Syphilis prevention in pregnancy: an opportunity to improve reproductive and child health in Kenya

Abstract

In Nairobi Kenya a survey of the operational quality and effectiveness of current syphilis control efforts of 10 City Commission maternal and child health (MCH) clinics revealed varied obstacles. In 1989 the European Communitys AIDS Task Force helped the Commission to implement interventions to improve the syphilis control program. One intervention was providing equipment and consumables for the central laboratory at Pumwani Hospital needles and syringes for the MCH clinics and a vehicle to transport samples and results between the lab and clinics. Lab staff and nurses attended refresher courses. The Commission budgeted funds for benzathine penicillin to treat mothers at the MCH clinics. The syphilis control program sent between 50 and over 250 blood samples to the lab each day. The blood collection system worked well. Health workers had ready access to needles and syringes. At 3 months the vehicle fell into disrepair reducing the mean to 80 blood samples/day. The vehicle was not repaired until 2 months late. 63% of mothers attended their 1st prenatal visit after 20 weeks gestation. MCH workers took blood samples from only 33% of women. (178 of 540) at their 1st prenatal visit. The blood samples of 61.5% of the 332 women whose samples were taken either during the 1st visit or at a later date were taken for syphilis screening. The result of the screening was available for 87% (291) of these women. 11 (3.8%) tested positive for syphilis. Only 1 woman was treated adequately. The cost of detecting 1 case was US$66. The cost of preventing 1 case of congenital syphilis was at least US$730. These results showed that the syphilis control program was ineffective. Major constraints were: pregnant women presenting at a late stage; referral to a sexually transmitted disease clinic for treatment; and inferior blood screening due to lack of transportation and deferral of taking blood samples.