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Maternal and congenital syphilis in Bolivia, 1996: prevalence
and risk factors.
Bulletin of the World Health Organization 2001;79(1):33-42.
Southwick KL, Blanco S, Santander A, Estenssoro M, Torrico F, Seoane
G, Brady W, Fears M, Lewis J, Pope V, Guarner J, Levine WC.
Abstract
OBJECTIVES: The present study was carried out in seven maternity hospitals
to determine the prevalence of maternal syphilis at the time of delivery
and the associated risk factors, to conduct a pilot project of rapid syphilis
testing in hospital laboratories, to assure the quality of syphilis testing,
and to determine the rate of congenital syphilis in infants born to women
with syphilis at the time of delivery--all of which would provide baseline
data for a national prevention programme in Bolivia. METHODS: All women delivering
either live-born or stillborn infants in the seven participating hospitals
in and around La Paz, El Alto, and Cochabamba between June and November 1996
were eligible for enrolment in the study. FINDINGS: A total of 61 out of
1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of
stillborn infants were found to have syphilis at delivery. Multivariate analysis
showed that women with live-born infants who had less than secondary-level
education, who did not watch television during the week before delivery (this
was used as an indicator of socioeconomic status), who had a previous history
of syphilis, or who had more than one partner during the pregnancy were at
increased risk of syphilis. While 76% of the study population had received
prenatal care, only 17% had syphilis testing carried out during the pregnancy;
91% of serum samples that were reactive to rapid plasma reagin (RPR) tests
were also reactive to fluorescent treponemal antibody-absorption (FTA-ABS)
testing. There was 96% agreement between the results from local hospital
laboratories and national reference laboratories in their testing of RPR
reactivity of serum samples. Congenital syphilis infection was confirmed
by laboratory tests in 15% of 66 infants born to women with positive RPR
and FTA-ABS testing. CONCLUSION: These results indicate that a congenital
syphilis prevention programme in Bolivia could substantially reduce adverse
infant outcomes due to this disease.