Health care for people with syphilis: an evaluative study
Janmilli da Costa Dantas Santiago1, Hosana Lourenço da Silva1, Dhyanine Morais de Lima2, Andressa Kaline Ferreira Araújo1, Olga Alice Alencar Moreira1, Richardson Augusto Rosendo da Silva1
1 Federal University of Rio Grande do Norte, RN, Brazil
2 Potiguar University, RN, Brazil
ABSTRACT
Objective: The general objective of the research is to evaluate health care for people with Syphilis in the State of Rio Grande do Norte. Method: This is an Evaluative study that evaluates the structure, process and results, with a qualitative approach, which will be developed in the State of RN. Directors of regional public health units, managers of public maternity wards, coordinators of primary care, directors of health districts in the state capital, professionals in family health strategy, users representing the municipal health council and technicians responsible for the syphilis condition at the state level and in the municipality of Natal will participate in the research. A semi-structured interview and the focus group technique will be applied. The data will be analyzed using the content analysis technique, according to Bardin. We will use the IRAMUTEC software.
DESCRIPTORS: Syphilis; Evaluation of Processes and Results; Public health.
INTRODUCTION
Syphilis has become a public health issue worldwide, due to the increase in the number of cases in recent years, despite the existence of prevention, diagnosis and treatment protocols. It affects one million pregnant women per year worldwide, leading to more than 300,000 fetal and neonatal deaths and increases the risk of premature death in more than 200,000 children(1).
In Brazil, in 2016, 87,593 cases of acquired syphilis, 37,436 cases of syphilis in pregnant women and 20,474 cases of congenital syphilis were reported – including 185 deaths. In the last ten years the infant mortality rate due to congenital syphilis in Brazil increased from 2.3/100,000 live births in 2006 to 6.7/100,000 live births in 2016(2).
In the last five years, the State of Rio Grande do Norte (RN) has shown an increase in the number of syphilis cases. The year of 2017 registered the highest record, with 559 cases of congenital syphilis. The increase in the number of syphilis in pregnant women is even more alarming in the state. Case notifications went from 280 in 2016 to 792 cases in 2018(3).
The prevention of syphilis has become a priority for the Ministry of Health. In 2016, the Ministry of Health formulated the Strategic Actions Agenda for the Reduction of Congenital Syphilis in Brazil, establishing priorities to qualify health care for prevention, treatment, assistance and surveillance of syphilis. In 2017, it released a document to renew these actions, involving federal, state and municipal spheres. Among the six axes that interact in these actions, the axes of Strengthening Health Care Networks and Rapid Response to Syphilis in Health Care Networks stand out.
The object of study of this research is the evaluation of the care network of people with syphilis in the State of RN. The study presents as guiding questions the following: What are the strategic actions developed by the state of RN to control syphilis? How are users with syphilis being monitored? Is there a care network for people with syphilis in the state of RN? How is this Network designed?
OBJECTIVES
General
To evaluate health care for people with syphilis in the state of Rio Grande do Norte.
Specific
To design the modeling of the Syphilis Assistance Network in the State of RN.
To know the aspects related to the structure, the process and the result in health care for people with syphilis in the State of RN.
To identify the weaknesses and potentialities in health care for people with Syphilis in the State of RN.
METHODS
It is an Evaluative study, which evaluates the structure, process and results(3), with a qualitative approach. It will be developed in all Health Regions of the state of RN. Eight directors of regional public health units will participate in the research, as well as twelve managers of public maternity hospitals, eight primary care coordinators, five directors of health districts in the state capital, 16 family health strategy professionals (physicians and nurses), eight users representing the municipal health council, a state technician responsible for the syphilis condition, a technical professional responsible for the syphilis condition in the municipality of Natal, totaling 59 participants. Two methods for data collection will be used: Interview and Focus Group, with pre-structured scripts and forms. In the first stage of data collection, we will apply a semi-structured interview to all study participants. In the second stage, the focus group technique will be carried out, which will be applied in the state capital, with 13 participants who were part of the first stage of data collection and who perform their assistance/administrative activities in the municipality of Natal. The thematic analysis that is included in Bardin's thematic analysis will be carried out. The data will be organized and analyzed with the aid of the qualitative analysis software called IRAMUTEQ. We will perform the descriptive, analytical and execution modeling of the care processes inserted in each health region of the state, using the Bizagi Modeler software, which will allow for the construction of the graphical representations of work and process flows. This project is under development in the Doctoral Program in Collective Health at UFRN and will be submitted to the Research Ethics Committee of the Federal University of Rio Grande do Norte.
EXPECTED RESULTS
We believe in contributing to strengthen the Unified Health System, since it will present theoretical knowledge of the processes involved in the strategic actions for syphilis control, providing tool to guide actions in the control of this public health problem. This will affect the reorganization of assistance policy. This study will show the processes involved in the prevention, detection and treatment of syphilis, and in the monitoring of people infected with treponema pallidum, demonstrating the assistance flows within the care networks, the obstacles and positive developments, which will serve as a basis for new planning and formulations of public policies.
REFERENCES
1. Organizacion Mundial de la Salud. Orientaciones mundiales sobre los criterios y processos para la validacion de la eliminacion de la transmision maternoinfantil del VIH y la sifilis. Ginebra: OMS; 2015.
2. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Boletim Epidemiológico Sífilis. Brasília: Ministério da Saúde; 2017. 48(36): 01-44.
3. Donabedian A. The Quality of Care. J American Medical Association. 1988; 260 (12).
Received:10/06/2019
Revised:01/29/2020
Approved:03/13/2020