title: Factors associated with failure to screen for syphilis during antenatal care in Ghana: a case control study.
abstract: BACKGROUND
  There is little data regarding the effect of ramping up new screening interventions on their uptake by target populations into routine care services in developing countries. This study aimed to determine patient-level factors associated with failure of pregnant women to get screened for syphilis during antenatal care, in the context of a national rollout of rapid syphilis point of care tests (POCTs) in Ghana.
  
  
  METHODS
  An unmatched 1:2 case control study conducted among women admitted for delivery in two district hospitals in the Ashanti Region of Ghana from August to October 2010, 7 to 9 months after the introduction of POCTs in the region. Cases were women who had not been screened for syphilis during antenatal care and controls were women who had been screened. Patient-reported factors for being unscreened were examined using logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  160 consecutive unscreened and 327 screened women were recruited. Most women had good knowledge of syphilis (58.7% among unscreened women vs. 64.2% among screened; P=0.24). Factors associated with failure to get screened were: attending antenatal care in a private health facility (adjusted OR, 11.09; 95% CI 5.48-22.48), previous adverse pregnancy outcome (adjusted OR, 1.98; 95% CI 1.22-3.23) and not being screened for HIV during the current pregnancy (adjusted OR, 2.78; 95% CI 1.50-5.13). The odds of being unscreened also increased with decreasing doses of intermittent preventive treatment for malaria in pregnancy received (P trend<0.001) and decreasing education level (P trend=0.02).
  
  
  CONCLUSIONS
  Significant risk factors for not being screened, following the national rollout of syphilis POCTs, related to the type of health facility where antenatal care was received and some of the women's personal characteristics. Targeting of private medical facilities to include syphilis POCTs and support other neglected public health interventions should be a priority.
authors.affiliation: Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, P. O. Box KS 1934, Kumasi, Ghana. edidassah@yahoo.com.|School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. edidassah@yahoo.com.
authors.forename: Edward Tieru
authors.initials: ET
authors.lastname: Dassah
authors.affiliation: Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, P. O. Box KS 1934, Kumasi, Ghana. yasax@hotmail.co.uk.|School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. yasax@hotmail.co.uk.
authors.forename: Yaw
authors.initials: Y
authors.lastname: Adu-Sarkodie
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. philippe.mayaud@lshtm.ac.uk.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mayaud
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000592:standards*; D012307:Risk Factors; D013587:Syphilis / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D014932:Women's Health Services; D055815:Young Adult