Download Testing for Syphilis in Pregnancy in Ghana. Policy vs Practice

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