title: Factors associated with syphilis screening uptake among pregnant women in health facilities in Brong Ahafo Region of Ghana.
abstract: BACKGROUND
  Congenital syphilis is a consequence of undiagnosed, untreated, or inadequately treated maternal syphilis and results in serious adverse outcomes. It is easily diagnosed and in Ghana it is treated at points of care free; yet most pregnant women attending antenatal clinic (ANC) in Ghana are not screened. This study identified some factors influencing syphilis screening uptake at medical facilities during pregnancy in the Brong Ahafo Region of Ghana.
  
  
  METHODS
  A cross-sectional study was conducted in two districts in Brong Ahafo Region of Ghana. All the health facilities in the selected districts that run antenatal services were assessed on their preparedness to screen syphilis for pregnant women. Interviews were conducted among 390 pregnant women attending ANC at five hospitals in the two districts to identify individual and community level barriers to syphilis screening.
  
  
  RESULTS
  In all 37 health facilities conducted antennal clinics in the two districts in 2013, 75.7% of the health facilities were public; Techiman had the higher number of health facilities (64.9%), test kits were available in only 29.7% of the health facilities and 43.2% of 37 health facilities were conducting syphilis screening. Majority of the pregnant women (57.7%) were within the age range of 20-29 years, 53.1% were in their third trimester, 32.6% in second trimester and 14.3% were in the first trimester. Syphilis screening was 52.4% among 37 health facilities. Among 390 pregnant women who participated in the study syphilis screening was 21.1%. At the health facility level, screening was significantly associated with the type of hospital (whether private or public), availability of test kits, and trained personnel, such as doctors/midwives and syphilis education. At the individual level, attending a public hospital (OR=5.49; 95% CI=1.71-17.65), willingness to request screening (OR=2.72; 95% CI=1.09-5.88), and being in the third trimester of pregnancy (OR=16.47; 95% CI=2.02-132.81) were significantly associated with syphilis screening uptake.
  
  
  CONCLUSIONS
  Despite government's free screening policy for syphilis among pregnant women, the coverage of antenatal screening is still low. Training of lower level health workers and regular supply of logistics are crucial for the success of the syphilis prevention programme.
authors.affiliation: Department of Epidemiology and Disease Control, Municipal Health Directorate, Techiman, University of Ghana, Legon, Ghana ; Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
authors.forename: Damien
authors.initials: D
authors.lastname: Punguyire
authors.affiliation: Department of Epidemiology and Disease, Kintampo Health Research Center, University of Ghana, Legon, Ghana.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mahama
authors.affiliation: Department of Epidemiology and Disease, Regional Health Directorate, Brong Ahafo Region, University of Ghana, Legon, Ghana.
authors.forename: Timothy
authors.initials: T
authors.lastname: Letsa
authors.affiliation: Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: Department of Epidemiology and Disease, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
authors.forename: Bismark
authors.initials: B
authors.lastname: Sarfo
keywords: Antenatal care; Congenital syphilis; Prematurity; Syphilis screening; Transmission