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 "interventi on" clinics, were compared regarding syphilis screening and treatment. Preg nant women with positive rapid plasma reagin (RPR) test (n=929) were enroll ed, 453 in the intervention and 476 in the control clinics. In control clin ics the normal routine regarding syphilis screening was followed for 383 wo men remaining for follow up. In intervention clinics nurse midwives were tr ained to perform the RPR test. RPR seropositive cases were immediately trea ted 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 RP R test was performed and all women with positive RPR test results were agai n treated and the partners were invited to come for treatment. Results: At delivery, the drop out rate was 15.7% in the intervention and 2 0.1% 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 re sults-40.9% v 24.2% (p=0.000). Conclusion: More active training of nurse midwives in antenatal care to per form on site RPR tests, to give syphilis treatment, and to notify partners results in improved perinatal outcome and more seronegative parturient wome n.