Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data

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Background:
The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis.

Methods and Findings:
Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was “probable active,” and for testing and treatment coverage.

Conclusions:
Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data. PLoS Med 10(2): e32767. doi:10.1371/journal.pmed.1001396
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001396

Souhrn

Zdroje

1. RothschildBM (2005) The history of syphilis. Clin Infect Dis 40: 1454–1463.

2. CrosbyAWJr (1969) The early history of syphilis: a reappraisal. Am Anthropol 2: 218–227.

3. HawkesS, MatinN, BroutetN, LowN (2011) Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 11: 684–691.

4. World Health Organization (2007) The global elimination of congenital syphilis: rationale and strategy for action. Geneva: World Health Organization. Available: http://www.who.int/reproductivehealth/publications/rtis/9789241595858/en/index.html. Accessed 17 January 2013.

5. World Health Organization (2011) Progress report 2011: Global HIV/AIDS response. Geneva, Switzerland. Available: http://www.who.int/hiv/pub/progress_report2011/en/index.html. Accessed 17 January 2013.

6. MabeyDC, SollisKA, KellyHA, BenzakenAS, BitarakwateE, et al. (2012) Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis. PLoS Med 9: e1001233 doi:10.1371/journal.pmed.1001233

7. YangLG, TuckerJD, WangC, ShenSY, ChenXS, et al. (2011) Syphilis test availability and uptake at medical facilities in southern China. Bull World Health Organ 89: 798–805.

8. Dinh TH, Lewis D, Trege L, Likibi M, Molebatsi T, et al.. (2008) Prevalence of and adherence to HIV prophylaxis and syphilis treatment regimens in pregnant women receiving antenatal care services in public facilities in Northern Cape and Gauteng Provinces, South Africa, 2004–2006 [poster presentation]. HIV/AIDS Implementers' Meeting; 3–7 June 2008; Kampala, Uganda.

9. Pan American Health Organization (2010) Regional initiative for the elimination of vertical transmission of HIV and congenital syphilis in Latin America and the Caribbean: regional monitoring strategy. Available: http://new.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=6944&Itemid=. Accessed 17 January 2013.

10. Joint United Nations Programme on HIV/AIDS, United Nations Children's Fund, United Nations Population Fund, World Health Organization (2011) Elimination of new paediatric HIV infections and congenital syphilis in Asia-Pacific, 2011–2015: conceptual framework; monitoring and evaluation guide. Available: http://www.eptctasiapacific.org/documents/cs-framework_0.pdf. Accessed 17 January 2013.

11. SchmidG, StonerBP, HawkesS, BroutetN (2007) The need and plan for global elimination of congenital syphilis. Sex Transm Dis 34: S5–S10.

12. World Health Organization (2013) About WHO: WHO—its people and offices. Available: http://www.who.int/about/structure/en/index.html. Accessed 17 January 2013.

13. World Health Organization (1993) International statistical classification of diseases and related health problems: tenth revision, volume 2. Instruction manual. Geneva: World Health Organization.

14. CousensS, BlencoweH, StantonC, ChouD, AhmedS, et al. (2011) National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet 377: 1219–1330.

15. LawnJ, BlencoweH, PattinsonR, CousensS, KumarR, et al. (2011) Stillbirths: Where? When? Why? How to make the data count? Lancet 377: 1448–1463.

16. FlenadyV, KoopmansL, MiddletonP, FrøenF, SmithG, et al. (2011) Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 377: 1331–1340.

17. World Health Organization (2012) Global incidence and prevalence of selected curable sexually transmitted infections—2008. Available: http://www.who.int/reproductivehealth/publications/rtis/stisestimates/en/index.html. Accessed 17 January 2013.

18. LujanJ, Arrazola de OnateW, DelvaW, ClaeysP, SambolaF, et al. (2008) Prevalence of sexually transmitted infections in women attending antenatal care in Tete province, Mozambique. S Afr Med J 98: 49–51.

19. TinajerosF, GrossmanD, RichmondK, SteeleM, GarciaSG, et al. (2006) Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia. Sex Transm Infect 82: 17–21.

20. Watson-JonesD, ChangaluchaJ, GumodokaB, WeissH, RusizokaM, et al. (2002) Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy. J Infect Dis 186: 940–947.

21. World Health Organization (2013) Global Health Observatory Data Repository: antenatal care coverage. Available: World Health Statistics Health inequities Antenatal care coverage. Accessed 17 January 2013.

22. GomezGB, KambML, NewmanLM, MarkJ, BroutetN, et al. (2012) Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis. Bull World Health Organ E-pub ahead of print. Article ID: BLT.12.107623.

23. BlencoweH, CousensS, KambM, BermanS, LawnJE (2011) Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality. BMC Public Health 11 Suppl 3 S9.

24. McDermottJ, SteketeeR, LarsenS, WirimaJ (1993) Syphilis-associated perinatal and infant mortality in rural Malawi. Bull World Health Organ 71: 773–780.

25. World Health Organization (2013) Global Health Observatory: antenatal care—situation. Available: http://www.who.int/gho/maternal_health/reproductive_health/antenatal_care_text/en/index.html. Accessed 17 January 2013.

26. KambML, NewmanLM, RileyPI, MarkJ, HawkesSJ, et al. (2010) A road map for the global elimination of congenital syphilis. Obstet Gynecol Int 2010: 312798.

27. BermanSM (2004) Maternal syphilis: pathophysiology and treatment. Bull World Health Organ 82: 433–438.

28. HawkesS, GomezG, BroutetN (2013) Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis. PLoS ONE In press.

29. World Health Organization (2011) Methods for surveillance and monitoring of congenital syphilis elimination within existing systems. Available: http://www.who.int/reproductivehealth/publications/rtis/9789241503020/en/index.html. Accessed 17 January 2013.

30. MwapasaV, RogersonSJ, KwiekJJ, WilsonPE, MilnerD, et al. (2006) Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi. AIDS 20: 1869–1877.

31. United Nations Secretary-General Ban Ki-moon (2010) Global strategy for women's and children's health. Available: http://www.everywomaneverychild.org/images/content/files/global_strategy/full/20100914_gswch_en.pdf. Accessed 17 January 2013.