Shanghai Center for Women and Children's Health, Shanghai 200062, China.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China.
Int J Environ Res Public Health. 2019 Mar 20;16(6):1002. doi: 10.3390/ijerph16061002.
This study aimed to compare the screening and diagnosis of maternal syphilis in Shanghai between the national and municipal prevent mother-to-child transmission (PMTCT) of syphilis policies, and then to assess whether PMTCT programs and enhancing healthcare infrastructure could bring about an early detection of maternal syphilis. Detection of maternal syphilis was initiated in 2001 and then scaled-up in 2011 along with the enhancement of antenatal healthcare infrastructure. The initial five-year periods of municipal and national PMTCT policies were defined as the "exploring period" (2002⁻2006) and the "comprehensive period" (2011⁻2015). The demographic and gestational weeks (GW) of syphilis screening and diagnosis were analyzed to identify the factors affecting early detection. During the study period, maternal syphilis screening increased from 83,718 in 2002 to 243,432 in 2015. Of the 1,894,062 pregnant women screened, 1526 and 2714 participants were diagnosed with maternal syphilis in 2002⁻2006 and 2011⁻2015, respectively. The average age of diagnosis was 28.36 years and non-residents accounted for 71.1%. In the comprehensive period, more women received early syphilis screening (14.0% vs. 10.8%) and diagnosis (13.3% vs. 7.3%) within 12 GWs compared with the exploring period. Significantly, early detection grew during 2011⁻2015, which was not seen in the exploring period. Multivariate analysis revealed a greater possibility for infected women to be diagnosed within 16 GWs (OR = 2.76) in the comprehensive period, but those who were non-residents and unemployed were less likely to receive early detection. In conclusion, early detection of maternal syphilis has been remarkably improved. More emphasis is required on the development of pro-vulnerable policies and the implementation of tailored health education to improve the accessibility of routine antenatal care and awareness of syphilis prevention.
本研究旨在比较上海市国家和市级预防母婴传播梅毒（PMTCT）政策下的梅毒筛查和诊断情况，评估 PMTCT 项目和加强医疗基础设施是否能够实现梅毒的早期检测。梅毒筛查始于 2001 年，并于 2011 年随着产前保健基础设施的加强而扩大规模。市级和国家 PMTCT 政策的最初五年期间被定义为“探索期”（2002-2006 年）和“综合期”（2011-2015 年）。分析了梅毒筛查和诊断的人口统计学和孕龄（GW），以确定影响早期检测的因素。在此研究期间，梅毒筛查从 2002 年的 83718 例增加到 2015 年的 243432 例。在接受筛查的 1894062 名孕妇中，2002-2006 年和 2011-2015 年分别诊断出 1526 例和 2714 例梅毒孕妇。诊断时的平均年龄为 28.36 岁，非本地居民占 71.1%。在综合期，与探索期相比，更多的孕妇在 12 GW 内接受了早期梅毒筛查（14.0%对 10.8%）和诊断（13.3%对 7.3%）。显著的是，与探索期相比，2011-2015 年期间早期检测有所增加。多变量分析显示，在综合期内，感染女性在 16 GW 内被诊断的可能性更大（OR=2.76），但非本地居民和失业者不太可能接受早期检测。总之，梅毒的早期检测有了显著的提高。需要更加重视制定有利于弱势群体的政策，并实施有针对性的健康教育，以提高常规产前保健的可及性和对梅毒预防的认识。
