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Saving Pregnancies and Saving Pregnancies and Newborn Babies From SyphilisNewborn Babies From Syphilis
Busisiwe KuneneReproductive Health Research Unit
(South Africa) January 2002
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Overview Syphilis is a preventable & curable disease
15% of antenatal women have syphilis
Syphilis causes 1out of 10 stillbirths
Testing of antenatal care is widely available
Policy recommended treatment is being followed by health providers
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Problem Statement
Syphilis treatment, compliance, and partner tracing remains a problem.
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Objective To document the program of providing
syphilis screening and management in South Africa:
Preparedness of program
Effectiveness of management strategy
Availability of drugs
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Methodology Reproductive Health Research Unit
conducted a case study in 2000
Site: KwaZulu-Natal, 9 clinics and 2 hospitals
Methods used: inventories, observations, interviews, and others
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Key Findings
Five out of nine facilities had the guidelines
All antenatal clients were screened
Blood analysis was done off-site
Blood results turn-around was 4-6 weeks
One penicillin injection given weekly for 3 weeks
Drugs were often out of stock
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Timing of First Antenatal Visit
3 months 8-9 months
6-7 months4-5 months
44%37%
7%12%
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Antenatal Care Services Clinics opened at 07.00
Clients come at least 2-3 hours before
Clients spend 4-6 hours for 20 minutes first visit and 10 minutes repeat visit
Each client can have up to 8 contacts per visit
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Group talk* Urine testingCard/Registration
BP*Weight*Full history
Blood sample MedicationExamination*
*Procedure repeated at subsequent visits
Routine Procedure for Antenatal Care
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Knowledge of Syphilis Status
53
20
20
5
2
0 10 20 30 40 50 60
Result & status known
Status not known
Results not known
Test not recorded
Client confused with HIV
Percent of clients
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Partner Tracing & Treatment “Now that you ask…I have worked for 15 years
here, I do not remember treating a man said to be a partner,” said one health provider
“I would like to see on-site testing being done, women start ANC late and end up delivering before treatment, let alone tracing partners,” said one health provider
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Policy Implications Pregnant women start ANC late
Pregnant women spend more time and get minimal quality of service
Analysis of blood off-site causes a delay in commencing treatment
Partners are not treated for syphilis
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Recommendations Initiate programmes for motivating women
to start ANC in their first 3 months
Provide more resources for syphilis screening and treatment
Review the following: Rendering of ANC services Partner tracing
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Summary Available programme can cure and even
prevent syphilis, provided that: Testing is done on-site Treatment begins on the first ANC visit Sufficient drugs are provided Partners are involved during ANC services