Temporal trend of congenital syphilis in the most populous municipality of metropolitan region II of Rio de Janeiro state

Morais, Lidiane Santos de; Pimentel, Sandra Vitoria Thuler; Kawa, Helia; Fonseca, Sandra Costa

doi:10.1590/1984-0462/2023/41/2021337

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021337 copy

Temporal trend of congenital syphilis in the most populous municipality of metropolitan region II of Rio de Janeiro state

Tendência da sífilis congênita no município mais populoso da região metropolitana II do estado do Rio de Janeiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study aimed to explore the temporal trend in congenital syphilis, according to sociodemographic and prenatal care in the city of São Gonçalo – Rio de Janeiro, from 2007 to 2018.

Methods:

Ecological time series study, with data from SINAN (Information System for Notifiable Diseases) and SINASC (Information System on Live Births databases). We calculated annual incidence (per 1,000 live births) according to sociodemographic and prenatal variables. For the same variables, we calculated trends by logarithmic regression (Joinpoint Regression), estimating the annual percentage change.

Results:

A total of 2,420 cases were reported from 2007 to 2018, with an increasing trend: 64.9% per year (2010–2013) and 24.9% (2013–2018). In 2018, the highest rates were in adolescents (90.6/1,000 live births), black women (87.6/1,000 live births), low-educated women (122.8/1,000 live births), and those without prenatal care (677.4/1,000 live births). The annual percentage change of these categories was, respectively, 37.3% (2010–2018), 33.5% (2012–2018), 39.9% (2014–2018), and 85.0% (2011–2015), but all categories showed a crescent trend.

Conclusions:

We identified high congenital syphilis incidences and crescent trends, especially in more vulnerable groups, pointing to social and healthcare inequalities. Prenatal care needs to be more comprehensive and qualified, primarily for young, low-educated, and black women.

Keywords:
Syphilis; congenital; Health information systems; Time series studies; Healthcare disparities

	2007–2009	2010–2012	2013–2015	2016–2018
Live births	34,449	34,791	36,251	33,649
Age range (years)
10–19	18.7	18.5	18.1	16.5
20–34	71.4	70.7	69.7	69.5
≥35	9.9	10.7	12.2	14.1
Education (years of study)
0–3	5.3	3.8	2.9	1.9
4–7	24.9	21.3	17.7	16.2
8–11	47.3	56.5	65.4	64.6
≥12	24.9	19.7	15.1	18.1
Skin color
Caucasian	48.9	47.4	38.4	33.2
Black	2.7	4.4	6.6	4.5
Yellow skin	<0.1	0.1	0.1	0.1
Brown skin	47.7	47.1	53.8	61.3
Indigenous	<0.1	<0.1	<0.1	<0.1
Prenatal (consultations)
Did not	1.4	1.7	1.1	0.7
1–3	4.7	4.6	5.1	5.9
4–6	21.2	19.8	25.2	26.0
≥7	72.1	72.7	66.6	66.9

	Field classification	Ignored or empty (%)	Quality
Maternal variables
Age	Mandatory	1	Great
Education	Essential	28.1	Not good
Color/race	Essential	5.7	Good
Occupation	No mandatory	22.6	Not good
Prenatal	Mandatory	6.3	Good
Maternal diagnosis	Mandatory	2.4	Great
Maternal treatment	Mandatory	17.5	Regular
Partner treatment	Essential	17.5	Regular
Maternal VDRL on admission	Mandatory	4.2	Great
Final diagnosis	Mandatory	0	Great
Evolution	Mandatory	1.1	Great
NB variables
NB’s VDRL	Mandatory	1.8	Great
Quantitative VDRL	Mandatory	22.3	Not good
VDRL in liquor	Essential	2.5	Great
Quantitative VDRL in liquor	Mandatory	99	Bad
Changes in liquor	Mandatory	4.2	Great
Long bone x-ray changes	Mandatory	23.2	Not good
Child treatment	Mandatory	2.4	Great
Clinical diagnosis	Mandatory	2.3	Great

	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
Total	6.3	4.4	4	4.1	4.9	9.5	15.4	18.5	27.4	32.3	41.2	41.6
Age range (years)
10–19	9	8.6	8.4	8.2	7.8	19.9	28.8	31.2	49.2	62.9	68.3	90.6
20–34	5.7	3.5	2.9	3.2	4.5	7.2	13.3	16.8	24.8	29.2	39.9	37.5
≥35	5.5	3.3	1.8	2.5	2.4	4	4.6	5.9	10	8.1	13.8	9.7
Education (years of study)*
<8	NA	NA	NA	NA	NA	NA	NA	27	62.5	81.4	86.9	122.8
≥8	NA	NA	NA	NA	NA	NA	NA	10	14.6	14.3	22.9	23.9
Skin color
White	3	2.3	1.4	1.2	2.1	2.8	5.5	3.9	19.8	8.9	15.3	10.4
Black	43.5	42.8	30	48.8	23.1	22.5	25.6	29.9	62.8	91.1	131.9	87.6
Brown skin	4.8	3.2	4.8	5	5.8	12.6	20.7	25.3	27.6	41.5	46.3	51.1
Prenatal care (completion of any number of consultations)
Yes	3.7	2.8	2.8	2.8	4	6.6	10.1	15.1	22.9	29.3	36.2	37.9
No	71	77.9	72.3	49.7	24.4	88.2	160.6	205.9	505.9	414.3	351.9	677.4

	2007	2018	Time course	Annual percentage change (95%CI)	Trend
Total	6.3	41.6	2007–2010	−15.6 (-32.4–5.3)	Stability
			2010–2013	64.9* (5.9–156.7)	Increase
			2013–2018	24.9* (13.2–37.9)	Increase
Age range (years)
10–19	9	90.6	2007–2010	−1.1 (-32.6–45.1)	Stability
10–19	9	90.6	2010–2018	37.3* (26.3–49.3)	Increase
20–34	5.7	37.5	2007–2009	−34.2 (-58.4–4.0)	Stability
			2009–2015	47.9* (33.5–63.9)	Increase
			2015–2018	17.5 (-6.5–47.7)	Stability
≥35	5.5	9.7	2007–2009	−41.5 (-72.4–24.0)	Stability
≥35	5.5	9.7	2009–2018	24.6* (16.3–33.4)	Increase
Skin color
White	3	10.4	2007–2018	23.6* (11.3–37.3)	Increase
Black	43.5	87.6	2007–2012	−14 (-31.9–8.8)	Stability
Black	43.5	87.6	2012–2018	33.5* (11.9–59.4)	Increase
Brown skin	4.8	51.1	2007–2018	31.6* (25–38.5)	Increase
Prenatal care
Yes	3.7	37.9	2007–2010	−7.9 (-19.8–5.7)	Stability
			2010–2015	55.6* (42.6–69.8)	Increase
			2015–2018	18.6* (3.3–36.2)	Increase
No	71.1	677.4	2007–2011	−18.9 (-34.7–22.5)	Stability
			2011–2015	85* (20.9–183)	Increase
			2015–2018	5.6 (-310–61.6)	Stability
Education (years of study) **
<8	27***	122.8	2014–2018	39.9* (9.8–78.3)	Increase
≥8	10***	23.9	2014–2018	24.5* (9.3–41.9)	Increase

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[1] *Corresponding author. E-mail: lidianemorais510@gmail.com (L. S. Morais).