The Elimination of Syphilis in Cuba
Abstract
Geographical area: Cuba
Health Condition: Between the periods of 2013 of 2017, an increase in rate of syphilis infection cases were reported in Cuba to have reached approximately 500 thousand. Out of these cases, it was reported that nearly 50 cases of these were untreated maternal syphilis which yearly results into congenital syphilis affecting pregnancies and in worse cases resulting to still births, early fetal loss, and premature births.
Global importance of the health condition: Syphilis, which one of the most common sexually transmitted infections affects approximately 18 million people globally with 0.5 percent being women and 0.5 percent being male individuals between the ages of 15 to 49 years. Out of these, approximately 1 million infections occur in pregnant women worldwide each year. In addition, roughly 500 thousand of these cases represent victims from Cuba and more importantly out of the 1 million cases of syphilis infections among pregnant women, nearly 50 cases represent a population of untreated maternal syphilis among women within the Cuban society which in many cases results to fetal deaths and premature births.
Invention or programs: Cuba has had intervention programs that help in the control and prevention of syphilis since the early periods of 1972 and especially for the control and prevention of congenital syphilis since 1974. The adoption of antenatal screening and treatment programs has greatly reduced the increased cases of morbidity and mortality which are associated with congenital syphilis. This program enables screening during pregnancy thus allowing and providing chances for early treatment of the fetus, mother, and partner. As a result, this reduces the case of increase still birth, infant deaths and clinical congenital syphilis. In addition, the national strategy for the protection and prevention of reproductive and sexual health through the social marketing of condoms is another key invention for the protection against syphilis in Cuba.
Cost-effectiveness: The various programs that are used as interventions strategies for the treatment, control, and prevention of syphilis are considered some of the most cost effective programs. For instance, the prevention and protection of men and women against syphilis through consistent use of condoms in all sexual relations has been made much more cost effective through the free condom distribution in public institutions, family planning offices, and family doctor’s offices. In such cases individuals are not able to face financial problems in acquiring these products that prevent and protect mothers, fetus, and partners from syphilis.
Impact: The adoption of various protection and preventive interventions such as antenatal screening and treatment programs and the national strategy for the protection and prevention of reproductive and sexual health through the social marketing of condoms have all produced impressive and significant change in health care between the period of 1972 and 2015. As a result, this has allowed Cuba to showcase to the entire globe the dedicated capacity of its health care programs and systems responsible for the elimination of congenital syphilis resulting to 0.00 and 0.24 rates cases per 1000 live births during the period of 2012 and 2013 respectively. With such success rates, Cuba became the first nation in the world to be validated by the World Health Organization in June 2015, for its success in eliminating Mother to child transmission of congenital syphilis.
Nearly 1 million infections involving syphilis occur among pregnant women worldwide every year. These syphilis affected pregnancies resulted in approximately 350, 000 poor birth outcomes as a result of congenital syphilis during the period of 2012. These untreated maternal syphilis results to congenital syphilis leading to premature births, fetal deaths, and still births and therefore creating the need by the Global Health Community which is led by the World Health Organization identify syphilis elimination a priority.
The Problem
Syphilis is one of the common sexually transmitted diseases (STDs) caused by a bacterial called Treponema pallidum. According to Organización Mundial de la Salud et al. (2003), syphilis can either be described as congenital (transmitted from mother to unborn child) or acquired syphilis, which is transmitted through sexual intercourse or blood transfusion. Over the years, approximately 18 million people globally have been diagnosed with Syphilis, with 500 thousand of its victims residing in Cuba. Syphilis mostly affects fetus, mothers, and their partners. However, congenital syphilis which affects the fetus usually results to case of stillbirths, premature births, and low birth weight which leads to early fetus loss (Taylor et al. 2017). In adults, acquired syphilis usually cause hair loss, rashes, and open sores in the genital organs which if untreated results to symptoms that affects the brain, heart, and other organs of the body resulting to severe illness and eventually death. Normally, syphilis develops through various stages each with varying symptoms that develop between 10 to 90 days. The first stage involves the development of painless sore on the genitals, mouth, and rectum. Afterwards, without proper medication, this progresses into the second stage characterized by rash development which if untreated result to the final stage that causes brain, eyes, nerves, and heart damage which posses economic difficulties to treat for many individuals. In men, untreated syphilis result to infertility causing individuals to shy away in fear of stigmatization. Therefore, in order to prevent these major consequences, it is imperative for individuals to adopt various health policies such as antenatal screening and treatment that help protect and prevent syphilis.
