Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil.

Background: Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality. Methods: A cohort of 75,339 live births (January 2009-December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms. Results: A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth. Interpretation: Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits. Funding: DFID/MRC/Wellcome Trust/ESRC.

Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil.

OBJECTIVES: As middle-income countries strive to achieve the Sustainable Development Goals (SDGs), it remains unclear to what degree expanding primary care coverage can help achieve those goals and reduce within-country inequalities in mortality. Our objective was to estimate the potential impact of primary care expansion on cause-specific mortality in the 15 largest Brazilian cities. DESIGN: Microsimulation model. SETTING: 15 largest cities by population size in Brazil. PARTICIPANTS: Simulated populations. INTERVENTIONS: We performed survival analysis to estimate HRs of death by cause and by demographic group, from a national administrative database linked to the Estratégia de Saúde da Família (Family Health Strategy, FHS) electronic health and death records among 1.2 million residents of Rio de Janeiro (2010-2016). We incorporated the HRs into a microsimulation to estimate the impact of changing primary care coverage in the 15 largest cities by population size in Brazil. PRIMARY AND SECONDARY OUTCOME MEASURES: Crude and age-standardised mortality by cause, infant mortality and under-5 mortality. RESULTS: Increased FHS coverage would be expected to reduce inequalities in mortality among cities (from 2.8 to 2.4 deaths per 1000 between the highest-mortality and lowest-mortality city, given a 40 percentage point increase in coverage), between welfare recipients and non-recipients (from 1.3 to 1.0 deaths per 1,000), and among race/ethnic groups (between Black and White Brazilians from 1.0 to 0.8 deaths per 1,000). Even a 40 percentage point increase in coverage, however, would be insufficient to reach SDG targets alone, as it would be expected to reduce premature mortality from non-communicable diseases by 20% (vs the target of 33%), and communicable diseases by 15% (vs 100%). CONCLUSIONS: FHS primary care coverage may be critically beneficial to reducing within-country health inequalities, but reaching SDG targets will likely require coordination between primary care and other sectors.

Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis.

Background: Robust evidence on the relationship between primary care and emergency admissions is lacking in low- and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs). Methods: A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multi-level Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic groups. Results: Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97; 95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37; 95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43; 95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS use. Interpretation: Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs. Funding: DFID/MRC/Wellcome Trust/ESRC.

Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection.

This article addresses the vector, sexual and vertical transmissions of the Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted more predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands specific prophylactic interventions, including the use of male or female condoms, especially among couples in a risk situation and planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system, and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with the basic principles of care and guidelines associated with the spread of the infection transcends the severity of the disease's symptoms. Although in Brazil Zika virus is predominantly transmitted by the Aedes aegypti mosquito, vertical and sexual transmission routes are important for reproductive health. Vertical transmission causes severe central nervous system structural abnormalities.

[Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection]. / Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo vírus Zika.

This article addresses vector, sexual and vertical transmission of Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted most predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands the use of specific prophylactic interventions, including the use of male or female condoms, especially among couples planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with basic principles of care and guidelines related to the spread of infection transcends the severity of the symptoms of the disease.

Este artigo aborda as transmissões vetorial, sexual e vertical do vírus Zika, tema contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Embora no Brasil o vírus Zika seja predominantemente veiculado pelo Aedes aegypti, as vias vertical e sexual de transmissão apresentam expressiva importância para a saúde reprodutiva. A transmissão sexual demanda o uso de intervenções profiláticas específicas, incluindo o uso do preservativo masculino ou feminino, principalmente entre casais que planejam gravidez. A transmissão vertical é ligada a graves anormalidades estruturais do sistema nervoso central e ainda não há vacina e nem recursos farmacológicos conhecidos que possam preveni-la. Como a doença é predominantemente assintomática, o não cumprimento dos princípios básicos de cuidados e orientações relacionadas à dispersão da infecção transcende a gravidade dos sintomas da doença.

Este artículo aborda la transmisión vectorial, sexual y vertical del virus Zika, tema tratado en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Aunque en Brasil el virus Zika sea principalmente transmitido por Aedes aegypti, las vías vertical y sexual de transmisión son de gran importancia para la salud reproductiva. La transmisión sexual exige el uso de intervenciones profilácticas específicas, incluido el uso de preservativos masculinos o femeninos, especialmente entre las parejas que planean un embarazo. La transmisión vertical está ligada a graves anomalías estructurales del sistema nervioso central y todavía no existe una vacuna o recursos farmacológicos conocidos que puedan prevenirla. Como la enfermedad es predominantemente asintomática, el incumplimiento de los principios básicos de atención y las pautas relacionadas con la propagación de la infección trasciende la gravedad de los síntomas de la enfermedad.

Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance.

This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published. sexually transmitted infections are among the most common diseases in the world. They affect people's health and life, impact reproductive and child health, contribute to infertility and complications during pregnancy and birth.

Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis.

In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including women's health, children's health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo vírus Zika / Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infección por el virus Zika

Este artigo aborda as transmissões vetorial, sexual e vertical do vírus Zika, tema contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Embora no Brasil o vírus Zika seja predominantemente veiculado pelo Aedes aegypti, as vias vertical e sexual de transmissão apresentam expressiva importância para a saúde reprodutiva. A transmissão sexual demanda o uso de intervenções profiláticas específicas, incluindo o uso do preservativo masculino ou feminino, principalmente entre casais que planejam gravidez. A transmissão vertical é ligada a graves anormalidades estruturais do sistema nervoso central e ainda não há vacina e nem recursos farmacológicos conhecidos que possam preveni-la. Como a doença é predominantemente assintomática, o não cumprimento dos princípios básicos de cuidados e orientações relacionadas à dispersão da infecção transcende a gravidade dos sintomas da doença.

This article addresses vector, sexual and vertical transmission of Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted most predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands the use of specific prophylactic interventions, including the use of male or female condoms, especially among couples planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with basic principles of care and guidelines related to the spread of infection transcends the severity of the symptoms of the disease.

Este artículo aborda la transmisión vectorial, sexual y vertical del virus Zika, tema tratado en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Aunque en Brasil el virus Zika sea principalmente transmitido por Aedes aegypti, las vías vertical y sexual de transmisión son de gran importancia para la salud reproductiva. La transmisión sexual exige el uso de intervenciones profilácticas específicas, incluido el uso de preservativos masculinos o femeninos, especialmente entre las parejas que planean un embarazo. La transmisión vertical está ligada a graves anomalías estructurales del sistema nervioso central y todavía no existe una vacuna o recursos farmacológicos conocidos que puedan prevenirla. Como la enfermedad es predominantemente asintomática, el incumplimiento de los principios básicos de atención y las pautas relacionadas con la propagación de la infección trasciende la gravedad de los síntomas de la enfermedad.

Protocolo Brasileiro para Infecções Sexualmente Transmissíveis 2020: infecção pelo vírus Zika / Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection / Protocolo Brasileño para Infecciones de Transmisión Sexual 2020: infección por el virus Zika

Resumo Este artigo aborda as transmissões vetorial, sexual e vertical do vírus Zika, tema contemplado no Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado pelo Ministério da Saúde do Brasil em 2020. Embora no Brasil o vírus Zika seja predominantemente veiculado pelo Aedes aegypti, as vias vertical e sexual de transmissão apresentam expressiva importância para a saúde reprodutiva. A transmissão sexual demanda o uso de intervenções profiláticas específicas, incluindo o uso do preservativo masculino ou feminino, principalmente entre casais que planejam gravidez. A transmissão vertical é ligada a graves anormalidades estruturais do sistema nervoso central e ainda não há vacina e nem recursos farmacológicos conhecidos que possam preveni-la. Como a doença é predominantemente assintomática, o não cumprimento dos princípios básicos de cuidados e orientações relacionadas à dispersão da infecção transcende a gravidade dos sintomas da doença.

Abstract This article addresses vector, sexual and vertical transmission of Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted most predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands the use of specific prophylactic interventions, including the use of male or female condoms, especially among couples planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with basic principles of care and guidelines related to the spread of infection transcends the severity of the symptoms of the disease.

Resumen Este artículo aborda la transmisión vectorial, sexual y vertical del virus Zika, tema tratado en el Protocolo Clínico y Directrices Terapéuticas para la Atención Integral a Personas con Infecciones de Transmisión Sexual, publicado por el Ministerio de Salud de Brasil en 2020. Aunque en Brasil el virus Zika sea principalmente transmitido por Aedes aegypti, las vías vertical y sexual de transmisión son de gran importancia para la salud reproductiva. La transmisión sexual exige el uso de intervenciones profilácticas específicas, incluido el uso de preservativos masculinos o femeninos, especialmente entre las parejas que planean un embarazo. La transmisión vertical está ligada a graves anomalías estructurales del sistema nervioso central y todavía no existe una vacuna o recursos farmacológicos conocidos que puedan prevenirla. Como la enfermedad es predominantemente asintomática, el incumplimiento de los principios básicos de atención y las pautas relacionadas con la propagación de la infección trasciende la gravedad de los síntomas de la enfermedad.

