University of Connecticut OpenCommons@UConn UCHC Graduate School Masters Theses 2003 - University of Connecticut Health Center Graduate 2010 School 6-1-2007 Maternal Syphilis in Rural Haiti Chaylah Joy Lomotey Follow this and additional works at: https://opencommons.uconn.edu/uchcgs_masters Recommended Citation Lomotey, Chaylah Joy, "Maternal Syphilis in Rural Haiti" (2007). UCHC Graduate School Masters Theses 2003 - 2010. 140. https://opencommons.uconn.edu/uchcgs_masters/140 Maternal Syphilis in Rural Haiti Chaylah Joy Lomotey B.S. Eastern Nazarene College, 2002 A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Public Health At the University of Connecticut 2007 APPROV AL PAGE Master of Arts Thesis Maternal Syphilis in Rural Haiti Presented By Chaylah Joy Lomotey BS Major Advisor _____J__ JUd)lLeWJ7 ._~___ ____""L_--"=~=----''--~-/-.---- University of Connecticut 2007 Acknowledgements There are many people that I would like to acknowledge for all of their help in creating this thesis. Without each of them, I could not have completed it. First of all, I would like to thank the Haitian Health Foundation for providing the opportunity for me to come down to Haiti and do my thesis research. I want to thank Bette Gebrian for spending countless hours working with me--discussing my project, helping me with the computer work, helping to coordinate and organize my time, and translating for me during focus groups and interviews. Without her help, I would not have been able to accomplish very much at all. I thank her for her dedication to the Haitian Health Foundation and to the students and volunteers who come to Jeremie. Thank you to Sister Maryann for allowing my project to take place. I would also like to thank the HHF staff, especially the IT department, including Elise Dasnay, for all of their help with my data entry work. I could not have done it without them. I would also like to thank the Haitian Health Foundation medical staff for all of their time and for opening the doors for me to see their work. Robert Harris, long term HHF volunteer, spent many hours trying to program the PHACT dataset to export my data. Thank you so much! I also want to express my appreciation to Judy Lewis, my major thesis advisor, for all of her time, energy, and caring. I thank her for suggesting that I go to Haiti in the first place and then for all of the time and energy she has given in helping me prepare to go, analyze my results, and write my thesis. She has been a big help! Also, I give thanks to Juan Salazar, one of my associate advisors for all of his guidance and 111 direction in preparing for my research as well as trying to understand and integrate my results. I want to thank my husband, Reuben, for all of his support in everything I do and for always encouraging me to pursue my dreams. Thank you to my parents as well for all of their help. Last, but certainly not least, thank you to God for the gifts and talents He has blessed me with and for providing everything I need in life. IV Table of Contents Title Page ............................................................................... Approval Page....................................................................... ... 11 Ackno,vledgements.................. ...................... .......................... ... 111 Table of Contents.................................................................... ... v Abbreviations........................................................................... VIl1 Introduction ............................................................................. Background. 2 Syphilis: Epidemiology, Risk Factors, Clinical Manifestations, Diagnosis And Treatment.. .................. ..... .. .. .. .. .. .. ... .. .. ......... 2 Maternal and Congenital Syphilis............... .. .. .. .. .... .......... 9 Endemic Treponematoses....................................................... 19 Haiti. ...... ......... ... ..... ................. ........ ... ....... ..... ... .......... .... 21 Maternal and Congenital Syphilis in Haiti. .. ..... .. .. ............. ... .. 26 Haitian Guidelines for Syphilis Testing and Treatment During Pregnancy.............................................................. ... 30 Sexual Practices in Haiti......................................................... 31 Endemic Treponematoses in Haiti........... ..... ... .. .. .. .. .. .... ........ 31 Jeremie............. ...... .......... .................... ..... ........... ..... ... ..... 32 The Haitian Health Foundation............................................... ... 32 The Role of the Community Health Agent. .. 34 v PHACT............................................................................. 35 KOMBIT........................................................................... 