Fetal mortality from congenital syphilis in Brazil, 2002 to 2017

Fetal mortality from congenital syphilis in Brazil, 2002 to 2017

Lays Janaina Prazeres Marques (1,2), Zilda Pereira da Silva (2), Gizelton Pereira de Alencar (2) Marcia Furquim de Almeida (2).

(1) PhD student in Public Health, (2) Dept. Epidemiology, University of Sao Paulo (USP)

1) Background:
The Mortality Information System (MIS) register all deaths, including fetal deaths occurring from the 22 or more weeks of gestation in Brazil. There has been a trend of decline in fetal mortality in the country. Although the diagnosis and treatment of syphilis and HIV in prenatal care is routine, there has been an increase in cases of Congenital Syphilis (CS). The goal of this study was to analyze the trend of the mortality rate by congenital syphilis in fetal deaths between 2002 and 2017 in Brazil.

2) Methods:
It was calculated the Fetal Mortality Rate (FMR) for congenital syphilis (A50) as the basic cause of death per thousand births. The temporal trend was assessed by gestational age (<37 and ≥37 weeks) using the exponential regression analysis in Excel®.

3) Results:
In the period from 2002 to 2017, there was an increase in the absolute number and the FMR by CS of 70 (0.02 deaths per thousand birth) to 509 (0.17), indicating a significant growth of 16% per year. The deaths by CS (90%) were concentrated in the gestation group with <37 weeks. Although adequate prenatal coverage in the country has grown 2.6% per year, reaching 67% of live births in 2016 with 7 or more visits, CS mortality has increased.

4) Conclusion:
The data showed a large increase of CS deaths. The increased access to prenatal care was insufficient to prevent CS deaths. The prenatal routine is to perform at least two tests for syphilis infection and when confirmed positive the treatment should also be offered to pregnant women and their sexual partners the results can be related to failures in diagnosis or treatment of pregnant women. The monitoring and evaluation of all pregnant women diagnosed are important strategies that can support the elimination of CS.

Ethics statement
The study does not require the approval of the Committee on Ethics in Research with Human Beings because it is a public information obtained through the computerized department of the Brazilian National Health System (DATASUS) at the electronic address http://datasus.saude.gov.br/

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