CHILDCARE AND FOLLOW-UP OF CHILDREN EXPOSED TO SYPHILIS OR NOTIFIED WITH CONGENITAL SYPHILIS

Oliveira, Fábio Alves; Araújo, Maria Alix Leite; Barros, Valéria Lima de; Guanabara, Marilene Alves Oliveira; Vasconcelos, Léa Dias Pimentel Gomes; Sena, Maria Vilani de Matos

doi:10.1590/1980-265X-TCE-2022-0318en

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Original Article • Texto contexto - enferm. 32 • 2023 • https://doi.org/10.1590/1980-265X-TCE-2022-0318en copy

CHILDCARE AND FOLLOW-UP OF CHILDREN EXPOSED TO SYPHILIS OR NOTIFIED WITH CONGENITAL SYPHILIS

PUERICULTURA Y SEGUIMIENTO DE NIÑOS EXPUESTOS A SÍFILIS O NOTIFICADOS CON SÍFILIS CONGÊNITA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to analyze childcare and follow-up of children exposed to or notified with congenital syphilis in Primary Health Care.

Method:

a descriptive study carried out in Fortaleza, Ceará, whose population was made up of children exposed to syphilis or notified with congenital syphilis in 2017 and 2018. The data were collected from notification forms and the children's medical records. Sociodemographic variables of the mother and childcare were analyzed. For this purpose, the Statistical Package for the Social Sciences (SPSS), version 22, was used.

Results:

a total of 715 children took part in the study. The mothers' age varied from 14 to 42 years old, 436 (61%) had Complete Elementary School, 276 (38.6%) had a steady or occasional partner, 97 (13.6%) had a paid job and 23 (3.2%) used drugs. A total of 712 (99.6%) attended prenatal care and 134 (18.7%) were treated for syphilis. In relation to the children, 50 (7.0%) attended only one childcare consultation and a considerable loss was observed in follow-up over the months. Ten (1.4%) completed all eight consultations recommended by the Ministry of Health. No child underwent the Venereal Disease Research Laboratory at one, three, six, 12 and 18 months.

Conclusion:

childcare and follow-up of children exposed to syphilis or notified with congenital syphilis do not meet the guidelines recommended by the Ministry of Health. There is a significant follow-up loss among the children.

DESCRIPTORS:
Syphilis; Congenital Syphilis; Disease notification; Childcare; Primary Health Care

NB*	Mother treated	Gestational age ≥ 37 weeks	Birth weight	Underwent VDRL^† at 1 month	VDRL^† result at 1 month	Underwent VDRL^† at 3, 6, 12, 18 months	Presented CS^‡ signs and symptoms	Consultation in outpatient clinic of reference service	Underwent Long Bone Radiog.^§	Ophthalmological evaluation	CSF evaluation	Received a visit from the FHS^\|\|
1	Yes	No	2,570	Yes	Unknown	No	Yes	Yes	Yes	No	No	Yes
2	Yes	No	3,440	No	-	No	No	No	No	No	No	No
3	Yes	No	3,040	No	-	No	Yes	Yes	No	No	No	Yes
4	No	No	3,205	No	-	No	Yes	Yes	No	No	No	Yes
5	No	No	3,310	No	-	No	No	Yes	No	No	No	Yes
6	No	No	3,595	No	-	No	Yes	Yes	No	No	No	Yes
7	No	No	3,940	Yes	Reactive	No	Yes	No	Yes	Yes	No	Yes
8	No	No	4,010	No	-	No	Yes	No	No	No	No	No
9	No	No	3,940	No	-	No	No	No	No	No	No	No
10	No	No	4,010	No	-	No	No	No	No	No	No	No
11	No	No	3,010	No	-	No	No	No	No	No	No	Yes
12	No	No	4,330	No	-	No	Yes	Yes	Yes	Yes	No	Yes
13	No	No	3,855	No	-	No	Yes	No	No	No	No	No

NB*	GA^†	Weight	Mother treated	No. of childcare appointments	Age at consultations (months old)	Number of VDRLs^‡ performed	Age (in months old) when the VDRL^‡ was performed	Consultation in outpatient clinic of reference service	Underwent Long Bone Radiography	Attended a consultation with a specialist^§	CSF evaluation	Visit from the FHS^\|\|
01	35	2,175	Yes	3	<1, 4, 29	None	-----	No	No	No	No	No
02	36	2,420	No	5	1, 2, 3, 4, 5	None	-----	No	No	No	No	No
03	37	1,040	No	4	1, 2, 3, 4	None	-----	No	No	No	No	No
04	37	1,100	No	1	8	None	-----	No	No	No	No	No
05	37	1,190	No	1	4	None	-----	No	No	No	No	No
06	37	2,040	No	6	1, 2, 3, 6, 8, 12	None	-----	No	No	No	No	No
07	37	2,400	No	6	1, 2, 3, 4, 6.7	None	-----	No	No	No	Yes	No
08	37	2,170	Yes	2	2.9	None	-----	Yes	No	No	No	No
09	37	2,120	No	3	4, 5, 6	None	-----	No	No	No	No	No
10	37	2,419	No	6	1, 3, 4, 5, 6	2	6 and 12	No	No	No	No	No
11	37	2,450	No	5	1, 2, 4, 5, 6	None	-----	No	No	No	No	No
12	37	2,500	No	2	1, 2	None	-----	No	No	No	No	Yes

