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Farahani M, Killian R, Reid GA, Musuka G, Mugurungi O, Kirungi W, Nuwagaba-Biribonwoha H, El-Sadr WM, Justman J. Prevalence of syphilis among adults and adolescents in five sub-Saharan African countries: findings from Population-based HIV Impact Assessment surveys. Lancet Glob Health 2024; 12:e1413-e1423. [PMID: 39151977 DOI: 10.1016/s2214-109x(24)00234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND HIV and syphilis are common sexually transmitted infections in sub-Saharan Africa. We aimed to investigate the prevalence and distribution of active syphilis while considering HIV status, demographic characteristics, and behavioural characteristics. METHODS The Population-based HIV Impact Assessment surveys used a cross-sectional, two-stage, stratified cluster sample design to collect data in Ethiopia, Tanzania, Uganda, Zambia, and Zimbabwe from 2015 to 2018. Eligible participants were aged 15 years and older and provided demographic information, behavioural information, and blood specimens for HIV and syphilis testing. Active syphilis was defined as the presence of both treponemal and non-treponemal antibodies, measured using an antigen-based rapid test. Multivariable logistic regression models with survey weights were applied. The estimated number of participants with active syphilis in each country was calculated by multiplying the survey-weighted syphilis prevalence by the corresponding participant population size from the latest national census data. The total burden across the five countries was obtained by summing these estimates. FINDINGS 102 831 participants enrolled in the five surveys (54 583 [57·6%] participants were female, 48 248 [42·4%] participants were male, 9036 [9·9%] participants were HIV positive). Population-based syphilis prevalence was 0·9% (95% CI 0·7-1·1) in Tanzania and Zimbabwe, 2·1% (1·9-2·4) in Uganda, and 3·0% (2·7-3·4) in Zambia. Overall, an estimated 1 027 615 (95% CI 877 243-1 158 246) participants had active syphilis across the five countries (266 383 HIV-positive and 761 232 HIV-negative individuals). Syphilis prevalence was higher among people living with HIV (range from 2·6% [95% CI 1·1-4·0] in Ethiopia to 9·6% [8·1-11·0] in Zambia) than among those without HIV (range from 0·8% [0·7-1·0] in Tanzania to 2·1% [1·8-2·4] in Zimbabwe). The odds of active syphilis were higher among people living with HIV than in those who were HIV negative (adjusted odds ratio [aOR] range from 2·5 [95% CI 1·8-3·4] in Uganda to 5·9 [3·8-9·2] in Zimbabwe), among divorced, separated, or widowed individuals (aOR range from 1·5 [1·1-2·0] in Uganda to 2·7 [1·7-4·3] in Zimbabwe), and among those reporting two or more sexual partners in the previous 12 months (aOR range from 1·1 [CI 0·8-1·5] in Uganda to 1·9 [1·1-3·3] in Zimbabwe). INTERPRETATION This study shows the high burden of syphilis in five sub-Saharan African countries, with a correlation between HIV and active syphilis, underscoring the need for integrated sexual health services and targeted diagnosis, prevention, and treatment strategies to address this public health challenge. FUNDING The President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Rose Killian
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Giles A Reid
- ICAP at Columbia University, New York City, NY, USA
| | | | | | | | - Harriet Nuwagaba-Biribonwoha
- ICAP at Columbia University, New York City, NY, USA; Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Wafaa M El-Sadr
- ICAP at Columbia University, New York City, NY, USA; Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
| | - Jessica Justman
- ICAP at Columbia University, New York City, NY, USA; Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, NY, USA
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Alemayehu T, Frigati L. Editorial: Perinatal infections among newborns in African countries: under-recognized, under-resourced and under-treated - a call for action. Front Public Health 2024; 12:1439757. [PMID: 38975358 PMCID: PMC11224513 DOI: 10.3389/fpubh.2024.1439757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Tinsae Alemayehu
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Zulu EM, Herlihy JM, Duffy CR, Mwananyanda L, Chilengi R, Forman L, Heeren T, Gill CJ, Chavuma R, Payne-Lohman B, Thea DM. Single-test syphilis serology: A case of not seeing the forest for the trees. PLoS One 2024; 19:e0303253. [PMID: 38723103 PMCID: PMC11081208 DOI: 10.1371/journal.pone.0303253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening. METHODS Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia. HIV positive and HIV negative women were enrolled in a 1:1 ratio. Blood collected at recruitment from the pregnant mothers was tested on-site for syphilis using a rapid treponemal test. Samples that tested positive were further tested at a different laboratory, with rapid plasma reagin using archived plasma. RESULTS Of the total 1,421 sera samples which were screened with a rapid treponemal test, 127 (8.9%) were positive and 1,294 (91.1%) were negative. Sufficient additional samples were available to perform RPR testing on 114 of the 127 (89.8%) RDT positive specimens. Thirty-one (27.2%) of these 114 were reactive by RPR and 83 (72.8%) were negative, resulting in a syphilis overtreatment rate of 3 fold (i.e, 84/114). Insufficient sample or test kit availability prevented any testing for the remaining 89 (5.9%) participants. CONCLUSION Use of only treponemal tests in low prevalence populations, like pregnant women, subjects individuals with non-active syphilis to the costs and possible risks of overtreatment. The use of the dual treponemal and non-treponemal tests would minimize this risk at some additional cost.
