Testing for Syphilis in Pregnancy in Ghana – Policy vrs Practice Development of a Research Agenda

1. Testing for Syphilis in Pregnancy in Ghana – Policy vrs PracticeDevelopment of a Research Agenda Britwum-Nyarko A , Opoku Baafuor K, Adu-Sarkodie Y Ghana Health Service, Kumasi. School of Medical Sciences, Kumasi, Ghana

2. Issues of maternal and infant morbidity/mortality on the agenda of many developmental agencies • Impact positively on MDG 4, 5, 6 • Syphilis in pregnancy - a major cause of adverse perinatal events - still births, spontaneous abortions, congenital syphilis, intrauterine growth retardation or preterm delivery.

3. 4% - 15% of pregnant women in Africa have syphilis with an estimated 492,000 infants dying of congenital syphilis each year (Schmid, 2004). • Syphilis in pregnancy: easily diagnosed with simple laboratory tests and treated with a cheap and effective antibiotic. • WHO recommends screening and treating pregnant women for syphilis.

4. Issues of syphilis within GHS – National AIDS/STD Programme and Reproductive and Child Health Unit of Family Health Division • Data on syphilis in pregnancy in Ghana: 0.0-2.2% (before 2004), then increased 100%-400% thereafter !! • Research agenda developed under DFID RPC for SRH/HIV

5. Development of Research Agenda • Positive impact on national policy • Stakeholders • Investigators • National Programme Managers • Research Implementers • Access to Facility level sites

6. Research Issues • Development of policy – who were the stakeholders, how has it been disseminated, issues of policy implementation at facility level • How much syphilis do we see in pregnant women in Ghana? • Has perceived increasing syphilis in pregnancy impacted negatively on pregnancy outcomes? • Does point of care testing have a place in antenatal syphilis screening in Ghana?

7. Health staff in 210 out of 400 clinics in the region involved in antenatal care (doctors, nurse/midwives, medical assistants and laboratory personnel) interviewed by questionnaire. • knowledge/awareness of the national syphilis policy, testing, treatment, and counselling related to syphilis, challenges faced ascertained.

8. Main result

9. Constraints in implementation of syphilis screening at facility level • Lack of knowledge of the policy - ?dissemination • No clearly outlined strategy to guide policy implementation • Lack of guidelines and protocols to guide staff • Belief that syphilis in pregnancy is not an issue so testing is not necessary • Cumbersome client flow in clinics • Logistics

10. Opportunities – Tie up syphilis screening with PMTCT programmes • Incorporate testing into free maternal health programme

11. Lessons learnt • Stakeholder involvement at all levels important in research agenda development. • Always have a plan for the possibility of changes of research champions