Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data
The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2...
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| Published in: | PLoS medicine Vol. 10; no. 2; p. e1001396 |
|---|---|
| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Public Library of Science
01.02.2013
Public Library of Science (PLoS) |
| Subjects: | |
| ISSN: | 1549-1676, 1549-1277, 1549-1676 |
| Online Access: | Get full text |
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| Abstract | The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis.
Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.
Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary. |
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| AbstractList | Background: The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and [greater than or equal to] 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings: Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938;249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Conclusions: Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary. The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis.Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary. Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Conclusions Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary Using multinational surveillance data, Lori Newman and colleagues estimate global rates of active syphilis in pregnant women, adverse effects, and antenatal coverage and treatment needed to meet WHO goals. Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for syphilis and ≥90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis. Methods and Findings Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage. Conclusions Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis.BACKGROUNDThe World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥ 90% to receive treatment by 2015. We calculated global and regional estimates of syphilis in pregnancy and associated adverse outcomes for 2008, as well as antenatal care (ANC) coverage for women with syphilis.Estimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.METHODS AND FINDINGSEstimates were based upon a health service delivery model. National syphilis seropositivity data from 97 of 193 countries and ANC coverage from 147 countries were obtained from World Health Organization databases. Proportions of adverse outcomes and effectiveness of screening and treatment were from published literature. Regional estimates of ANC syphilis testing and treatment were examined through sensitivity analysis. In 2008, approximately 1.36 million (range: 1.16 to 1.56 million) pregnant women globally were estimated to have probable active syphilis; of these, 80% had attended ANC. Globally, 520,905 (best case: 425,847; worst case: 615,963) adverse outcomes were estimated to be caused by maternal syphilis, including approximately 212,327 (174,938; 249,716) stillbirths (>28 wk) or early fetal deaths (22 to 28 wk), 91,764 (76,141; 107,397) neonatal deaths, 65,267 (56,929; 73,605) preterm or low birth weight infants, and 151,547 (117,848; 185,245) infected newborns. Approximately 66% of adverse outcomes occurred in ANC attendees who were not tested or were not treated for syphilis. In 2008, based on the middle case scenario, clinical services likely averted 26% of all adverse outcomes. Limitations include missing syphilis seropositivity data for many countries in Europe, the Mediterranean, and North America, and use of estimates for the proportion of syphilis that was "probable active," and for testing and treatment coverage.Syphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary.CONCLUSIONSSyphilis continues to affect large numbers of pregnant women, causing substantial perinatal morbidity and mortality that could be prevented by early testing and treatment. In this analysis, most adverse outcomes occurred among women who attended ANC but were not tested or treated for syphilis, highlighting the need to improve the quality of ANC as well as ANC coverage. In addition, improved ANC data on syphilis testing coverage, positivity, and treatment are needed. Please see later in the article for the Editors' Summary. |
| Audience | Academic |
| Author | Seuc, Armando Hawkes, Sarah Newman, Lori Gomez, Gabriela Broutet, Nathalie Kamb, Mary Say, Lale |
| AuthorAffiliation | 5 School of Public Health, Imperial College London, London, United Kingdom 4 Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands 2 Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America 3 University College London, London, United Kingdom 1 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland Hospital Clinic, Barcelona, Spain |
