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Published in: Systematic Reviews 1/2021

Open Access 01-12-2021 | Sexually Transmitted Infection | Research

Sero-prevalence of syphilis and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Authors: Habtamu Geremew, Demeke Geremew

Published in: Systematic Reviews | Issue 1/2021

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Abstract

Background

Syphilis remained a major cause of reproductive morbidity and poor pregnancy outcomes in developing countries. Previously, studies showed inconsistent results and failed to show the actual picture of the diseases in Ethiopia. Thus, the aim of this meta-analysis was, first, to determine the updated pooled prevalence of syphilis among pregnant women in Ethiopia and, second, to assess its associated factors.

Methods

A comprehensive search was made on PubMed, Google scholar, Science Direct, and African Journals Online databases to identify relevant articles. A random effects model was used to estimate pooled syphilis prevalence and odds ratio (OR) with the respective 95% confidence intervals (CIs) using STATA 14 statistical software. I2 statistics and Egger’s regression test in conjunction with funnel plot was used to determine heterogeneity and publication bias among included studies respectively.

Result

We identified 13 suitable studies in this analysis. Accordingly, the pooled prevalence of syphilis among pregnant women in Ethiopia was 2.32% (95% CI, 1.68–2.97). Specifically, syphilis prevalence was 2.53% (95% CI, 1.92–3.14%) and 1.90% (95% CI, 0.40–3.40%) as per the treponemal and non-ytreponemal diagnostic test, respectively. On the other hand, regional analysis indicated that 4.06% (95% CI, 2.86–5.26) in Southern Nations Nationalities and Peoples (SNNP), 2.16% (95% CI, 1.57–2.75) in Amhara and 1.46% (95% CI, 0.69–2.23) in Oromia region. Being married (OR, 0.37 (95% CI, 0.12–0.91%)) was less likely to develop syphilis. On the other hand, women with history of multiple sexual partner (OR, 2.98 (95% CI, 1.15–7.70)) and women with history of previous sexually transmitted infection (STI) (OR, 4.88 (95% CI, 1.35–17.62)) have higher risk to develop syphilis. Besides, the pooled syphilis-HIV coinfection was 0.80% (95% CI, 0.60–1.01%).

Conclusion

This study provides evidence of relatively high prevalence of syphilis among pregnant women in Ethiopia. Therefore, it is recommended to further ramping up of current intervention measures to prevent future generations.

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Appendix
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Literature
2.
go back to reference Khan S, Menezes GA, Dhodapkar R, Harish BN. Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India. Asian Pac J Trop Biomed. 2014;4(12):995–7.CrossRef Khan S, Menezes GA, Dhodapkar R, Harish BN. Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India. Asian Pac J Trop Biomed. 2014;4(12):995–7.CrossRef
3.
go back to reference Peeling RW, Hook EW III. The pathogenesis of syphilis: the Great Mimicker, revisited. J Pathol. 2006;208(2):224–32.PubMedCrossRef Peeling RW, Hook EW III. The pathogenesis of syphilis: the Great Mimicker, revisited. J Pathol. 2006;208(2):224–32.PubMedCrossRef
4.
go back to reference Tiruneh M. Seroprevalence of multiple sexually transmitted infections among antenatal clinic attendees in Gondar Health Center Northwest Ethiopia. Ethiopian Med J. 2008;46(4):359–66. Tiruneh M. Seroprevalence of multiple sexually transmitted infections among antenatal clinic attendees in Gondar Health Center Northwest Ethiopia. Ethiopian Med J. 2008;46(4):359–66.
5.
go back to reference Organization WH. The global elimination of congenital syphilis: rationale and strategy for action. 2007. Organization WH. The global elimination of congenital syphilis: rationale and strategy for action. 2007.
6.
go back to reference Gloyd S, Chai S, Mercer MA. Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction. Health Policy Plan. 2001;16(1):29–34.PubMedCrossRef Gloyd S, Chai S, Mercer MA. Antenatal syphilis in sub-Saharan Africa: missed opportunities for mortality reduction. Health Policy Plan. 2001;16(1):29–34.PubMedCrossRef
7.
go back to reference Kuznik A, Habib AG, Manabe YC, Lamorde M. Estimating the public health burden associated with adverse pregnancy outcomes resulting from syphilis infection across 43 countries in sub-Saharan Africa. Sex Transm Dis. 2015;42(7):369.PubMedPubMedCentralCrossRef Kuznik A, Habib AG, Manabe YC, Lamorde M. Estimating the public health burden associated with adverse pregnancy outcomes resulting from syphilis infection across 43 countries in sub-Saharan Africa. Sex Transm Dis. 2015;42(7):369.PubMedPubMedCentralCrossRef
8.
go back to reference Naeye R, Tafari N, Marboe C, Judge D. Causes of perinatal mortality in an African city. Bull World Health Organ. 1977;55(1):63.PubMedPubMedCentral Naeye R, Tafari N, Marboe C, Judge D. Causes of perinatal mortality in an African city. Bull World Health Organ. 1977;55(1):63.PubMedPubMedCentral
9.
go back to reference Tesfaye B: Gestational syphilis in Ethiopia, meta-analysis and systemic review. In: 30th EPHA Annual Conference: 2019;2019. Tesfaye B: Gestational syphilis in Ethiopia, meta-analysis and systemic review. In: 30th EPHA Annual Conference: 2019;2019.
10.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMedCentralCrossRef Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.PubMedPubMedCentralCrossRef
11.
go back to reference Kenyon CR, Osbak K, Chico RM. What underpins the decline in syphilis in Southern and Eastern Africa? An exploratory ecological analysis. Int J Infect Dis. 2014;29:54–61.PubMedCrossRef Kenyon CR, Osbak K, Chico RM. What underpins the decline in syphilis in Southern and Eastern Africa? An exploratory ecological analysis. Int J Infect Dis. 2014;29:54–61.PubMedCrossRef
12.
go back to reference Geremew D, Endalamaw A, Negash M, Eshetie S, Tessema B. The protective effect of isoniazid preventive therapy on tuberculosis incidence among HIV positive patients receiving ART in Ethiopian settings: a meta-analysis. BMC Infect Dis. 2019;19(1):1–9.CrossRef Geremew D, Endalamaw A, Negash M, Eshetie S, Tessema B. The protective effect of isoniazid preventive therapy on tuberculosis incidence among HIV positive patients receiving ART in Ethiopian settings: a meta-analysis. BMC Infect Dis. 2019;19(1):1–9.CrossRef
13.
go back to reference JB I. The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews checklist for prevalence studies. North Adelaide: The Joanna Briggs Institute; 2017. JB I. The Joanna Briggs Institute critical appraisal tools for use in JBI systematic reviews checklist for prevalence studies. North Adelaide: The Joanna Briggs Institute; 2017.
14.
go back to reference Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193.PubMedCrossRef Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193.PubMedCrossRef
