A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California.

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients' social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.

Congenital syphilis in East Baton Rouge parish, Louisiana: providers' and women's perspectives.

BACKGROUND: Congenital syphilis is completely preventable through screening and treatment, but rates have been rising in the United States. Certain areas are at particularly high risk. We aimed to assess attitudes, knowledge, and barriers around effective prevention of congenital syphilis among health care providers and community women potentially at risk. METHODS: Two parallel studies were conducted: in-depth interviews with health care providers and focus groups with community women in the area of Baton Rouge, Louisiana. Each group was questioned about their experience in providing or seeking prenatal care, knowledge and attitudes about congenital syphilis, sources of information on testing and treatment, perceptions of risk, standards of and barriers to treatment. Results were transcribed into QSR NVivo V10, codes developed, and common themes identified and organized. RESULTS: Providers identified delays in testing and care, lack of follow-through with partner testing, and need for community connection for prevention, as major contributors to higher rates of congenital syphilis. Women identified difficulties in accessing Medicaid contributing to delayed start of prenatal care, lack of transportation for prenatal care, and lack of knowledge about testing and prevention for congenital syphilis. CONCLUSIONS: Providers and community members were in broad agreement about factors contributing to higher rates of congenital syphilis, although some aspects were emphasized more by one group or another. Evidence-based interventions, likely at multiple levels, need to be tested and implemented to eliminate congenital syphilis.

Sífilis congênita no recém-nascido: repercussões para a mãe / Congenital syphilis in newborns: repercussions for the mother / Sífilis congénita en el neonato: repercusiones para la madre

Objetivo: conhecer as repercussões do diagnóstico da Sífilis Congênita no recém-nascido para a mãe. Método: pesquisa qualitativa desenvolvida com 15 mães de recém-nascidos com Sífilis Congênita e internados em um hospital público do sul do Brasil. Os dados foram coletados por entrevistas semiestruturadas, submetidos à análise de conteúdo e aprovados pelo Comitê de Ética em Pesquisa. Resultados: as mães manifestaram sentimentos de culpa, desespero, tristeza e horror. Havia esperança de não passar a infecção para o recém-nascido. Verificou-se a reincidência da doença em mais de uma gestação. Referiram medo do estigma social e buscaram informações acerca da doença na internet, como também com médicos e enfermeiros. Conclusão: há desinformação das mães quanto à infecção da sífilis, principalmente sobre como evitar a transmissão vertical e a reinfecção. Cabe ao enfermeiro, instrumentalizar a mãe para o cuidado ao recém-nascido com Sífilis Congênita, por meio de um processo educativo que qualifique o cuidado da criança e da mãe

Objective: to learn how a diagnosis of congenital syphilis in newborns affects the mothers. Method: in this qualitative study of 15 mothers of newborns with congenital syphilis admitted to a public hospital in southern Brazil, data were collected by semistructured interview, and treated by content analysis. The study was approved by the research ethics committee. Results: the mothers expressed feelings of guilt, despair, sadness and horror. They hoped not to transmit the infection to the newborn. The disease was found to have recurred in more than one pregnancy. They reported fear of social stigma, and looked for information about the disease on the Internet, as well as from doctors and nurses. Conclusion: mothers are misinformed regarding infection by syphilis, especially on how to prevent vertical transmission and reinfection. It is up to nurses to instruct mothers on how to care for newborns with congenital syphilis, through an educational process to improve care for the child and the mother.

Objetivo: conocer las repercusiones, para la madre, del diagnóstico de sífilis congénita en el neonato. Método: investigación cualitativa desarrollada junto a 15 madres de neonatos con sífilis congénita e ingresados en un hospital público en el sur de Brasil. Se recolectaron los datos a través de entrevistas semiestructuradas y se sometieron al análisis de contenido; después fueron aprobados por el Comité de Ética en Investigación. Resultados: las madres expresaron sentimientos de culpa, desesperación, tristeza y horror. Había esperanza de no transmitir la infección al neonato. Se verificó la reincidencia de la enfermedad en más de un embarazo. Declararon el temor al estigma social y buscaron información sobre la enfermedad en internet, así como junto a médicos y enfermeros. Conclusión: las madres están desinformadas en cuanto a la infección por Sífilis, especialmente sobre cómo prevenir la transmisión vertical y la reinfección. Le toca al enfermero darle a la madre herramientas para que cuide bien al neonato con Sífilis Congénita, a través de un proceso educativo que califique el cuidado del niño y la madre