Etiology
Being one of the common sexual transmitted diseases, syphilis is caused by bacterium called Treponema pallidum (Organización Mundial de la Salud et al., 2003). This bacterium is commonly referred as the great imitator due to its numerous symptoms that are hard to tell apart from other sexually transmitted diseases. The most common form of syphilis transmission is direct contact with infected individual’s sores especially during sexual intercourse. Additionally, this transmission can also take place between infected mothers to their unborn child in the Utero. The Treponema pallidum bacterium enters the body of an individual through minor cuts or abrasions found in the mucus membrane or the skin. It is also important to note that syphilis can also be spread through kissing or using of the same utensils and clothing. Therefore, it is clear that engaging in unprotected intercourse, having unprotected sex with multiple individuals, and sharing of the same items such as toilets and cloths increases the risk of acquiring syphilis.
Recommendations
In order to address the cause and reduce the impacts associated with syphilis, it is imperative for individuals to follow and adopt various suggestions. For instance, Rodríguez et al. (2016), suggests that the use of condoms during sexual activity is one of the main recommendations that help prevent the contraction and spread of syphilis. In addition, individual can also prevent the contraction of syphilis by avoiding the use of recreational drugs such as alcohol. Normally, the consumption of these substances inhibits individual’s judgment leading to unsafe sexual practice which in one way or another result to syphilis contraction.
Implementations
According to Rodríguez et al. (2016), the social marketing of condoms for lower prices in order to make them accessible for everyone is one of the main interventions conducted by the Cuban national strategy in order to protect and promote the reproductive and sexual health of individuals. In addition, this intervention also involved free condom distribution in public institutions, family planning offices, and family doctor’s offices making it one the most unique intervention and so successful in eliminating syphilis within the Cuban society. Apart from providing free condoms, the provision of free access to reproductive and health services is another major intervention carried out by the national strategy of the Cuban Ministry of health for the prevention of STIs such as syphilis (Rodríguez et al., 2016). Normally, syphilis develops through various stages each with varying symptoms that develop between 10 to 90 days. The first stage (primary level) involves the development of painless sore on the genitals, mouth, and rectum. Afterwards, without proper medication, this progresses into the second stage (secondary level) characterized by rash development which if untreated result to the final stage (tertiary level) that causes brain, eyes, nerves, and heart damage and therefore the need of immediate intervention.
Evaluation
Rodríguez et al. (2016), suggests that the health programs and interventions responsible for the elimination of congenital syphilis resulted to 0.00 and 0.24 rates cases per 1000 live births during the period of 2012 and 2013 respectively. With such success rates, Cuba became the first nation in world to be validated by the World Health Organization in June 2015, for its success in eliminating Mother to child transmission of congenital syphilis. The provision of free access to reproductive and health services and the free distribution in public institutions demonstrates the cost effectiveness of the interventions used to address syphilis (Ishikawa et al., 2016). Some of the overall impacts of the interventions used have promoted the health care pregnant women. As a result this reduces case of stillbirths, premature births, and fetus deaths. In addition, the interventions have also enabled Cuba to work with other countries to eliminate congenital syphilis. Also, the elimination of syphilis through the various intervention has enabled individuals avoid costs associated with treatment of syphilis (Rodríguez et al., 2016).
Wold and Mittelmark (2018) indicate that from the socio-ecological perspective, skills and knowledge on syphilis has been one of the impacts of the interventions to eliminate mother-to-child transmission syphilis. Knowledge helps individuals know more about syphilis, and how serious it is concerning its overall threat. In addition, interpersonal level involves relations between parents, friends, and family. At this level for instance, parents are able to communicate with their children about sex and the importance of going for screening from time to time and hence preventing syphilis transmission. On the other hand, the organization level involves schools and workplace which have more people creating better environments for counseling and access to free condoms and hence the prevention of syphilis. The community level involves different organizations working together to create awareness of syphilis. Such organizations include hospitals which provide sex education to other individuals. The final level involves public policy which includes governing bodies that work to establish laws and agencies that do research on STDs such as syphilis and adopt ways to prevent them (Wold, & Mittelmark, 2018).
Lessons learned
Congenital syphilis has severe impacts on the pregnancy of many women globally especially when left untreated. In addition, acquired syphilis in men also results to brain, heart, and nerve damages if also left untreated. With this in mind, it is therefore important that individuals should avoid unprotected sex and pregnant women should go for antenatal screening for check up.
References
Ishikawa, N., Newman, L., Taylor, M., Essajee, S., Pendse, R., & Ghidinelli, M. (2016).
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Organización Mundial de la Salud (Ginebra, Suiza), World Health Organization Staff, Światowa
Organizacja Zdrowia, World Health Organization, & UNAIDS. (2003). Guidelines for the management of sexually transmitted infections. World Health Organization.
Rodríguez, I., Noda, A. A., Ale, K., & Stamm, L. V. (2016). The Cuban experience in the
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Taylor, M., Newman, L., Ishikawa, N., Laverty, M., Hayashi, C., Ghidinelli, M., … & Essajee, S.
(2017). Elimination of mother-to-child transmission of HIV and syphilis (EMTCT): process, progress, and program integration. PLoS medicine, 14(6), e1002329.
Wold, B., & Mittelmark, M. B. (2018). Health-promotion research over three decades: The
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