GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
Development Agencies through the University of Nairobi. In addition, centralized and decentralized programs aiming at reducing congenital syphilis, were set up in NCC public health clinics with the support of the EC’s AIDS program whose strategies have always focused on the fight against AIDS and STDs in a combined approach. The supervision, monitoring and evaluation activities of the syphilis program are the responsibilities of a task force consisting of representatives of the NCC, the Ministry of Health, the University of Nairobi and the University of Ghent, Belgium (Temmerman 1993, Jenniskens 1995). In 1992-93, an overall syphilis prevalence of 6.5% (95% CI: 6.1-6.9) was found in over 13,000 pregnant women visiting these prenatal clinics (Jenniskens 1995). In this paper we describe the trend in syphilis in pregnant women between 1994 and 1997. Methods Population Nairobi and its peri-urban area have a population of approximately 2-7 million inhabitants, of whom the larger part live in peri-urban slums. Public health facilities fall within the jurisdiction of the NCC with 54 health units providing maternal and child health (MCH) and family planning (FP) services, of which 30 also render curative services. The centers are distributed evenly in the peri-urban and urban areas and the catchment population per clinic is estimated at 80,000. Setting In 1992, 10 NCC clinics were selected out of the 30 health centers with both MCH/FP and curative components to have syphilis screening programs set up. The selection was done by NCC in collaboration with the Task Force at the University of Nairobi and was based on geographical distribution and catchment population. Techniques Syphilis serology was performed by clinic nurses, using the rapid plasma reagin (RPR) card test (RPR, Wellcome, London, UK) because of its simplicity and low cost. Quality control (Macrovalue, RPR card test, Becton Dickinson, Cockeysville, USA) was done by the reference laboratory at the University of Nairobi (UoN), Department of Medical Microbiology. RPR seroreactive women were promptly treated with a single dose of 2.4 million units of intramuscular benzathin penicillin and advised to refer the partners for treatment. The program was initiated in June 1992 and is still going on. Data were analyzed up to December 1997. PREVALENCE AND RISK FACTORS OF STI 33
Training Nurses at the antenatal clinics were trained in components of patient care, RPR testing techniques, promoting behavior change and counseling women with syphilis and their partners. Equipment Health centers’ MCH clinics were provided with laboratory equipment (centrifuge and RPR card shaker) and supplies, drugs and counseling facilities. Supervision Monitoring and supervision were performed on a monthly basis using a standardized form with checklists to evaluate the laboratory, stock management, clinic staff on duty, record keeping, quality control and partner tracing activities. Statistical methods 95% confidence intervals were calculated and Chi-square for trends was used to study trends over time. Results A total of 81,311 pregnant women were screened for syphilis during their first visit to one of the antenatal clinics in Nairobi, over a period of 44 months (1994-97) (Table 1). Of them, 4244 (5.2%, 95% CI: 5.1-5.4) women were found to be RPR reactive. Table 1: Syphilis seroprevalence in pregnant women in Nairobi between 1992 and 1997. N tests N test positive Test positive % 95% CI P for trend 1992-1993 13131 860 6.5 6.1-6.9 1994 10267 739 7.2 6.7-7.7 1995 17557 1279 7.3 6.9-7.7 0.03 1996 24480 1124 4.5 4.3-4.8 1997 29007 1102 3.8 3.6-4.0 < 0.0001 Total 81311 4244 5.2 5.1-5.4 Over an 8-month period in 1994, 10,267 were screened of whom 739 tested positive (7.2%, 95% CI: 6.7-7.7). In 1995, 1279 out of 17,557 women tested were found to be RPR positive (7.3%, 95% CI: 6.9-7.7). Due to logistic constraints, screening was offered on alternating days, still leaving significant proportions of the pregnant population unscreened. PREVALENCE AND RISK FACTORS OF STI 34
- Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
- Page 3 and 4: AIDS Acquired Immune Deficiency Syn
- Page 5 and 6: 1.1. Sexually Transmitted Infection
- Page 7 and 8: countries, the rate of reporting co
- Page 9 and 10: district of Uganda randomized villa
- Page 11 and 12: By identifying where significant
- Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
