Investigação das internações por sífilis congênita: distribuição espaço-temporal, fluxos e gastos

Abstract

In the state of Pará, the high incidence of diagnosis of gestational syphilis in the third trimester of pregnancy and at the time of delivery may be predictors of greater use of hospital services, however, the lack of availability of information on the magnitude and pattern of distribution of hospitalizations in the state do not make it possible to fully estimate the impact of congenital syphilis on the public health system, mainly in the financial aspects, access and sufficiency of quality services. Objective: To investigate hospital admissions for congenital syphilis in Pará, in children under one year old from 2009 to 2018. Methodology: This is an ecological, cross-sectional study with a quantitative approach. Data were collected in the Hospital Information System and Live Birth Information System. Descriptive analyzes of hospitalization rates, lethality, mortality and proportion of expenses were performed. Temporal, spatial analysis and mapping of hospitalization flows for congenital syphilis. Minitab 18®, Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5 and ArcGis 10.3.1 were used in the analysis of the study. Results: 6,487 hospitalizations for SC were recorded in the 10 years studied, most frequently in the early neonatal period, 94% (6,096) of cases. A gross hospitalization rate for SC in Pará shows an increasing increase with an annual percentage variation of 11.9%. Despite the growth without number of cases and the gross rate of hospitalization, there was a reduction in the lethality rate. As hospitalizations for registered SC resulted in an expense to SUS of R $ 6,014,782.17, with R $ 927.20 being the average expenditure of hospitalizations. A spatial analysis indicates direct spatial autocorrelation in the high-high pattern in the two periods. As for the flow, one Metropolitana I was the only one that received all hospitalizations from its residents in the region itself. Thus, there was a greater absorption of interactions from other regions and a positive balance. Conclusion: The results presented here showed a significant increase in the rate of hospitalization for SC in Pará, in several regions and in all health macro-regions, with a proportional increase in expenses. Despite failures in primary health care, there was an improvement in the quality of tertiary care. The mapping of care networks and flows pointed to the predominance of HI that occurred in the same place of residence as the inpatient. However, it demonstrated differences in the organization and compliance with the foundations of the Cegonha Network, within the health regions and macro-regions, with Macroregion I being the one that most managed to guarantee the resolution of hospital health care.