Variables	The child attended childcare follow-up in PHC*
Variables	n	%
Mother's age (years old)
≤18	33	4.6
19-29	634	88.7
≥30	48	6.7
Schooling
Incomplete/Complete Elementary School	436	61.0
Incomplete/Complete High School/Higher Education	279	39.0
Marital status
With a partner	276	38.6
Without a partner	439	61.4
Performs some paid activity
Yes	97	13.6
No	618	86.4
Use of illicit drugs
Yes	23	3.2
No	692	96.8
Number of miscarriages (n=61)
1	52	85.2
≥1	9	14.8
Attended prenatal care
Yes	712	99.6
No	03	0.4
No.^† of prenatal consultations (n=712)
<6	128	18.0
≥6	584	82.0
Underwent 1^st VDRL^‡ in prenatal care
Yes	210	29.4
No	505	70.6
1^st VDRL^‡ result (n=210)
Reactive	111	52.9
Non-reactive	99	47.1
Titration of the 1^st VDRL^‡ (n=97)
≤1:8	61	62.9
>1:8	36	37.1
Underwent a 2^nd VDRL^‡ in prenatal care
Yes	166	23.2
No	549	76.8
Mother adequately treated^§
Yes	134	18.7
No	581	81.3

Variables	The child attended childcare and follow-up in PHC*
Variables	n	%
Number of childcare consultations
1	50	7.0
2	134	18.7
3	135	18.9
4	194	27.1
5	99	13.8
6	64	9.0
7	26	3.6
8	10	1.4
>8	3	0.5
Month of life when VDRL^† was performed
First	9	1.3
Third	2	0.3
Sixth	3	0.4
Did not undergo any VDRL^†	701	98.0
Follow-up locus
Only in PHC*	648	90.6
In PHC* and in outpatient clinics of reference services	67	9.4
Received a visit from the FHS^‡ team
Yes	130	18.2
No	585	81.8
Prematurity
Yes	118	16.5
No	597	83.5
Low birth weight (n=710)
Yes	38	5.4
No	672	94.0
Other clinical manifestations suggestive of congenital syphilis^§
Yes	223	31.2
No	492	68.8

Variables	The child attended childcare and follow-up in PHC*
	Presence of clinical manifestations at birth (n=223)		Prematurity (n=17)		Low weight (n=36)
	n	%	n	%	n	%
Mother's age
≤18	14	6.3	-	-	04	11.1
19-29	199	89.2	17	100.0	31	86.1
≥30	10	4.5	-	-	01	2.8
Mother's schooling level
Inc./Com. El. Sc.^†	137	61.4	09	52.9	24	66.7
Inc./Com. Hi. Sc./Hi. Ed.^‡	86	38.6	08	47.1	12	33.3
Mother attended prenatal care
Yes	223	100.0	16	94.1	36	100.0
No	-	-	1	5.9	00	00
No.^§ of prenatal consultations
<6	88	39.5	04	23.5	08	22.2
≥6	135	60.5	12	70.6	28	65.8
Unknown	-	-	01	5.9	-	-
Mother treated adequately
Yes	43	19.3	01	5.9	10	27.8
No	180	80.7	16	94.1	26	72.2
Number of childcare consultations
<8	215	96.4	17	100	<8	215
≥8	8	3.6	-	-	-	-
Child monitored in outpatient clinic of reference services
Yes	32	14.3	01	5.9	4	11.1
No	191	85.7	16	94.1	32	88.9
Age at child's appointment (months old)
1-3	174	78.0	07	41.2	4	11.1
>3	49	22.0	07	41.2	28	77.8
Unknown	-	-	03	17.6	4	11.1
Month of life when the VDRL^\|\| was performed
1	7	3.1	-	-	-	-
3	1	0.4	-	-	-	-
Did not undergo VDRL^\|\|	215	96.5	117	99.2	36	100
The child underwent
Ophthalmological evaluation	13	5.8	1	5.9	1	2.8
Hearing evaluation	8	3.6	1	5.9	2	5.6
Long Bone Radiography	16	7.2	-	-	-	-
No evaluations	186	83.4	15	88.2	33	91.6
The child presented
Delay in psychomotor development	08	3.6	-	-	3	8.3
Serosanguinous rhinitis	-	-	3	17.6	6	16.7
No alterations	215	96.4	14	82.4	27	75.0
The child received a visit from the FHS^¶ team
Yes	85	38.1	4	23.5	02	5.6
No	138	61.9	13	76.5	34	94.4

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[1] CORRESPONDING AUTHOR Valéria Lima de Barros valeriabarros@ufpi.edu.br