Browsing by Author "Dionne JA"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Benzathine penicillin G stockouts and other barriers to documented syphilis treatment in pregnancy in Zambia.
    (2024) Jones AV; Manasyan A; Xue Y; Kapesa H; Mwendafilumba K; Nalwamba L; Mzumara M; Mubiana-Mbewe M; Dionne JA
    OBJECTIVE: The prevalence of syphilis in Zambia remains high and is a critical public health concern. The Zambian Ministry of Health recommends universal screening and same-day treatment for syphilis in pregnancy, yet the syphilis screening rate is low, and treatment is poorly documented. The goal of this study was to document syphilis treatment rates and associated factors among pregnant women in care in Zambia. METHODS: This retrospective cohort study included pregnant women diagnosed with syphilis according to rapid plasma reagin (RPR) screening during routine antenatal care (ANC) in Lusaka, Zambia in 2018-2019. The main outcome of interest was lack of documented BPG treatment during pregnancy. Additional information about pregnancy and neonatal outcomes, partner referral for therapy, and facility level stockout data were included. Patient characteristics were compared by treatment status using Pearson Chi-Square Test and logistic regression models were created to estimate the association between individual level-factors, facility type, and lack of BPG treatment. A Cochran-Mantel-Haenszel test was used to evaluate facility-level data with significance set at p<0.05. RESULTS: Among 1,231 pregnant women who screened positive for syphilis at clinic, 643 (52%) lacked documented antibiotic treatment at the facility. BPG was the only antibiotic used to treat syphilis in the cohort and 8% of sex partners had evidence of referral for therapy. Preterm delivery rates were higher in women without documented BPG (43% vs 32%; p = 0.003). In adjusted models, only calendar year and hospital facility type were associated with lack of treatment. At the facility level, annual syphilis screening rates ranged from 37-65% and most (7/10) clinics reported at least one stockout of BPG. CONCLUSION: Treatment rates for syphilis in pregnancy in Zambia were low and BPG medication stockouts at the facility level were common. A consistent supply of BPG at all ANC facilities is needed to facilitate timely treatment and improve birth outcomes.
  • Thumbnail Image
    Item
    Low syphilis treatment rates and associated birth outcomes in pregnant women with and without HIV in Zambia: A cohort study.
    (2025-Sep-03) Manasyan A; Jones AV; Xue Y; Kapesa H; Mzumara M; Dionne JA; Mubiana-Mbewe M
    OBJECTIVE: Syphilis and HIV in pregnancy contribute to adverse birth outcomes in Africa. Benzathine penicillin G remains an effective treatment for syphilis in pregnancy, yet gaps persist in timely treatment. The aim of this study was to compare factors associated with adverse birth outcomes among pregnant women diagnosed with syphilis in health facilities according to their HIV status. METHODS: This retrospective cohort analysis included pregnant women who screened positive for syphilis with routine rapid plasma reagin (RPR) testing in 10 antenatal care (ANC) clinics in Zambia between January 2018 and December 2019. Adverse birth outcomes (preterm delivery, low birth weight, fetal demise, congenital syphilis, and neonatal death) were collected through June 2020. Patient characteristics according to HIV status were compared using Pearson chi-square test or Fisher exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Logistic regression models were used to estimate the association between maternal and facility-level factors and a composite measure of adverse birth outcomes. RESULTS: In this cohort of 1204 pregnant women diagnosed with syphilis in health facilities, 42.5% had HIV coinfection and only 48.1% had documented penicillin treatment. Although preterm delivery rates were higher among women with syphilis and HIV (39.9% vs. 30.0% with syphilis alone; P = 0.003) the odds of having any adverse birth outcome were similar in both groups. CONCLUSION: Adverse birth outcomes were highly prevalent in Zambia among pregnant women with syphilis and treatment rates were low. Universal access to syphilis treatment in ANC clinic is needed to improve outcomes.