Brazilian Protocol for Sexually Transmitted Infections 2020: epidemiological surveillance

Abstract This article summarizes the chapter on epidemiological surveillance of sexually transmitted infections (STI) that comprises the 2020 Clinical Protocol and Therapeutic Guidelines (PCDT) for Comprehensive Care for People with STI, published by the Health Surveillance Department of the Brazilian Ministry of Health. It presents some reflections on the new case definitions for surveillance of acquired syphilis, syphilis in pregnant women, and congenital syphilis. The 2020 PCDT-IST was elaborated grounded on scientific evidence and validated in discussions with specialists. Epidemiological and clinical aspects are addressed, and health service managers' guidelines regarding programmatic and operational management of these diseases are presented. Guidelines for health professionals on screening, diagnosing, and treating people with STI and their sex partners, in addition to strategies for surveillance, prevention, and control actions, are also published.

Impact of isoniazid preventive therapy for HIV-infected adults in Rio de Janeiro, Brazil: an epidemiological model.

BACKGROUND: The potential epidemiological impact of isoniazid preventive therapy (IPT), delivered at levels that could be feasibly scaled up among people living with HIV (PLHIV) in modern, moderate-burden settings, remains uncertain. METHODS: We used routine surveillance and implementation data from a cluster-randomized trial of IPT among HIV-infected clinic patients with good access to antiretroviral therapy in Rio de Janeiro, Brazil, to populate a parsimonious transmission model of tuberculosis (TB)/HIV. We modeled IPT delivery as a constant process capturing a proportion of the eligible population every year. We projected feasible reductions in TB incidence and mortality in the general population and among PLHIV specifically at the end of 5 years after implementing an IPT program. RESULTS: Data on time to IPT fit an exponential curve well, suggesting that IPT was delivered at a rate covering 20% (95% confidence interval: 16% to 24%) of the 2500 eligible individuals each year. By the end of year 5 after modeled program rollout, IPT had reduced TB incidence by 3.0% [95% uncertainty range (UR): 1.6% to 7.2%] in the general population and by 15.6% (95% UR: 15.5% to 36.5%) among PLHIV. Corresponding reductions in TB mortality were 4.0% (95% UR: 2.2% to 10.3%) and 14.3% (14.6% to 33.7%). Results were robust to wide variations in parameter values on sensitivity analysis. CONCLUSIONS: TB screening and IPT delivery can substantially reduce TB incidence and mortality among PLHIV in urban, moderate-burden settings. In such settings, IPT can be an important component of a multi-faceted strategy to feasibly reduce the burden of TB in PLHIV.

Duas décadas de vigilância epidemiolóica da sífilis congênita no Brasil: a propósito das definições de caso / Two decades of epidemiological surveillance of congenital syphilis in Brazil: concerning the case definitions

Introdução: a definição de caso representa uma estratégia da vigilância epidemiológica para o monitoramento de um agravo ou doença de interesse para a saúde pública. Além disso, permite a descrição de sua ocorrência, o registro e a avaliação de estratégias de controle adotadas em uma determinada população. Objetivo: o presente artigo resgata o processo de definição de caso da sífilis congênita no Brasil desde 1986 até 2004, um evento que ainda persiste como um importante desafio. Métodos: revisão sistemática de documentos técnico-científicos sobre definição de casos de sífilis no Brasil e em outros países. Resultados: o artigo subsidia o entendimento da atual definição de caso, vigente desde janeiro de 2004, contextualizando o processo de vigilância epidemiológica. Conclusão: ressalta-se a importância da adequada definição de caso para as ações de vigilância da sífilis congênita, bem como o reconhecimento dos limites e potencialidades das diferentes modalidades de vigilância epidemiológica com o objetivo de gerar informações de qualidade para programar as ações de controle.

Introduction: the process of case definition represents an important strategy of epidemiological surveillance to follow important diseases and eventsfor public health. Moreover, it allows the description of occurrence, besides the registry and control strategies’ evaluation adopted in a certain population. Objective: this article rebuilds the process of congenital syphilis case definition in Brazil since 1986 up to 2004, an event that still persists as an important challenge in many countries. Methods: systematic review of technical-scientific documents about the definition of congenital syphilis cases in Brazil and in other countries. Results: this analysis subsidizes, therefore, the understanding of the current case definition, effective since January 2004, as the basis for the development of the epidemiological surveillance process. Conclusion: the importance of the appropriate case definition and revision for surveillance actions of congenital syphilis are emphasized, as well as the recognition of limits and potentialities of differentmodalities of epidemiological surveillance in order to generate good information to subsidize the control actions.

Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis

In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including women's health, children's health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.

