Syphilis in pregnancy and associated adverse outcomes: Global estimates and analysis of multinational antenatal surveillance data Öffentlichkeit

Abstract

Introduction The World Health Organization (WHO) first estimated global syphilis infections based on national antenatal data in 2008. The WHO aims to validate congenital syphilis elimination for countries with low incidence rates and high performing antenatal care (ANC) systems. Our objective was to estimate for 2011 the global, regional and national number of pregnant women with probable active syphilis and associated adverse pregnancy outcomes, and ANC coverage for syphilitic women.

Methods We used WHO data on syphilis seropositivity for ANC attendees from 121, ANC coverage from 167, and live births from 193 of 194 WHO member-states. WHO regional advisors and peer-reviewed literature sources provided proportions describing relationships between variables for our calculations. We estimated the number of probable active maternal syphilis infections and conducted a sensitivity analysis for three testing and treatment scenarios to estimate associated adverse outcomes.

Results In 2011, we estimated that globally 882,851 pregnant women had syphilis infections leading to 346,983 congenital syphilis outcomes including 141,307 stillbirths or early fetal deaths, 61,021 neonatal deaths, 43,139 preterm or low birth weight newborns, and 101,517 clinical infections in infants. Among the 691,972 (78.4%) syphilitic women who attended ANC, those who were not tested or not treated had 226,678 (65.3%) adverse outcomes. From 2008 to 2011 global numbers of maternal and congenital syphilis decreased by 525,960 and 197,274 infections respectively, and 25 more countries reported syphilis seropositivity.

Discussion There continue to be, in 2011, a large number of maternal and congenital syphilis infections. There appear to be global decreases and there may be a true change in the global burden of disease along with changes in completeness of reporting between 2011 and 2008. Limitations of these estimates include missing syphilis seropositivity including over 50% of countries in Europe and the Mediterranean, and using estimates for the proportion of "probable active" syphilis and for regional testing and treatment coverage.

Conclusions Syphilis infections in pregnancy continue to cause perinatal morbidity and mortality. Improving the completeness and quality of reporting, and access to quality antenatal care, syphilis testing, and treatment are critical to eliminating congenital syphilis as a public health problem.

Table of Contents

TABLE OF CONTENTS Section Page Number

Dedication and Acknowledgements ............................................................... iv

Table of Contents ...................................................................................... v

List of Figures ........................................................................................... vi

List of Tables ............................................................................................ vii

Chapter 1: Introduction ............................................................................... 1

Background of the Problem .......................................................................... 1

Statement of the Problem ............................................................................ 4

Purpose of the Study ................................................................................... 6

Research Questions and Hypothesis ................................................................ 6

Importance of the Study/Significance Statement ............................................... 6

Scope of the Study ...................................................................................... 7

Definition of Terms ..................................................................................... 8

Chapter 2: Comprehensive Review of Literature ............................................... 10

Introduction ............................................................................................... 10

The origins of syphilis ................................................................................. 10

Stages, symptoms, and transmission ............................................................. 12

Syphilis diagnosis ....................................................................................... 13

Treatment of syphilis in pregnancy ................................................................ 15

Cost-effectiveness of syphilis screening in antenatal care .................................. 15

Global Elimination of Congenital Syphilis Initiative rationale and estimation .......... 16

Summary of Current Problem ....................................................................... 17

Chapter 3: Manuscript (for submission to The Lancet) ....................................... 19

Contribution of Student ................................................................................ 20

Summary .................................................................................................. 21

Introduction ............................................................................................... 22

Methods .................................................................................................... 24

Results ...................................................................................................... 30

Discussion/Limitations/Conclusion .................................................................. 34

Figures and Tables ...................................................................................... 39

References ................................................................................................ 50

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	stillbirth penicillin early fetal death sexually transmitted infection sexually transmitted disease syphilis congenital syphilis low birth weight preterm birth reproductive health neonatal death maternal syphilis maternal and child health elimination infectious disease global health pregnancy tropical disease
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) CDC

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