Abstract
To prevent mother-to-child transmission (MTCT) of syphilis, Hunan Province launched a free syphilis screening and treatment programme in 2011. Thus far, the programme has been implemented for 6 years. This study aimed to assess progress toward the elimination of MTCT of syphilis in Hunan Province from 2011–2016. Estimates of syphilis-related adverse pregnancy outcomes (APOs) were based on the health service delivery model developed by the WHO, which were then translated into disability-adjusted life years (DALYs). Default values in the model were replaced by a Chinese version. The progress of this programme was assessed through the reduction of estimated DALYs with and without screening and treatment services. The results showed that the estimated number of syphilis-related APOs in Hunan Province from 2011 to 2016 was 3,840, more than 70% of which occurred among women who had at least one antenatal care visit but were not screened or treated for syphilis during pregnancy. The public health burden resulting from maternal syphilis-related APOs was 192,528 DALYs over six years, and with the current screening and treatment coverage, approximately 163,794 expected DALYs (46%) were averted. Our estimates indicate that in Hunan Province, syphilis in pregnancy continues to be an important cause of APOs, which can lead to substantial perinatal morbidity and mortality. Approximately half of the expected public health burden resulting from syphilis-related APOs was averted by the current screening and treatment services, which suggests progress toward the elimination of MTCT of syphilis in Hunan Province.
Highlights
Syphilis in pregnancy can induce adverse pregnancy outcomes (APOs), including stillbirth, preterm birth, low birth weight, neonatal death and congenital infection among infants [1]
The primary objective of this analysis was to assess the progress made in the programme of preventing mother-to-child transmission (MTCT) of syphilis in Hunan Province, which was achieved through the estimation of three values: the number of syphilis-related APOs, the estimated number of APOs in the form of disability-adjusted life years (DALYs), and the reduction in DALYs achieved by screening and treatment services
We found that approximately 192,528 DALYs occurred in Hunan Province between 2011 and 2016, with an average of 32,088 DALYs per year, which equated to 72% of DALYs associated with tuberculosis in the province in 2005 [21], 36% of DALYs associated with cardiovascular disease in the province in 2011 [22], and 30% of DALYs associated with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) throughout the country in 2007 [23]
Summary
Syphilis in pregnancy can induce adverse pregnancy outcomes (APOs), including stillbirth, preterm birth, low birth weight, neonatal death and congenital infection among infants [1]. Nearly 1.0 million cases of syphilis occur among pregnant women in 2012, a high proportion of which are untreated or inadequately treated [2]. Half of women with untreated syphilis can experience catastrophic foetal outcomes, including an estimated 205,000 perinatal deaths in 2012 globally [2]. APOs associated with maternal syphilis can be effectively prevented by screening pregnant women early in pregnancy and by the timely treatment of those who were diagnosed as syphilis-seropositive. A single dose of long-acting penicillin can effectively prevent syphilis-related APOs [5]. Depending on the disease stage, maternal syphilis can be effectively treated by giving one-dose (primary and secondary syphilis) or three doses (latent syphilis) of long-acting penicillin [6]. Health economists estimate that screening and treatment programme for syphilis are one of the most cost-effective public health interventions available [7], and antenatal syphilis screening and treatment is clearly cost-effective, even in the settings with prevalence rates below 1% [7,8,9,10]
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