MOTHER TO CHILD TRANSMISSION OF DISEASES: ASPECTS TO HUMAN IMMUNODEFICIENCY VIRUS AND TREPONEMA PALLIDUM IN FORTALEZA, CEARA, BRAZIL

Abstract

The mother to child transmission of HIV control and the congenital syphilis control can be reached with earlier diagnosis of the infection during the prenatal period, emphasizing the relevance of the primary health care net in Brazil. The objective of this study was to describe epidemiological and operational aspects of the control of the HIV and Treponema pallidum mother to child transmission in the Municipal district of Fortaleza. The study has a cross-sectional design, with a descriptive component. The data were obtained from the cases notifications in SINAN, being identified the women that had childbirths between november/2003, and november/2004 in a reference maternity. Demographic and prenatal attendance data were collected from patient records and the analysis of the certificates of live birth was made. Thirty one women with HIV were studied, with ages between 16 to 41 years (median, 24 years old). Most woman was coming from Fortaleza (58.1%), had from four to seven years of concluded studies (41.9%) and was unmarried (74.2%). 93.5% accomplished the prenatal care (19.4%, six or more consultations), 35.5% in the first quarter. In 48.4% women the diagnosis of the HIV infection was established during the pregnancy; 12.9% were already aids cases, and 6.5% used antiretroviral for treatment. The time at the beginning of the anti-retroviral prophylaxis in 71.0% happened until the second quarter. Among the 21 women infected by T. pallidum, the age varied from 13 to 39 years old (median, 25 years). Most was coming from Fortaleza (85.7%) had from four to seven years of concluded studies (42.9%) and was unmarried, 71.4%. 71.4% accomplished prenatal (9.6%, 6 or more consultations). The gestational age at the beginning of the prenatal was difficult to evaluate: only in two cases (9.6%) this information was available (15 and 20 weeks). 38.1% accomplished VDRL (Venereal Disease Research Laboratories) in the prenatal period, and 38.1% had unknown information. Of the ones that accomplished VDRL, the number of exams in the prenatal was of 3 or more in 12.5%; 33.3% had positive VDRL, but in 42.9% of them that information was ignored. In all of the treated women the treatment was inadequate; in 19.0% it was not accomplished and in 42.9% it was ignored. Although these control interventions are available for the whole population of pregnant women infected by HIV and T. pallidum and their children in Brazil, the difficulties of the SUS net in providing laboratorial diagnosis of the infection, the women’s insufficient covering tested in the prenatal, mainly in the most vulnerable populations, and the low quality of the prenatal results in an unfavorable control situation, mainly in relation to syphilis.