Notifica??es de s?filis gestacional e cong?nita: uma an?lise epidemiol?gica

Autor: Oliveira, Samara Isabela Maia de
Jazyk: portugalština
Rok vydání: 2016
Předmět:
Zdroj: Repositório Institucional da UFRNUniversidade Federal do Rio Grande do NorteUFRN.
Druh dokumentu: masterThesis
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A s?filis ? uma doen?a infecciosa que permanece como um dos principais agravos de notifica??o a ser enfrentado em ?mbito global. No contexto materno-infantil relaciona-se a efeitos delet?rios a partir da transmiss?o vertical e exp?e o bin?mio m?e e filho a riscos como o aborto e a morte perinatal. Desse modo, a??es efetivas para o controle da doen?a devem ser realizadas no pr?-natal, em momento oportuno, para garantir a preven??o da forma cong?nita da doen?a. Neste sentido, esta pesquisa objetiva analisar as notifica??es de s?filis gestacional e cong?nita e os fatores relacionados ? transmiss?o vertical. Trata-se de uma pesquisa de abordagem quantitativa epidemiol?gica, tipo seccional, de dados secund?rios, realizado no ano de 2016. A amostra foi composta a partir dos crit?rios de elegibilidade e totalizou 129 notifica??es de s?filis em gestantes e 132 notifica??es para s?filis cong?nita no per?odo entre junho de 2011 e dezembro de 2015, no Munic?pio de Natal/RN. A coleta de dados ocorreu entre os meses de maio a agosto por meio do banco do Sistema de Informa??o de Agravos de Notifica??o. Os dados foram analisados pela estat?stica descritiva e inferencial. Os testes Qui-Quadrado, T-Student e Fisher foram utilizados para verificar as associa??es entre as vari?veis de interesse. A pesquisa recebeu parecer favor?vel pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, sob o n?mero 1.449.134 e Certificado de Apresenta??o para Aprecia??o ?tica 53305315.3.0000.5537. No per?odo investigado foi observado um incremento de casos notificados no ano de 2012. O perfil materno registrado aponta mulheres com idade m?dia de 24,78 anos, pardas (70,5%), residentes na zona urbana (95,3%) do Munic?pio de Natal. A an?lise do pr?-natal identificou predom?nio do diagn?stico materno no terceiro trimestre gestacional (69%) e presen?a de testes n?o trepon?micos reagentes em 94,6% das mulheres no momento do parto. No tocante ao tratamento materno, apenas 1,6% destas mulheres foram registradas com esquema de tratamento adequado e 16,3% dos parceiros foram tratados concomitantemente ?s gestantes. Nos desfechos relativos ?s crian?as, 78,8% foram registradas como assintom?ticas, contudo, essa vari?vel apresentou signific?ncia estat?stica quando relacionada ? titula??o do teste n?o trepon?mico materno e ? realiza??o de tratamento antes do parto. Na an?lise espacial por georreferenciamento, foi identificado o predom?nio de casos nos bairros Quintas e Felipe Camar?o, ambos assistidos pelo Distrito Sanit?rio Oeste do munic?pio. Os resultados apontam, al?m disso, para lacunas importantes nos processos de vigil?ncia epidemiol?gica quanto ao preenchimento das notifica??es no que versa a informa??es ignoradas e em branco. A an?lise da notifica??o da s?filis gestacional e cong?nita, possibilitou concluir que a transmiss?o vertical esteve relacionada a perdas de oportunidades diagn?sticas e terap?uticas. A elabora??o de estrat?gias para detec??o precoce e ades?o ao tratamento da doen?a devem ser adotadas, tendo em vista o fortalecimento da assist?ncia e a quebra na cadeia da transmiss?o vertical da s?filis. Ressalta-se a necessidade de qualifica??o profissional para notifica??o da doen?a e amplia??o no fornecimento de informa??es ? vigil?ncia epidemiol?gica, a fim de possibilitar a continuidade da an?lise ao agravo.
Syphilis is an infectious disease that remains as one of the major reporting aggravations to be addressed globally. In the maternal-infant context it is related to deleterious effects from the vertical transmission and exposes the mother-child binomial to risks such as abortion and perinatal death. Thus, effective actions to control the disease must be performed in prenatal care, in a timely manner, to ensure the prevention of the congenital form of the disease. In this sense, this research aims to analyze the reports of gestational and congenital syphilis and the factors related to vertical transmission. This is a cross-sectional, epidemiological, epidemiological approach to secondary data, conducted in 2016. The sample was composed of eligibility criteria and totaled 129 reports of syphilis in pregnant women and 132 reports for congenital syphilis in the period Between June 2011 and December 2015, in the Municipality of Natal / RN. Data collection occurred between May and August through the Database of the Notification of Injury Information System. Data were analyzed by descriptive and inferential statistics. The Chi-square, T-Student, and Fisher tests were used to verify the associations between the variables of interest. The research received a favorable opinion by the Ethics Committee of the Federal University of Rio Grande do Norte under number 1,449,134 and Certificate of Presentation for Ethical Appraisal 53305315.3.0000.5537. In the period under investigation, there was an increase in reported cases in the year 2012. The registered maternal profile indicates women with a mean age of 24.78 years, browns (70.5%), living in the urban area (95.3%) of the Municipality from Natal. The prenatal analysis identified a predominance of maternal diagnosis in the third gestational trimester (69%) and presence of non-treponemal reactive tests in 94.6% of the women at the time of delivery. Regarding maternal treatment, only 1.6% of these women were registered with an adequate treatment regimen and 16.3% of the partners were treated concomitantly with the pregnant women. In the outcomes related to the children, 78.8% were registered as asymptomatic, however, this variable presented statistical significance when related to the titration of the non-treponemal maternal test and to the pre-delivery treatment. In the spatial analysis by geo - referencing, the predominance of cases in Quintas and Felipe Camar?o neighborhoods, both assisted by the Sanitary District West of the municipality, was identified. The results point, moreover, to important gaps in the epidemiological surveillance processes regarding the filling of notifications regarding unknown and blank information. The analysis of the notification of gestational and congenital syphilis made it possible to conclude that vertical transmission was related to loss of diagnostic and therapeutic opportunities. The development of strategies for early detection and adherence to treatment of the disease should be adopted, with a view to strengthening care and breaking down the vertical syphilis transmission chain. The need for professional qualification for notification of the disease and extension in the provision of information to epidemiological surveillance is emphasized, in order to allow the continuity of the analysis to the disease.
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