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Affiliation(s)
| | - Julie M. Herlihy
- Department of Pediatrics, Boston Medical Center, Boston University, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Cassandra R. Duffy
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lawrence Mwananyanda
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Leah Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Tim Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Christopher J. Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | | | - Barbara Payne-Lohman
- Institute for Immunology and Informatics, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Donald M. Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Simiyu A, Atuheire CGK, Taremwa M, Ssali SN, Mwiine FN, Kankya C, Mugimba KK. Sero-prevalence of syphilis and associated risk factors among pregnant women attending antenatal care at an urban-poor health centre in Kampala, Uganda: a cross-sectional study. Pan Afr Med J 2024; 47:129. [PMID: 38854863 PMCID: PMC11161699 DOI: 10.11604/pamj.2024.47.129.31622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/05/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction syphilis and its outcomes remain a healthcare system burden with adverse consequences such as stillbirths, neonatal deaths and spontaneous abortions among others. The situation might have worsened because the COVID-19 pandemic has caused a major attention drift from other diseases. Additionally, much as testing for syphilis is a routine practice among pregnant mothers, its proportion is not known in urban health care setting. A study to determine the prevalence of syphilis among pregnant mothers in an urban poor setting is warranted. Methods a cross-sectional study was conducted among pregnant women who attended antenatal care at Kawaala Health Centre IV in Kampala Capital City between December 2019 to March 2020. Informed consent was sought from study participants prior to data collection using structured questionnaires. Whole blood was collected and tested using SD Bioline HIV/syphilis duo rapid test kit (SD Standard Diagnostics, INC, Korea). Data analysis was done using STATA 14.2. Results one thousand one hundred and sixty-nine pregnant women participated in the study, with a mean age of 25 years. About 27% of them had completed only primary-level education. Approximately 6% of the participants were HIV seropositive. The prevalence of syphilis was 5.9% (69/1169). HIV positivity (aOR: 4.13, 95%CI: 2.05-8.34), elevated blood pressure (aOR: 2.84, 95%CI: 1.42-5.69), and status of previous pregnancy (aOR: 0.21, 95%CI: 0.05-0.89) were significant predictors of the risk of syphilis among pregnant women in this setting. Conclusion the prevalence of syphilis among pregnant women in urban poor settings is not low and so must not be underestimated. The potential drivers of syphilis among pregnant women are HIV, elevated blood pressure, and status of previous pregnancy. There should be increased awareness about routine syphilis testing among pregnant mothers attending antenatal care.
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Affiliation(s)
- Andrew Simiyu
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Collins Grace Kalanga Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Martha Taremwa
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Sarah Nabwire Ssali
- School of Women and Gender Studies, College of Humanities, Makerere University, Kampala, Uganda
| | - Frank Norbert Mwiine
- Department of Biomolecular and Biolaboratory Sciences (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Clovice Kankya
- Department of Biosecurity, Ecosystems and Veterinary Public Health (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Kizito Kahooza Mugimba
- Department of Biomolecular and Biolaboratory Sciences (School of Biosecurity, Biotechnology and Laboratory Sciences (SBLS)), College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
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Hensen B, Phiri MM, Sigande L, Schaap A, Simuyaba M, Zulu-Phiri R, Mwape L, Floyd S, Fidler S, Hayes R, Simwinga M, Ayles H. Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002491. [PMID: 38437238 PMCID: PMC10911628 DOI: 10.1371/journal.pgph.0002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/06/2024]
Abstract
There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.
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Affiliation(s)
- Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Ab Schaap
- Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Marais YA, Mason D, Barnard A, Saaiman CR, Els HC, Kluge J, Glass AJ, Wright CA, Schubert PT. Placental Syphilis: A Comprehensive Review of Routine Histomorphology, HIV Co-infection, Penicillin Treatment, Immunohistochemistry, and Polymerase Chain Reaction. Fetal Pediatr Pathol 2023; 42:870-890. [PMID: 37668986 DOI: 10.1080/15513815.2023.2253309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/24/2023] [Accepted: 06/28/2023] [Indexed: 09/06/2023]
Abstract
Introduction: Placental examination is valuable for diagnosing congenital syphilis, but the classic histological triad is not always observed. This study aimed to identify additional morphological clues, evaluate the sensitivity of IHC and qPCR, and investigate the impact of HIV co-infection and penicillin treatment on placental morphology. Materials and methods: Two hundred and fifteen placental specimens with treponemal infection were reviewed. Morphological findings, IHC, and qPCR results were analyzed. Results: Chronic villitis (94%), acute chorioamnionitis (91.6%), and villous immaturity (65.6%) were the most common abnormalities. HIV co-infection and penicillin treatment were associated with reduced frequencies of inflammatory lesions. IHC and qPCR exhibited sensitivities of 74.4 and 25.8%, respectively, confirming the diagnosis in 42 cases with negative or unknown serology. Conclusion: Villitis, chorioamnionitis, and villous immaturity were identified as the predominant placental abnormalities. HIV co-infection and penicillin treatment can impact morphology and hamper the diagnosis. IHC and q-PCR are valuable adjuncts when serology is negative.
