Syphilis intervention in pregnancy: Zambian demonstration project.

Abstract

Despite availability of simpler serologic tests for syphilis and near cure with penicillin, unacceptably high prevalence of infectious maternal syphilis exist in many developing countries, including Zambia. It is the foremost risk factor for mid-trimester abortions, stillbirths, prematurity and morbidity and mortality among infants born with congenital syphilis in Zambia. An intervention project was conducted in Lusaka aimed at demonstrating the effectiveness of new health education methods and prenatal screening for syphilis in reducing the adverse outcomes during pregnancy. During pre-intervention phase, approximately 150 consecutive pregnant women from each of the three study and the three control centres were recruited when they presented in labour at the University Teaching Hospital. The intervention phase lasted for one year at the three study centres during which new methods of health education were introduced to improve early attendances during pregnancy. Also, on-site syphilis screening was performed twice during pregnancy and seroreactive women, and in many cases their sexual partners, were treated by the existing prenatal clinic staff. During the post-intervention phase the steps of pre-intervention phase were repeated to evaluate the impact of intervention. Overall, 8.0% of women were confirmed seroreactive for syphilis; there was no difference between the study and the control centres (p > 0.05). Fifty seven percent (132/230) of syphilitic pregnancies ended with an adverse outcome, that is, abortion (RR 5.0), stillbirth (RR 3.6), prematurity (RR 2.6) and low birth weight (RR 7.8). The overall risk of University Teaching

Patterns of Routine Antenatal Laboratory Test Results at Booking in Enugu State University Teaching Hospital, Enugu, Southeast Nigeria

“…Our result is within 0.6%-2.3% reported rates in Nigeria for over 40 years [31][32][33]. However, the seropositive rates in otherAfrica countries range from 3%-18%, and thus syphilis has remained a major problem in many countries of sub-Saharan Africa [34][35][36]. It is still necessary to continue the antenatal VDRL test in the developing countries until the disease is eradicated.…”

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

“…316,328,329 Stillbirths and perinatal mortality 328,329,332 were reduced in offspring of mothers diagnosed and subsequently treated for syphilis during pregnancy. An observational study also demonstrated that women who were diagnosed and treated for syphilis during pregnancy had lower risk (OR: 0.25; P Ͻ .0001) of giving birth to an LBW infant.…”

“…We identified 5 intervention trials in developing countries that addressed the issue of antenatal screening and treatment of syphilis and evaluated the impact on pregnancy outcomes (Table 16). Of these, only one 316 was rural-based, and one was in a periurban/suburban setting 328,329 ; the rest were urban hospital-based studies. We included these hospital-based studies in the current review because they were conducted in developing countries and represented typical catchment populations.…”

Syphilis screening in Mozambique

“…7,8 Syphilis control is facilitated by the availability of inexpensive and sensitive diagnostic tests and effective and affordable treatment. 7,[9][10][11][12] Antenatal screening and treatment for the disease is highly cost-effective as a means to reduce fetal and infant morbidity and mortality, 13 and furthermore, such measures could contribute to reduced HIV transmission. 8,14 Every year, about 1.6 million pregnant women with syphilis remain undiagnosed in sub-Saharan Africa, including more than one million attending antenatal care.…”