广州市梅毒暴露儿童随访检测情况及影响因素分析

Follow-up status and influencing factors of syphilis-exposed children in Guangzhou

目的分析广州市梅毒暴露儿童随访检测情况及影响因素,以寻找可能的改进措施,助力消除梅毒母婴传播。方法分析2019年7月1日至2020年6月30日期间广州出生的梅毒暴露儿童随访检测情况,对部分儿童母亲进行问卷调查了解其接受服务顾虑因素及领悟社会支持。结果共需随访检测603名梅毒暴露儿童,521名(86.4%)儿童随访成功,82名(13.6%)随访失败。多因素分析显示,母亲小学及以下文化(a OR=4.700,95%CI:1.389~15.897)、不在婚状态(a OR=2.133,95%CI:1.048~4.342)、孕期未进行驱梅治疗(a OR=7.544,95%CI:1.236~46.057)及未进行规范驱梅治疗(a OR=5.302,95%CI:2.450~11.477)增加儿童随访失败的风险(P<0.05)。89.0%(81/91)梅毒暴露儿童母亲获取服务的主要顾虑因素为“孩子小,需多次抽血,心疼”,随访失败儿童的母亲认为“孩子没必要进行抽血检测”比例更高、领悟社会支持更低,这些差异有统计学意义(P<0.05)。结论广州市梅毒暴露儿童随访成功率略低于消除母婴传播认证目标,今后应加强对文化水平低、不在婚、孕期未进行驱梅治疗、领悟社会支持低等重点人群健康教育以提高其随访依从性。

Objective To explore the improvement measures and assist in the eliminating mother-to-child transmission of syphilis by analyzing the status on follow-up detection and influence factors among children exposed to syphilis in Guangzhou.Methods The follow-up and detection of syphilis-exposed children born between July 1,2019,and June 30,2020 were analyzed.In addition,a questionnaire survey was conducted on mothers of children to understand their concerns about service acceptance and perceived social support.Results A total of 603 syphilis-exposed children should be followed up and tested.Among them,521(86.4%)were successfully followed up and 82(13.6%)failed to be followed up.Mothers with primary school education and below(a OR=4.700,95%CI:1.389-15.897),unmarried(a OR=2.133,95%CI:1.048-4.342),did not receive treatment(a OR=7.544,95%CI:1.236-46.057)or standard treatment during pregnancy(a OR=5.302,95%CI:2.450-11.477)increased the risk of follow-up failure of their offspring(P<0.05).89.0%(81/91)mothers of syphilis-exposed children reject follow-up as"distress because the child needs multiple blood draws."The mothers of children who failed to follow up were likely to believe that"the child does not need blood testing"and perceived lower social support.These differences were statistically significant(P<0.05).Conclusions The success rate of follow-up of children exposed to syphilis in Guangzhou is slightly lower than the goal of eliminating the mother-to-child transmission of syphilis.Health education should be strengthened for critical populations with low education levels who are not married,do not receive anti-syphilis treatment,and have low social support to improve follow-up compliance.