| AuthorAffiliation_xml | – name: 1 Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland – name: 3 University College London, London, United Kingdom – name: 2 Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America – name: 4 Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands – name: Hospital Clinic, Barcelona, Spain – name: 5 School of Public Health, Imperial College London, London, United Kingdom |
| Author_xml | – sequence: 1 givenname: Lori surname: Newman fullname: Newman, Lori – sequence: 2 givenname: Mary surname: Kamb fullname: Kamb, Mary – sequence: 3 givenname: Sarah surname: Hawkes fullname: Hawkes, Sarah – sequence: 4 givenname: Gabriela surname: Gomez fullname: Gomez, Gabriela – sequence: 5 givenname: Lale surname: Say fullname: Say, Lale – sequence: 6 givenname: Armando surname: Seuc fullname: Seuc, Armando – sequence: 7 givenname: Nathalie surname: Broutet fullname: Broutet, Nathalie |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23468598$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/S0140-6736(10)62310-0 10.1136/sti.2006.022640 10.1016/S1473-3099(11)70104-9 10.1016/S0140-6736(10)62187-3 10.1186/1471-2458-11-S3-S9 10.1097/01.aids.0000244206.41500.27 10.1016/S0140-6736(10)62233-7 10.1525/aa.1969.71.2.02a00020 10.1097/01.olq.0000261456.09797.1b 10.2471/BLT.11.089813 10.1371/journal.pmed.1001233 10.1086/342952 10.1086/429626 |
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| Copyright | COPYRIGHT 2013 Public Library of Science 2013 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Citation: Newman L, Kamb M, Hawkes S, Gomez G, Say L, et al. (2013) Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data. PLoS Med 10(2): e1001396. doi:10.1371/journal.pmed.1001396 2013 2013 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Citation: Newman L, Kamb M, Hawkes S, Gomez G, Say L, et al. (2013) Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data. PLoS Med 10(2): e1001396. doi:10.1371/journal.pmed.1001396 |
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| Keywords | Predictive Value of Tests Infant Mortality Delivery of Health Care, Integrated Humans Stillbirth Pregnancy Complications, Infectious Fetal Mortality Syphilis, Congenital Anti-Bacterial Agents Fetal Death Time Factors Health Services Accessibility Syphilis World Health Female Infant, Newborn Serologic Tests Infant, Low Birth Weight Premature Birth Infectious Disease Transmission, Vertical Gestational Age Pregnancy Infant, Premature Early Diagnosis Prenatal Care |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 The authors have declared that no competing interests exist. Conceived and designed the experiments: LN MK SH LS NB. Performed the experiments: LN GG AS. Analyzed the data: LN GG AS. Contributed reagents/materials/analysis tools: LN MK SH GG LS AS. Wrote the first draft of the manuscript: LN. Contributed to the writing of the manuscript: LN MK SH GG AS NB. ICMJE criteria for authorship read and met: LN MK SH GG LS AS NB. Agree with manuscript results and conclusions: LN MK SH GG LS AS NB. |
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| References | ref13 BM Rothschild (ref1) 2005; 40 ref12 G Schmid (ref11) 2007; 34 ref31 S Hawkes (ref28) 2013 ref10 ref17 V Mwapasa (ref30) 2006; 20 AW Crosby Jr (ref2) 1969; 2 LG Yang (ref7) 2011; 89 ref25 J Lawn (ref15) 2011; 377 GB Gomez (ref22) 2012 H Blencowe (ref23) 2011; 11 ML Kamb (ref26) 2010; 2010 ref21 D Watson-Jones (ref20) 2002; 186 SM Berman (ref27) 2004; 82 S Hawkes (ref3) 2011; 11 DC Mabey (ref6) 2012; 9 J McDermott (ref24) 1993; 71 ref29 ref8 J Lujan (ref18) 2008; 98 ref9 ref4 ref5 F Tinajeros (ref19) 2006; 82 S Cousens (ref14) 2011; 377 V Flenady (ref16) 2011; 377 |
| References_xml | – volume: 377 start-page: 1219 year: 2011 ident: ref14 article-title: National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis publication-title: Lancet doi: 10.1016/S0140-6736(10)62310-0 – volume: 82 start-page: 433 year: 2004 ident: ref27 article-title: Maternal syphilis: pathophysiology and treatment publication-title: Bull World Health Organ – volume: 82 start-page: 17 year: 2006 ident: ref19 article-title: Diagnostic accuracy of a point-of-care syphilis test when used among pregnant women in Bolivia publication-title: Sex Transm Infect doi: 10.1136/sti.2006.022640 – volume: 11 start-page: 684 year: 2011 ident: ref3 article-title: Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis publication-title: Lancet Infect Dis doi: 10.1016/S1473-3099(11)70104-9 – ident: ref5 – volume: 2010 start-page: 312798 year: 2010 ident: ref26 article-title: A road map for the global elimination of congenital syphilis publication-title: Obstet Gynecol Int – volume: 377 start-page: 1448 year: 2011 ident: ref15 article-title: Stillbirths: Where? When? Why? How to make the data count? publication-title: Lancet doi: 10.1016/S0140-6736(10)62187-3 – volume: 98 start-page: 49 year: 2008 ident: ref18 article-title: Prevalence of sexually transmitted infections in