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      Syphilis in riverine communities: prevalence and associated factors* Translated title: Sífilis en comunidades ribereñas: prevalencia y factores asociados Translated title: Sífilis em comunidades ribeirinhas: prevalência e fatores associados

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          Abstract

          Objective:

          To estimate the prevalence of syphilis and associated factors in riverine communities.

          Method:

          This is a cross-sectional and analytical study carried out with 250 riverside dwellers living in five communities in the city of João Pessoa, state of Paraíba. Data were collected through interviews and rapid screening tests to investigate syphilis. Bivariate, logistic regression and weight of evidence analysis were performed to identify the association between risk factors and behavior variables and rapid test positivity.

          Results:

          he prevalence of syphilis was 11.6% (95%CI: 7.5–15.6). Riverside dwellers who have a previous history of Sexually Transmitted Infection (OR 8.00; 95%CI: 2.76–23.2), history of imprisonment (OR 7.39; 95%CI: 1.61–33.7) and who reported having more than two sexual partners in the last 12 months (OR 4.31; 95%CI: 1.55–11.9) were more likely to be positive for syphilis.

          Conclusion:

          High prevalence of syphilis among riverside dwellers and the presence of behavioral factors that increase vulnerability to acquiring the infection. The need to invest in preventive and screening strategies for syphilis in populations considered vulnerable is highlighted.

          RESUMO

          Objetivo:

          estimar a prevalência de sífilis e fatores associados em comunidades ribeirinhas.

          Método:

          estudo transversal e analítico realizado com 250 ribeirinhos residentes em cinco comunidades no município de João Pessoa, estado da Paraíba. Os dados foram coletados por meio de entrevista e testes rápidos de triagem para investigação da sífilis. Realizaram-se análise bivariada, de regressão logística e análise do peso da evidência ( Weight of Evidence ) para identificar a associação entre as variáveis de fatores e de comportamento de risco e a positividade do teste rápido.

          Resultados:

          a prevalência de sífilis foi de 11,6% (IC95%: 7,5–15,6). Ribeirinhos que possuem história prévia de Infecção Sexualmente Transmissível (OR 8,00; IC95%: 2,76–23,2), histórico de prisão (OR 7,39; IC95%: 1,61–33,7) e que relataram ter mais de dois parceiros sexuais nos últimos 12 meses (OR 4,31; IC95%: 1,55–11,9) apresentaram maiores chances de apresentar resultado positivo para sífilis.

          Conclusão:

          alta prevalência de sífilis entre os ribeirinhos e presença de fatores comportamentais que aumentam a vulnerabilidade à aquisição da infecção. Reforça-se a necessidade do investimento de estratégias preventivas e de rastreamento de sífilis em populações consideradas vulnerabilizadas.

          RESUMEN

          Objetivo:

          estimar la prevalencia de sífilis y factores asociados en comunidades ribereñas.

          Método:

          estudio transversal y analítico realizado con 250 ribereños residentes en cinco comunidades en el municipio de João Pessoa, Paraíba, Brasil. Los datos fueron recolectados por medio de entrevista y pruebas serológicas rápidas de triaje para investigación de sífilis. Se realizaron análisis bivariado, análisis de regresión logística y análisis del peso de la evidencia (Weight of Evidence) para identificar la asociación entre las variables de factores y de comportamiento de riesgo y la positividad de la prueba serológica rápida.

          Resultados:

          la prevalencia de sífilis fue un 11,6% (IC95%: 7,5–15,6). Ribereños que poseen historia anterior de Infección Sexualmente Transmisible (OR 8,00; IC95%: 2,76–23,2), histórico de cárcel (OR 7,39; IC95%: 1,61–33,7) y que relataron tener más de dos parejas sexuales en los últimos 12 meses (OR 4,31; IC95%: 1,55–11,9) demostraron mayores riesgos de presentar resultado positivo para la enfermedad.

          Conclusión:

          alta prevalencia de sífilis entre los ribereños y presencia de factores comportamentales que aumentan la vulnerabilidad a la adquisición de la infección. Se refuerza la necesidad de inversión en estrategias preventivas y de identificación de sífilis en poblaciones consideradas vulnerables.

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          Most cited references34

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          Risk factors for syphilis in women: case-control study

          ABSTRACT OBJECTIVE To determine the sociodemographic, behavioral, and health care factors related to the occurrence of syphilis in women treated at public maternity hospitals. METHODS This is a case-control study (239 cases and 322 controls) with women admitted to seven maternity hospitals in the municipality of Recife, Brazil, from July 2013 to July 2014. Eligible women were recruited after the result of the VDRL (Venereal Disease Research Laboratory) under any titration. The selection of cases and controls was based on the result of the serology for syphilis using ELISA (enzyme-linked immunosorbent assay). The independent variables were grouped into: sociodemographic, behavioral, clinical and obstetric history, and health care in prenatal care and maternity hospital. Information was obtained by interview, during hospitalization, with the application of a questionnaire. Odds ratios and 95% confidence intervals were estimated using logistic regression to identify the predicting factors of the variable to be explained. RESULTS The logistic regression analysis identified as determinant factors for gestational syphilis: education level of incomplete basic education or illiterate (OR = 2.02), lack of access to telephone (OR = 2.4), catholic religion (OR = 1.70 ), four or more pregnancies (OR = 2.2), three or more sexual partners in the last year (OR = 3.1), use of illicit drugs before the age of 18 (OR = 3.0), and use of illicit drugs by the current partner (OR = 1.7). Only one to three prenatal appointments (OR = 3.5) and a previous history of sexually transmitted infection (OR = 9.7) were also identified as determinant factors. CONCLUSIONS Sociodemographic, behavioral, and health care factors are associated with the occurrence of syphilis in women and should be taken into account in the elaboration of universal strategies aimed at the prevention and control of syphilis, but with a focus on situations of greater vulnerability.
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            Inquérito de saúde em comunidades ribeirinhas do Amazonas, Brasil

