David Mabey is a professor at the London School of Hygiene and Tropical Medicine. The opinions expressed are his own.
Syphilis in pregnancy causes more than half a million stillbirths or neonatal deaths annually -- deaths which could be prevented if all pregnant women were screened for syphilis and treated with a single dose of penicillin before the third trimester.
A report published in The Lancet last year showed that syphilis is one of the major causes of stillbirths and newborn deaths. ‘Born Too Soon: The Global Action Report on Preterm Birth’ tells us that premature birth is on the rise in most countries, and it is now the second leading cause of death globally. According to the report, 15 million babies (more than one in ten) are born too early. In China alone, almost 1.2 million births are premature.
Although policies on screening pregnant mothers for syphilis have been in place in most countries for years, only about one third of pregnant women with syphilis are screened. This is, in part, due to logistical challenges with testing methods, which require electricity, refrigeration and laboratory equipment.
Working with a team from The London School of Hygiene & Tropical Medicine, I carried out a research study published this week, funded by The Bill & Melinda Gates Foundation, to determine the feasibility of introducing new point-of-care-tests for pre-natal syphilis screening.
Unlike previous tests, the ones used in the recent study do not need to be refrigerated and do not require any equipment or electricity.
We selected a diverse range of countries and settings, from urban areas in China and Peru, to remote villages in East Africa, and even more isolated indigenous populations deep in the Amazon rain forest.
This project has shown that these new simple tests can be effectively introduced into a variety of locations anywhere. Screening pregnant women for syphilis is one of the most cost-effective health interventions available.
We have made significant progress in reducing mortality in under-fives in many countries, but mortality in the first month of life is not declining. In fact, 40 percent of children who die before their fifth birthday actually die in the first month of life.
By working closely with each of the governments before and while doing the research, we’ve been able to bring about rapid changes in policy in all of the six countries where the study took place.
This has happened remarkably quickly, given that the project was only completed in 2011. We hope that this project will lead to other similar research being given high priority in the future, thus overcoming the well-known lag between research and action through policy change.
On the back of this research, the Global Congenital Syphilis Partnership was launched in March 2012.
The partnership seeks to build on the success of the project by expanding strategic partnerships, strengthening global advocacy and supporting country’s implementation of integrated screening programmes for HIV, syphilis and other infections in pregnancy. Partners include The London School of Hygiene & Tropical Medicine, Save the Children, Centers for Disease Control and Prevention, University College London, and the Bill & Melinda Gates Foundation.