Background and Purpose:
Mozambique has an estimated perinatal mortality rate of 110/1000 births and a prenatal syphilis seroprevalence rate of 7-10%. Estimated prenatal care attendance is 70-80%. Universal prenatal syphilis screening has been national policy since 1979; however, screening has been sporadic, generally under 5%. We describe simple, effective, low-cost interventions and their impact in increasing and sustaining prenatal syphilis screening in a resource-poor setting.
Data sources:
Routine health service records and prenatal registries were used to monitor proportions of the following: prenatal care attendance, RPR (syphilis) screening, RPR positivity rate, treatment, partner notification, and perinatal mortality rates. Sentinel investigations corroborated routine records. MOH documents provided information on policy changes.
Interventions and results:
A 6-month demonstration project provided training, screening registry books, and modest additional payment to midwives to gather data and strengthen screening. RPR screening of prenatal attendees increased from ~5% to 60% at 10 sites. Screening rates dropped to <40% on project termination.
Establishment of clear policy priorities, official prenatal registries, and new monitoring systems increased screening rates which remained at 60%-70% for >2 years without donor support.
Intensive supervision, in-clinic blood draw and treatment, and batch RPR testing increased screening rates which have remained for 2 years at 85-95% in spite of stock outages. Stillbirth rates have decreased from >50/1000 to <40/1000.
Discussion:
Prenatal syphilis screening can prevent substantial perinatal, infant, and maternal morbidity and mortality. Major inputs necessary for successful implementation are simple organizational improvements of service delivery and emphasis of existing policy. The cost is $0.25 per woman screened and $1.00 per treatment.
Learning Objectives: Understand details of approaches to make cost-effective interventions actually work in resource poor settings
Keywords: Syphilis Screening, Pregnancy Outcomes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: