How Effective is South Africa’s Congenital Syphilis Notification Surveillance System?
Congenital syphilis poses a severe threat to infants, being a debilitating and potentially life-threatening infection. When a pregnant mother carries syphilis, the spirochete Treponema pallidum can be transmitted to the unborn infant through the placenta, a process known as vertical transmission. Up to 80% of cases involve mother-to-child transmission (MTCT) in untreated mothers.
Early congenital syphilis is characterized by its impact on infants or children (< 2 years) whose mothers had untreated or inadequately treated syphilis during delivery, irrespective of visible signs in the infant. On the other hand, late congenital syphilis emerges from the third year of life onward, resulting from vertically acquired infections.
Congenital syphilis is preventable through testing, diagnosis, and adequate benzathine penicillin treatment for syphilis-infected mothers. SA’s national guidelines recommend universal syphilis and HIV testing during pregnancy with immediate antiretroviral therapy or benzathine penicillin treatment for positive women. The occurrence of CS depicts a failure to prevent MTCT of syphilis due to undetected, untreated, or inadequately treated maternal syphilis (<30 days before delivery). Infants born to syphilis-infected mothers with little or no treatment also require treatment for congenital infection.
In South Africa (SA), maternal syphilis is increasing among pregnant women, and failure to effectively diagnose and treat CS increases MTCT of HIV and syphilis. Establishing surveillance, monitoring, and evaluation systems is one of the pillars towards the elimination of MTCT in syphilis. SA has established surveillance and programmes to measure progress towards preventing MTCT of HIV and CS.
This evaluation aimed to assess the performance of the CS notification and surveillance system using the United States Centers for Disease Control and Prevention (US-CDC) guidelines.
Methods
The primary objectives of the evaluation was to determine the performance of the CS notification system concerning knowledge, relevance/usefulness, representativeness, timeliness, completeness, flexibility, data quality, acceptability, , and stability of CS in 2020.
The evaluation was cross-sectional, using both quantitative and qualitative methods. Quantitatively, a retrospective analysis of the NMC-CS line list included clinically notified CS cases in 2020. The qualitative component was a survey of healthcare providers and NICD key informants. Both evaluation components were designed using the US-CDC-updated guidelines for evaluating public health surveillance systems.
Results
6,946 records were extracted from the NMCS system for children <2 years. We excluded from the analysis 6,256 (90.1%) laboratory-generated alerts and 333/690 (48.3%) cases labelled as discarded because they did not meet the case definition or were missing age information. We included 357/690 (51.7%) records in the analysis. Of the 357 infants notified as CS cases, the median age at diagnosis was six days (interquartile range, IQR 0–254 days) with 184 (51.5%) males, 161 (45.1%) females, and 12 (3.36%) unknown. A total of 254 (71.2%) of the reported cases were notified within seven days or less from the date of diagnosis. KwaZulu-Natal Province reported the largest number of cases, 176 (49.3%) followed by Gauteng with 86 cases (24.1%). Limpopo, Mpumalanga, and the Eastern Cape reported the fewest number of three cases each (0.84%).
For a more in-depth look into this thought-provoking evaluation, download the full article below
