title: Maternal and congenital syphilis programmes: case studies in Bolivia, Kenya and South Africa.
abstract: Preventing congenital syphilis is not technically difficult, however operational difficulties limit the effectiveness of programmes in many settings. This paper reports on programmes in Bolivia, Kenya, and South Africa. All three countries have established antenatal syphilis control programmes. Early antenatal syphilis screening and management of positive cases were difficult to implement since most women presented for their first antenatal clinic visit after 6 months of pregnancy. Most women had rapid plasma reagin (RPR) testing; results were available on the same day in some clinics but took up to 4 weeks in others. No clinic had a system for tracking RPR-reactive women who did not return for their results. There were no guidelines for providers in Kenya and Bolivia. In all countries, supplies, drugs, notification cards, and other consumables were often unavailable. Health-care providers were unmotivated in Kenya and reported an excessive client load. In South Africa and Kenya some clients reported at their exit interview that they had never heard of syphilis nor had they been informed why blood was collected. Several prevention strategies could be implemented at the clinic level. These include encouraging women to attend for antenatal care before the fourth month of pregnancy, providing point-of-care testing so that results are available immediately and women who test positive can be treated, implementing presumptive treatment of sexual partners of women who test positive, adding a second test later in pregnancy so that incident cases can be managed, and improving the quality of syphilis care during pregnancy, delivery, and the neonatal period.
authors.affiliation: Technical Officer, Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland. deperthesb@who.int
authors.forename: Bidia D
authors.initials: BD
authors.lastname: Deperthes
authors.forename: André
authors.initials: A
authors.lastname: Meheus
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Reilly
authors.forename: Nathalie
authors.initials: N
authors.lastname: Broutet
mesh_terms: D001838:Bolivia / Q000453:epidemiology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007630:Kenya / Q000453:epidemiology; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D015397:Program Evaluation; D013019:South Africa / Q000453:epidemiology; D013588:Syphilis Serodiagnosis; D013590:Syphilis, Congenital / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*