Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016.
Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016.
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先天性梅毒病例母亲的社会脆弱性：印第安纳州案件的定性评估，2014年至2016年。
DOI：
10.1097/olq.0000000000000783
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发表时间：
2018-07
影响因子：
3.1
通讯作者：
Ross A
中科院分区：
文献类型：
--
作者：
DiOrio D;Kroeger K;Ross A
当患有梅毒的孕妇没有得到诊断或治疗，感染在子宫内传播时，就会发生先天性梅毒，导致严重的婴儿发病率和死亡率。如果妇女得到及时和充分的产前护理，先天性梅毒是很容易预防的。先天梅毒病例被认为是安全网存在问题的指标。然而，产妇的社会和行为因素可能会阻碍妇女的护理，即使提供者遵循指导方针。我们回顾了2014年至2016年期间从印第安纳州向CDC报告的23例先天性梅毒病例的病例访谈和孕产妇记录。我们使用定性的方法来分析母亲访谈的叙述性记录，以了解更多可能导致CS病例的因素。所有提供者都遵循疾病预防控制中心和国家的建议，对患有梅毒的孕妇进行筛查和治疗。23名妇女中有21人有医疗保险。妇女接受产前护理的次数不理想;三分之一以上的妇女没有接受产前护理。近三分之一的妇女的唯一风险因素是与主要男性性伴侣发生性关系。大多数妇女在社会上处于弱势地位，包括无家可归、滥用药物和被监禁。尽管提供者遵守指南和健康保险的可用性，一些梅毒孕妇不太可能得到及时的诊断和治疗。梅毒高危孕妇可能需要额外的社会和物质支持，以防止CS病例。需要作出更多的努力，以帮助感染梅毒的脆弱女性的男性伴侣。
Congenital syphilis occurs when a pregnant woman with syphilis is not diagnosed or treated and the infection is passed in utero, causing severe infant morbidity and mortality. Congenital syphilis is easily prevented if women receive timely and adequate prenatal care. Cases of congenital syphilis are considered indicators of problems in the safety net. However, maternal social and behavioral factors can impede women’s care, even when providers follow guidelines. We reviewed case interviews and maternal records for 23 congenital syphilis cases reported to CDC from Indiana between 2014 and 2016. We used qualitative methods to analyze narrative notes from maternal interviews to learn more about factors that potentially contributed to CS cases. All providers followed CDC and state recommendations for screening and treatment of pregnant women with syphilis. Twenty-one of 23 women had health insurance. The number of prenatal care visits women had was suboptimal; more than one third of women had no prenatal care. Nearly one third of women’s only risk factor was sex with a primary male sex partner. The majority of women suffered social vulnerabilities, including homelessness, substance abuse, and incarceration. Despite provider adherence to guidelines and health insurance availability, some pregnant women with syphilis are unlikely to receive timely diagnosis and treatment. Pregnant women at high risk for syphilis may need additional social and material support to prevent a CS case. Additional efforts are needed to reach the male partners of vulnerable females with syphilis.