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巴西监狱中孕妇梅毒和艾滋病毒感染率以及监狱分娩中先天性梅毒的发病率。

Prevalence of syphilis and HIV infection during pregnancy in incarcerated women and the incidence of congenital syphilis in births in prison in Brazil.

作者信息

Domingues Rosa Maria Soares Madeira, Leal Maria do Carmo, Pereira Ana Paula Esteves, Ayres Barbara, Sánchez Alexandra Roma, Larouzé Bernard

机构信息

Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

出版信息

Cad Saude Publica. 2017 Nov 21;33(11):e00183616. doi: 10.1590/0102-311X00183616.

Abstract

This study aimed to estimate the prevalence of syphilis and HIV infection during pregnancy, the mother to child transmission of syphilis and the incidence of congenital syphilis in incarcerated women in Brazil; to compare these rates to those observed in pregnant women outside of jail; and to verify the maternal factors associated with syphilis infection during pregnancy in free and incarcerated women. We used data from two nationwide studies conducted during the period 2011-2014. The Birth in Brazil study included 23,894 free women cared for in 266 hospitals. The Maternal and Infant Health in Prisons study included 495 incarcerated pregnant women or mothers living with their children, according to a census conducted in 33 female prisons. The same case definitions and data collection methods were used in both studies. The chi-square test was used to compare the characteristics of incarcerated and free women with a significance of 0.05. For incarcerated women, the estimated prevalence of syphilis during pregnancy was 8.7% (95%CI: 5.7-13.1) and for HIV infection 3.3% (95%CI: 1.7-6.6); the estimated mother to child transmission of syphilis was 66.7% (95%CI: 44.7-83.2) and the incidence of congenital syphilis was 58.1 per 1,000 living newborns (95%CI: 40.4-82.8). Incarcerated women had a greater prevalence of syphilis and HIV infection during pregnancy, lower quality of antenatal care and higher levels of social vulnerability. Syphilis infection showed to be an indicator of social vulnerability in free women, but not in incarcerated women. Health initiatives in prison are necessary to reduce healthcare inequalities and should include adequate antenatal and birth care.

摘要

本研究旨在估计巴西被监禁女性孕期梅毒和艾滋病毒感染率、梅毒母婴传播情况以及先天性梅毒发病率;将这些比率与监狱外孕妇的比率进行比较;并验证自由女性和被监禁女性孕期梅毒感染的相关母体因素。我们使用了2011年至2014年期间开展的两项全国性研究的数据。巴西出生研究纳入了在266家医院接受护理的23,894名自由女性。监狱母婴健康研究根据对33所女子监狱进行的普查,纳入了495名被监禁的孕妇或与子女同住的母亲。两项研究采用相同的病例定义和数据收集方法。采用卡方检验比较被监禁女性和自由女性的特征,显著性水平为0.05。对于被监禁女性,孕期梅毒估计感染率为8.7%(95%置信区间:5.7 - 13.1),艾滋病毒感染率为3.3%(95%置信区间:1.7 - 6.6);梅毒母婴传播估计率为66.7%(95%置信区间:44.7 - 83.2),先天性梅毒发病率为每1000例活产新生儿58.1例(95%置信区间:40.4 - 82.8)。被监禁女性孕期梅毒和艾滋病毒感染率更高,产前护理质量更低,社会脆弱性水平更高。梅毒感染在自由女性中是社会脆弱性的一个指标,但在被监禁女性中并非如此。监狱中的健康倡议对于减少医疗保健不平等现象是必要的,应包括充分的产前和分娩护理。

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