15.
16.
go back to reference Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225.PubMedPubMedCentralCrossRef Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225.PubMedPubMedCentralCrossRef
17.
go back to reference Geremew D, Melku M, Endalamaw A, Woldu B, Fasil A, Negash M, Baynes HW, Geremew H, Teklu T, Deressa T. Tuberculosis and its association with CD4+ T cell count among adult HIV positive patients in Ethiopian settings: a systematic review and meta-analysis. BMC Infect Dis. 2020;20:1–10.CrossRef Geremew D, Melku M, Endalamaw A, Woldu B, Fasil A, Negash M, Baynes HW, Geremew H, Teklu T, Deressa T. Tuberculosis and its association with CD4+ T cell count among adult HIV positive patients in Ethiopian settings: a systematic review and meta-analysis. BMC Infect Dis. 2020;20:1–10.CrossRef
18.
go back to reference Sterne JA, Egger M, Smith GD. Investigating and dealing with publication and other biases in meta-analysis. BMJ (Clinical research ed). 2001;323(7304):101–5.CrossRef Sterne JA, Egger M, Smith GD. Investigating and dealing with publication and other biases in meta-analysis. BMJ (Clinical research ed). 2001;323(7304):101–5.CrossRef
19.
go back to reference Assefa A. A three year retrospective study on seroprevalence of syphilis among pregnant women at Gondar University Teaching Hospital Ethiopia. Afr Health Sci. 2014;14(1):119–24.PubMedPubMedCentralCrossRef Assefa A. A three year retrospective study on seroprevalence of syphilis among pregnant women at Gondar University Teaching Hospital Ethiopia. Afr Health Sci. 2014;14(1):119–24.PubMedPubMedCentralCrossRef
20.
go back to reference Biadgo B, Hassen A, Getaneh M, Tesfa H, Jaleta KN, Eshetu T, Kasew D, Melku M. Syphilis and human immunodeficiency virus infections among pregnant women attending antenatal care clinic of Gondar family guidance association, Northwest Ethiopia: implication for prevention of mother to child transmission. Reprod Health. 2019;16(1):27.PubMedPubMedCentralCrossRef Biadgo B, Hassen A, Getaneh M, Tesfa H, Jaleta KN, Eshetu T, Kasew D, Melku M. Syphilis and human immunodeficiency virus infections among pregnant women attending antenatal care clinic of Gondar family guidance association, Northwest Ethiopia: implication for prevention of mother to child transmission. Reprod Health. 2019;16(1):27.PubMedPubMedCentralCrossRef
21.
go back to reference Endris M, Deressa T, Belyhun Y, Moges F. Seroprevalence of syphilis and human immunodeficiency virus infections among pregnant women who attend the University of Gondar teaching hospital, Northwest Ethiopia: a cross sectional study. BMC Infect Dis. 2015;15:111.PubMedPubMedCentralCrossRef Endris M, Deressa T, Belyhun Y, Moges F. Seroprevalence of syphilis and human immunodeficiency virus infections among pregnant women who attend the University of Gondar teaching hospital, Northwest Ethiopia: a cross sectional study. BMC Infect Dis. 2015;15:111.PubMedPubMedCentralCrossRef
22.
go back to reference Melku M, Kebede A, Addis Z. Magnitude of HIV and syphilis seroprevalence among pregnant women in Gondar, Northwest Ethiopia: a cross-sectional study. HIV/AIDS (Auckland, NZ). 2015;7:175–82. Melku M, Kebede A, Addis Z. Magnitude of HIV and syphilis seroprevalence among pregnant women in Gondar, Northwest Ethiopia: a cross-sectional study. HIV/AIDS (Auckland, NZ). 2015;7:175–82.
23.
go back to reference Tareke K, Munshea A, Nibret E. Seroprevalence of syphilis and its risk factors among pregnant women attending antenatal care at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2019;12(1):69.PubMedPubMedCentralCrossRef Tareke K, Munshea A, Nibret E. Seroprevalence of syphilis and its risk factors among pregnant women attending antenatal care at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia: a cross-sectional study. BMC Res Notes. 2019;12(1):69.PubMedPubMedCentralCrossRef
24.
go back to reference YidegYitbarek G, Ayele BA. Prevalence of syphilis among pregnant women attending antenatal care clinic, Sede Muja District, South Gondar, Northwest Ethiopia. J Pregnancy. 2019;2019:1584527. YidegYitbarek G, Ayele BA. Prevalence of syphilis among pregnant women attending antenatal care clinic, Sede Muja District, South Gondar, Northwest Ethiopia. J Pregnancy. 2019;2019:1584527.
25.
