An intervention study to reduce adverse pregnancy outcomes as a result of syphilis in Mozambique

Objectives: To create and evaluate an alternative screening approach among pregnant women in order to reduce adverse pregnancy outcome as a result of syphilis in Mozambique. Methods: Four suburban antenatal clinics, two "control" and two "intervention" clinics, were compared regarding syphilis screening and treatment. Pregnant women with positive rapid plasma reagin (RPR) test (n=929) were enrolled, 453 in the intervention and 476 in the control clinics. In control clinics the normal routine regarding syphilis screening was followed for 383 women remaining for follow up. In intervention clinics nurse midwives were trained to perform the RPR test. RPR seropositive cases were immediately treated on site by the nurse midwives and the partners were invited to come any afternoon for treatment. In the third trimester (around 30 weeks) a new RPR test was performed and all women with positive RPR test results were again treated and the partners were invited to come for treatment. Results: At delivery, the drop out rate was 15.7% in the intervention and 20.1% in the control group. The perinatal mortality was significantly higher in the control group than in the intervention group, 3.4% v 1.3% (p=0.030). At delivery the intervention group had significantly more negative RPR results-40.9% v 24.2% (p=0.000). Conclusion: More active training of nurse midwives in antenatal care to perform on site RPR tests, to give syphilis treatment, and to notify partners results in improved perinatal outcome and more seronegative parturient women.