fetus, and may or may not present clinical manifestations, abortions, and even fetal death. In Brazil, despite having a maternal and child care network, which has diagnostic tests for syphilis and easily accessible and low-cost treatment, in 2018 26,219 cases of congenital syphilis were reported, in the Midwest Region, 1,469 cases and in the State of Mato Grosso, 204 cases. OBJECTIVE: To analyze the occurrence of congenital syphilis as an expression of the quality of prenatal care in Primary Health Care in the Western Region of Mato Grosso, from 2012 to 2018. METHODS: This is a descriptive-exploratory case study, with a quali-quantitative approach, with primary and secondary data collection, referring to the West Region of Mato Grosso, from 2012 to 2018. In the quantitative approach, the network was characterized by health services, the maternal and child care network, and the epidemiological profile of syphilis in pregnant women and congenital syphilis in the twelve municipalities in the region, using the various information systems (SIM, Sinasc, Sisab, Cnes, and DwWeb). In the qualitative approach, semi-structured online questionnaires were applied to doctors, nurses, and coordinators of the Primary Health Care units in twelve municipalities to describe their practices related to prenatal care for syphilis in pregnant women and congenital syphilis. As inclusion criteria, professionals in the profession/position were considered for a minimum period of six months, so that there was enough time to know the organization and functioning of the services, and these data were categorized according to categorical content analysis. Regarding the ethical aspects, this study is part of the matrix project “Análise de Governança nas Regiões de Saúde do Estado de Mato Grosso e das Redes de Atenção à Saúde instituídas neste estado”, CAAE registration: 57859816.0.0000.554, opinion of the Ethics Committee 1.689 .636, and the project linked to it “Gestão regional: APS e rede de atenção à saúde (RAS) nas regiões do estado de Mato Grosso” (Project financed by FAPEMAT). RESULTS: The results showed the evolution of most of the indicators analyzed in the service network in the region and the maternal and child care network in the period studied, however, despite the evolution in the period, there are still weaknesses in terms of infrastructure, resources human resources and service quality. Regarding syphilis in pregnant women and congenital syphilis, a high rate of detection of syphilis in pregnant women (7.96/1,000 live births) and a high rate of incidence of congenital syphilis (2.58/1,000 live births) was identified. As for the questionnaires applied to Primary Health Care professionals and coordinators, there was a need to reorganize work processes and train these professionals in terms of service flows and prenatal care, prevention, treatment, and monitoring of syphilis. CONCLUSION: The high incidence of congenital syphilis in the region, the weaknesses of the service network and the maternal and child care network, the interviewees' reports, and the result of other indicators allow us to affirm that there are flaws in care and that Congenital syphilis is an expression of the low quality of prenatal care offered in the public health network in this region.