GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
Our risk score algorithm (C) resulted in a sensitivity of 66% with PPV of 24% among nonpregnant women. The results among pregnant women were less good and comparable with what Mayaud et al. had found in Mwanza. Using this flow chart, the rate of overtreatment in non-pregnant women was 46% while it was 33% in pregnant women. We included several signs in the flow chart. Among pregnant women, however, none of these signs was associated with cervical infection. This is contrary to findings from Thomas et al. who found that among asymptomatic women in Nairobi, cervical friability was associated with cervical infection. An earlier study in Nairobi among pregnant women had identified friability and endocervical mucopus as predictors of cervical infection (Braddick 1990). And in another study in Nairobi, Temmerman et al. reported an association between gonococcal infection post partum and cervical mucopus. We tested algorithm D based on observation of the color of vaginal discharge. This algorithm does not require the use of a speculum. Algorithm E was based on observation of the cervix hence requiring speculum examination that is seldom possible in health centers in Kenya. Both resulted in too low sensitivity to be of value. Algorithm F combined the risk assessment and the inspection of the vaginal discharge. In both groups of women high sensitivity was reached but with low specificity. Several other combinations of risks, symptoms, and signs were tested but all performed worse. While none of the tested algorithms reached acceptable levels of sensitivity and specificity, the algorithm with risk score performed somewhat better than the algorithm actually in use in Kenya and would identify more true cervical infections although at a higher overall cost. Introducing the risk assessment among non-pregnant women could be an option. It is, however, doubtful that the introduction of the risk score into the existing algorithm, which would imply printing of new charts and retraining of health staff, is worthwhile. Among pregnant women this flow chart would fail to identify cervical infections. Treatment of pregnant women with vaginal discharge might be considered for both vaginal and cervical infections on the first visit. Further operational research is needed to assess the rate of follow up and return visits among these women. We can conclude that simple, cheap, and reliable tests for the diagnosis of cervical infection in women are still urgently needed. DIAGNOSIS AND MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS 67
C HAPTER 6 PREVENTION OF SEXUALLY TRANSMITTED 6.1. Syphilis Control During Pregnancy: INFECTIONS INCLUDING HIV Effectiveness and Sustainability of a Decentralized Program. Summary Published in the American Journal of Public Health 2001; 91:705-7 by Fonck K, Claeys P, Bashir F, Bwayo J, Fransen L and Temmerman M. This study sought to assess the performance, effectiveness, and costs of a decentralized antenatal syphilis-screening program in Nairobi, Kenya. Health clinic data, quality control data, and costs were analyzed. The rapid plasma regain (RPR) seroprevalence was 3.4%. In terms of screening, treatment, and partner notification, the program’s performance was adequate. The program’s effectiveness was problematic because of false-negative and falsepositive RPR results. The cost per averted case was calculated to be US$ 95 to US$ 112. The sustainability of this labor-intensive program is threatened by costs and logistic constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant women in high-prevalence areas, should be considered. Introduction Pregnant women who are seroreactive to syphilis are at an increased risk for spontaneous abortion, stillbirth, prematurity, and perinatal death (Schultz 1990, Watts 1984, Temmerman 1992, Berkowitz 1993, How 1994). In Africa, the reported prevalence of syphilis in pregnancy ranges from 3.6% to 19% (Meda 1997, Grosskurth 1995, Wawer 1998, Mayaud 1997, Wilkinson 1997, Newell 1993, Temmerman 1992). Although syphilis screening in pregnancy is a national health policy in most African countries, few screening programs achieve implementation, mainly owing to financial and logistical constraints. Chapter 6 68
- 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 and 36: Training Nurses at the antenatal cl
- 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: In this study of symptomatic women,
- 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
C HAPTER 6<br />
PREVENTION OF SEXUALLY TRANSMITTED<br />
6.1. Syphilis Control During Pregnancy:<br />
INFECTIONS INCLUDING HIV<br />
Effectiveness and Sustainability of a Decentralized Program.<br />
Summary<br />
Published in the American Journal of Public Health 2001;<br />
91:705-7 by Fonck K, Claeys P, Bashir F, Bwayo J, Fransen L<br />
and Temmerman M.<br />
This study sought to assess the per<strong>for</strong>mance, effectiveness, and costs of a decentralized<br />
antenatal syphilis-screening program in Nairobi, Kenya. Health clinic data, quality control<br />
data, and costs were analyzed. The rapid plasma regain (RPR) seroprevalence was 3.4%. In<br />
terms of screening, treatment, and partner notification, the program’s per<strong>for</strong>mance was<br />
adequate. The program’s effectiveness was problematic because of false-negative and falsepositive<br />
RPR results. The cost per averted case was calculated to be US$ 95 to US$ 112.<br />
The sustainability of this labor-intensive program is threatened by costs and logistic<br />
constraints. Alternative strategies, such as the mass epidemiologic treatment of pregnant<br />
women in high-prevalence areas, should be considered.<br />
Introduction<br />
Pregnant women who are seroreactive to syphilis are at an increased risk <strong>for</strong> spontaneous<br />
abortion, stillbirth, prematurity, and perinatal death (Schultz 1990, Watts 1984, Temmerman<br />
1992, Berkowitz 1993, How 1994). In Africa, the reported prevalence of syphilis in pregnancy<br />
ranges from 3.6% to 19% (Meda 1997, Grosskurth 1995, Wawer 1998, Mayaud 1997,<br />
Wilkinson 1997, Newell 1993, Temmerman 1992). Although syphilis screening in pregnancy<br />
is a national health policy in most African countries, few screening programs achieve<br />
implementation, mainly owing to financial and logistical constraints.<br />
Chapter 6 68
Change language