A simple and rapid test done near the patient that does not need laboratories, electricity, or highly trained staff (known as a point-of-care test) can effectively diagnose syphilis in pregnant women and has been adopted in six low- and middle-income countries thus preventing many stillbirths and deaths in newborn babies according to a report from international researchers published in this week's PLoS Medicine.
Syphilis in pregnancy causes more than half a million stillbirths or neonatal deaths every year but these deaths could be prevented if all pregnant women were screened for syphilis and treated with a single dose of penicillin before the third trimester (last three months) of their pregnancy.
In an international project in 6 countries, funded by the Bill & Melinda Gates Foundation and led by Rosanna Peeling from the London School of Hygiene and Tropical Medicine, researchers engaged policy makers in each country in the design of a prenatal syphilis screening project using point-of-care tests to ensure that the screening programme was appropriate to the local health care system: syphilis point-of-care tests were introduced in rural antenatal clinics in Tanzania, Uganda, and China; both rural and urban clinics in Peru and Zambia; and remote indigenous communities in Brazil.
In each country, health workers were trained in how to use the tests using training materials translated into the local language, and adapted according to the local cultural and social context. During the project, over 100,000 pregnant women were screened for syphilis—90% of women attending antenatal clinics and over 90% of these women were treated on the same day. Furthermore, the test was acceptable to women and increased the job satisfaction of health workers.
Importantly, as a result of this project, all six countries changed policy to adopt point-of-care syphilis testing into their prenatal screening programmes.
The authors say: "This project has shown that [point-of-care tests] for syphilis can be effectively introduced in a range of settings, from cities in China and Peru, to remote villages in East Africa, and even more remote indigenous populations in the Amazon rain forest. By working with the existing health care system to integrate testing, the introduction of [point-of-care tests] resulted in large numbers of women being tested and treated for syphilis, averting many stillbirths and reducing neonatal mortality."
The authors conclude: "Our long-term vision is to facilitate the development and implementation of an essential [point-of-care test] package for prenatal care that could be broadened to include diagnostics for both infectious diseases and conditions such as anaemia and pre-eclampsia to ensure safe motherhood and healthy babies. Such an integrated approach could result in improved efficiency, a more robust health care system, and lives saved."