Syphilis control during pregnancy: effectiveness and sustainability of a decentralized program.
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.
Fonck
K
K
International Center for Reproductive Health, Ghent University, UZ P3, De Pintelaan, 9000 Ghent, Belgium.
Claeys
P
P
Bashir
F
F
Bwayo
J
J
Fransen
L
L
Temmerman
M
M
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*