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Affiliation(s)
- Yolandi Anne Marais
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
| | - Deidré Mason
- Department of Obstetrics and Gynecology, Tygerberg Hospital, Cape Town, South Africa
| | - Annelize Barnard
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chestley Rashaell Saaiman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hester Christine Els
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judith Kluge
- Department of Obstetrics and Gynecology, Paarl Hospital, Cape Town, South Africa
| | - Allison Joy Glass
- Lancet Laboratories, Johannesburg, South Africa
- Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Colleen Anne Wright
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
- Lancet Laboratories, Johannesburg, South Africa
| | - Pawel Tomasz Schubert
- Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, National Health Laboratory Service, Stellenbosch University, Cape Town, South Africa
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Sunguya B, Mboya EA, Mizinduko M, Balandya B, Sabasaba A, Amani DE, Kamori D, Ruhago G, Mkumbwa R, Faustine P, Maokola W, Sambu V, Mushi J, Nyamuhagata M, Jullu BS, Juya A, Rugemalila J, Mgomella G, Asiimwe S, Pembe AB. Epidemiology of syphilis infections among pregnant women in Tanzania: Analysis of the 2020 national representative sentinel surveillance. PLoS One 2023; 18:e0285069. [PMID: 37651360 PMCID: PMC10470872 DOI: 10.1371/journal.pone.0285069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Syphilis has detrimental effects on the health of the mother and that of both fetuses and newborns exposed in utero or at delivery. Understanding its local epidemiology is essential for policies, planning, and implementation of targeted preventive interventions. Using data from the 2020 National Sentinel Surveillance of pregnant women attending antenatal clinics (ANCs) in Tanzania we determined the prevalence and determinants of syphilis among pregnant women in Tanzania mainland. METHODOLOGY The ANC surveillance was conducted in 159 ANC sites from all 26 regions of Tanzania's mainland from September to December 2020. It included all pregnant women 15 years and above on their first ANC visit in the current pregnancy during the survey period. Counseling for syphilis was done using standard guidelines at the ANC and testing was done using rapid SD Bioline HIV/Syphilis Duo test kits. Analysis was done using both descriptive statistics to determine the prevalence and characteristics of syphilis, whereas, logistic regressions were used to examine the independent association between syphilis and dependent variables. RESULTS A total of 38,783 women [median age (Interquartile range (IQR)) = 25 (21-30) years] participated in the surveillance. Of them, 582 (1.4%) tested positive for syphilis. A wide regional variation was observed with the highest burden in Kagera (4.5%) to the lowest burden in Kigoma (0.3%). The odds of syphilis infections were higher among older women and those with no formal education. Compared with primigravids, women with 1-2, those with 3-4 and those with more than four previous pregnancies had 1.8 (aOR = 1.8, 95% CI: 1.2-2.5), 2.1 (aOR = 2.1, 95% CI: 1.4-3.1) and 2.6 (aOR = 2.6, 95% CI: 1.7-3.9) higher odds of syphilis infection respectively. CONCLUSION Syphilis is still prevalent among pregnant women in Tanzania with a wide regional disparity. Efforts to prevent new infections, screen pregnant women, and treat those infected should be strategized to include all regions and renewed emphasis on regions with high burden, and importantly among women who are multipara, with a low level of education, and advanced age.
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Affiliation(s)
- Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | - Mucho Mizinduko
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Belinda Balandya
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Amon Sabasaba
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Davis Elias Amani
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Doreen Kamori
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - Rebecca Mkumbwa
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | | | | | | | | | | | - Boniphace S. Jullu
- St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - Amir Juya
- Tanzania Field Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | | | | | | | - Andrea B. Pembe
- Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
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Hakizimana T, Muhumuza J, Selamo FM, Ishimwe MPS, Kajabwangu R, Jelle OM, Muhumuza J, Kiyaka SM, Nyakato S, Fajardo Y. Prevalence and Factors Associated with Syphilis among Mothers with Missed Opportunities for Antenatal Syphilis Testing in Rural Western Uganda: A Cross-Sectional Study. Int J Reprod Med 2023; 2023:2971065. [PMID: 37664641 PMCID: PMC10471452 DOI: 10.1155/2023/2971065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/10/2023] [Accepted: 07/10/2023] [Indexed: 09/05/2023] Open
Abstract
Background Early prenatal syphilis testing and treatment are essential preventative measures for maternal syphilis and associated adverse pregnancy outcomes of pregnancy; however, data shows that two-thirds of all cases are missed among women who visit prenatal care center at least once but are not tested for syphilis. This study determined the prevalence and factors associated with syphilis infection among mothers with missed opportunities for antenatal syphilis testing in rural western Uganda delivered at Fort Portal Regional Referral Hospital (FRRH). Methods A cross-sectional study was done during the period from April 2022 to June 2022. A total of 124 participants had been recruited consecutively from postnatal ward of FRRH. Pretested questionnaires were used to obtain information on data required for analysis. Venous blood sampling (2 ml taken from the forearm using anticoagulant free vacutainer) was done for all mothers who missed opportunity for prenatal syphilis testing using both RPR and TPHA. Descriptive statistics followed by binary logistic regression analysis was done using SPSS version 22.0. Results The prevalence of syphilis infection was 27 (21.8%). After adjusted analysis, having more than one sexual partners in the past one year was associated with higher odds of syphilis infection (aOR = 24.922, 95% CI: 4.462-139.201, p < 0.001), and staying with the partner was found to be associated with lower odds of syphilis infection (aOR = 0.213, 95% CI: 0.040-1.142, p = 0.050). Conclusions The study identified high prevalence of syphilis infection among mothers with missed opportunities for antenatal syphilis testing, and this was positively associated with having more than one sexual partners in the past one year and negatively associated with not staying with partner.
