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Estimating the Public Health Burden Associated With Adverse Pregnancy Outcomes Resulting From Syphilis Infection Across 43 Countries in Sub-Saharan Africa
Open accessAbstract
BACKGROUND: Untreated syphilis in pregnancy is associated with adverse clinical outcomes to the infant. The study aimed to estimate the public health burden resulting from adverse pregnancy outcomes due to syphilis infection among pregnant women not screened for syphilis in 43 countries in sub-Saharan Africa. METHODS: Estimated country-specific incidence of syphilis was generated from annual number of live births, the proportion of women with at least 1 antenatal care (ANC) visit, the syphilis prevalence rate, and the proportion of women screened for syphilis during ANC.Adverse pregnancy outcome data (stillbirth, neonatal death, low birth weight, and congenital syphilis) were obtained from published sources. Disability-adjusted life-year (DALY) estimates were calculated using undiscounted local life expectancy, the neonatal standard loss function, and relevant disability weights. The model assessed the potential impact of raising ANC coverage to at least 95% and syphilis screening to at least 95% (World Health Organization targets). RESULTS: For all 43 sub-Saharan Africa countries, the estimated incidence of adverse pregnancy outcomes was 205,901 (95% confidence interval [CI], 113,256-383,051) per year, including stillbirth (88,376 [95% CI, 60,854-121,713]), neonatal death (34,959 [95% CI, 23,330-50,076]), low birth weight (22,483 [95% CI, 0-98,847]), and congenital syphilis (60,084 [95% CI, 29,073-112,414]), resulting in approximately 12.5 million DALYs. Countries with the greatest burden are (in DALYs, millions) Democratic Republic of the Congo (1.809), Nigeria (1.598), Ethiopia (1.466), and Tanzania (0.961). Attaining World Health Organization targets could reduce the burden by 8.5 million DALYs. CONCLUSIONS: Substantial infant mortality and morbidity results from maternal syphilis infection concentrated in countries with low access to ANC or low rates of syphilis screening.
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“Untreated or inadequately treated syphilis infection during pregnancy contributes significantly to preventable perinatal morbidity and mortality.”
From Syphilis in pregnancy: A practical guide for prenatal care providers (2025) · cites this paper as [5]
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Sexually Transmitted Diseases 7982 Treatment Guidelines
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Cousens, S., Blencowe, H. K., Stanton, C., Chou, D., Ahmed, S., Steinhardt, L. C., Creanga, A. A., Tunçalp, Ö., Balsara, Z. P., Gupta, S., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(10)62310-0 · Cited by 645
Untreated maternal syphilis and adverse outcomes of pregnancy: a systematic review and meta-analysis
Gomez, G. B., Kamb, M. L., Newman, L. M., Mark, J., Broutet, N., & Hawkes, S. J. (2013) · Bulletin of the World Health Organization · doi:10.2471/blt.12.107623 · Cited by 634
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Syphilis in Pregnancy in Tanzania. I. Impact of Maternal Syphilis on Outcome of Pregnancy
Watson‐Jones, D., Changalucha, J., Gumodoka, B., Weiss, H., Rusizoka, M., Ndeki, L., Whitehouse, A., Balira, R., Todd, J., Ngeleja, D., et al. (2002) · The Journal of Infectious Diseases · doi:10.1086/342952 · Cited by 261
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Point-of-Care Tests to Strengthen Health Systems and Save Newborn Lives: The Case of Syphilis
Mabey, D. C. W., Sollis, K. A., Kelly, H. A., Benzaken, A. S., Bitarakwate, E., Changalucha, J. M., Chen, X., Yin, Y.-P., Garcia, P. J., Strasser, S., et al. (2012) · PLoS Medicine · doi:10.1371/journal.pmed.1001233 · Cited by 194
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Hussen, S., & Tadesse, B. T. (2019) · BioMed Research International · doi:10.1155/2019/4562385 · Cited by 63
Syphilis in pregnancy: A practical guide for prenatal care providers
Desjardins, A. A., Amaral, E., Miranda, J., Pasupathy, D., Martins, M. L., Buga, E., Aronoff, D., Money, D., Boucoiran, I., & FIGO Committee on Infections During Pregnancy and FIGO Committee on Health Systems Strengthening (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70511 · Cited by 12
Metadata
- Authors
- Kuznik, A., Habib, A. G., Manabe, Y. C., & Lamorde, M.
- Affiliations
- Johns Hopkins University (US)
- Bayero University Kano (NG)
- Infectious Diseases Institute (UG)
- Corresponding author
- Kuznik, Andreas
- Manabe, Yukari C.
- Lamorde, Mohammed
- Venue
- Sexually Transmitted Diseases
- Published
- 2015-07
- Volume
- 42
- Issue
- 7
- Pages
- 369-375
- ISSN
- 0148-5717 (ISSN-L)
- PMC
- PMC4520246
- OpenAlex
- W2284742317
- Cited by
- 69
- References
- 19
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 6 · 2020: 3 · 2019: 10 · 2018: 5 · 2017: 6 · 2016: 5 · 2015: 1
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sexually Transmitted Diseases (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Biomedical Imaging and Bioengineering (U54EB007958)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Syphilis Diagnosis and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- maternal syphilis, adverse pregnancy outcomes, congenital syphilis, stillbirth, neonatal death, low birth weight, antenatal care coverage, syphilis screening, disability-adjusted life years, public health burden, sub-Saharan Africa
- MeSH terms
- Adult, Anti-Bacterial Agents, Female, Fetal Death, Health Promotion, Health Services Accessibility, Humans, Infant, Infant Mortality, Infant, Newborn, Mass Screening, Penicillin G Benzathine, Policy Making, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Prenatal Care, Public Health, Syphilis, Africa South of the Sahara, Infectious Disease Transmission, Vertical, Delivery of Health Care, Integrated, Early Diagnosis, Premature Birth, Stillbirth
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