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6.2. Partner notification of pregnant women infected with syphilis in Nairobi, Kenya. Summary Published in the International Journal of STD & AIDS 2000; 11:257-61 by Gichangi P, Fonck K, Sekande-Kigondu C, Ndinya-Achola Temmerman M. J, Bwayo J, Kiragu D, Claeys P and We examined partner notification among syphilitic pregnant women in Nairobi. At delivery, 377 women were found to be rapid plasma reagin (RPR) reactive. Data were available for 94% of the partners of women who were tested during pregnancy; over 67% of the partners had received syphilis treatment while 23% had not sought treatment mainly because they felt healthy. Six per cent of the women had not informed their partners as they feared blame and/or violence. Adverse pregnancy outcome was related to lack of partner treatment during pregnancy (7% versus 19%, odds ratio (OR) 3.0, 95% confidence interval (CI) 0.9-10.0). Our data suggest that messages focusing on the health of the unborn child have a positive effect on partner notification and innovative and locally adapted strategies for partner notification need more attention. Introduction Partner notification contributes to the control of sexually transmitted diseases (STDs) by identifying and treating previously undiagnosed infection the sexual contacts of known cases, thereby preventing re-infection of the index case or transmission to others (Potterat 1991). The effectiveness of the strategy depends upon the ability of the patient or the health advisor to locate contacts and ensure treatment (Bell 1998). In resource-poor settings with limited public health infrastructures, patient referral may be the most feasible method. The proportion of partners notified and treated has been used as a measure of program success but depends on various factors such as prevalence and symptomatology of the disease, sexual behavior of the index patient and motivating factors (Gunn 1997, Andrus 1990, Jenniskens 1995). In Zimbabwe, partner referral increased from 19% to 42% through outreach workers (Winfield 1985). PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 73
The use of mailed reminders did not increase the rate of partner referral in Nigeria, as the addresses given by the index patients were mostly incorrect (Asuzu 1984, Asuzu 1990). In industrialized countries, prompt treatment of infected individuals and their partners is seen as a strategy to eradicate syphilis (Gunn 1997). In the USA, partner notification played an important role in reduction of incidence of syphilis from 72 cases per 100,000 in 1943 to 4 cases per 100,000 in 1956 (Brown 1970, Brandt 1988). In Kenya, syphilis control in pregnancy is national health policy and is part of the strategy for antenatal care in both the government and private sectors. Partner notification and counseling however were not considered part of the antenatal syphilis control by Nairobi City Council staff providing antenatal care until after an evaluation of syphilis control activities in 1993 (Temmerman 1993). Since then, partner notification has become an integral part of syphilis control in pregnancy. All women attending antenatal care are tested for syphilis using the RPR card test. Women who are RPR reactive are treated and encouraged to bring their partner(s) for treatment. As a result, partner notification reached 50% in 1993 (Jenniskens 1995). In this paper, we report the determinants and effects of partner notification and treatment in pregnant women in Nairobi, Kenya. Subjects and methods As part of a study on the effectiveness of syphilis screening and treatment during pregnancy, we interviewed women at the main maternity hospital in Nairobi after the delivery. After giving informed consent, they were tested for syphilis and HIV-1. Women who were seroreactive were treated and requested to bring their partners for treatment. They were given a verbal message and partner notification coupons. The importance of treatment of partner(s) in relation to adverse events for future pregnancies and re-infection was emphasized. A structured questionnaire was administered to all women who were RPR positive during pregnancy and/or at delivery. The questionnaire included demographic, medical and obstetrical factors. Partners who presented to the study clinic were treated, counseled and were given the option to be tested for syphilis or not. Partners who consented to HIV testing were given HIV pre-test counseling. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS INCLUDING HIV 74
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GHENT UNIVERSITY STI PREVENTION AND
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AIDS Acquired Immune Deficiency Syn
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1.1. Sexually Transmitted Infection
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countries, the rate of reporting co
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district of Uganda randomized villa
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By identifying where significant
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4.5%, 3.9%, 67.7% and 30.1% while t
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female primary health care or anten
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The research data have been publish
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2.1. OBJECTIVES 2.1.1. General obje
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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
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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
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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
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Page 77 and 78: Table 1: Characteristics of women w
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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
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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.
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Van Dam J, Anastasi MC. Male Circum
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WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
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We hebben aangetoond dat de kost va
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