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Affiliation(s)
- Theoneste Hakizimana
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Joy Muhumuza
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | | | | | - Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Osman Mohamud Jelle
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Kampala International University, Western Campus, Uganda
| | - Sonye Magugu Kiyaka
- Department of Surgery, Kampala International University, Western Campus, Uganda
| | - Sandra Nyakato
- Department of Laboratory, Fort Portal Regional Referral Hospital, Kabarole, Uganda
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Kampala International University, Western Campus, Uganda
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Shepard DS, Halasa-Rappel YA, Rowlands KR, Kulchyckyj M, Basaza RK, Otieno ED, Mutatina B, Kariuki S, Musange SF. Economic analysis of a new four-panel rapid screening test in antenatal care in Kenya, Rwanda, and Uganda. BMC Health Serv Res 2023; 23:815. [PMID: 37525192 PMCID: PMC10391856 DOI: 10.1186/s12913-023-09775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 07/03/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND We performed an economic analysis of a new technology used in antenatal care (ANC) clinics, the ANC panel. Introduced in 2019-2020 in five Rwandan districts, the ANC panel screens for four infections [hepatitis B virus (HBV), human immunodeficiency virus (HIV), malaria, and syphilis] using blood from a single fingerstick. It increases the scope and sensitivity of screening over conventional testing. METHODS We developed and applied an Excel-based economic and epidemiologic model to perform cost-effectiveness and cost-benefit analyses of this technology in Kenya, Rwanda, and Uganda. Costs include the ANC panel itself, its administration, and follow-up treatment. Effectiveness models predicted impacts on maternal and infant mortality and other outcomes. Key parameters are the baseline prevalence of each infection and the effectiveness of early treatment using observations from the Rwanda pilot, national and international literature, and expert opinion. For each parameter, we found the best estimate (with 95% confidence bound). RESULTS The ANC panel averted 92 (69-115) disability-adjusted life years (DALYs) per 1,000 pregnant women in ANC in Kenya, 54 (52-57) in Rwanda, and 258 (156-360) in Uganda. Net healthcare costs per woman ranged from $0.53 ($0.02-$4.21) in Kenya, $1.77 ($1.23-$5.60) in Rwanda, and negative $5.01 (-$6.45 to $0.48) in Uganda. Incremental cost-effectiveness ratios (ICERs) in dollars per DALY averted were $5.76 (-$3.50-$11.13) in Kenya, $32.62 ($17.54-$46.70) in Rwanda, and negative $19.40 (-$24.18 to -$15.42) in Uganda. Benefit-cost ratios were $17.48 ($15.90-$23.71) in Kenya, $6.20 ($5.91-$6.45) in Rwanda, and $25.36 ($16.88-$33.14) in Uganda. All results appear very favorable and cost-saving in Uganda. CONCLUSION Though subject to uncertainty, even our lowest estimates were still favorable. By combining field data and literature, the ANC model could be applied to other countries.
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Affiliation(s)
- Donald S Shepard
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA.
| | - Yara A Halasa-Rappel
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
- Commonwealth Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Katharine R Rowlands
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
| | - Maria Kulchyckyj
- The Heller School for Social Policy & Management, Brandeis University, Waltham, MA, 02454-9110, USA
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Abstract
In 2007, the World Health Organization (WHO) launched a global health initiative for the elimination of mother-to-child transmission (MTCT) of syphilis. This condition is highly preventable through antenatal identification of syphilis infection and treatment with penicillin during pregnancy. This review summarizes the global status of MTCT of syphilis and concludes that this condition remains a significant issue worldwide. There are large variations in case rates by region, with the highest numbers of cases in the African and Eastern Mediterranean regions, where there are also the least data available. There are also pockets of high-incidence areas within the other regions. Although the general trend is of decreasing rates over time, there are concerning indications of consistently increasing congenital syphilis cases in some areas, particularly in areas which have previously had very low case numbers. A concerted effort will be required to achieve the 2007 WHO goal of worldwide elimination of MTCT of syphilis in the near future.
