The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors
BackgroundMother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in dise...
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1242870/full |
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| author | James Chirombo James Chirombo Annielisa Majamanda Vester Gunsaru Simeon Yosefe Washington Ozituosauka Christina Mchoma Chelsea Morroni Chelsea Morroni Effie Chipeta Peter MacPherson Peter MacPherson Bridget Freyne Bridget Freyne Bridget Freyne |
| author_facet | James Chirombo James Chirombo Annielisa Majamanda Vester Gunsaru Simeon Yosefe Washington Ozituosauka Christina Mchoma Chelsea Morroni Chelsea Morroni Effie Chipeta Peter MacPherson Peter MacPherson Bridget Freyne Bridget Freyne Bridget Freyne |
| author_sort | James Chirombo |
| collection | DOAJ |
| description | BackgroundMother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission.MethodsWe collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas.ResultsOverall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27–0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89–1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12–1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10–1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80–1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15–49 years) in 2022.ConclusionMaternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs. |
| first_indexed | 2024-03-08T13:39:36Z |
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| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-08T13:39:36Z |
| publishDate | 2024-01-01 |
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| series | Frontiers in Public Health |
| spelling | doaj.art-bd417ea04c1f4b20a73f2670ee2710362024-01-16T12:51:04ZengFrontiers Media S.A.Frontiers in Public Health2296-25652024-01-011110.3389/fpubh.2023.12428701242870The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factorsJames Chirombo0James Chirombo1Annielisa Majamanda2Vester Gunsaru3Simeon Yosefe4Washington Ozituosauka5Christina Mchoma6Chelsea Morroni7Chelsea Morroni8Effie Chipeta9Peter MacPherson10Peter MacPherson11Bridget Freyne12Bridget Freyne13Bridget Freyne14Statistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, MalawiDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United KingdomDepartment of Quality, Blantyre District Health Office, Blantyre, MalawiStatistical Support Unit, Malawi Liverpool Wellcome Programme, Blantyre, MalawiDigital Health Department, Ministry of Health, Lilongwe, MalawiSTI/HIV Program, Ministry of Health, Lilongwe, MalawiReproductive Health Department, Ministry of Health of Malawi, Lilongwe, MalawiBotswana Harvard AIDS Institute Partnership, Gaborone, BotswanaMRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United KingdomKamuzu University of Health Sciences, Blantyre, Malawi0School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom1Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom2Department of Paediatric Infectious Diseases, Children’s Health Ireland, Dublin, Ireland3Division of Women and Children’s Health, School of Medicine, University College Dublin, Dublin, Ireland4Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United KingdomBackgroundMother-to-child transmission of syphilis remains high especially in the WHO AFRO region with a prevalence of 1.62%, resulting in a congenital syphilis rate of 1,119 per 100,000 live births. Elimination efforts can be supported by an understanding of the spatial and temporal changes in disease over time, which can identify priority areas for targeted interventions aimed at reducing transmission.MethodsWe collated routine surveillance data from health facilities and covariate data from demographic and health surveys conducted in Malawi between 2014 and 2022. We fitted a Bayesian hierarchical mixed model with spatial and temporally structured random effects to model the district-level monthly counts of maternal syphilis notifications as a function of individual- and district-level predictors. We then generated district-level spatiotemporally explicit risk profiles to estimate the effect of individual- and district-level covariates on maternal syphilis notifications and to identify hotspot areas.ResultsOverall, the national prevalence of maternal syphilis increased from 0.28% (95% CI: 0.27–0.29%) in 2014 to peaking in 2021 at 1.92% (95% CI: 1.89–1.96%). Between 2020 and 2022, there was a decline in prevalence, with the most significant decline seen in Zomba District (1.40, 95% CI: 1.12–1.66%). In regression models, a one percentage point increase in district-level antenatal HIV prevalence was associated with increased maternal syphilis (prevalence ratio [PR]: 1.15, 95% credible interval [CrI]: 1.10–1.21). There was also an increased prevalence of maternal syphilis associated with an increased district-level mean number of sex partners (PR: 1.05, 95% CrI: 0.80–1.37). The number of districts with a high prevalence of maternal syphilis also increased between 2014 and 2022, especially in the southern region, where most had a high probability (approaching 100%) of having high maternal syphilis (defined as relative risk >1 compared to the standard population of women aged 15–49 years) in 2022.ConclusionMaternal syphilis prevalence in Malawi shows an increasing upward trend, with an estimated six times relative increase between 2014 and 2022 (0.28% to 1.73%) and strong associations with higher district-level HIV prevalence. Controlling syphilis depends on reaching vulnerable populations at the sub-national level, which may be disproportionately affected. Our findings support the move to integrate the elimination of mother-to-child transmission (EMTCT) of syphilis programs with existing prevention of mother-to-child transmission (PMTCT) of HIV programs.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1242870/fullmaternal syphiliseMTCTsyphilis prevalencespatio-temporal modelHIV |
| spellingShingle | James Chirombo James Chirombo Annielisa Majamanda Vester Gunsaru Simeon Yosefe Washington Ozituosauka Christina Mchoma Chelsea Morroni Chelsea Morroni Effie Chipeta Peter MacPherson Peter MacPherson Bridget Freyne Bridget Freyne Bridget Freyne The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors Frontiers in Public Health maternal syphilis eMTCT syphilis prevalence spatio-temporal model HIV |
| title | The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors |
| title_full | The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors |
| title_fullStr | The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors |
| title_full_unstemmed | The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors |
| title_short | The prevalence of gestational syphilis in Malawi between 2014 and 2022: spatiotemporal modeling of population-level factors |
| title_sort | prevalence of gestational syphilis in malawi between 2014 and 2022 spatiotemporal modeling of population level factors |
| topic | maternal syphilis eMTCT syphilis prevalence spatio-temporal model HIV |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1242870/full |
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