1. Testing for Syphilis in Pregnancy in Ghana – Policy vrs Practice Development of a Research Agenda Britwum-Nyarko A, Opoku Baafuor K, Adu- Sarkodie Y Ghana Health Service, Kumasi. School of Medical Sciences, Kumasi, Ghana

2. Issues of maternal and infant morbidity/mortality on the agenda of many developmental agencies Impact positively on MDG 4, 5, 6 Syphilis in pregnancy - a major cause of adverse perinatal events - still births, spontaneous abortions, congenital syphilis, intrauterine growth retardation or preterm delivery.

3. 4% - 15% of pregnant women in Africa have syphilis with an estimated 492,000 infants dying of congenital syphilis each year (Schmid, 2004). Syphilis in pregnancy: easily diagnosed with simple laboratory tests and treated with a cheap and effective antibiotic. WHO recommends screening and treating pregnant women for syphilis.

4. Issues of syphilis within GHS – National AIDS/STD Programme and Reproductive and Child Health Unit of Family Health Division Data on syphilis in pregnancy in Ghana: 0.0- 2.2% (before 2004), then increased 100%- 400% thereafter !! Research agenda developed under DFID RPC for SRH/HIV

5. Development of Research Agenda Positive impact on national policy Stakeholders – Investigators – National Programme Managers – Research Implementers – Access to Facility level sites

6. Research Issues Development of policy – who were the stakeholders, how has it been disseminated, issues of policy implementation at facility level How much syphilis do we see in pregnant women in Ghana? Has perceived increasing syphilis in pregnancy impacted negatively on pregnancy outcomes? Does point of care testing have a place in antenatal syphilis screening in Ghana?

7. Health staff in 210 out of 400 clinics in the region involved in antenatal care (doctors, nurse/midwives, medical assistants and laboratory personnel) interviewed by questionnaire. knowledge/awareness of the national syphilis policy, testing, treatment, and counselling related to syphilis, challenges faced ascertained.

8. Main result

9. Constraints in implementation of syphilis screening at facility level Lack of knowledge of the policy - ?dissemination No clearly outlined strategy to guide policy implementation Lack of guidelines and protocols to guide staff Belief that syphilis in pregnancy is not an issue so testing is not necessary Cumbersome client flow in clinics Logistics

10. Opportunities – Tie up syphilis screening with PMTCT programmes – Incorporate testing into free maternal health programme

11. Lessons learnt Stakeholder involvement at all levels important in research agenda development. Always have a plan for the possibility of changes of research champions