GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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From 1996, RPR tests were carried out on a daily basis covering all pregnant women attending the primary health-care clinics. Earlier reports from the same prenatal clinics showed a RPR seroreactivity rate of 6.5% (95% Cl: 6.1-6.9) in 1992-93 (Jenniskens 1995). Taking these figures into account we found a significant rise in syphilis prevalence rates between 1992 and 1996 (Chi-square for trend: P=0.03). In 19%, 24,480 RPR tests were Figure 1: Syphilis prevalence (1992-1997) performed, 1124 were found to be seroreactive, resulting in a 9 8 syphilis prevalence of 4.5% (95% 7 Cl: 4.3-4.8). In 1997, 1162 out of 6 29,007 (3.8%) women examined, 5 4 were RPR positive (95% CI: 3.6- 3 4.0). The Chi-square test for 2 trend showed a significant 1 decrease in syphilis prevalence 0 1992-1993 1994 1995 1996 1997 between 1995 and 1997 years (P
We believe that the observed decline in syphilis rates in pregnant women in Nairobi is a real event. Population differences and consultation bias cannot be excluded but are not likely to play a major role, as population characteristics (age, parity, ethnicity) have remained unchanged over the years. The number of women screened has increased substantially since 1995, which could be responsible for a selection bias. Most likely however, the coverage of the program, expanding slowly, was not complete until 1995-96, and explains the rising numbers of women in the study. Obviously, the syphilis control program by itself might have an impact on the declining syphilis rates. The decentralized syphilis program was initiated in Nairobi in June 1992. From that time high numbers of syphilis seroreactive women in the reproductive age group have been adequately treated for syphilis in pregnancy. Since the mean interval between 2 pregnancies is about 2 years for Kenyan women, some of them may attend the clinics for a subsequent pregnancy and will not be RPR positive anymore because of previous treatment, unless re-infection occurred. Syphilis prevalence in pregnancy seems to show a large spread in different African countries. In a nationwide study performed in Burkina Faso in 1994-95, a syphilis prevalence of 2.5% was found in pregnant women (Sangare 1997). In Rwanda, in a prospective cohort study in 1992-93, 5% of the pregnant women tested positive for syphilis (Leroy 1995). Guarenti et al. reported a syphilis prevalence of 4.8% in pregnant women in 4 different areas in Tanzania in 1995 (personal communication). A high syphilis prevalence was found in South African publications, varying from 17% in 1990 (Bam 1994) to 9.3% in 1992 (Qolohle 1995) and 6.5% in 1994 (Wilkinson 1997). These figures could reflect a decline in syphilis prevalence in South Africa between 1990 and 1994, but are derived from different settings, not allowing calculating trends over time. In conclusion, this study provides data on trends in syphilis screening results in a set population of pregnant women in Nairobi between 1994 and 1997. Until 1995 the syphilis prevalence was on the rise, followed by a marked decline in 1996 and 1997. Population bias or other unrelated factors could theoretically play a role, but we believe that this decline is real suggesting an effect of prevention and intervention programs aimed at sexual behavior modifications, changes in health-seeking behavior and improved health services. PREVALENCE AND RISK FACTORS OF STI 36
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 and 34: 3.2. Declining Syphilis Prevalence
Page 35: Training Nurses at the antenatal cl
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
Page 85 and 86: In univariate analysis, the odds ra
Page 87 and 88:
Widows, divorcees and separated wom
Page 89 and 90:
They did not report much condom use
Page 91 and 92:
The low prevalence of the other STD
Page 93 and 94:
There is some evidence that frequen
Page 95 and 96:
Table 1. Characteristics of HIV- po
Page 97 and 98:
A significantly higher prevalence o
Page 99 and 100:
There is now considerable evidence
Page 101 and 102:
patients. The analysis revealed hig
Page 103 and 104:
contributory factor may be that mal
Page 105 and 106:
use in Kenya. In a supplement of Se
Page 107 and 108:
with intensive behavioral change in
Page 109 and 110:
C HAPTER 8 FINAL REMARKS STIs illus
Page 111 and 112:
to protect themselves and be empowe
Page 113 and 114:
Bell G, Ward H, Day S et al. Partne
Page 115 and 116:
Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120:
Manning B, Moodley J, Ross SM. Syph
Page 121 and 122:
Oberlander L, Elverdam B. Malaria i
Page 123 and 124:
Serwadda D, Gray R, Wawer M et al.
Page 125 and 126:
Van Dam J, Anastasi MC. Male Circum
Page 127 and 128:
WHO Collaborating Center on HIV/AID
Page 129 and 130:
S UMMARY Sexually transmitted infec
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notification. Innovative and locall
Page 133 and 134:
connaissance des femmes sur la sant
Page 135 and 136:
Nous avons démontré que le coût
Page 137 and 138:
vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
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