women attending antenatal care in Tete province, Mozambique publication-title: S Afr Med J – ident: ref29 – year: 2012 ident: ref22 article-title: Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis publication-title: Bull World Health Organ – year: 2013 ident: ref28 article-title: Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis publication-title: PLoS ONE – ident: ref25 – volume: 11 start-page: S9 year: 2011 ident: ref23 article-title: Lives Saved Tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality publication-title: BMC Public Health doi: 10.1186/1471-2458-11-S3-S9 – ident: ref9 – volume: 20 start-page: 1869 year: 2006 ident: ref30 article-title: Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi publication-title: AIDS doi: 10.1097/01.aids.0000244206.41500.27 – ident: ref17 – ident: ref13 – volume: 377 start-page: 1331 year: 2011 ident: ref16 article-title: Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis publication-title: Lancet doi: 10.1016/S0140-6736(10)62233-7 – ident: ref4 – volume: 2 start-page: 218 year: 1969 ident: ref2 article-title: The early history of syphilis: a reappraisal publication-title: Am Anthropol doi: 10.1525/aa.1969.71.2.02a00020 – ident: ref21 – volume: 34 start-page: S5 year: 2007 ident: ref11 article-title: The need and plan for global elimination of congenital syphilis publication-title: Sex Transm Dis doi: 10.1097/01.olq.0000261456.09797.1b – volume: 89 start-page: 798 year: 2011 ident: ref7 article-title: Syphilis test availability and uptake at medical facilities in southern China publication-title: Bull World Health Organ doi: 10.2471/BLT.11.089813 – volume: 71 start-page: 773 year: 1993 ident: ref24 article-title: Syphilis-associated perinatal and infant mortality in rural Malawi publication-title: Bull World Health Organ – volume: 9 start-page: e1001233 year: 2012 ident: ref6 article-title: Point-of-care tests to strengthen health systems and save newborn lives: the case of syphilis publication-title: PLoS Med doi: 10.1371/journal.pmed.1001233 – ident: ref8 – volume: 186 start-page: 940 year: 2002 ident: ref20 article-title: Syphilis in pregnancy in Tanzania. I. Impact of maternal syphilis on outcome of pregnancy publication-title: J Infect Dis doi: 10.1086/342952 – ident: ref10 – ident: ref12 – volume: 40 start-page: 1454 year: 2005 ident: ref1 article-title: The history of syphilis publication-title: Clin Infect Dis doi: 10.1086/429626 – ident: ref31 |
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| Snippet | The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for syphilis and ≥... Background: The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥ 90% of pregnant women to be tested for... Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for... Using multinational surveillance data, Lori Newman and colleagues estimate global rates of active syphilis in pregnant women, adverse effects, and antenatal... Background The World Health Organization initiative to eliminate mother-to-child transmission of syphilis aims for ≥90% of pregnant women to be tested for... |
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| SubjectTerms | Anti-Bacterial Agents - therapeutic use Babies Delivery of Health Care, Integrated Disease transmission Early Diagnosis Estimates Female Fetal Death - epidemiology Fetal Death - prevention & control Fetal Mortality Gestational Age Global Health Health aspects Health Services Accessibility Humans Infant Mortality Infant, Low Birth Weight Infant, Newborn Infant, Premature Infectious Disease Transmission, Vertical - prevention & control Medicine Mother and child Physiological aspects Predictive Value of Tests Pregnancy Pregnancy Complications, Infectious - diagnosis Pregnancy Complications, Infectious - epidemiology Pregnancy Complications, Infectious - mortality Pregnancy Complications, Infectious - therapy Premature Birth - epidemiology Premature Birth - prevention & control Prenatal Care Public health Serologic Tests Stillbirth - epidemiology Syphilis Syphilis - diagnosis Syphilis - epidemiology Syphilis - mortality Syphilis - therapy Syphilis - transmission Syphilis, Congenital - diagnosis Syphilis, Congenital - epidemiology Syphilis, Congenital - mortality Syphilis, Congenital - therapy Syphilis, Congenital - transmission Time Factors Womens health |
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| Title | Global Estimates of Syphilis in Pregnancy and Associated Adverse Outcomes: Analysis of Multinational Antenatal Surveillance Data |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/23468598 https://www.proquest.com/docview/1314340157 https://www.proquest.com/docview/1315628779 https://pubmed.ncbi.nlm.nih.gov/PMC3582608 https://doaj.org/article/7ce43a37d33d410e8f376dd78b9e0a3b http://dx.doi.org/10.1371/journal.pmed.1001396 |
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