go back to reference Amsalu A, Ferede G, Assegu D. High seroprevalence of syphilis infection among pregnant women in Yiregalem hospital southern Ethiopia. BMC Infect Dis. 2018;18(1):109.PubMedPubMedCentralCrossRef Amsalu A, Ferede G, Assegu D. High seroprevalence of syphilis infection among pregnant women in Yiregalem hospital southern Ethiopia. BMC Infect Dis. 2018;18(1):109.PubMedPubMedCentralCrossRef
26.
go back to reference Mulu A, Kassu A, Tessema B, Yismaw G, Tiruneh M, Moges F, Wondmikun Y, Nishikawa T, Ota F. Seroprevalence of syphilis and HIV-1 during pregnancy in a teaching hospital in northwest Ethiopia. Jpn J Infect Dis. 2007;60(4):193.PubMed Mulu A, Kassu A, Tessema B, Yismaw G, Tiruneh M, Moges F, Wondmikun Y, Nishikawa T, Ota F. Seroprevalence of syphilis and HIV-1 during pregnancy in a teaching hospital in northwest Ethiopia. Jpn J Infect Dis. 2007;60(4):193.PubMed
27.
go back to reference Schönfeld A, Feldt T, Tufa TB, Orth HM, Fuchs A, Mesfun MG, Pfäfflin F, Nordmann T, Breuer M, Hampl M, et al. Prevalence and impact of sexually transmitted infections in pregnant women in central Ethiopia. Int J STD AIDS. 2017;0(0):1–8. Schönfeld A, Feldt T, Tufa TB, Orth HM, Fuchs A, Mesfun MG, Pfäfflin F, Nordmann T, Breuer M, Hampl M, et al. Prevalence and impact of sexually transmitted infections in pregnant women in central Ethiopia. Int J STD AIDS. 2017;0(0):1–8.
28.
go back to reference Ageru TA, Abiso TL. Sero-prevalence of HIV and syphilis infection among pregnant mothers attended labor ward at Wolaita Sodo University Teaching Referral Hospital: a five-year retrospective study (2012–2016). Am J Health Res. 2018;6(3):67–73.CrossRef Ageru TA, Abiso TL. Sero-prevalence of HIV and syphilis infection among pregnant mothers attended labor ward at Wolaita Sodo University Teaching Referral Hospital: a five-year retrospective study (2012–2016). Am J Health Res. 2018;6(3):67–73.CrossRef
29.
go back to reference Zinabie S, Belachew E, Yidenek T, Lewetegn M, Asfaw T. Sero-prevalence of syphilis and HIV and associated factors in pregnant women attending antenatal care clinics in Debre Berhan Public Health Institutions, Ethiopia. Am J Biomed Life Sci. 2018;6(3):56–62.CrossRef Zinabie S, Belachew E, Yidenek T, Lewetegn M, Asfaw T. Sero-prevalence of syphilis and HIV and associated factors in pregnant women attending antenatal care clinics in Debre Berhan Public Health Institutions, Ethiopia. Am J Biomed Life Sci. 2018;6(3):56–62.CrossRef
31.
go back to reference Fikadu B, Gebrish S, Asfaw T. Sero-prevalence of syphilis among pregnant women attending Antenatal Care Clinic at Jimma Univeristy specialized Hospital, Ethiopia. J Med Medical Sci. 2019;10(1):1–5. Fikadu B, Gebrish S, Asfaw T. Sero-prevalence of syphilis among pregnant women attending Antenatal Care Clinic at Jimma Univeristy specialized Hospital, Ethiopia. J Med Medical Sci. 2019;10(1):1–5.
32.
go back to reference Henao-Martínez AF, Johnson SC. Diagnostic tests for syphilis: new tests and new algorithms. Neurology. 2014;4(2):114–22.PubMedPubMedCentral Henao-Martínez AF, Johnson SC. Diagnostic tests for syphilis: new tests and new algorithms. Neurology. 2014;4(2):114–22.PubMedPubMedCentral
34.
go back to reference Korenromp EL, Mahiané SG, Nagelkerke N, Taylor MM, Williams R, Chico RM, Pretorius C, Abu-Raddad LJ, Rowley J. Syphilis prevalence trends in adult women in 132 countries–estimations using the spectrum sexually transmitted infections model. Sci Rep. 2018;8(1):1–10.CrossRef Korenromp EL, Mahiané SG, Nagelkerke N, Taylor MM, Williams R, Chico RM, Pretorius C, Abu-Raddad LJ, Rowley J. Syphilis prevalence trends in adult women in 132 countries–estimations using the spectrum sexually transmitted infections model. Sci Rep. 2018;8(1):1–10.CrossRef
35.
go back to reference Manyahi J, Jullu BS, Abuya MI, Juma J, Ndayongeje J, Kilama B, Sambu V, Nondi J, Rabiel B, Somi G. Prevalence of HIV and syphilis infections among pregnant women attending antenatal clinics in Tanzania, 2011. BMC Public Health. 2015;15(1):501.PubMedPubMedCentralCrossRef Manyahi J, Jullu BS, Abuya MI, Juma J, Ndayongeje J, Kilama B, Sambu V, Nondi J, Rabiel B, Somi G. Prevalence of HIV and syphilis infections among pregnant women attending antenatal clinics in Tanzania, 2011. BMC Public Health. 2015;15(1):501.PubMedPubMedCentralCrossRef
36.
