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Sex Transm Infect 2000;76:117-121 doi:10.1136/sti.76.2.117

Effect of a syphilis control programme on pregnancy outcome in Nairobi, Kenya

  1. M Temmerman1,
  2. P Gichangi2,
  3. K Fonck1,2,
  4. L Apers1,
  5. P Claeys1,
  6. L Van Renterghem3,
  7. D Kiragu4,
  8. G Karanja5,
  9. J Ndinya-Achola2,
  10. J Bwayo2
  1. 1International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, University of Ghent, Belgium
  2. 2Department of Medical Microbiology, University of Nairobi, Kenya
  3. 3Department of Microbiology and Immunology, University of Ghent, Belgium
  4. 4Pumwani Maternity Hospital, Nairobi City Council, Nairobi, Kenya
  5. 5Department of Gynaecology and Obstetrics, University of Nairobi, Kenya
  1. Professor Marleen Temmerman, International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, University of Ghent, De Pintelaan 185, 9000 Ghent, Belgium marleen.temmerman{at}rug.ac.be
  • Accepted 5 November 1999

Abstract

Objectives: To assess the impact of a syphilis control programme of pregnant women on pregnancy outcome in Kenya.

Method: Women who came to deliver to Pumwani Maternity Hospital (PMH) between April 1997 and March 1998 were tested for syphilis. Reactive rapid plasma reagin (RPR) tests were titrated and confirmed with treponema haemagglutination test (TPHA). Equal numbers of RPR and TPHA negative women were enrolled. Antenatal syphilis screening and treatment history were examined from the antenatal cards.

Results: Of 22 466 women giving birth, 12 414 (55%) were tested for syphilis. Out of these, 377 (3%) were RPR reactive of whom 296 were confirmed by TPHA. Syphilis seroreactive women had a more risky sexual behaviour and coexistent HIV antibody positivity; 26% were HIV seropositive compared with 11% among syphilis negative mothers. The incidence of adverse obstetric outcome defined as low birth weight and stillbirth, was 9.5%. Syphilis seropositive women had a higher risk for adverse obstetric outcome (OR 4.1, 95% CI 2.4–7.2). Antenatal treatment of RPR reactive women significantly improved pregnancy outcome but the risk of adverse outcome remained 2.5-fold higher than the risk observed in uninfected mothers.

Conclusions: These data confirm the adverse effect of syphilis on pregnancy outcome. This study also shows the efficacy of antenatal testing and prompt treatment of RPR reactive mothers on pregnancy outcome.

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