SYPHILIS-ASSOCIATED PERINATAL AND INFANT-MORTALITY IN RURAL MALAWI

In Mangochi District, a rural area of Malawi, the prevalence of active syphilis was 3.6% among 3591 women who had singleton births and who w ere negative for human immunodeficiency virus (HIV). Compared with non -syphilitic women, those with active syphilis (positive Venereal Disea se Research Laboratory/rapid plasmin reagin tests (titre greater than or equal to 1:8) and a reactive microhaemagglutination assay) were mor e likely to experience stillbirths as well as the early and late neona tal deaths and even postneonatal deaths of their children. Characteris tics associated with active syphilis were not very useful in targeting women at high risk of having the condition, which makes universal scr eening in antenatal programmes the most efficacious way to prevent syp hilis-associated morbidity and mortality. The potential for a programm e to prevent congenital syphilis in the perinatal, neonatal, and post neonatal periods is evident. In considering resource allocation to chi ld survival programmes in areas where the prevalence of syphilis is hi gh, officials need to include antenatal syphilis screening, using rapi d tests and treatment at the first contact of the mother with the heal th care system.