            Os inquéritos populacionais de saúde são instrumentos importantes para o reconhecimento de determinantes de morbidades, sobretudo em regiões de grande dispersão demográfica e baixa cobertura do sistema de saúde. O objetivo deste estudo foi apresentar os principais aspectos metodológicos e descrever as características socioeconômicas, demográficas e de saúde dos ribeirinhos de Coari, Amazonas, Brasil. Estudo transversal de base populacional conduzido com ribeirinhos residentes na zona rural do Município de Coari, no período de abril a julho de 2015. A amostra probabilística por conglomerados foi composta por 492 sujeitos. Os resultados indicaram que a maioria dos ribeirinhos é do sexo feminino (53%), tem até 9 anos de estudos (68,5%), apresenta em média renda familiar mensal equivalente a 1/3 do salário mínimo. Dentre os problemas de saúde relatados nos últimos 30 dias, destacaram-se as queixas álgicas (45,2%). Os principais recursos utilizados nos cuidados com a saúde foram medicamentos alopáticos (70,3%), superando o uso de plantas medicinais (44,3%). Os ribeirinhos navegam em média 60,4km e demoram cerca de 4,2 horas para acessar a zona urbana do município. De maneira geral, a população ribeirinha estudada é caracterizada pelo baixo nível econômico e acesso limitado à zona urbana. Os problemas de saúde são solucionados na maior parte das vezes pelo uso de medicamentos alopáticos. As limitações geográficas que constituem barreiras ao acesso aos serviços de saúde e à melhoria das condições de vida dos ribeirinhos podem limitar a aquisição de informações epidemiológicas dessas populações.
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              Trends of syphilis in Brazil: A growth portrait of the treponemic epidemic

              Syphilis is a chronic infectious disease with its prevalence being described since the 15th century. Although its etiological agent and also the treatment measures are widely known, syphilis is still a great public health problem worldwide, mainly in countries with limited resources associated to low investments in health primary care. The aim of the present study was to analyze the trend and regional distribution of syphilis in Brazil between 2007 and 2017. This is an ecological study using secondary data from the Brazilian notification system. The Ministry of Health selected 100 municipalities which presented the worse outcomes related to syphilis from the 5,570 Brazilian municipalities as a target for a comprehensive project in order to tackle the prevalence of syphilis, called the “No Syphilis Project”. These priority municipalities represent 57.7% of syphilis cases and about one third of the Brazilian population. They were compared with other 189 non-priority municipalities with more than 100 thousand inhabitants among the Brazilian regions (North, Northeast, Southeast, South and Center-West). Polynomial regression methods and Joinpoint analyses were used to analyze the trend, from which the Annual Average Percent Change (AACP) for each time period was calculated. There was a significant growth trend in all regions for the main three forms of syphilis (in pregnancy, congenital and acquired), especially in the South. The ratio between syphilis in pregnancy and congenital syphilis increased in both priority (AAPC: 8.54%; p<0.001) and non-priority municipalities (AAPC: 2.61%; p = 0.005), as well as in the regions, except the Center-West. High growth trends in syphilis prevalence were found in all municipalities, as well as all five regions between 2007 and 2017, showing that the challenge to reduce or even eliminate syphilis in Brazil is still difficult.
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                Author and article information

                Journal
                Rev Esc Enferm USP
                Rev Esc Enferm USP
                reeusp
                Revista da Escola de Enfermagem da USP
                Universidade de São Paulo, Escola de Enfermagem
                0080-6234
                1980-220X
                07 January 2022
                2022
                : 56
                : e20210258
                Affiliations
                [1 ]Universidade Federal da Paraíba, Programa de Pós-Graduação em Enfermagem, João Pessoa, PB, Brazil.
                [2 ]Universidade Federal de Campina Grande, Centro de Educação e Saúde, Cuité, PB, Brazil.
                [3 ]Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
                Author notes
                Corresponding author: Wynne Pereira Nogueira Rua João Soares Padilha, 21 58036-835 – João Pessoa, PB, Brazil, wynnenogueira@ 123456hotmail.com

                * Extracted from the thesis: “Prevalence and factors associated with syphilis, HIV, hepatitis B and C infection in a riverine communities”, Universidade Federal da Paraíba, Programa de Pós-Graduação em Enfermagem, 2020.

                Author information
                http://orcid.org/0000-0002-7492-7939
                http://orcid.org/0000-0002-5787-7861
                http://orcid.org/0000-0002-2673-0285
                http://orcid.org/0000-0002-0305-4843
                http://orcid.org/0000-0002-3757-4900
                http://orcid.org/0000-0001-8605-5229
                Article
                00408
                10.1590/1980-220X-reeusp-2021-0258
                10184761
                35007316
                5cc3e927-bf3b-4e96-9d41-342da0a4c0d3

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 June 2021
                : 11 November 2021
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 30
                Funding
                Funded by: Coordination for the Improvement of Higher Education Personnel – Brazil (CAPES)
                Award ID: 001
                Categories
                Original Article

                syphilis,vulnerable populations,prevalence,risk factors,sexually transmitted diseases,sífilis,poblaciones vulnerables,prevalencia,factores de riesgo,enfermedades de transmisión sexual,populações vulneráveis,prevalência,fatores de risco,doenças sexualmente transmissíveis

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