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Effect of Maternal Syphilis Screening on Congenital Syphilis Prevention in Nigeria

Abstract

Syphilis remains an important public health concern during pregnancy and poses a significant risk to maternal and newborn health in Nigeria. Untreated maternal syphilis can be transmitted from mother to fetus during pregnancy, resulting in congenital syphilis, miscarriage, stillbirth, prematurity, low birth weight, neonatal illness, or other serious complications. Early maternal screening provides an important opportunity to identify infection during pregnancy and facilitate timely treatment, partner management, and follow-up, thereby reducing the risk of mother-to-child transmission. However, inadequate antenatal care attendance, limited access to screening services, shortages of diagnostic supplies, delayed treatment, inadequate partner notification, and weak follow-up systems may reduce the effectiveness of congenital syphilis prevention programmes. Against this background, this study investigates the effect of maternal syphilis screening on congenital syphilis prevention in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to syphilis, perceived severity of infection, perceived benefits of screening and treatment, perceived barriers, and cues to action may influence participation in maternal syphilis screening. The Social Ecological Model emphasizes the influence of individual, family, healthcare, community, and policy factors on maternal screening, treatment, and newborn health. The Health Systems Framework emphasizes antenatal service delivery, health workforce, diagnostic services, medicines, health information systems, financing, governance, and accessibility as essential components of effective prevention of mother-to-child transmission of syphilis. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal syphilis screening may influence congenital syphilis prevention in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities in Nigeria and their newborns. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible mother-newborn pairs. Maternal syphilis screening will be assessed using indicators such as screening coverage, timing of screening during pregnancy, type of screening test used, availability of testing services, documentation of screening results, repeat screening where indicated, linkage to treatment, and partner management. Congenital syphilis prevention will be assessed using indicators such as maternal treatment following a positive screening result, completion and timing of appropriate treatment, partner treatment, newborn clinical assessment, laboratory evidence of congenital infection where testing is available, appropriate newborn evaluation and treatment, and congenital syphilis-related outcomes. Data will be collected using structured questionnaires, antenatal care records, maternal screening registers, laboratory records, treatment records, delivery records, newborn medical records, referral records, and relevant prevention-of-mother-to-child-transmission programme documents. Descriptive statistics will be used to summarize maternal and newborn characteristics, screening coverage, screening results, treatment patterns, and congenital syphilis prevention outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of maternal syphilis screening on congenital syphilis prevention. Where a cohort design is adopted, congenital syphilis-related outcomes among newborns whose mothers received timely syphilis screening may be compared with outcomes among newborns whose mothers were inadequately screened or not screened, with relevant maternal and healthcare factors appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal syphilis screening has a significant positive effect on congenital syphilis prevention in Nigeria. Pregnant women who receive timely syphilis screening are expected to have a greater likelihood of receiving appropriate treatment when infection is detected, thereby reducing the risk of syphilis transmission to their newborns. Early identification and treatment may also reduce adverse pregnancy outcomes associated with untreated maternal syphilis. However, screening alone may not prevent congenital syphilis unless positive cases are promptly linked to effective treatment and appropriate follow-up. Limited availability of diagnostic services, delayed test results, inadequate treatment, lack of partner management, missed antenatal care visits, stigma, and weak referral and follow-up systems may reduce the effectiveness of screening programmes. The study therefore expects integrated maternal syphilis screening, timely treatment, partner management, and appropriate newborn evaluation to contribute significantly to congenital syphilis prevention in Nigeria. The study is expected to contribute to the literature on maternal syphilis screening, congenital syphilis prevention, sexually transmitted infections, prevention of mother-to-child transmission, antenatal care, maternal and newborn health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, maternal and child health programmes, laboratory services, obstetricians, midwives, community health workers, development partners, and policymakers regarding strategies for strengthening congenital syphilis prevention. The study will also provide evidence-based recommendations for expanding routine maternal syphilis screening, improving access to reliable diagnostic services, ensuring prompt treatment of infected pregnant women, strengthening partner notification and treatment, improving documentation and follow-up, integrating syphilis screening into antenatal care, and strengthening prevention of mother-to-child transmission programmes across Nigeria.

Keywords: Maternal syphilis screening, congenital syphilis prevention, syphilis in pregnancy, mother-to-child transmission, antenatal care, maternal health, newborn health, sexually transmitted infections, early detection, Nigeria, public health.