Abstract
Objective Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design Systematic review and meta-analysis. Data Sources Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.
Highlights
Syphilis is one of the most imperative sexually transmitted infections (STI), caused by the spirochete Treponema pallidum and it is a significant public health issue, especially in developing countries including subSaharan Africa [1]
Antenatal care (ANC) follow-up screening plays a great role in diagnosing syphilis early
The actual burden of syphilis infection during pregnancy is not well known especially in resource poor settings where diagnosis is made based on clinical signs and symptoms, short of diagnostic laboratory tests
Summary
Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum and it is a significant public health issue, especially in developing countries including subSaharan Africa [1]. More than 10 million people are infected with syphilis worldwide; the majority of these infections occur in sub-Saharan Africa and Asia [2]. Around 2 million pregnant women are estimated to have active syphilis infection while only less than one-tenth would be diagnosed and receive the treatment. The prevalence of syphilis infection among pregnant women in sub-Saharan Africa is estimated to be 2.7%, which represents nearly 1 million pregnancies to be at risk annually [6]. In the United States, recent data show that more than 30,000 cases of primary and secondary syphilis infection were reported [7]. Unfavorable pregnancy outcomes were reported to be more than four times higher in untreated syphilis infection among pregnant women as compared to pregnant women without syphilis infection [8]
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