Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

Kuznik, Andreas; Lamorde, Mohammed; Nyabigambo, Agnes; Manabe, Yukari C.

doi:10.1371/journal.pmed.1001545

Cited by 71 publications

(122 citation statements)

References 39 publications

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“…In a study in sub-Saharan Africa only 40% of women were screened for syphilis [24]. Blood group testing was lower than 84% in the South African Study [19].…”

Section: Discussionmentioning

confidence: 92%

Utilisation of antenatal services at comprehensive health center umunya, anambra state: a retrospective study

Agu¹,

Agu²,

Nnaji³

2015

Fam Pract Rep

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Background: Early antenatal booking leads to early detection and management of abnormalities resulting in a reduction in maternal morbidity and mortality rates. The study sought to determine the frequency of antenatal visits, the gestational age at booking and to audit the provision and examine the utilization of antenatal services provided at Comprehensive Health Centre, Umunya. Methods: A retrospective, cross sectional, descriptive study carried out among women who delivered at comprehensive health center, Umunya from January 2007 to July 2014. A sample size of 323 determined by Vaughan's formula was used. Data was extracted from the patients' records and analysed using SPSS 15. Chi-square tests was used as test of significance at p<0.05. Results: Mean gestational age at booking was (mean±SD), 22.76±8.151 weeks. Approximately, two thirds of the women (66.3%) attended antenatal clinic ≥4 times. The assessment of antenatal care services at the center showed that height and weight measurements were done in 33.7% and 65.9%, respectively. Blood pressure was recorded in 99.7%, while almost all the women (95.6%) had routine iron and folic acid supplementation prescribed. Intermittent malaria prophylaxis was prescribed in 19.5% of the women. Tetanus toxoid immunization was administered in 80.5% of the women. In the examination of the utilization of the services, heamoglobin assessment was recorded in 82% of the women, urinalysis in 292 (90.4%), HIV screening in 99.4%, Syphilis test in 75.5% and Blood group test in 77.7%. Conclusion:The study demonstrates suboptimal provision of services especially with height and weight measurements and prescription of malaria intermittent preventive therapy. It also showed suboptimal utilization of laboratory services.

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“…In a study in sub-Saharan Africa only 40% of women were screened for syphilis [24]. Blood group testing was lower than 84% in the South African Study [19].…”

Section: Discussionmentioning

confidence: 92%

Utilisation of antenatal services at comprehensive health center umunya, anambra state: a retrospective study

Agu¹,

Agu²,

Nnaji³

2015

Fam Pract Rep

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“…Sua sensibilidade e especificidade foram comparáveis às de testes não treponêmi-cos utilizados na testagem de rotina realizada em clínicas de DST ou em serviços de pré-natal 28 . Sua utilização em locais com recursos limitados na África Subsaariana mostrou-se altamente custo-efetiva, mesmo se ocorrer redução da prevalência de sífilis na gestação 29 .…”

Section: Discussionunclassified

Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil

2016

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Resumo: O objetivo foi estimar a incidência de sífilis congênita ao nascimento e verificar os fatores associados à transmissão vertical da sífilis. Estudo nacional, de base hospitalar, realizado em 2011-2012 com 23.894 puérperas, por meio de entrevista hospitalar, dados de prontuário e cartão de pré-natal. Realizada regressão logística univariada para verificar os fatores associados à sífilis congênita. Estimada incidência de sífilis congênita de 3,51 por mil nascidos vivos (IC95% 2,29-5,37) e taxa de transmissão vertical de 34,3% (IC95%: 24,7-45,4). Casos de sífilis congênita estiveram associados à menor escolaridade materna, cor da pele preta e maior proporção de fatores de risco para prematuridade, bem como ao início mais tardio do pré-natal, menor número de consultas e menor realização de exames sorológicos. A mortalidade fetal foi seis vezes superior nos casos de sífilis congênita, e recém-natos com sífilis congênita apresentaram maior frequência de internação. A sífilis congênita persiste como problema de saúde pública, estando associada à maior vulnerabilidade social e falhas na assistência pré-natal.

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“…In fact, a recent bioethical assessment concluded that it would be ethically preferable to include stillbirths in burden of disease estimates, 19 such as the GHE, and several cost-effectiveness analyses focused on maternal health have included stillbirth in their DALY estimates. 5,20,21 In our model, stillbirths associated with maternal syphilis infection account for almost two-thirds of the disease burden (8.1 million DALYs). In fact, the burden associated with syphilis-related stillbirths is slightly below the public health burden associated with tuberculosis in the African region (9.4 million DALYs in 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, rapid, reliable and inexpensive immunochromatographic point-of-care tests were introduced that are reported to be highly cost-effective within antenatal care (ANC) settings. 5,6 A study in Tanzania reported no increased risk for adverse pregnancy outcomes among seropositive pregnant women that were treated with a single dose of intramuscular benzathine penicillin. 7 A meta-analysis of interventional studies concluded that adverse pregnancy outcomes can be prevented if infected mothers are identified and treated prior to the third trimester of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa

Kuznik¹,

Habib²,

Manabe³

et al. 2015

Sexually Transmitted Diseases

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Background Untreated syphilis in pregnancy is associated with adverse clinical outcomes to the infant. The study aimed to estimate the public health burden resulting from adverse pregnancy outcomes due to syphilis infection among pregnant women not screened for syphilis in 43 countries in sub-Saharan Africa (SSA). Methods Estimated country-specific incidence of syphilis was generated from annual number of live births, the proportion of women with ≥1 antenatal care (ANC) visit, the syphilis prevalence rate, and the proportion of women screened for syphilis during ANC. Adverse pregnancy outcome data (stillbirth, neonatal death, low birth weight, and congenital syphilis) were obtained from published sources. Disability-adjusted life year (DALY) estimates were calculated using undiscounted local life expectancy, the neonatal standard loss function and relevant disability weights. The model assessed the potential impact of raising antenatal care coverage to ≥95% and syphilis screening to ≥95% (WHO targets). Results For all 43 SSA countries, the estimated incidence of adverse pregnancy outcomes was 205,901(95% CI: 113,256–383,051) per year, including stillbirth: 88,376 (95% CI: 60,854–121,713), neonatal death: 34,959 (95% CI: 23,330–50,076), low birth weight: 22,483 (95% CI: 0–98,847), and congenital syphilis: 60,084 (95% CI: 29,073–112,414), resulting in approximately 12.5 million DALYs. Countries with the greatest burden are (in DALYs, millions) Democratic Republic of the Congo: 1.809, Nigeria: 1.598, Ethiopia: 1.466, and Tanzania: 0.961. Attaining WHO targets could reduce the burden by 8.5 million DALYs. Conclusions Substantial infant mortality and morbidity results from maternal syphilis infection concentrated in countries with low access to ANC or low rates of syphilis screening.

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Antenatal Syphilis Screening Using Point-of-Care Testing in Sub-Saharan African Countries: A Cost-Effectiveness Analysis

Cited by 71 publications

References 39 publications

Utilisation of antenatal services at comprehensive health center umunya, anambra state: a retrospective study

Utilisation of antenatal services at comprehensive health center umunya, anambra state: a retrospective study

Incidência de sífilis congênita e fatores associados à transmissão vertical da sífilis: dados do estudo Nascer no Brasil

Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa

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