Academic journal article Bulletin of the World Health Organization

Maternal and Congenital Syphilis in Bolivia, 1996: Prevalence and Risk Factors

Academic journal article Bulletin of the World Health Organization

Maternal and Congenital Syphilis in Bolivia, 1996: Prevalence and Risk Factors

Article excerpt

Bulletin of the World Health 0rganization, 2001, 79: 33-42.

Voir page 40 le resume en francais. En la pagina 41 figura un resumen en espanol.

Introduction

Much attention and considerable resources are being focused on limiting the vertical transmission of human immunodeficiency virus (HIV) infection from pregnant women to their infants (1). At the same time, it is essential for public health programmes not to neglect the prevention of another congenital infection, namely congenital syphilis. This is a potentially devastating condition that can cause fetal death, prematurity, meningitis, vasculitis, bone and joint destruction, and multi-system disease (2). Studies in the pre-penicillin era demonstrated that a woman with primary or secondary syphilis had a 70% or greater chance of infecting her fetus (3). More recently it was reported that 30-60% of infected live-born infants show no signs of congenital syphilis at birth (4). Penicillin treatment is effective for both the pregnant woman and the fetus if given a sufficient time before birth (3).

Congenital syphilis causes a large burden of disease in resource-poor settings (5). For example, a study in Zambia reported that almost 1% of infants born in a major university hospital in Lusaka had signs of congenital syphilis at delivery (6). Also, a recent population-based study in Malawi showed that 26% of stillbirths, 11% of neonatal deaths, 5% of post-neonatal deaths, and 8% of infant deaths were attributable to active maternal syphilis infection (7).

Maternal syphilis is also a significant problem in South America. Several studies during the 1990s in Central and South America showed reactive syphilis tests in pregnant women ranging from 1.7% in Panama to 11.5% in Recife, Brazil (8). Consequently, in 1995, the Pan American Health Organization (PAHO) began a campaign to reduce the rate of congenital syphilis in the Americas to 0.5 (or fewer) cases per 1000 live births by increasing the coverage of antenatal care, establishing routine syphilis serology testing during prenatal care and at delivery, and promoting diagnostic strategies to ensure rapid treatment of infected pregnant women (8).

In Bolivia, neonatologists and hospital-based paediatricians have reported anecdotally that congenital syphilis is a common problem, but few data are available. In 1994, the prevalence of symptomatic congenital syphilis reported to the Bolivian Ministry of Health was 3.1 per 1000 live births (9). However, this may be an underestimate because a study during the early 1990s reported that 10.9% of 892 women who gave birth in the German Urquidi maternity hospital in Cochabamba had a reactive VDRL test (F. Torrico, unpublished data, 1993). At the time of the present study, the Bolivian Ministry of Health recommended routine syphilis testing during pregnancy. However, funds and services for such testing were not provided, and the recommendation was not widely followed.

The present study's objectives were as follows: 1) to determine the prevalence of syphilis in women giving birth in Bolivian maternity hospitals and the associated risk factors; 2) to conduct a pilot project on rapid plasma reagin (RPR) testing at the time of delivery; 3) to assure the quality of syphilis serological testing; and 4) to determine the rate of congenital syphilis in infants born to women with maternal syphilis at delivery.

The results of this investigation were used as a baseline to develop a national congenital syphilis prevention programme.

Materials and methods

All women delivering either live-born or stillborn infants in the seven participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in this investigation. The study was approved by the Bolivian Ministry of Health and Social Welfare, the participating local institutions, the Office for Protection from Research Risks of the National Institutes of Health, and the institutional review board of the Centers for Disease Control and Prevention (CDC) in the USA. …

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