Elimination of congenital syphilis - a story of sheer negligence and apathy

Congenital Syphilis Makes a Comeback

In light of a resurgence, clinicians need to remember the clinical features of syphilis in infants.

— Jan V. Hirschmann, MD

Published in Journal Watch Dermatology May 7, 2010

 WHO estimate says, every year, globally, 12 million people get affected by syphilis, 2 million pregnancies get affected with 25% of them end in still-birth and 25% of the newborn are born low birth weight or with serious infection.

It is estimated that more number of children are being affected by congenital syphilis than HIV.

Congenital syphilis is a preventable and treatable disease. This can be eliminated by regularized ante-natal screening of syphilis and timely treatment of the infected pregnant women. The interventions are cost-effective and can be easily managed at primary healthcare level.

Unfortunately, very unfortunately, other than WHO, there is no global level advocacy to sensitize the countries for elimination of congenital syphilis, where, the picture is so completely contrasting in PMTCT programs. Syphilis is lacking the ‘HIV glamour’ in it and continues to stay back in the dark forgotten corner of the ‘neglected’ diseases.

In India, the picture is not different. Elimination of congenital syphilis is yet to find its place neither in RCH II nor NACP III as one of the key strategies.

Is anyone listening?

Sugata Mukhopadhyay

UNIVERSAL Health

Key link: http://dermatology.jwatch.org/cgi/content/citation/2010/507/2

UNIVERSAL Health demands for better and effective health services for MSM and Transgender

I have some experiences of working in the STI/HIV intervention programs with MSM and Transgender in India and South East Asia . I found the service delivery component the weakest in most of the programs. The MSM and Transgender have special health needs which are not captured adequately in the programs. Besides, the capacities of the healthcare providers to respond correctly to the needs of MSM & Transgender are very limited till now. This is so unfortunate after so many years of HIV/AIDS programs.

The urgent needs to enhance health services of MSM & Transgender at the country level are:

1) Standardized guideline for control and management of anal & oral STIs

2) Users'-friendly health clinics for MSM & Transgender

3) Appropriate training modules and curriculum to strengthen capacities of the healthcare providers

4) Strategic plan to scale up those services

 UNIVERSAL Health demands for better and effective health services for MSM and Transgender.

Sugata Mukhopadhyay

UNIVERSAL Health 

Engaging unqualified rural healthcare practitioners effectively in polio surveillance activities – experience from India

"We will eradicate polio soon. We will make this world safe for our children"

Objective: The intervention was targeted to improve Acute Flaccid Paralysis (AFP) surveillance in Purnia district of Bihar India as part of polio eradication initiative.

Background: Poor villagers of Purnia, due to lack of public health services in rural areas, visited mostly local unqualified practitioners. The district polio surveillance field office found it challenging to receive timely AFP case reports from rural areas due to defunct public health system. Late or no reporting was common. As a result, Purnia showed poor AFP and stool collection rates among AFP cases with increasing ‘polio compatible’ cases, indicating inadequate surveillance in 2002-03. This abstract shares experiences of improving AFP surveillance through active participation of rural, grass root level practitioners.

Methods: Popular rural practitioners were mapped through tracking histories of AFP, and compatible cases, interviewing immunization teams, PHC staffs, parents of AFP cases, villagers. About 100 rural practitioners were identified across Purnia who were reported treating paralysis cases.  Once identified, they were trained on basics of AFP identification, significance and reporting. Detailed contact particulars were provided to them for timely reporting.  Training absentees were sensitized in their clinics. Prioritized practitioners were repeatedly visited, rest regularly contacted telephonically, for constant motivation. AFP posters were pasted inside their clinics. A mail box was kept outside polio field office to enable people drop AFP reports during closing hours. Small incentives were paid for AFP case reporting.

Results: In 2004, timely reporting from remote areas, improvement in AFP and stool rates with decreasing compatible cases was observed. Rural practitioners reported 2 confirmed polio cases.

Conclusion: Where public health system is weak, alternative system run by unqualified rural practitioners can be effectively utilized to improve sensitivity of AFP surveillance.

Implication: The learning of Purnia and adjoining districts was replicated across Bihar to enhance efforts of AFP surveillance and polio eradication in subsequent years.