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Affiliation(s)
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Department of Paediatrics, Christchurch Hospital, Christchurch, New Zealand
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11
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Israel E, Hizkel I, Geta T, Feleke T, Samuel B, Markos D. Triple sexually transmitted infections among pregnant woman in the context of Elimination of mother to child transmission in Southern Ethiopia: Reports from a survey of questionnaires and laboratory studies. Front Glob Womens Health 2023; 4:1190170. [PMID: 37404231 PMCID: PMC10316963 DOI: 10.3389/fgwh.2023.1190170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Sexually transmitted infections (STIs) cause a wide range of public health problems if left untreated. They can lead to adverse birth outcomes, including stillbirth, fetal loss, neonatal death, preterm birth, and low birth weight. Although great efforts have been made to reduce STIs nationally, their incidence remains high in Ethiopia, and their co-infection calls for urgent action. Therefore, this study aimed to identify the determinants of three STIs among pregnant women attending antenatal care (ANC) in the context of the elimination of mother-to-child transmission in public health facilities in Sawla Town, Gofa zone, Southern Ethiopia. Methods A cross-sectional study design was conducted among pregnant women attending antenatal care in public health facilities in Sawla Town, Southern Ethiopia, from May to July 2022. Data were collected from pregnant women's serum using an HIV rapid test, an HBsAg rapid test device, and a VDRL for HIV, HBV, and syphilis, respectively. Descriptive statistics, such as frequencies and percentages, were used to describe each relevant variable. Logistic regression analyses were used to identify the determinants of STIs. Results A total of 484 pregnant women attending antenatal care were screened. The mean age of the women was 24.0 ± 4.6 years, and nearly half of the participants had completed secondary school or higher. The overall seroprevalence of three STIs (HIV, HBV, and syphilis) among pregnant women was 6.8%. These three sexually transmitted infections were shown to be more common among pregnant women who were not able to read and write, had tattoos, had previously had an abortion, and had a history of multiple sexual partners. Conclusions The seroprevalence found in this study was intermediate in comparison with the WHO standard. Efforts should be made to strengthen the existing health education and RH service integration on STI screening, and treatment that further eliminates vertical infection.
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Affiliation(s)
- Eskinder Israel
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Iskindir Hizkel
- Department of Maternal and Child Health, Sawla Town Health Office, Gofa Zone, Sawla, Ethiopia
| | - Temesgen Geta
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tihun Feleke
- Department of Nursing, Hawassa College of Health Sciences, Hawassa, Ethiopia
| | - Beniyam Samuel
- Department of Midwifery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Desta Markos
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Gamberini C, Juliana NCA, de Brouwer L, Vogelsang D, Al-Nasiry S, Morré SA, Ambrosino E. The association between adverse pregnancy outcomes and non-viral genital pathogens among women living in sub-Saharan Africa: a systematic review. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1107931. [PMID: 37351522 PMCID: PMC10282605 DOI: 10.3389/frph.2023.1107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Adverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality, including long-term physical and psychological sequelae. These events are common in low- and middle-income countries, particularly in Sub Saharan Africa, despite national efforts. Maternal infections can cause complications at any stage of pregnancy and contribute to adverse outcomes. Among infections, those of the genital tract are a major public health concern worldwide, due to limited availability of prevention, diagnosis and treatment approaches. This applies even to treatable infections and holds true especially in Sub-Saharan Africa. As late as 2017, the region accounted for 40% of all reported treatable non-viral genital pathogens worldwide, many of which have been independently associated with various adverse pregnancy outcomes, and that include Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum. Two databases (PubMed and Embase) were examined to identify eligible studies published up to October 2022. This study reviewed findings on the association between infections by treatable non-viral genital pathogens during pregnancy and adverse pregnancy outcomes among women living in Sub-Saharan Africa. Articles' title and abstract were screened at first using keywords as "sexually transmitted infections", "non-viral", "adverse pregnancy outcome", "Africa", "sub-Saharan Africa", "pregnant women", "pregnancy", and "pregnancy outcome". Subsequently, according to the eligibility criteria, potential articles were read in full. Results showed that higher risk of preterm birth is associated with Treponema pallidum, Chlamydia trachomatis and Candida albicans infections. Additionally, rates of stillbirth, neonatal death, low birth weight and intrauterine growth restriction are also associated with Treponema pallidum infection. A better insight on the burden of non-viral genital pathogens and their effect on pregnancy is needed to inform antenatal care guidelines and screening programs, to guide the development of innovative diagnostic tools and other strategies to minimize transmission, and to prevent short- and long-term complications for mothers and children.