36 The HHF Syphilis Program...................................................... 37 Research Goal. .. 37 Methodology.... .... .. .. .... ..... ...................... ... .. .. .. ... .. .. .. ........... 38 Qualitative... .... .... ... .... ...................... .. .. ... ... .. .. .. .. .......... 39 Quantitative........................................................................ 41 Results.... ..... .... ... ......... ... ...... ................ ..... ... ......... .................... 45 Qualitative: General Observation........................................................... .... 45 Key Infonnant Interviews. .... 47 Nursing Staff Picture Identification........ .. ... .. .... .. .. ... .. .............. 55 Individual Interviews.............................................................. 56 Group Interviews............. ...................................................... 58 Quantitative: Descliption of the Villages..................................................... ... 65 PHACT Dataset. .. .. .. .. .... 66 Past Birth Outcomes Dataset.... .. ................ .. .. .. .. .. .. .. .............. 75 Other Data Sources .................................................................. 76 Discussion................................................................................................................ 78 VI Study Limitations ........................................................................... 94 Summary of Recommendations ....................................... " ................. 95 References .................................................................................... 98 Appendices .................................................................................... 101 Appendix 1: CDC Guidelines ...................................................... 101 Appendix 2: Key Informant Interviews .......................................... 107 Appendix 3: Nurse Picture Identification ........................................ 114 Appendix 4: Focus Groups ......................................................... 121 Appendix 5: Education Cards ...................................................... 126 Vll Abbreviations CDC-Centers for Disease Control COH-Center of Hope FTA-ABS--Fluorescent Treponemal Antibody Absorption Test GHEISKIO-"Groupe Haitien d'Etude du Sarcome de Kaposi et des infections Opportunistes" i.e. The Haitian Group for Kaposi's Sarcoma and Opportunistic Infections HAS-Hospital Albert Schweitzer HHF-Haitian Health Foundation IUGR-Intrauterine Growth Retardation LMP-Last Menstrual Period KOMBIT-Community Organized for Mothers and Babies with Innovation and Technology NGO-Non-GovemmentalOrganization PCN-Penicillin PHACT-Public Health Active Census Tracking RPR-Rapid Plasma Reagin SES-Socioeconomic Status STD-Sexually Transmitted Disease TORCH-An acronym for maternal infections that can cause congenital disease TPHA-Treponema Pallidum Haemagglutination Test VDRL-Venereal Disease Research Laboratories WHO-World Health Organization Vlll Introduction Maternal syphilis is a major problem in the world today. It is not only a problem because of the morbidity and mortality it can cause for a woman herself, but also because it can have serious consequences for her developing infant, including miscarriage, stillbirth, neonatal death, and congenital syphilis. Because of this, there has been a major effOlt in most of the world to get all pregnant women tested and treated early in pregnancy. Maternal syphilis is a particularly important issue in the Grand Anse region of Haiti. A seroprevalence study done by the Centers for Disease Control in 2004 showed a prevalence of 7% in this region, and it had been even higher in previous studies (Ministere De La Sante Publique, 2004). This was the highest prevalence in the country of Haiti. The Haitian Health Foundation (HHF) is a non-governmental organization which has maternal-child health as a major focus. It serves over 200,000, some in the town of Jeremie and most from its surrounding villages. One program involves syphilis testing and treatment for all pregnant women at their first prenatal visit. The program has reduced the prevalence of maternal syphilis in the area, but research is needed to understand the causes and effective interventions. The purpose of this thesis is to provide a broad overview of the problem of maternal syphilis in rural communities in Jeremie, Haiti. It examines available syphilis data including prevalence, sociodemographic characteristics of syphilis positive pregnant women, the relationship between syphilis and adverse pregnancy outcomes, community knowledge about syphilis and the implementation of the HHF syphilis testing and treatment program. This knowledge