Study: Prenatal screening in Haiti region cut syphilis by 75 percent

Using a simple intervention, clinicians and health scientists working in Haiti successfully cut the incidence of congenital syphilis in a rural region of that impoverished nation by 75 percent — meaning that far fewer babies will inherit the dangerous illness from infected mothers.

The scientists decentralized prenatal syphilis screening, shifting blood testing from a regional hospital out to 14 community dispensaries. Those dispensaries enjoy almost none of the amenities people in developed countries take for granted, including running water and electricity, and many are inaccessible by motor vehicle.

A report on the public health effort and its success appears in the March issue of the American Journal of Public Health.

“This study shows that even in a very rural, very poor area, an effective program for syphilis control in pregnant women is feasible,” said Dr. Frieda M. T. Behets of the University of North Carolina at Chapel Hill, one of the chief authors. “Our experience shows that even in rudimentary clinics that lack running water and electricity, staff with minimal formal training can carry out serologic screening for syphilis and treat pregnant women successfully.”

Behets is research associate professor of medicine and research assistant professor of epidemiology, respectively, at the UNC schools of medicine and public health. Other authors of the report are Dr. Daniel W. Fitzgerald, Dr. Johanne Preval, Lauren Schulwolf, Vidya Bommi and Pascal Chaillet, all of Hospital Albert Schweitzer in Deschapelles, Haiti. Fitzgerald, also a faculty member at Cornell University Medical College, was first author.

“This is very important for other developing countries with similar problems,” Behets said. “In Madagascar, for example, where I have been working recently, I have been pleading for a similar program for more than five years, but I have been told repeatedly that this is not feasible. Madagascar has an important syphilis problem, and 8 to 12 percent of pregnant women have tested positive for it.”

Before 1996, syphilis screening for pregnant women in Haiti’s Artibonite region — about 100 miles north of Port-au-Prince — entailed drawing blood at the dispensaries, transporting it to a central laboratory, returning the results and then treating women who showed signs of the sexually transmitted disease, she said. Unfortunately, that screening strategy failed, and congenital syphilis rates in the region were 550 per 100,000 live births.

The new study showed that by testing pregnant women at the dispensaries at small laboratories on site, health workers cut the congenital syphilis rate to an average of 137 cases per 100,000 live births since 1996. In 1998, the rate was only 95 cases per 100,000.

A laboratory for performing Rapid Plasma Reagin tests was installed at each dispensary. The cost, including training, was about $3,000 at each. No new construction was required, nor was new staff hired. Workers stored sun-generated electricity in 6-volt batteries for conversion to alternating current for a centrifuge and rotator. They stored reagents in propane-powered refrigerators.

During the study, blood samples tested on-site also were re-analyzed at the central laboratory to ensure the work was done correctly. Health workers gave patients penicillin the same day they were tested. While rates of syphilis in pregnant women remained the same over time there, follow-up data collection showed the marked drop in babies born infected.

“We are quite proud of this,” said Behets, who spends most of her working time in developing nations with high levels of AIDS and other sexually transmitted diseases. “It shows that it’s possible with minimal resources to bring medical discoveries to the poorest of the poor even in remote areas.”

More than 90 percent of Haitian women in the Artibonite region deliver their babies at home unattended by medical personnel, she said.

German scientist August von Wasserman developed the simple blood test for syphilis in 1906. In 1928, British scientist Alexander Fleming discovered penicillin, which can cure syphilis and prevent its transmission from mother to infant.

While abroad, Behets now operates out of Madagascar’s capital city Antananarivo, but also conducts research and interventions in Tamatave and Mahajanga. As part of a multi-center study in the United States and Madagascar, she and colleagues are conducting a clinical trial to compare azithromycin with benzathine penicillin for treatment of early syphilis. They also study professional sex workers to learn ways of preventing the spread of sexually transmitted diseases on the large island, which lies off the southeast coast of Africa.

###
Note: Behets can be reached (919) 966-7440 or via email at frieda_behets@unc.edu

School of Public Health Contact: Lisa Katz, (919) 966-7467
UNC News Services Contact: David Williamson, (919) 962-8596