Maternal and congenital syphilis in Bolivia, 1996: prevalence and risk factors

Objectives The present study was carried out in seven maternity hospitals t o determine the prevalence of maternal syphilis at the time of delivery and the associated risk factors, to conduct a pilot project of rapid syphilis testing in hospital laboratories, to assure the quality of syphilis testing , and to determine the rate of congenital syphilis in infants born to women with syphilis at the time of delivery - all of which would provide baselin e data for a national prevention programme in Bolivia. Methods All women delivering either live-born or stillborn infants in the s even participating hospitals in and around La Paz, El Alto, and Cochabamba between June and November 1996 were eligible for enrolment in the study. Findings A total of 61 out of 1428 mothers (4.3%) of live-born infants and 11 out of 43 mothers (26%) of stillborn infants were found to have syphilis at delivery. Multivariate analysis showed that women with live-born infant s who had less than secondary-level education, who did not watch television during the week before delivery (this was used as an indicator of socioeco nomic status), who had a previous history of syphilis, or who had more than one partner during the pregnancy were at increased risk of syphilis. While 76% of the study population had received prenatal care, only 17% had syphi lis testing carried out during the pregnancy; 91% of serum samples that wer e reactive to rapid plasma reagin (RPR) tests were also reactive to fluores cent treponemal antibody-absorption (FTA-ABS) testing. There was 96% agreem ent between the results from local hospital laboratories and national refer ence laboratories in their testing of RPR reactivity of serum samples. Cong enital syphilis infection was confirmed by laboratory tests in 15% of 66 in fants born to women with positive RPR and FTA-ABS testing. Conclusion These results indicate that a congenital syphilis prevention pro gramme in Bolivia could substantially reduce adverse infant outcomes due to this disease.