ABSTRACT

Background: Treponema pallidum and Brucella spp. infection have been reported to be one of the most common cause of stillbirths world-wide. Despite the burden of these infections in this setting, minimal work has been done in Mwanza, Tanzania associating syphilis and brucella with macerated stillbirth. This study was conducted to establish the seroprevalence and factors associated with T. pallidum and Brucella spp. among women with macerated stillbirth in urban and rural Mwanza, Tanzania

Methods: An analytical cross-sectional hospital-based study involving 301 women with macerated stillbirths attending selected health facilities was conducted in Mwanza between October 2017 and March 2018. Sociodemographic, obstetrics and other relevant information were collected by using pre-tested structured data collection tool. Detection of Brucella spp. antibodies was done by using slide agglutination test while detection of T. pallidum was done by using venereal diseases research laboratory
(VDRL) and T.pallidum hemagglutination test (TPHA) as per manufacturer’s instructions. Data were analyzed by STATA version 13 as per study objectives

Results: The median age of the study participants was 27 (IQR: 22 - 34) years. Out of 301 women with stillbirths enrolled 18(6.0%, 95% CI: 3.0-8.0) and 87(29.0%, 95% CI: 23-34) were found to be seropositive for T. pallidum and Brucella spp., respectively. Seroprevalence of T. pallidum was significantly higher among women who were residing in rural area than urban area ( p=0.010 ), and HIV positive than HIV negative(0.036). None of the factors tested was found to be associated with Brucella
spp. seropositivity among women with macerated still birth. By multivariable logistic regression analysis positive HIV serostatus (OR: 3.9, 95% CI: 1.2-14.1, p=0.036) and residing in rural areas (OR: 5.6, 95% CI: 1.5-20.3, p=0.010) were found to predict T.pallidum positivity among women with stillbirth in Mwanza.

CONCLUSION AND RECOMMENDATIONS: The seroprevalence of T. pallidum (6%) and Brucella spp. (29%) infections are significantly higher in women with MSB than in normal pregnant women and in general population. The independent factors associated with T. pallidum among women with MSB were residing in rural area and HIV infection. However, a considerable proportion of women with stillbirth seroconverted during the course of pregnancy We recommend screening for Brucella spp. in all pregnant women during antenatal period and rescreening for T. pallidum at beginning of third trimester (28 weeks) or at delivery. Also, Treponemal test to be considered during antenatal screening for confirmation of T. pallidum infection to avoid
unnecessary false positive results and consequently treatment.