Universidade Estadual Paulista "Júlio de Mesquita Filho" . Faculdade de Medicina de Botucatu . Programa de Pós-Graduação em Saúde Coletiva . Botucatu , SP , Brazil.
Universidade Estadual Paulista "Júlio de Mesquita Filho" . Faculdade de Medicina de Botucatu . Departamento de Saúde Pública . Botucatu , SP , Brazil.
Rev Saude Publica. 2023 Nov 3;57:78. doi: 10.11606/s1518-8787.2023057004965. eCollection 2023.
To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo.
Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated.
2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements.
The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.
评估巴西圣保罗州基层医疗保健服务中先天性梅毒预防措施。
这是一项使用 2017 年巴西圣保罗州基本保健服务评估和监测调查（Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB）中提取的指标进行的横断面评价研究。评价矩阵由 31 个先天性梅毒预防指标组成，分为四个分析领域：获得性梅毒的诊断和治疗（10 个）；基本基础设施和资源（7 个）；产前保健中先天性梅毒的预防（7 个）；以及性传播感染的教育行动和预防（7 个）。根据每个指标报告的服务比例和观察到的总体平均值，计算每个指标的服务阳性率和服务表现的百分比。随后，根据服务质量将服务分为四个质量组，并估计组间以及与每个指标、组织安排类型和地点的关联。
共有 2565 个服务点参与了研究，分布在 503 个城市，整体表现平均得分为 74.9%。“获得性梅毒的诊断和治疗”领域表现最好（89.8%），其次是“基础设施和基本资源”（79.5%）、“产前保健中先天性梅毒的预防”（73.3%）和“性传播感染的教育行动和预防”（56.8%）。质量组之间与所有指标和组织安排类型均存在显著差异。
评估的服务在开展预防先天性梅毒的行动方面存在局限性，主要与产前保健中包含的健康教育和行动有关，如筛查和对孕妇及其伴侣进行适当治疗。需要改变工作流程，扩大教育和监测行动，并提高团队的资质，以有效遵守方案。
