Fragilidades na atenção primária em saúde favorecem o aumento das tendências de sífilis adquirida no Brasil

Abstract

Syphilis is a sexually transmitted infection that affects the general population and it has been increasing in recent years in many countries. A study was developed in order to analyze the rates of detection of syphilis and to know the predictive factors of its highest time series, proposing a technological model for its reduction. These are ecological studies that used secondary data from the national notification systems from 5.570 Brazilian municipalities and a database from 37.350 primary health care teams. A test of a technological proposition was also released. The rates of acquired syphilis and its sociodemographic stratifications were calculated at the municipal level and the trends were calculated using log-linear regression, crossing them with primary health care variables and sociodemographic indicators, building a multiple model from logistic regression. There are significant growth trends in the rates of acquired syphilis, in pregnant women and congenital in Brazil. The tendencies of acquired syphilis are more accentuated, simply because pregnant women are removed from the sample and they are significantly different for the males, in the age group of 20 to 29 years old, in elementary schooling, black race and in the municipalities from 20.001 to 50.000 inhabitants. The predictors of upwardly acquired syphilis trends are related to the following variables: not all primary health care teams apply penicillin; higher proportion of primary health care teams assessed as bad/regular; population size > 100.000 inhabitants; female condom partially available. Thus, it is concluded that there are significant trends of syphilis in Brazil, and the weaknesses of primary health care linked to population size contribute for favoring the increase of the acquired syphilis epidemic in Brazilian municipalities. Strategies aimed at the development of health promotion practices, reinforcing the joint action of primary health care in schools, especially in the younger population, with low education, with greater social vulnerability, is a viable alternative to reduce the epidemic. In addition, the development of a National Serological Registry and the national serological testing campaign could assist in this reduction.