- Page 15 and 16: female primary health care or anten
- Page 17 and 18: The research data have been publish
- Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
- Page 21 and 22: 2.2.3. Laboratory procedures The mi
- Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
- Page 25 and 26: After registration by the clinic cl
- Page 27 and 28: The majority of the women were infe
- Page 29 and 30: eing single, ever having been treat
- Page 31 and 32: prevalence found in a family planni
- Page 33: 3.2. Declining Syphilis Prevalence
- Page 37 and 38: We believe that the observed declin
- Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
- Page 41 and 42: Table 1: Demographic data of 471 pa
- Page 43 and 44: women. Overall, significantly fewer
- Page 45 and 46: Stigmatization by health staff also
- Page 47 and 48: 4.2. Health-Seeking Behavior and Se
- Page 49 and 50: Between September and November 1998
- Page 51 and 52: Table 2: Healthcare-seeking behavio
- Page 53 and 54: Thirteen women had engaged in sex w
- Page 55 and 56: Men reported more extramarital affa
- Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
- Page 59 and 60: discharge and abdominal pain-two co
- Page 61 and 62: Data were entered and analyzed in S
- Page 63 and 64: One of the peripheral health center
- Page 65 and 66: Evaluation of Algorithms The result
- Page 67 and 68: In this study of symptomatic women,
- Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
- Page 71 and 72: Table 1: Syphilis Rapid Plasma Reag
- Page 73 and 74: One should keep these problems in m
- Page 75 and 76: The use of mailed reminders did not
- Page 77 and 78: Table 1: Characteristics of women w
- Page 79 and 80: studies, indicating that couples ar
- Page 81 and 82: 6.3. A Randomized, Placebo-controll
- Page 83 and 84: esistance patterns in bystander flo
Development Agencies through the University of Nairobi. In addition, centralized and<br />
decentralized programs aiming at reducing congenital syphilis, were set up in NCC public<br />
health clinics with the support of the EC’s AIDS program whose strategies have always<br />
focused on the fight against AIDS and STDs in a combined approach. The supervision,<br />
monitoring and evaluation activities of the syphilis program are the responsibilities of a task<br />
<strong>for</strong>ce consisting of representatives of the NCC, the Ministry of Health, the University of<br />
Nairobi and the University of Ghent, Belgium (Temmerman 1993, Jenniskens 1995).<br />
In 1992-93, an overall syphilis prevalence of 6.5% (95% CI: 6.1-6.9) was found in over<br />
13,000 pregnant women visiting these prenatal clinics (Jenniskens 1995). In this paper we<br />
describe the trend in syphilis in pregnant women between 1994 and 1997.<br />
Methods<br />
Population<br />
Nairobi and its peri-urban area have a population of approximately 2-7 million inhabitants, of<br />
whom the larger part live in peri-urban slums. Public health facilities fall within the jurisdiction<br />
of the NCC with 54 health units providing maternal and child health (MCH) and family<br />
planning (FP) services, of which 30 also render curative services. The centers are distributed<br />
evenly in the peri-urban and urban areas and the catchment population per clinic is<br />
estimated at 80,000.<br />
Setting<br />
In 1992, 10 NCC clinics were selected out of the 30 health centers with both MCH/FP and<br />
curative components to have syphilis screening programs set up. The selection was done by<br />
NCC in collaboration with the Task Force at the University of Nairobi and was based on<br />
geographical distribution and catchment population.<br />
Techniques<br />
Syphilis serology was per<strong>for</strong>med by clinic nurses, using the rapid plasma reagin (RPR) card<br />
test (RPR, Wellcome, London, UK) because of its simplicity and low cost. Quality control<br />
(Macrovalue, RPR card test, Becton Dickinson, Cockeysville, USA) was done by the<br />
reference laboratory at the University of Nairobi (UoN), Department of Medical Microbiology.<br />
RPR seroreactive women were promptly treated with a single dose of 2.4 million units of<br />
intramuscular benzathin penicillin and advised to refer the partners <strong>for</strong> treatment. The<br />
program was initiated in June 1992 and is still going on. Data were analyzed up to December<br />
1997.<br />
PREVALENCE AND RISK FACTORS OF STI 33
Change language