title: Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program.
abstract: OBJECTIVE
  This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis screening program in Nairobi, Kenya.
  
  
  METHODS
  Health clinic data, quality control data, and costs were analyzed.
  
  
  RESULTS
  The rapid plasma reagin (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program's performance was adequate. The program's effectiveness was problematic because of false-negative and false-positive RPR results. The cost per averted case was calculated to be US$95 to US$112.
  
  
  CONCLUSIONS
  The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered.
authors.affiliation: International Center for Reproductive Health, Ghent University, UZ P3, De Pintelaan, 9000 Ghent, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Fonck
authors.forename: P
authors.initials: P
authors.lastname: Claeys
authors.forename: F
authors.initials: F
authors.lastname: Bashir
authors.forename: J
authors.initials: J
authors.lastname: Bwayo
authors.forename: L
authors.initials: L
authors.lastname: Fransen
authors.forename: M
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration*; D015397:Program Evaluation; D013587:Syphilis / Q000453:epidemiology / Q000517:prevention & control*