Impacto do Plano Estadual da Mãe Saudável no enfrentamento da sífilis congênita no estado da Bahia.

Abstract

Introduction: In 2017, the Healthy Mother State Plan (PEMS) was launched by the Bahia State Health Department (SESAB) with the purpose of mitigating the impacts of the congenital syphilis (CS) epidemic, a disease of high magnitude and transcendence in the state. Objective: To carry out an assessment of the impact of PEMS in combating SC in Bahia. Methods: This investigation integrates two studies: 1- descriptive, retrpspective and 2- quasi-experimental study. For the first, we used: social and epidemiological analysis of congenital syphilis in the state in a time series, between October 2014 and December 2019. In the quasi-experimental study, an impact assessment of the PEMS was carried out, using the series analysis method Interrupted temporal measurements (ITS) with Poisson segmented linear regression. Impact assessment and changes in trends were calculated, before and after general actions for non-priority municipalities (n=395) and specific actions for priority municipalities (n=22). The period was clearly defined as the beginning of the intervention, May 2017, totaling 32 months pre-intervention, October 2014 to April 2017, and 32 months postintervention, May 2017 to December 2019. Results: They were presented in two articles: Article 1- Epidemiological analysis of CS in the state in a time series, between October 2014 and December 2019. It was possible to analyze that syphilis is not the same for everyone, and there are sensitive aspects to the Plan. The incidence of CS was, in addition to being high, increasing in Bahia until 2018, after 1 year of PEMS implementation, and in 2019 it showed a tendency to reduce for the first time in the state. The TVS proportion indicator showed a decreasing trend throughout the entire time series analyzed and may present variations due to flaws in the notification process on Sinan and case investigation. Article 2- Assessment of the impact of PEMS in combating SC in the state. Non-priority municipalities showed a greater reduction (change in level and trend) compared to the state's priority municipalities. The Poisson linear regression model revealed level changes after the intervention, with both indicators in non-priority municipalities, there was a reduction in the average monthly number of cases per 1,000 live births, with a decrease of 17% (- 0.17; RR 0.831; 95% CI 0.827- 0.836) and records a reduction in the proportion of vertical transmission of syphilis of 39% (RR 0.61; 95% CI 0.603- 0.623). Conclusion: The immediate impact assessment of the general intervention shows an increase in the CS incidence rate of 6% (RR) of 1.061; 95% CI= 1.058 - 1.064), however, it shows at the end of the series analyzed, in 2019 after a year of PEMS actions, a drop in the number of reported CS cases, being the first time that the state presents a drop in the trend of SC cases. This study reveals that small municipalities face the lowest incidence rates of CS and SVT in the state, when compared to large municipalities that have lower Primary Health Care coverage in the state. The TVS proportion indicator showed a change in level and a decreasing trend throughout the time series analyzed, but it is still quite high in the state and all actors must be involved in achieving the goals for eliminating SVT.