OBJECTIVES: To synthesise data from four recent studies in Tanzania
examining maternal syphilis screening and its operational implementation
in routine antenatal clinics (ANC), drawing lessons for strengthened
antenatal services for the prevention of mother-to-child transmission
(PMTCT) of HIV.
METHODS: The impact of untreated maternal syphilis was examined in a
retrospective cohort of 380 Tanzanian women. Effectiveness and
cost-effectiveness of screening and single dose benzathine penicillin
treatment were prospectively examined in 1688 pregnant women.
Observation, interviews and facility audits were carried out in health
facilities within nine districts to determine the operational reality of
RESULTS: Overall, 49% of women with untreated high titre syphilis
experienced an adverse pregnancy outcome compared with 11% of uninfected
women. Stillbirth and low birthweight rates among those treated for
high- or low-titre syphilis were reduced to rates similar to those for
uninfected women. The economic cost was $1.44 per woman screened and
$10.56 per disability-adjusted life year saved. In the operational
study, only 43% of 2256 ANC attenders observed were screened and only
61% of seroreactive women and 37% of their partners were treated.
Adequate training, continuity of supplies, supervision and quality
control are critical elements for strengthened antenatal services, but
are frequently overlooked.
CONCLUSIONS: Maternal syphilis has a severe impact on pregnancy outcome.
Same-day screening and treatment strategies are clinically effective and
highly cost-effective, but there are significant challenges to
implementing syphilis screening programmes in sub-Saharan Africa.
Current PMTCT interventions present an opportunity to reinforce and
improve syphilis screening. Increasing PMTCT coverage will involve
similar operational challenges to those faced by syphilis screening
Watson-Jones, D.; Oliff, M.; Terris-Prestholt, F.; Changalucha, J.; Gumodoka, B.; Mayaud, P.; Semakafu, A.M.; Kumaranayake, L.; Gavyole, A.; Mabe, y D.; Hayes, R. Antenatal syphilis screening in sub-Saharan Africa: lessons learned from Tanzania. Tropical Medicine and International Health (2005) 10 (9) 934-943. [DOI: 10.1111/j.1365-3156.2005.01473.x]