Syphilis-associated perinatal and infant mortality in rural Malawi

Abstract

In Mangochi District, a rural area of Malawi, the prevalence of active syphilis was 3.6% among 3591 women who had singleton births and who were negative for human immunodeficiency virus (HIV). Compared with non-syphilitic women, those with active syphilis (positive Venereal Disease Research Laboratory/rapid plasmin reagin tests (titre > or = 1:8) and a reactive microhaemagglutination assay) were more likely to experience stillbirths as well as the early and late neonatal deaths and even postneonatal deaths of their children. Characteristics associated with active syphilis were not very useful in targeting women at high risk of having the condition, which makes universal screening in antenatal programmes the most efficacious way to prevent syphilis-associated morbidity and mortality. The potential for a programme to prevent congenital syphilis in the perinatal, neonatal, and post-neonatal periods is evident. In considering resource allocation to child survival programmes in areas where the prevalence of syphilis is high, officials need to include antenatal syphilis screening, using rapid tests and treatment at the first contact of the mother with the health care system.

PIP: Syphilis infection in pregnancy causes high rates of fetal and early infant death and adversely affects women's health. Despite the existence of a simple screening test for syphilis and the continued effectiveness of penicillin in treating the disease, syphilis remains a largely ignored maternal and perinatal health problem in most sub-Saharan African countries. The prevalence of reactive syphilis serology among pregnant women in Africa is in the range 6-16%. In Malawi, despite national policy, routine antenatal syphilis screening programs were discontinued in many rural district hospitals when they could not sustain the programmatic requirements. In this context, the authors explored the prevalence of and risk factors for acquiring syphilis and its outcomes in 1991-92 among 3591 women in Mangochi District, Malawi, who had singleton births and were negative for HIV. 3.6% of the subjects had active syphilis. Women with syphilis were more likely than nonsyphilitic women to experience stillbirths, early and late neonatal deaths, and even postneonatal deaths of their children. Characteristics associated with active syphilis were not, however, very useful in targeting women at high risk of having the condition. Universal screening in antenatal programs is therefore the best way to prevent syphilis-associated morbidity and mortality. Syphilis prevention programs in areas with a high prevalence of syphilis should include antenatal syphilis screening with rapid tests and treatment when the mother first contacts the health care system.