title: Ten-year trends of syphilis in sero-surveillance of pregnant women in Rwanda and correlates of syphilis-HIV co-infection.
abstract: Syphilis can be transmitted by pregnant women to their children and is a public health problem in Africa. A cross-sectional survey was conducted in 24 antenatal clinics from 2002 to 2003 and increased to 30 sites from 2005 to 2011. Participants were tested for syphilis and HIV. Multi-variate logistic regression was performed to identify risks associated with syphilis and its co-infection with HIV. Results showed that syphilis decreased from 3.8% in 2002 to 2.0% in 2011. Syphilis in the HIV-infected participants increased from 6.0% in 2002 to 10.8% in 2011, but decreased from 3.7% to 1.7% in the HIV-negative participants. In 2011, syphilis in urban participants was 2.7% and 1.4% in rural ones. HIV-infected participants screened positive for syphilis more frequently in both rural (aOR = 3.64 [95% CI: 1.56%-8.51%]) and urban areas (aOR = 7.26 [95% CI: 5.04%-10.46%]). Older participants (25-49 years) residing in urban areas (aOR = 0.43[95% CI: 0.32%-0.58%]) and women with secondary or high education (aOR = 0.35[95% CI: 0.20%-0.62%]) were less likely to screen positive for syphilis. HIV-syphilis co-infection was more likely in women residing in urban areas (aOR = 8.32[95% CI: 3.54%-19.56%]), but less likely in women with secondary/high education (aOR = 0.11[95% CI: 0.01%-0.77%]). In conclusion, syphilis increased in HIV-positive pregnant women, but decreased in HIV-negative women. Positive HIV status and young age were associated risks for syphilis. HIV-syphilis co-infection was associated with a lower level of education and urban residence.
authors.affiliation: 1 Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.
authors.forename: Mwumvaneza
authors.initials: M
authors.lastname: Mutagoma
authors.affiliation: 1 Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.
authors.forename: Helene
authors.initials: H
authors.lastname: Balisanga
authors.affiliation: 1 Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.
authors.forename: Eric
authors.initials: E
authors.lastname: Remera
authors.affiliation: 2 Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA.|3 Partners in Health / Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.affiliation: 4 U.S. Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Rwanda.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Malamba
authors.affiliation: 5 Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, MD, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
authors.affiliation: 1 Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda.|6 Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
mesh_terms: D000293:Adolescent; D000328:Adult; D060085:Coinfection / Q000453:epidemiology*; D003151:Community Health Centers; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D011295:Prenatal Care; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D018571:Sentinel Surveillance; D016036:Seroepidemiologic Studies; D013587:Syphilis / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
keywords: HIV co-infection; Rwanda; Syphilis surveillance; prevalence; risk factors