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Testing for Syphilis in Pregnancy in Ghana – Policy vrs Practice Development of a Research Agenda Britwum-Nyarko A , Opoku Baafuor K, AduSarkodie Y Ghana Health Service, Kumasi. School of Medical Sciences, Kumasi, Ghana • 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. • 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. • 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: 0.02.2% (before 2004), then increased 100%400% thereafter !! • Research agenda developed under DFID RPC for SRH/HIV Development of Research Agenda • Positive impact on national policy • Stakeholders – Investigators – National Programme Managers – Research Implementers – Access to Facility level sites 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? • 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. Main result 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 • Opportunities – Tie up syphilis screening with PMTCT programmes – Incorporate testing into free maternal health programme Lessons learnt • Stakeholder involvement at all levels important in research agenda development. • Always have a plan for the possibility of changes of research champions