go back to reference Tesfay GH. Note on: the adverse effects of polygamy on the rights of women: a case study in Gedeo and Sidama Zones. Haramaya Law Rev. 2017;6:91–110. Tesfay GH. Note on: the adverse effects of polygamy on the rights of women: a case study in Gedeo and Sidama Zones. Haramaya Law Rev. 2017;6:91–110.
38.
go back to reference Françoise N, Bosco MJ, Bellancille N, Théoneste N. HIV/AIDS and syphilis sero-prevalence among pregnant women attending antenatal care center in Rwanda. Am J Lab Med. 2020;5(4):83.CrossRef Françoise N, Bosco MJ, Bellancille N, Théoneste N. HIV/AIDS and syphilis sero-prevalence among pregnant women attending antenatal care center in Rwanda. Am J Lab Med. 2020;5(4):83.CrossRef
39.
go back to reference Yahya-Malima KI, Evjen-Olsen B, Matee MI, Fylkesnes K, Haarr L. HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: prevalence and risk factors. BMC Infect Dis. 2008;8(1):75.PubMedPubMedCentralCrossRef Yahya-Malima KI, Evjen-Olsen B, Matee MI, Fylkesnes K, Haarr L. HIV-1, HSV-2 and syphilis among pregnant women in a rural area of Tanzania: prevalence and risk factors. BMC Infect Dis. 2008;8(1):75.PubMedPubMedCentralCrossRef
41.
go back to reference Macêdo VCd, Lira PICd, Frias PGd, Romaguera LMD, Caires SdFF, Ximenes RAdA. Risk factors for syphilis in women: case-control study. Rev Saude Publica. 2017;51:78.PubMedPubMedCentralCrossRef Macêdo VCd, Lira PICd, Frias PGd, Romaguera LMD, Caires SdFF, Ximenes RAdA. Risk factors for syphilis in women: case-control study. Rev Saude Publica. 2017;51:78.PubMedPubMedCentralCrossRef
42.
go back to reference Sombie I, Meda N, Cartoux M, Tiendrebeogo S, Ouangre A, Yaro S, Ky-Zerbo O, Dao B, Van de Perre P, Mandelbrot L. Seroprevalence of syphilis among women attending urban antenatal clinics in Burkina Faso, 1995–8. Sexually Transm Infect. 2000;76(4):314–6.CrossRef Sombie I, Meda N, Cartoux M, Tiendrebeogo S, Ouangre A, Yaro S, Ky-Zerbo O, Dao B, Van de Perre P, Mandelbrot L. Seroprevalence of syphilis among women attending urban antenatal clinics in Burkina Faso, 1995–8. Sexually Transm Infect. 2000;76(4):314–6.CrossRef
43.
go back to reference Kwiek JJ, Mwapasa V, Alker AP, Muula AS, Misiri HE, Molyneux ME, Rogerson SJ, Behets FM, Meshnick SR. Socio-demographic characteristics associated with HIV and syphilis seroreactivity among pregnant women in Blantyre, Malawi, 2000–2004. Malawi Med J. 2008;20(3):80–5.PubMedPubMedCentralCrossRef Kwiek JJ, Mwapasa V, Alker AP, Muula AS, Misiri HE, Molyneux ME, Rogerson SJ, Behets FM, Meshnick SR. Socio-demographic characteristics associated with HIV and syphilis seroreactivity among pregnant women in Blantyre, Malawi, 2000–2004. Malawi Med J. 2008;20(3):80–5.PubMedPubMedCentralCrossRef
44.
go back to reference Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM, Yin YP, Peeling RW, Mabey D. Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen China. Sex Transm Infect. 2007;83(6):476–80.PubMedPubMedCentralCrossRef Zhou H, Chen XS, Hong FC, Pan P, Yang F, Cai YM, Yin YP, Peeling RW, Mabey D. Risk factors for syphilis infection among pregnant women: results of a case-control study in Shenzhen China. Sex Transm Infect. 2007;83(6):476–80.PubMedPubMedCentralCrossRef
45.
go back to reference Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P, Mosha F, Gavyole A, Mabey D, Hayes R. Risk factors for active syphilis and TPHA seroconversion in a rural African population. Sexually Transm Infect. 2001;77(1):37–45.CrossRef Todd J, Munguti K, Grosskurth H, Mngara J, Changalucha J, Mayaud P, Mosha F, Gavyole A, Mabey D, Hayes R. Risk factors for active syphilis and TPHA seroconversion in a rural African population. Sexually Transm Infect. 2001;77(1):37–45.CrossRef
46.
go back to reference Potter D, Goldenberg RL, Read JS, Wang J, Hoffman IF, Saathoff E, Kafulafula G, Aboud S, Martinson FE, Dahab M. Correlates of syphilis seroreactivity among pregnant women: the HIVNET 024 Trial in Malawi, Tanzania, and Zambia. Sex Transm Dis. 2006;33(10):604.PubMedPubMedCentralCrossRef Potter D, Goldenberg RL, Read JS, Wang J, Hoffman IF, Saathoff E, Kafulafula G, Aboud S, Martinson FE, Dahab M. Correlates of syphilis seroreactivity among pregnant women: the HIVNET 024 Trial in Malawi, Tanzania, and Zambia. Sex Transm Dis. 2006;33(10):604.PubMedPubMedCentralCrossRef
Metadata
Title
Sero-prevalence of syphilis and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis
Authors
Habtamu Geremew
Demeke Geremew
Publication date
01-12-2021

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