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Affiliation(s)
- Carlotta Gamberini
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Naomi C. A. Juliana
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
| | - Lenya de Brouwer
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Dorothea Vogelsang
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Salwan Al-Nasiry
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Research School GROW for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, UP, India
- Dutch Chlamydia trachomatis Reference Laboratory on Behalf of the Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Research School GROW for Oncology and Reproduction, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands
- Research School GROW for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
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13
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Tao YT, Gao TY, Li HY, Ma YT, Li HJ, Xian-Yu CY, Deng NJ, Zhang C. Global, regional, and national trends of syphilis from 1990 to 2019: the 2019 global burden of disease study. BMC Public Health 2023; 23:754. [PMID: 37095461 PMCID: PMC10124004 DOI: 10.1186/s12889-023-15510-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Syphilis is a sexually transmitted disease caused by Treponema pallidum, and the infection source is syphilis patients. This study aimed to estimate the incidence, mortality rate, and disability-adjusted life years (DALYs) of syphilis to improve the understanding of the current global situation of syphilis. METHODS This study collected data on syphilis incidence, mortality, and DALYs from the 2019 Global Burden of Disease database. RESULTS The global number of incident cases and age-standardized incidence rate (ASIR) increased from 8,845,220 (95% UI: 6,562,510-11,588,860) in 1990 to 14,114,110 (95% UI: 10,648,490-18,415,970) in 2019 and 160.03/100,000 persons (95% UI: 120.66-208.1) to 178.48/100,000 persons (95% UI: 134.94-232.34), respectively. The estimated annual percentage change (EAPC) in the ASIR was 0.16 (95% CI: 0.07-0.26). The EAPC in the ASIR associated with high and high-middle sociodemographic indices increased. The ASIR increased among males but decreased among females, and the incidence peaked among males and females between the ages of 20 and 30 years. The EAPCs in the age-standardized death rate and age-standardized DALY rate decreased. CONCLUSIONS The incidence and ASIR of syphilis increased worldwide from 1990 to 2019. Only the regions with high and high-middle sociodemographic indices showed an increase in the ASIR. Moreover, the ASIR increased among males but decreased among females. The age-standardized death rate and DALY rate both declined worldwide. The increase in the global ASIR of syphilis is a challenge.
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Affiliation(s)
- Yu-Ting Tao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Teng-Yu Gao
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Hao-Yang Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Yu-Tong Ma
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Hui-Jun Li
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Chen-Yang Xian-Yu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Nian-Jia Deng
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, No.32, Renmin South Road, Shiyan, 442000, Hubei, China.
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Adem Beriso J, Lemessa F, Fereda A, Kaso AW. Magnitude of syphilis and associated factors among pregnant women attending ANC in public facilities in Shashamene town, Oromia Region, Ethiopia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
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15
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Befekadu B, Shuremu M, Zewdie A. Seroprevalence of syphilis and its predictors among pregnant women in Buno Bedele zone, southwest Ethiopia: a community-based cross-sectional study. BMJ Open 2022; 12:e063745. [PMID: 35940833 PMCID: PMC9364416 DOI: 10.1136/bmjopen-2022-063745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The study was aimed at assessing the prevalence of syphilis and associated factors among pregnant women with antenatal care follow-up. DESIGN A health facility-based, cross-sectional study. SETTING The study was conducted in 12 health facilities in Buno Bedele zone, southwest Ethiopia. PARTICIPANTS Randomly selected 920 pregnant women who came to health facilities in the Buno Bedele zone for antenatal care services from May to August 2021 were included in the study. Women with previously diagnosed syphilis and those on treatment were excluded from the study. OUTCOME MEASURES Blood samples and data on sociodemographic and other risk factors for syphilis were collected. Sera were screened for syphilis using the one-step rapid syphilis diagnostic test kit, and positive tests were retested using the rapid plasma reagin test. Data were analysed using SPSS V.22. Bivariate and multivariate logistic regression analyses were used to identify risk factors for maternal syphilis at a p value less than 0.05. RESULTS The prevalence of syphilis among pregnant women was found to be 1.4% (95% CI: 0.8% to 2.3%, p=0.002). Women with no formal education (adjusted OR (AOR)=3.6; 95% CI: 1.02 to 13.2, p=0.047), husbands with a history of substance use (AOR=3.3, 95% CI: 1.04 to 10.7, p=0.042), more than one antenatal care visit (AOR=3.5, 95% CI: 1.07 to 10.5, p=0.038), age at marriage under 18 years (AOR=4.3, 95% CI: 2.2 to 7.9, p=0.045) and a woman's poor knowledge of syphilis (AOR=3.3, 95% CI: 1.04 to 10.4, p=0.042) were significantly associated with syphilis. CONCLUSION The prevalence of maternal syphilis in this study area was found to be comparable with the national prevalence. Women's educational status, husbands' history of substance use, antenatal care, age at marriage and knowledge about syphilis were the independent predictors of syphilis. Emphasis shall be given to screening all pregnant women, education of women, lifestyle factors and avoiding early marriage.
