Percent of pregnant women attending antenatal clinics screened for syphilis

The percent of pregnant women attending antenatal care (ANC) screened for syphilis.
This indicator is calculated as:

# of pregnant women attending antenatal clinics screened for syphilis x 100
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# of pregnant women attending antenatal clinics

This indicator is usually calculated for women attending for their first antenatal visit but may also be collected after delivery.

The most common screening tests for syphilis include rapid plasma reagin (RPR) and venereal disease reference laboratory (VDRL) blood tests.


The number of women attending antenatal clinics during a reference period (e.g., one year) who were screened for syphilis; the number of women attending the same antenatal clinics during the same reference period.


Clinic registries (data on first visit) or individual prenatal records (individual ANC records/cards after births or immediately postpartum).

Health facility exit interviews and provider observations are useful for evaluation purposes but not for ongoing monitoring.


The purpose of this indicator is to measure the extent to which ANC clients are screened for syphilis. Since all women attending for ANC should be screened for syphilis at least once during pregnancy, the measure can also potentially serve as a proxy measure of the quality of antenatal care services (UNFPA, 1998a). Furthermore, when an explicit standard exists that all women should be tested at least once during pregnancy, the indicator may also be used as a benchmark to audit provider (or system) performance against compliance with local screening policy.

Syphilis infection is a major cause of maternal morbidity and perinatal morbidity and mortality in the developing world. For many African countries, reported prevalence of syphilis among pregnant women at sentinel surveillance sites ranges between 10-15 percent, with over half these pregnancies resulting in an adverse outcome, such as abortion, stillbirth, low birth weight, premature delivery, or congenital infection (WHO, 1991b).

Because adverse outcomes from syphilis are preventable, and screening and treatment in pregnancy are highly cost effective, many countries have adopted universal syphilis screening for pregnant women as a national policy (Gloyd, Chai, and Mercer, 2001). Screening programs by themselves cannot help reduce the adverse outcomes associated with syphilis and must be linked to efforts to increase ANC coverage and to improve follow up and treatment of women and their partners who test positive.


Researchers may routinely collect data to calculate this indicator if antenatal clinic registries record completed syphilis screening. Most often, however, the information is collected in the context of special surveys that review the antenatal clinic cards of women who have had a recent birth. Researchers may conduct these surveys in facilities or in the community, if women keep their antenatal cards.

Health facility exit interviews and provider observations (MEASURE DHS+, 2001; WHO, 1998a) may provide a baseline measure for evaluation purposes, but are limited because they assess women who have not yet completed antenatal care and who theoretically could still be tested (MEASURE DHS+, 2001; WHO, 1998a).

The percentage of women screened for syphilis should respond quickly to changes in provider practice, particularly if the indicator is used in a local audit of facility quality of care.

This indicator is a facility-based measure and does not represent the general population, particularly when ANC coverage is low. In addition, where the indicator is obtained by record review, the validity of the findings depends on the quality and completeness of the data. Incomplete data recording may also further indicate low service quality.

Adequate syphilis screening does not equate with adequate syphilis treatment, because studies show that despite effective screening, inadequate treatment can be an important cause of preventable perinatal death. In high prevalence areas, even when syphilis testing is theoretically universal, most women are not tested (Gloyd, Chai, and Mercer, 2001).


Safety of care, Process of Care, Antenatal care, Reproductive Health, Maternal health
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