Factors associated with inadequate follow-up of children with congenital syphilis

Abstract

OBJECTIVE To analyze factors associated with outpatient follow-up of children with congenital syphilis.METHODS A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson’s chi-square and Fisher’s exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression.RESULTS The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones.CONCLUSIONS Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.

Avaliação epidemiológica da sífilis congênita na região Nordeste do Brasil

“…Os fatores sociodemográficos são marcantes nessa sendo necessário conhecer esses aspectos e como podem afetar, no qual segundo Cavalcante et al, (2019), uma baixa condição socioeconômica pode dificultar o comparecimento das crianças aos postos de saúde, inferindo que filhos de mães solteiras retornam menos ao serviço de saúde, correlacionando ao fato de serem as responsáveis pelo lar, apresentando maior objeção para se ausentar do trabalho, além disso há também a falta de renda.…”

Treatment administered to newborns with congenital syphilis during a penicillin shortage in 2015, Fortaleza, Brazil

“…Although the majority of newborns reported with CS were born without obvious clinical signs, it is possible that they may present early and/or late manifestations of CS if the treatment given was inadequate [ 16 – 19 ]. There is ongoing concern related to the follow-up of newborns reported with CS in Brazil during the period of 2014–2016 who received other treatment regimens for which clinical efficacy data are not available.…”

Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance

“…Qualified health care personnel in the Primary Health Care service is essential to the optimal management of congenital syphilis cases. Children exposed to maternal syphilis, but not considered active cases, should be linked to the primary care, in order to avoid missing diagnostic opportunities, treatment and underreporting of congenital syphilis cases detected after discharge from the maternity ward 28 , 29 .…”