Are National Policies, Services and Indicators Ready to Eliminate Global Gongenital Syphilis as a Public Health Problem?

Background:
In October 2007 the World Health Organization (WHO) launched a global initiative for congenital syphilis elimination (CSE). In preparation, WHO, with CDC support, surveyed nations on their policies, programs and monitoring and evaluation measures for CSE.

Objective:
To assess the status of participating nations on supportive congenital syphilis (CS) policies and strategies, early maternal syphilis screening and prompt treatment (before 24 weeks gestation) and existence of national CS program and impact indicators.

Method:
From March – June 2007, WHO distributed surveys to Ministries of Health in 23 nations with high maternal syphilis prevalence and/or expressed commitment to actively participate in global CSE. The surveys (in English, Russian and Spanish) asked 32 questions on three themes: CS policies and programs, service access and delivery, and monitoring and evaluation. Data were submitted electronically to CDC.

Result:
Of 16 (70%) respondents representing Africa, the Americas, Europe, Southeast Asia, and East Asia, most (88%) had a national STI control program and promoted universal syphilis screening for pregnant women (94%). Half had specific CSE plans. Eleven (69%) were able to report women's access to screening by 24 weeks gestation. Ten (63%) reported using rapid treponemal tests for rural sites, although many were pilot sites. Seven (44%) nations collected program process indicators, half had CS case definitions (with wide variability), and only one had a specific target goal toward CSE. Although some had resources through international donors or national healthcare, all reported resources were insufficient.

Conclusion:
Most countries have supportive policies. Fewer had established programs or monitoring strategies, and only one had an impact measure. All nations reported needing additional resources and support for CSE.

Implications:
Global CSE will require sustained political commitment, integration into existing antenatal services, funding, clarity of partnership roles, and may benefit from common monitoring and impact measures.