title: Barriers to antenatal syphilis screening in Burkina Faso.
abstract: BACKGROUND
  Despite advances in treatment and management, syphilis remains a major public health problem in Burkina Faso. Syphilis in pregnancy poses major health risks for the mother and the fetus and also increases the risk for HIV transmission. Despite its potential benefits, antenatal syphilis screening is often poorly implemented in many sub-Saharan African countries. The purpose of the study is to identify and understand barriers affecting health system performance for syphilis screening among pregnant women in Burkina Faso.
  
  
  METHODS
  We conducted in-depth interviews and observations in the Kaya health district, Burkina Faso. Participants were purposively selected to capture a range of perspectives across different actors with different roles and responsibilities. Seventy-five interviews were conducted with health providers, district managers, facility managers, traditional healers, pregnant women, community health workers, and Non-Governmental Organizations (NGO) managers. Interviews were transcribed and organized into codes and categories using NVivo software.
  
  
  RESULTS
  Participants identified multiple barriers at health providers and community levels. Key barriers at provider level included fragmentation of services, poor communication, low motivation for prescription, and low awareness of syphilis burden. Cost of testing, distance to laboratory and lack of knowledge about syphilis were identified as barriers at community level.
  
  
  CONCLUSIONS
  The study highlights barriers such as distance, cost of testing, and knowledge about syphilis. The introduction of point of care testing for syphilis could be an entry point for improving coverage of antenatal syphilis screening.
authors.affiliation: Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso ; School of Public Health, University of Western Cape, Cape Town, South Africa.
authors.forename: Fadima Yaya
authors.initials: FY
authors.lastname: Bocoum
authors.affiliation: Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso ; Institut Africain de santé publique, Ouagadougou, Burkina Faso.
authors.forename: Seni
authors.initials: S
authors.lastname: Kouanda
authors.affiliation: School of Public Health, University of Western Cape, Cape Town, South Africa.
authors.forename: Christina
authors.initials: C
authors.lastname: Zarowsky
mesh_terms: D002050:Burkina Faso; D003142:Communication; D003625:Data Collection; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011296:Prenatal Diagnosis / Q000379:methods*; D013587:Syphilis / Q000175:diagnosis*
keywords: Burkina Faso; Screening; antenatal; barriers; syphilis