Abstract

PIP: The high incidence of sexually transmitted diseases (STDs) in Africa and inadequate means to control STDs indicates that it would be difficult to implement prenatal interventions without also implementing interventions in the entire population. Besides, few women in Africa attend STD clinics. Thus, the proportion, frequency, and pattern of attendance at prenatal clinics basically define the success of prenatal intervention. Yet cultural, demographic, and socioeconomic barriers to attendance at prenatal clinics exist. Routine antibiotic prophylaxis and case detection through screening are 2 key antenatal interventions. Problems with routine prophylaxis to all pregnant women include considerable costs of providing antibiotics to protect 7% to 10% of such women and possibility of the etiological agents developing multiple drug resistance. If antibiotics were given routinely to just pregnant women, they could become reinfected after delivery. Including husbands in an antibiotic prophylaxis scheme would increase the cost 2-fold, but would not improve efficacy. Even though there are logistic, financial, and manpower handicaps to implementing case detection through prenatal screening, it has the most potential. The main barrier is the inability of many African countries to support large-scale routine screening for gonorrhea using conventional methods. Thus, health workers must depend on clinical suspicion to detect cases. On the other hand, easy, fast, reliable, and inexpensive screening tests for syphilis exist, making large-scale routine antenatal screenings in Africa possible. In Zambia, a pilot project indicates that such screening can be done and may even significantly improve pregnancy outcomes. It suggests that mandatory prenatal screening for syphilis could usher in other prenatal interventions against STDs an research into the effectiveness of prenatal care and maternal health. It could also allow health workers to identify women who may have other STDs.