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Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa

BACKGROUND: Syphilis in pregnancy is an under-recognized public health problem, especially in sub-Saharan Africa which accounts for over 60% of the global burden of syphilis. If left untreated, more than half of maternal syphilis cases will result in adverse pregnancy outcomes including stillbirth a...

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Autores principales: Kanyangarara, Mufaro, Walker, Neff, Boerma, Ties
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983468/
https://www.ncbi.nlm.nih.gov/pubmed/29856849
http://dx.doi.org/10.1371/journal.pone.0198622
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author Kanyangarara, Mufaro
Walker, Neff
Boerma, Ties
author_facet Kanyangarara, Mufaro
Walker, Neff
Boerma, Ties
author_sort Kanyangarara, Mufaro
collection PubMed
description BACKGROUND: Syphilis in pregnancy is an under-recognized public health problem, especially in sub-Saharan Africa which accounts for over 60% of the global burden of syphilis. If left untreated, more than half of maternal syphilis cases will result in adverse pregnancy outcomes including stillbirth and fetal loss, neonatal death, prematurity or low birth weight, and neonatal infections. Achieving universal coverage of antenatal syphilis screening and treatment has been the focus of the global campaign for the elimination of mother-to-child transmission of syphilis. However, little is known about the availability of antenatal syphilis screening and treatment across sub-Saharan Africa. The objective of this study was to estimate the ‘likelihood of appropriate care’ for antenatal syphilis screening and treatment by analyzing health facility surveys and household surveys conducted from 2010 to 2015 in 12 sub-Saharan African countries. METHODS: In this secondary data analysis, we linked indicators of health facility readiness to provide antenatal syphilis detection and treatment from Service Provision Assessments (SPAs) and Service Availability and Readiness Assessments (SARAs) to indicators of ANC use from the Demographic and Health Surveys (DHS) to compute estimates of the ‘likelihood of appropriate care’. RESULTS: Based on data from 5,593 health facilities that reported offering antenatal care (ANC) services, the availability of syphilis detection and treatment in ANC facilities ranged from 2% to 83%. The availability of syphilis detection and treatment was substantially lower in ANC facilities in West Africa compared to the other sub-regions. Levels of ANC attendance were high (median 94.9%), but only 27% of ANC attendees initiated care at less than 4 months gestation. We estimated that about one in twelve pregnant women received ANC early (<4 months) at a facility ready to provide syphilis detection and treatment (median 8%, range 7–32%). The largest implementation bottleneck identified was low health facility readiness, followed by timeliness of the first ANC visit. CONCLUSIONS: While access was fairly high, the low levels of likelihood of antenatal syphilis detection and treatment identified reinforce the need to improve the availability of syphilis rapid diagnostic tests and treatment and the timeliness of antenatal care-seeking across sub-Saharan Africa.
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spelling pubmed-59834682018-06-17 Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa Kanyangarara, Mufaro Walker, Neff Boerma, Ties PLoS One Research Article BACKGROUND: Syphilis in pregnancy is an under-recognized public health problem, especially in sub-Saharan Africa which accounts for over 60% of the global burden of syphilis. If left untreated, more than half of maternal syphilis cases will result in adverse pregnancy outcomes including stillbirth and fetal loss, neonatal death, prematurity or low birth weight, and neonatal infections. Achieving universal coverage of antenatal syphilis screening and treatment has been the focus of the global campaign for the elimination of mother-to-child transmission of syphilis. However, little is known about the availability of antenatal syphilis screening and treatment across sub-Saharan Africa. The objective of this study was to estimate the ‘likelihood of appropriate care’ for antenatal syphilis screening and treatment by analyzing health facility surveys and household surveys conducted from 2010 to 2015 in 12 sub-Saharan African countries. METHODS: In this secondary data analysis, we linked indicators of health facility readiness to provide antenatal syphilis detection and treatment from Service Provision Assessments (SPAs) and Service Availability and Readiness Assessments (SARAs) to indicators of ANC use from the Demographic and Health Surveys (DHS) to compute estimates of the ‘likelihood of appropriate care’. RESULTS: Based on data from 5,593 health facilities that reported offering antenatal care (ANC) services, the availability of syphilis detection and treatment in ANC facilities ranged from 2% to 83%. The availability of syphilis detection and treatment was substantially lower in ANC facilities in West Africa compared to the other sub-regions. Levels of ANC attendance were high (median 94.9%), but only 27% of ANC attendees initiated care at less than 4 months gestation. We estimated that about one in twelve pregnant women received ANC early (<4 months) at a facility ready to provide syphilis detection and treatment (median 8%, range 7–32%). The largest implementation bottleneck identified was low health facility readiness, followed by timeliness of the first ANC visit. CONCLUSIONS: While access was fairly high, the low levels of likelihood of antenatal syphilis detection and treatment identified reinforce the need to improve the availability of syphilis rapid diagnostic tests and treatment and the timeliness of antenatal care-seeking across sub-Saharan Africa. Public Library of Science 2018-06-01 /pmc/articles/PMC5983468/ /pubmed/29856849 http://dx.doi.org/10.1371/journal.pone.0198622 Text en © 2018 Kanyangarara et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kanyangarara, Mufaro
Walker, Neff
Boerma, Ties
Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title_full Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title_fullStr Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title_full_unstemmed Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title_short Gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-Saharan Africa
title_sort gaps in the implementation of antenatal syphilis detection and treatment in health facilities across sub-saharan africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983468/
https://www.ncbi.nlm.nih.gov/pubmed/29856849
http://dx.doi.org/10.1371/journal.pone.0198622
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