Equal distribution of disease, unequal distribution of cure: using biological data to highlight health services inequities in sub-Saharan Africa

Kiersten Johnson, Macro International Inc.

Syphilis is a sexually transmitted disease cause by a bacteria Treponema pallidum. If left untreated, it can lead to paralysis, aching bones, blindness, chest pain, heart failure and even death. In addition, syphilis facilitates the transmission of other sexually transmitted diseases including HIV. Treatment for syphilis is simple, effective, and inexpensive, yet in the developing world, the majority of those ever exposed to the bacteria continue to have active infections. We use biomarker data from the nationally-representative Demographic and Health Surveys in Madagascar, Uganda and Zambia to demonstrate that while distribution of disease is equal across a wealth gradient, the wealthiest are disproportionately likely to be treated for syphilis. In addition to describing these inequities, we analyze the sociodemographic and biological factors that are associated with syphilis infection. Using a comparative perspective, this analysis will highlight the role of public and health policy in mediating health outcomes for the poorest.