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It is with great interest that I read the report on maternal and congenital syphilis in Haiti in which Lomotey and colleagues reported on a very high prevalence of maternal syphilis and concluded that, "This prevalence combined with late entry into prenatal care contributes to adverse pregnancy outcomes and a high estimated rate of congenital syphilis" (1). Indeed, there have been several efforts to control syphilis in Haiti. Recently, Schackman and colleagues reported on the use of prenatal screening for syphilis in Haiti and concluded that it could be an effective tool for solving the problem (2). Although the cost effectiveness of prenatal screening has been demonstrated, the success of implementation has not been reached.
Regardless, the biggest obstacles to syphilis prevention and control in Haiti may be the country's limited resources and its very low gross domestic product. In a situation as challenging as this, even cost effective measures may sometimes not be applicable. This is a particularly difficult challenge for public health in poor, resource-limited countries, and one rarely mentioned by standard textbooks.
In addition, taking into account the present earthquake crisis in Haiti, the problem of maternal and neonatal syphilis can be expected to last a long time. Assistance from external sources is needed, especially from wealthy, developed countries.
1. Lomotey CJ, Lewis J, Gebrian B, Bourdeau R, Dieckhaus K, Salazar JC. Maternal and congenital syphilis in rural Haiti. Rev Panam Salud Publica. 2009;26(3):197-202.
2. Schackman BR, Neukermans CP, Fontain SN, Nolte C, Joseph P, Pape JW, Fitzgerald DW. Cost-effectiveness of rapid syphilis screening in prenatal HIV testing programs in Haiti. PLoS Med. 2007;4(5):e183.