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Affiliation(s)
- Biruk Befekadu
- Shobe Health Center, Buno Bedele Zone Health Department, Bedele, Oromia, Ethiopia
| | - Muluneh Shuremu
- Department of Public Health, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
| | - Asrat Zewdie
- Department of Public Health, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia
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Tadesse A, Geda A. Why Syphilis Infection is High Among Pregnant Women in Refugee Camps? A Case in Ethiopia. Int J Womens Health 2022; 14:481-489. [PMID: 35392501 PMCID: PMC8982802 DOI: 10.2147/ijwh.s354045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/18/2022] [Indexed: 01/10/2023] Open
Abstract
Background Almost 1 million pregnant women were estimated to be infected with syphilis in 2016, resulting in over 350,000 adverse birth outcomes including 200,000 stillbirths and new-born deaths (7–9). More than half of infected pregnant women transmit the infection to their babies, resulting in adverse pregnancy outcomes, including foetal death, stillbirth, preterm birth, low birth weight, neonatal death, and congenital infection in infants. Objective The objective of the study was to assess the syphilis status and associated factors among pregnant women attending antenatal care in Kule refugee camp health facilities, Gambella regional state, Southwest Ethiopia, in 2021. Methods Facility based cross-sectional study design was conducted among 374 pregnant women in a Kule refugee camp health facility from March 1, to July 15, 2021. A systematic random sampling technique was used to select the study participants. After the interview, 2mL of venous blood sample was drawn from each of the study participants. Then, RPR test was done. When RPR tests were positive, the study subjects were considered as syphilis positive. Results The overall syphilis positivity rate was 11.8%. Education status (unable to read and write) [AOR 6.6; 95% CI (1.5, 29.3)], presence of other STDs [AOR 3.6; 95% CI (1.4, 8.8)], having polygamy husband [AOR 3.3; 95% CI (1.6, 6.9)] and being HIV positive [AOR=5.5; 95% CI (1.1, 27.5), P=0.04] were among factors associated with syphilis infection. Conclusions and recommendation This study showed that there is very high syphilis prevalence and it is still a very important public health problem the study area. Therefore, syphilis screening and treatment of pregnant women towards the first ANC points and health education towards the mode of transmission and prevention of syphilis have to be strengthened.
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Affiliation(s)
- Amare Tadesse
- Medicine Sans Frontiers (MSF), Gambella, Gambella Region, Ethiopia
| | - Abdi Geda
- Public Health Department, College of Health Science, Mettu University, Mettu, Oromia Region, Ethiopia
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Genetu K, Abere K, Tachbele E. Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia. Infect Dis Obstet Gynecol 2022; 2022:6156613. [PMID: 35221648 PMCID: PMC8865988 DOI: 10.1155/2022/6156613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia. METHOD A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25. RESULT A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs. CONCLUSION There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.
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Affiliation(s)
- Kassa Genetu
- College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Kerebih Abere
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Erdaw Tachbele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Vasconcelos A, Sousa S, Bandeira N, Alves M, Papoila AL, Pereira F, Machado MC. Antenatal screenings and maternal diagnosis among pregnant women in Sao Tome & Principe-Missed opportunities to improve neonatal health: A hospital-based study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001444. [PMID: 36962895 PMCID: PMC10021443 DOI: 10.1371/journal.pgph.0001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022]
Abstract
Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.
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Affiliation(s)
- Alexandra Vasconcelos
- Unidade de Clínica Tropical-Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Nelson Bandeira
- Hospital Dr. Ayres de Menezes, São Tomé, Sao Tome and Principe
| | - Marta Alves
- CEAUL, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Luísa Papoila
- CEAUL, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Filomena Pereira
- Unidade de Clínica Tropical-Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Maria Céu Machado
- Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
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Enbiale M, Getie A, Haile F, Tekabe B, Misekir D. Magnitude of syphilis sero-status and associated factors among pregnant women attending antenatal care in Jinka town public health facilities, Southern Ethiopia, 2020. PLoS One 2021; 16:e0257290. [PMID: 34506600 PMCID: PMC8432762 DOI: 10.1371/journal.pone.0257290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Syphilis is one of the leading causes of perinatal morbidity and mortality and is one of the most important public health problems. There was no study showing syphilis serostatus and its related factors among pregnant women in the current study area. This study was aimed to assess the magnitude of syphilis serostatus and associated factors among pregnant women attending antenatal care in Jinka town public health facilities. METHOD Institution based cross-sectional study design was conducted in Jinka town public health facilities, southern Ethiopia from the 1st July to the 1st September, 2020. A systematic sampling technique was used to select 629 study subjects. Data were collected using a structured questionnaire through face-to-face interviews and records were reviewed to check syphilis test results. Data were coded and entered by using Epi-data version 4.432 and analyzed using SPSS version 25. The binary logistic regression model was used to investigate factors associated with syphilis. A p-value of < 0.05 at multivariable analysis was considered statistically significant. RESULT In this study, syphilis sero-prevalence among pregnant women attending antenatal care clinics was 4.8% (95% CI: 3.12, 6.48). Rural residence [AOR: 2.873; 95%CI (1.171, 7.050)], alcohol use [AOR: 3.340; 95% CI (1.354, 8.241)] and having multiple sexual partner [AOR: 5.012; 95% CI (1.929, 13.020)] were statistically significantly associated with syphilis. CONCLUSION Sero-prevalence of syphilis was high. Being a rural residence, having multiple sexual partners, alcohol use were factors associated with syphilis. Therefore, substantial efforts have to be made to provide regular health education for pregnant women at the antenatal clinic on the avoidance of risky behaviors and the risk of syphilis on their pregnancy.
