# Caregiver adherence to outpatient follow-up of children infected with or exposed to syphilis during pregnancy

## TL;DR

This study examines how well caregivers follow medical guidelines for children exposed to or infected with syphilis during pregnancy, finding low adherence rates in Brazil.

## Contribution

The study provides new insights into adherence patterns to congenital syphilis follow-up protocols and identifies predictors of adherence in a Brazilian cohort.

## Key findings

- Only 16% of caregivers adhered to both clinical-laboratory and specialist consultation follow-ups.
- Higher maternal age and presence of child sequelae were associated with better adherence.
- 68% of children were lost to follow-up during the study period.

## Abstract

To describe the caregiver adherence to the various interventions proposed by the Ministry of Health in the follow-up of children infected with or exposed to Treponema pallidum during pregnancy.

This is a prospective cohort study that included 256 children treated for congenital syphilis during the neonatal period. The children were referred from maternity to a reference outpatient clinic in the state of Rio de Janeiro between 2016 and 2021. Adherence was used as the outcome variable. It was assessed in two components: clinical-laboratory adherence (basic adherence) and adherence to specialist consultations (final adherence). Factors associated with adherence were investigated using logistic regression.

It was observed that 41 % of the children were followed for at least 18 months, and 68 % had two consecutive non-reactive VDRL tests. Basic adherence was 32 %, while final adherence (including specialist consultations and clinical-laboratory follow-up) was only 16 %. Additionally, 36 children presented permanent sequelae during follow-up. Factors such as higher maternal age (OR = 1.10; 95 % CI:1.03–1.20) and the presence of permanent sequelae in the children (OR = 4.87; 95 % CI: 2.29–10.35) were predictors of adherence. Loss to follow-up occurred in 68 % (173/256) of the cases.

This study highlights a very low level of caregiver adherence to the congenital syphilis management protocol recommended by the Brazilian Ministry of Health. The presence of sequelae in children and higher maternal age were associated with improved adherence.