Syphilis in pregnancy: a medical audit in a rural district

Abstract

A medical audit was performed in Umzingwane District, Zimbabwe, to assess the quality of antenatal care in 1991 regarding detection and management of syphilis. Two thousand one hundred and sixty one women booked for antenatal care, 1433 (66 pc) received a RPR test result, 197 (14 pc) tests were positive. In 32 (16 pc) of the 197 RPR positive women the outcome of the pregnancy could not be established. Of 165 women 111 (67 pc) received adequate treatment for syphilis. A perinatal mortality rate (PNMR) of 173/1,000 was associated with inadequately or not treated RPR positive mothers and a PNMR of 21/1,000 with RPR negative and untested mothers (odd's ratio = 9.9; 95 pc confidence interval 3.8-24.9, p < 0.001). It is estimated that only 42 pc of all pregnant women and 24 pc of the couples with syphilis in 1991 were treated adequately. Recommendations are made to improve the quality of surveillance of syphilis in pregnancy in a rural district.

PIP: Studies in Zimbabwe have shown that the prevalence of syphilis in antenatal women is about 10%, not different from other Central African countries. Syphilis during pregnancy can result in abortions, stillbirths, prematurity, neonatal deaths, and surviving babies with features of congenital syphilis, while transplacental infection of the fetus can occur at any stage of the pregnancy. Screening for syphilis in pregnancy in Zimbabwe is done routinely with the nonspecific Rapid Plasma Reagin (RPR) test. A positive test should then be confirmed with the more specific Treponema Pallidum Hemagglutination (TPHA) test, but most district and mission hospitals do not have this latter test. A medical audit was performed in Umzingwane District, Zimbabwe, to assess the quality of antenatal care in 1991 regarding the detection and management of syphilis. The antenatal booking rate in Zimbabwe is high; a 1991 survey found that 95% of pregnant women had made at least one visit and 79% had delivered in an health institution. The author found that 66% of a sample of 2160 women booked for antenatal care received a RPR test result, of which 14% were positive. The outcome of the pregnancy could not be determined in 16% of the RPR-positive women. Only 111 of 165 women received adequate treatment for syphilis. The perinatal mortality rate (PNMR) of 173/1000 was associated with inadequately or not treated RPR-positive mothers compared to a PNMR of 21/1000 with RPR negative and untested mothers. It is estimated that only 42% of all pregnant women and 24% of couples with syphilis in 1991 were treated adequately. Recommendations are made on how to improve the quality of surveillance of syphilis in pregnancy in the district.