A case study of Nairobi City Council\u27s decentralised syphilis screening programme in antenatal clinics

It has long been known that syphilis is one of the more serious sexually transmitted infections (STI), especially during pregnancy when, if untreated, at least 60 percent of infected women will experience an adverse pregnancy outcome. There has been renewed interest in its control and prevention because of its proven link with HIV transmission. In 1992, the Nairobi City Council (NCC) pilot-tested a decentralized approach to syphilis screening and management in a sample of their antenatal clinics. A case study was carried out to assess the effectiveness, readiness, and cost effectiveness of the NCC’s antenatal care program, with a focus on the decentralized syphilis screening and treatment service. This report concludes that decentralization of maternal syphilis screening and management is feasible in a public-sector urban program, and, when implemented properly, leads to more antenatal clients and their partners being screened and treated. However, the NCC clinics are insufficiently prepared to offer good quality antenatal services and to ensure that syphilis screening and treatment are available for all antenatal clients