Syphilis in Murewa District, Zimbabwe : an old problem that rages on

Kambarami, R A Manyame, B Macq, Jean [UCL]

OBJECTIVE: To determine the prevalence of syphilis among pregnant women and women giving birth in health centres in a rural district and to identify problems associate with syphilis control in the same district. DESIGN: Cross sectional descriptive study. SETTING: Murewa District health facilities. SUBJECTS: Women attending health facilities in this district for antenatal care or delivery between February and May 1993. MAIN OUTCOME MEASURES: Syphilis sero-prevalence rate. Factors associated with poor syphilis control. RESULTS: Even though it is recommended that all women attending clinics for antenatal care (ANC) should be screened for syphilis at first visit only 308 (20%) out of 1,556 first visit attenders were screened during the study period. Three hundred and sixty six (33%) out of 1,096 women giving birth in health institutions were screened. The RPR/TPHA sero positivity rate for antenatal women was 9.2% while that for women delivering was 9.8%. A positive RPR was not significantly associated with the women's age, parity, infant's birth weight, sex or pregnancy outcome. Factors associated with poor syphilis control in this district included: lack of motivation and appreciation of the seriousness of syphilis in pregnancy; lack of transport to send specimens and receive results from Murewa District Hospital; poor record keeping; loss to follow up of women being tested or after starting treatment; lack of contact tracing and treatment of contacts and difficulties in implementing the 10 day neonatal regime and follow up of these infants. CONCLUSION: Syphilis remains poorly controlled in Murewa district and may be contributing significantly to high perinatal mortality rates. There is need to strengthen the syphilis control programme through motivation and training of health workers, decentralisation of testing and treatment of the condition and improved contact tracing. A repeat RPR test at delivery may not be cost effective. PIP: A cross-sectional descriptive study was conducted at Murewa District health facilities to determine the prevalence of syphilis among antenatal women and women giving birth and to identify problems associated with syphilis control. The data were collected from the health center nursing staff who took care of the women during antenatal period or delivery at Murewa District health facilities. The results showed that only 308 (20%) out of 1556 first visit attendees were screened during the study period while only 366 (33%) women giving birth were screened out of 1096 subjects. The RPR/TPHA seropositivity rate for antenatal women was 9.2%, while that for women delivering was 9.8%. There was no significant association between positive RPR result and the women's age, parity, the infant's birth weight or sex or pregnancy outcome. Poor syphilis control in Murewa District Health facilities was due to lack of motivation and appreciation of the seriousness of syphilis in pregnancy, lack of transport to send specimens and receive results from Murewa District Hospital, poor record keeping, loss during follow-up of women during testing or after treatment, lack of contact tracing and treatment of contacts and difficulties in implementing the 10 day neonatal regimen and follow up for these infants. Owing to these factors, syphilis remains poorly controlled in Murewa district and may be considered a significant contributing factor to high perinatal mortality rates. Action is needed to strengthen the syphilis control program through motivation and training of health workers, improved contact tracing, and decentralization of testing and treatment.