A crise do desabastecimento da penicilina benzatina e o impacto na sífilis congênita: um estudo ecológico no município do Rio de Janeiro.

Abstract

The object of study is the crisis of the shortage of benzathine penicillin (BP) supply and the impact on congenital syphilis by an ecological study in the city of Rio de Janeiro. The goals are to (i) describe the temporal evolution of benzathine penicillin supply shortage, the incidence of congenital syphilis (CS) and the significant increase in its incidence in the municipality in the 2013-2017 period; (ii) to study the relation between the shortage of benzathine penicillin and the significant increase in the incidence of CS. This is a mixed-type (multiple groups and temporal) ecological study based on secondary data on CS and gestational syphilis (GS), benzathine penicillin dispensation, and demographic data of populations living in the neighborhoods of Rio de Janeiro. The units of study were neighborhood (geographical) and quarter (temporal) of the studied years. The study population consisted of all cases of SC reported by the Notification Aggravation Information System (SINAN) of the city of Rio de Janeiro, by place of residence (neighborhood) in the city of Rio de Janeiro. The study period considered the need to contemplate the expressive shortage of BP in the health units. It is known that in 2014, the shortage began due to regulatory-sanitary problems, a crisis that prevented the full production of penicillin in the Brazilian market. Only in 2016 were there indications that the situation had been regularized. The study's exposure was the level of BP supply in the basic health units calculated by the ratio between the number of doses dispensed and the number of doses required according to SINAN's gestational syphilis notification data. The main outcome was a significant increase in the incidence of CS, but the incidence rate of each neighborhood population was also considered. The theoretical model included the socio-demographic dimension (age structure, sex, female heads of household, schooling), economic dimension (poverty, unemployment, income gini index), geographic dimension (agglomeration, homicide) and prenatal care (amount of appointments, partners treated and examinations performed). For the data analysis it was used the negative binomial regression model inflated from zero to variable outcome significant increase of the incidence of SC (over 200% comparing the previous quarter) and the BP supply level per health units of each neighborhood-quarter each year between 2013-2017. The variables considered in the adjustment were those dimensions mentioned. The results indicate that (a) the shortage of BP in the studied period had heterogeneous distribution in space and time; (b) increase in the incidence of CS was also distributed heterogeneously in time and space, and (c) a relation between BP shortages and increased CS incidence, considering the influence of the factors described in the theoretical model. The conclusion was that the supply influenced the increase of the incidence of this disease in Rio de Janeiro in the years of study.