Majoko F, Munjanja S, Nystrom L, Mason E, Lindmark G
Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe.
Cent Afr J Med. 2003 Jul-Aug;49(7-8):90-3.
To determine coverage for antenatal syphilis screening in a rural area and evaluate the accuracy of on-site Rapid Plasma Reagin (RPR) tests performed by nurse-midwives.
Descriptive cross sectional.
Rural Health Centres (n = 23) in the Gutu District of Zimbabwe.
Women booking for antenatal care in the district were used to determine coverage of screening. Results from women who had an RPR test performed during a nine week period were used in assessing the accuracy of tests performed by nurse-midwives.
On-site antenatal screening for syphilis using an RPR kit with immediate results and treatment for women who tested positive.
Prevalence of syphilis (positive RPR) at booking and the level of agreement between three observers (RHC nurse-midwife, medical practitioner under field conditions and medical laboratory technologist).
Eighty five percent of women were screened for syphilis at the first antenatal visit and 11% had a positive RPR. Almost all (97.3%) women with a positive RPR test result were treated. The accuracy of tests performed by RHC staff was poor with a sensitivity of 40% (95% CI 21.8 to 61.1) when compared to those done by the medical practitioner and 8.7% (95% CI 1.5 to 29.5) when compared to those done in a laboratory. The predictive value of a positive test was 22.7% and that of a negative test was 94.9%.
The coverage of screening for syphilis in pregnant women in Gutu District was good but the results were unreliable. There is need for nurse-midwives, who perform the majority of RPR tests in the RHC, to receive adequate training to ensure competence in testing and to strengthen quality control procedures.
确定农村地区产前梅毒筛查的覆盖率，并评估助产士现场快速血浆反应素（RPR）检测的准确性。
描述性横断面研究。
津巴布韦古图区的农村卫生中心（共23个）。
该地区预约产前护理的妇女用于确定筛查覆盖率。在九周期间进行RPR检测的妇女的结果用于评估助产士检测的准确性。
使用RPR试剂盒进行现场产前梅毒筛查，结果即时可得，对检测呈阳性的妇女进行治疗。
预约时梅毒患病率（RPR阳性）以及三名观察者（农村卫生中心助产士、现场条件下的医生和医学检验技师）之间的一致性水平。
85%的妇女在首次产前检查时接受了梅毒筛查，11%的妇女RPR呈阳性。几乎所有（97.3%）RPR检测结果呈阳性的妇女都接受了治疗。与医生进行的检测相比，农村卫生中心工作人员进行的检测准确性较差，敏感性为40%（95%可信区间21.8至61.1）；与实验室检测相比，敏感性为8.7%（95%可信区间1.5至29.5）。阳性检测的预测值为22.7%，阴性检测的预测值为94.9%。
古图区孕妇梅毒筛查覆盖率良好，但结果不可靠。在农村卫生中心进行大部分RPR检测的助产士需要接受充分培训，以确保检测能力，并加强质量控制程序。
