Marginal validity of syndromic management for reproductive tract infections among pregnant women in Jamaica.
We assessed the validity of a syndromic case management approach for reproductive tract infections (RTIs) among 371 pregnant women attending antenatal care facilities in Kingston, Jamaica, using an algorithm previously validated in high-risk Jamaican women. For our antenatal attenders, the algorithm had low sensitivities for all RTIs (66.7% for cervicitis, 35.4% for trichomoniasis, 11.1% for bacterial vaginosis (BV) and 24% for candidiasis). Specificities for BV (88.9%) and candidiasis (81.1%) were higher than for cervicitis (62.8%) and trichomoniasis (68.5%). The positive predictive values were lower than 36% for all diagnoses, especially BV (6.9%). Syndromic management of RTIs in pregnant women was problematic using a clinical algorithm that had worked well for high-risk women. Syndromic management for RTIs in Jamaican antenatal clinics is only a temporary solution until more simple and affordable diagnostic tests for RTIs are developed and/or until laboratory support and clinical care can be upgraded at antenatal clinics.
Hylton-Kong
T
T
Jamaican Ministry of Health, Kingston, Jamaica.
Brathwaite
A R
AR
Del Rosario
G R
GR
Kristensen
S
S
Kamara
P
P
Jolly
P E
PE
Hook
E W
EW
Figueroa
J P
JP
Vermund
S H
SH
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000554:Ambulatory Care Facilities; D005260:Female; D006801:Humans; D007563:Jamaica; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000382:microbiology; D011295:Prenatal Care; D012680:Sensitivity and Specificity; D002575:Uterine Cervicitis / Q000175:diagnosis; D014623:Vaginal Diseases / Q000175:diagnosis* / Q000382:microbiology