title: A study on usefulness of a set of known risk factors in predicting maternal syphilis infections in three districts of Western Province, Zambia.
abstract: BACKGROUND
  Despite roll-out of cost-effective point-of-care tests, less than half antenatal attendees in rural western Zambia are screened for syphilis. This study formulated a clinical, risk-based assessment criteria and evaluated its usefulness as a non-biomedical alternative for identifying high-risk prenatal cases.
  
  
  METHODS
  We conducted a cross-sectional survey of antenatal clinic attendees in Kaoma, Luampa and Nkeyema districts to collect data on exposure to nine pre-selected syphilis risk factors. These factors were classified into major and minor factors based on their observed pre-study association strengths to maternal syphilis. Clinical disease was defined as exposure to either two major factors, one major with two minor factors or three minor factors. Sensitivity, specificity and predictive values of the clinical protocol were then calculated in comparison to rapid plasmin reagin results.
  
  
  RESULTS
  The observed syphilis prevalence was 9.3% (95% CI: 7.4 - 11.6%) and the overall sensitivity of the study criteria was 62.3% with positive predictive value of 72.9%. Sensitivities of individual case-defining categories were even lower; from 17.4% to 33.3%. Results confirmed that abortion history, still birth, multiple sexual partners, previous maternal syphilis infection, partner history of sexually transmitted infection and maternal co-morbid conditions of HIV and genital ulcer disease were significantly associated to maternal syphilis in study population as well.
  
  
  CONCLUSIONS
  The criteria was not as effective as biomedical tests in identifying maternal syphilis. However, it could be a useful adjunct/alternative in antenatal clinics when biomedical tests are either inadequate or unavailable.
authors.affiliation: Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia; Kaoma District Medical Office, Ministry of Health, Kaoma, Zambia.
authors.forename: Jacob
authors.initials: J
authors.lastname: Sakala
authors.affiliation: Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: Nellisiwe
authors.initials: N
authors.lastname: Chizuni
authors.affiliation: Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia.
authors.forename: Selestine
authors.initials: S
authors.lastname: Nzala
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012747:Sexual Partners; D013587:Syphilis / Q000150:complications / Q000453:epidemiology*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
keywords: RPR; Zambia; assessment criteria; maternal syphilis