Rodrigues Celeste Souza, Guimarães Mark Drew Crosland, César Cibele Comini
Gerência de Vigilância em Saúde e Informação, Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2008 Oct;42(5):851-8. doi: 10.1590/s0034-89102008000500010.
To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections.
Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression.
The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation.
High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.
评估有机会接受产前护理的孕妇中先天性梅毒和艾滋病预防错失机会的发生率，并评估与这些感染未检测相关的因素。
这是一项横断面研究，随机选取了1999年至2000年期间在巴西妇产医院住院分娩或刮宫且至少接受过一次产前护理的2145名产妇作为样本。孕期未进行梅毒和/或艾滋病检测是预防错失机会的标志。将未进行任何一项或两项检测的女性与孕期至少进行过一次梅毒和一次艾滋病检测的女性（参照组）进行比较。对每一类别的预防错失机会发生率进行估计，并给出95%置信区间。通过多项逻辑回归评估与预防错失机会独立相关的因素。
梅毒或艾滋病预防错失机会的发生率分别为41.2%和56.0%。多变量分析显示，种族/肤色（非白人）、受教育程度（<8年）、婚姻状况（单身）、收入（<3个每月最低工资）、孕期有性行为、本次怀孕前有梅毒病史、产前护理次数（<6次）以及妊娠晚期前的最后一次产前检查与预防错失机会风险增加相关。婚姻状况（单身）、产前护理地点（医院）与妊娠晚期首次产前检查与预防错失机会呈负相关。
未检测女性比例高表明艾滋病感染和先天性梅毒的预防和控制措施存在不足。孕妇过早停止产前护理，未接受艾滋病和梅毒的产前筛查。