No Brasil, a infecção pelo Treponema pallidum e pelo vírus da imunodeficiência humana são eventos considerados prioritários. No entanto, apesar das políticas públicas, a resposta em termos das ações de vigilância e prevenção, assistência pré-natal e ao recém-nascido, é diferenciada, parecendo ser mais bem estruturada para a redução da transmissão vertical do HIV do que para a do T. pallidum. No presente artigo, potenciais diferenças são analisadas quanto ao desenvolvimento das ações. Identificou-se que as desigualdades existentes na atenção aos dois problemas apresentam dimensões diferenciadas nas regiões do país. Reconheceu-se a necessária e urgente priorização da sífilis na gravidez, envolvendo áreas técnicas como atenção básica, saúde da mulher, saúde da criança e controle de doenças sexualmente transmissíveis, em todas as esferas de governo. Emerge como questão relevante no encaminhamento do problema a formação de profissionais de saúde e a mobilização da sociedade na perspectiva do controle. É ainda necessário inserir o tema e formas de enfrentamento na agenda de gestão. A eliminação da sífilis congênita requer insumos de baixo custo, bem como ações sustentáveis em longo prazo.

Vigilância da sífilis na gravidez / Surveillance of syphilis in pregnancy

A sífilis congênita persiste como grave problema de Saúde Pública. Este artigo tem por objetivo apresentar os dados da vigilância da sífilis na gravidez, realizada pela Secretaria Municipal de Saúde do Rio de Janeiro no período de 1999 a 2004. Realizou-se um estudo descritivo, com análise dos dados dos relatórios trimestrais enviados pelas unidades municipais de saúde, mediado pelo programa Epi Info 6.04 d [Centers for Disease Control and Prevention, dos Estados Unidos da América (CDC/EUA). Seus resultados foram: cobertura de testagem das gestantes superior a 70 por cento; idade gestacional média de 19 semanas, no momento da testagem; baixa proporção de gestantes e parceiros tratados durante a gestação; e redução da incidência de sífilis na gravidez e de sífilis congênita. Ainda se mantiveram, entretanto, taxas elevadas para esses agravos. Esses resultados demonstram a importância da vigilância da sífilis na gravidez para a eliminação da sífilis congênita. Somente a qualificação das ações realizadas durante a assistência pré-natal permitirá a redução da transmissão vertical dessa doença...

Congenital syphilis (CS) is still ongoing as a huge public health matter. This paper describes the surveillance of syphilis in pregnancy by the Municipal Health Secretariat of Rio de Janeiro, from 1999 to 2004. The analysis was done based upon the quarterly reports sent by the municipal health units, using Epi Info 6.04 d [Centers for Disease Control and Prevention, of The United States of America (CDC/USA)]. Their results were: more than 70% of pregnant women were subjected to VDRL testing; mean gestational age at testing of 19 weeks; low proportion of partners treated during pregnancy; and reduction on both syphilis in pregnancy and incidence of congenital syphilis, although high level rates of these diseases still persist. The results also point out the relevance of surveillance strategy for syphilis in pregnancy, regarding the goal of congenital syphilis elimination. Only a better antenatal care, achieved by means of training health care providers, will allow the reduction of vertical transmission of syphilis.

Avaliacão de campanhas de saúde com ênfase na sífilis congênita: uma revisão sistemática / Evaluation of health campaigns with emphasis on congenital syphilis: a systematic review

Campanhas têm sido instrumentos de políticas públicas de saúde, freqüentemente utilizadas no Brasil para esclarecer, motivar ou conseguir o apoio da populacão e/ou dos profissionais de saúde, em acões relevantes para a saúde pública. Esta revisão procurou levantar subsídios para a avaliacão de campanhas de saúde, particularizando-se as metodologias utilizadas, tendo em vista a avaliacão de campanhas dirigidas ao controle da sífilis congênita. Os conjuntos de palavras-chave utilizados foram sífilis congênita + avaliacão; campanhas de saúde + avaliacão e, campanha + saúde + avaliacão. As bases de dados pesquisadas foram a Medline (Medical Literature Analysis and Retrieval System Online) da National Library of Medicine (EUA), a LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e da PAHO (Pan-American Health Organization), no período de 1980 e 2003. Foram incluídos 37 artigos nessa revisão, sendo 15 referentes à sífilis congênita e avaliacão e 22 à campanha de saúde e avaliacão. A revisão realizada mostrou que existe um espaco a ser preenchido neste campo, principalmente no que se refere à construcão metodológica. Apesar da palavra avaliacão constar nesses vários artigos, a fundamentacão teórica encontrada não foi totalmente condizente com as propostas apresentadas.