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Affiliation(s)
- Mulusew Enbiale
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Asmare Getie
- School of Nursing, Arba Minch University, Arba Minch, Ethiopia
| | - Frehiwot Haile
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Beemnet Tekabe
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Direslgn Misekir
- School of Public Health, Arba Minch University, Arba Minch, Ethiopia
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Kiragga AN, Bwanika JM, Kyenkya J, Banturaki G, Kigozi J, Musinguzi D, Namimbi F, Chander G, Reynolds SJ, Manabe YC. Point-of-care testing for HIV and sexually transmitted infections reveals risky behavior among men at gambling centers in Uganda". Int J STD AIDS 2021; 32:903-910. [PMID: 33890852 DOI: 10.1177/09564624211000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In sub-Saharan Africa (SSA), men are generally difficult to engage in healthcare programs. However, sports gambling centers in SSA can be used as avenues for male engagement in health programs. We offered point-of-care HIV and syphilis testing for men located at five gambling centers in Uganda and assessed HIV risky sexual behavior. Among 507 men, 0.8% were HIV-positive and 3.8% had syphilis. Risky sexual behavior included condomless sex with partner(s) of unknown HIV status (64.9%), having multiple sexual partners (47.8%), engaging in transactional sex (15.5%), and using illicit drugs (9.3%). The majority at 64.5% were nonalcohol consumers, 22.9% were moderate users, and 12.6% had hazardous consumption patterns. In 12 months of follow-up, the incidence rate of syphilis was 0.95 (95% CI: 0.82-1.06) among 178 men. Thus, men in SSA have a high prevalence of syphilis and risky sexual behavior which should be more effectively addressed to reduce the risk of HIV acquisition.
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Affiliation(s)
- Agnes N Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John M Bwanika
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,The Medical Concierge Group, Kampala, Uganda
| | - Joshua Kyenkya
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Banturaki
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanita Kigozi
- Outreach Department, College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Florence Namimbi
- Outreach Department, College of Health Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Geetanjali Chander
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Steven J Reynolds
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Intramural Research, National Institute of Allergy and Infectious Diseases, 2511National Institutes of Health, Bethesda, MD, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Hu F, Guo SJ, Lu JJ, Hua NX, Song YY, Lin SF, Zhu S. New screening approach to detecting congenital syphilis in China: a retrospective cohort study. Arch Dis Child 2021; 106:231-237. [PMID: 33355158 PMCID: PMC7907569 DOI: 10.1136/archdischild-2020-320549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS. METHODS Confirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women. RESULTS Among 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively. CONCLUSIONS An algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.
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Affiliation(s)
- Fang Hu
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuai-Jun Guo
- Centre for Community Child Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Pediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jian-Jun Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China,Department of Medical Affairs, Sun Yat-sen University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Ning-Xuan Hua
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yan-Yan Song
- Department of Child Health, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui-Fang Lin
- Department of Child Health, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sui Zhu
- Department of Medical Statistics, School of Medicine, Jinan University, Guangzhou, Guangdong, China
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Prevalence of hepatitis B surface antigen and serological markers of other endemic infections in HIV-infected children, adolescents and pregnant women in Sierra Leone: A cross-sectional study. Int J Infect Dis 2020; 102:45-52. [PMID: 33002619 DOI: 10.1016/j.ijid.2020.09.1459] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the prevalence of serological markers of HBV and endemic acute and chronic infections (HAV, HCV, CMV, HTLV-1/2 and syphilis) in HIV-infected children, adolescents and pregnant women in Sierra Leone. METHOD We conducted a cross-sectional study at the national children's and women's hospitals in Freetown. Logistic regression was used to assess predictors of HBsAg positivity. RESULTS 183 HIV-infected participants were enrolled, comprising children (n = 88), adolescents (n = 47) and pregnant women (n = 48). All participants (100%) were CMV IgG-positive, while 56.8%, 93.6% and 100% of children, adolescents and pregnant women, respectively, were HAV IgG-positive. The prevalence of HCV, HTLV-1/2 and syphilis were <4%. HBV markers were distributed as follows-children: HBsAg (2.3%), HBeAg (0%), anti-HBc (5.7%); adolescents: HBsAg (17.0%), HBeAg (6.4%), anti-HBc (27.7%); and pregnant women: HBsAg (18.8%), HBeAg (4.2%), anti-HBc (77.1%). Age >10 years, i.e., being born pre-2009 before implementation of routine hepatitis B immunization (aOR 5.05 [1.18-21.28]; p = 0.029) and CD4 count <350 cells/mm3 (aOR 3.97 [1.07-14.71]; p = 0.039) predicted HBsAg positivity. CONCLUSION A high burden of chronic HBV and other endemic infections was observed among HIV-infected patients born pre-2009 before implementation of routine HBV immunization in Sierra Leone, warranting targeted screening and immunization of this high-risk population.
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