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Protecting Bolivian
Mothers and Their Babies from Syphilis
Syphilis infection has serious consequences for pregnant women and
their newborn babies. Congenital syphilis can lead to stillbirth,
premature birth, and neonatal death. It can cause meningitis, vasculitis,
and other complications for the newborn. Syphilis has also been
associated with a heightened risk of HIV infection among women and their
partners.
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A Bolivian mother brings her infant to a
health-care facility.
Photo
credit: Freddie Tinajeros/Population Council |
According to the World Health Organization (WHO), most people with
syphilis are unaware of their infection. WHO recommends syphilis testing
at least once during pregnancy, preferably in the first or second
trimester. If the infection is detected and treated with penicillin
before about 18 weeks’ gestation, the problems the infection can cause
at pregnancy and birth can be prevented. Despite estimates that every
year three million people in Latin America acquire the infection, many
hospitals in Latin America do not offer routine syphilis testing to
women seeking antenatal care. Until recently, testing involved a
laboratory procedure performed by trained personnel that required
refrigeration and other electrical equipment, which precluded testing in
rural settings lacking trained providers and laboratory facilities.
Results from a laboratory test might not be available for days or weeks,
and people who travel far to reach a medical facility often will not or
cannot return to learn their status.
To address this situation, Population Council researchers and
collaborators from the Bolivia Ministry of Health and other local
organizations designed a project to assess the feasibility,
acceptability, costs, and benefits of introducing a rapid strip test (RST)
for syphilis into existing antenatal care services in Bolivia. RSTs are
simple to perform using blood from a finger prick, and they produce
results in less than half an hour.
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Worldwide, 12 million new cases of
syphilis occur every year. Congenital syphilis kills more than
one million babies annually. In developing countries, 3–15
percent of women of childbearing age are infected with syphilis.
About 30 percent of pregnant women with syphilis give birth to
stillborn babies and another 30 percent to live babies with
congenital syphilis, who have a mortality rate as great as 50
percent.
—WHO |
The study was conducted in 37 rural health centers and four urban
maternity hospitals in four Bolivian provinces. In all, 8,900 women
attending urban hospitals and 2,718 women attending rural clinics for
antenatal care were tested using RSTs. About 5 percent of these women
tested positive for syphilis; 81 percent of those who tested positive
received all three recommended doses of penicillin, and 85 percent of
their partners completed treatment. More than 95 percent of participants
and clinical and laboratory staff found this testing method acceptable.
Based on the study’s findings, the Bolivia Ministry of Health has
expanded its universal maternal and child health insurance coverage to
include RSTs in rural health-care settings.
The findings of this pilot study have important implications for the
treatment of syphilis in sub-Saharan Africa and South and Southeast
Asia, where there are over eight million annual infections. Council
researchers are disseminating their findings widely: to date, three
articles have appeared in the journal Sexually Transmitted Diseases
and one in Sexually Transmitted Infections, and coinvestigators
made six presentations at the American Public Health Association’s
November 2006 annual meeting. The study was supported by a grant from
the Bill & Melinda Gates Foundation.
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