title: Estimating disease burden of maternal syphilis and associated adverse pregnancy outcomes in India, Nigeria, and Zambia in 2012.
abstract: OBJECTIVE
  To estimate maternal syphilis and its associated adverse pregnancy outcomes in India, Nigeria, and Zambia.
  
  
  METHODS
  An online estimation tool was used to generate point estimates and uncertainty ranges of maternal syphilis and adverse pregnancy outcomes due to mother-to-child transmission (MTCT). The most recent data (2010-2012) on antenatal care coverage, syphilis seroprevalence, and syphilis screening and treatment coverage at the subnational level in India, Nigeria, and Zambia were used to estimate disease burden for 2012. Sensitivity analysis was conducted for three screening and treatment scenarios (current coverages, current coverages minus 20%, and ideal coverages consistent with WHO targets for eliminating MTCT of syphilis).
  
  
  RESULTS
  A total of 103 960, 74 798, and 9072 pregnant women with probable active syphilis were estimated to occur in India, Nigeria, and Zambia, resulting in 53 187, 37 045, and 2973 adverse outcomes, respectively; approximately 1.6%, 4.8%, and 37.0% of these were averted under the current service coverages in India, Nigeria, and Zambia. The disease burden varied significantly in its subnational distribution within India and Nigeria, but was distributed evenly across Zambia.
  
  
  CONCLUSIONS
  The obtained results suggest an ongoing, unaverted high burden of maternal syphilis and associated adverse outcomes in India, Nigeria, and Zambia. Screening and treatment for syphilis must be scaled-up significantly in these countries to achieve elimination of MTCT of syphilis.
authors.affiliation: National Center for STD Control and Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China. Electronic address: chenxs@ncstdlc.org.
authors.forename: Xiang-Sheng
authors.initials: XS
authors.lastname: Chen
authors.affiliation: National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Khaparde
authors.affiliation: National AIDS Control Organization, Ministry of Health and Family Welfare, New Delhi, India.
authors.forename: Turlapati L N
authors.initials: TL
authors.lastname: Prasad
authors.affiliation: Jhpiego India Country Office, New Delhi, India.
authors.forename: Vani
authors.initials: V
authors.lastname: Srinivas
authors.affiliation: National AIDS/STI Control Programme, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Chukwuma
authors.initials: C
authors.lastname: Anyaike
authors.affiliation: National AIDS/STI Control Programme, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ijaodola
authors.affiliation: National AIDS/STI Control Programme, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ngige
authors.affiliation: Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
authors.forename: Grace
authors.initials: G
authors.lastname: Tembo Mumba
authors.affiliation: Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
authors.forename: Carolline
authors.initials: C
authors.lastname: Phiri
authors.affiliation: Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
authors.forename: Bushimbwa
authors.initials: B
authors.lastname: Tambatamba
authors.affiliation: World Health Organization, New Delhi, India.
authors.forename: Laxmikant
authors.initials: L
authors.lastname: Chavan
authors.affiliation: World Health Organization, New Delhi, India.
authors.forename: Nicole
authors.initials: N
authors.lastname: Seguy
authors.affiliation: World Health Organization, Abuja, Nigeria.
authors.forename: Taiwo A
authors.initials: TA
authors.lastname: Oyelade
authors.affiliation: World Health Organization, Lusaka, Zambia.
authors.forename: Malumo Sarai
authors.initials: MS
authors.lastname: Bvulani
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Newman
mesh_terms: D000328:Adult; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D009549:Nigeria / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000276:immunology; D011256:Pregnancy Outcome; D016036:Seroepidemiologic Studies; D013587:Syphilis / Q000453:epidemiology / Q000635:transmission*; D015024:Zambia / Q000453:epidemiology
keywords: Adverse outcomes; Estimation; Pregnant women; Syphilis