Abstract
INTRODUCTION: The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. The spatial approach to diseases with social indicators improves knowledge of health situations. Herein, we aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. METHODS: This is an ecological study with data from different health information systems. After data procedure linkage, we analyzed the Bayesian incidences of triennial infections during specific periods. We performed SATSCAN screenings to identify spatiotemporal clusters. Further, we verified the differences between the clusters and indicators using Pearson’s chi-square test. RESULTS: The variations in PS incidence were 0.9-20.5/1,000 live births (LB), 0.6-46.3/1,000 LB, and 2.1-23.2/1,000 LB in the first, second, and last triennium, respectively; for CS, the variations were 0-7.1/1,000 LB, 0-7.5/1,000 LB, and 0.3-10.8/1,000 LB in the first, second, and last triennium, respectively. Three clusters each 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). The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of LB mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling. CONCLUSIONS: The increase in the spatiotemporal evolution of PS and CS incidences and the extension of areas with persistent infections indicate the need for monitoring, especially of priority areas in the state.
Highlights
The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil
The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of live births (LB) mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling
There was a progressive increase in the incidence of PS in most municipalities of Mato Grosso
Summary
The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. We aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. Syphilis is a sexually transmitted disease caused by Treponema pallidum[1,2] that has been prevalent for several centuries, and its incidence in several countries has increased in recent years[3]. In 2012, an estimated 900,000 cases of syphilis among pregnant women (PS) were reported globally, and resulted in more than. An epidemic alert for congenital syphilis (CS) was issued in Brazil in 20164, when estimates indicated approximately 18,000 cases in the previous year[5]. The incidence of CS exceeded the acceptable level (0.5 per 1,000 LB) at which mother-to-child transmission of syphilis can be certifiably eliminated[3]
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