1.1 Introduction
Syphilis is a sexually transmitted infectious disease caused by the bacterium Treponema pallidum and it spreads most commonly through sexual activity. In addition, it can also be transmitted from infected preg- nant women to their unborn children. If syphilis is left untreated, it can lead to devastating fetal outcomes in the second or third trimesters of pregnancy (Peeling et al., 2006 and Miller et al., 2014). Syphilis is a disease caused by bacteria called Treponema pallidum. Treponema pallidum, the causative organism of syphilis has been a public health challenge for centuries. Syphilis is a significant cause of morbidities and mortalities in pregnant women, and information regarding its prevalence in Nigerian pregnant women is scanty.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Prevalence rate of syphilis infections among pregnant mothers differs between countries and regions depending on a number of factors such as the national HIV prevalence and culture of the general population. Syphilis in pregnant women can result in adverse outcomes of pregnancy in up to 80% of cases, such as stillbirth and spontaneous abortion (40%), perinatal death (20%), and serious neonatal infections and low-birth weight babies (20%). Syphilis has also acquired a new potential for morbidity and mortality through association with increased risk for HIV (Nair et al., 2013).
The mother can transmit the infection transplacentally to the fetus or during passage through the birth canal. Until recently, a commonly held but erroneous obstetric principle stated that infection of the fetus does not occur before 18 weeks. But Silver and immunofluorescence staining of the fetal tissue or polymerase chain reaction and rabbit infectivity testing of amniotic fluid showed that T. pallidum gains access to the fetal compartment as early as 9-10 weeks (Genc, 2000).
The World Health Organization (WHO) estimates that 10-12 million new infections of syphilis occur every year. Infection rates show extreme variation between countries of the same region as well as various subcategories of populations studied with syphilis 2009 (Khan et al., 2014). Seroprevalence during pregnancy is generally low in developed countries: it ranges from 0.02% in Europe to 4.5% in parts of the United States (Saloojee et al., 2004). In contrast, there has been a dramatic increase in the incidence of con- genital syphilis in rural areas of Eastern Europe and Central Asia. High rates of syphilis seropositivity have consistently been reported at antenatal clinics in Africa (3–18%) (Korenromp et al., 2018).
The risk of transmission to child is related to the maternal Treponema load hence early maternal infection carries a much greater risk of transmission than late infection. Almost all babies born to mothers with untreated primary or secondary infection will be infected, but the likelihood of transmission and severity of infection will fall with subsequent pregnancies as the mother Treponema load will fall with time (Ageru and Abiso, 2016).
Syphilis can progress to many stages if left untreated like secondary, primary, tertiary, and latent syphilis which can be characterized by painless sores in the mouth, genitals, rectum, or skin, body rash, headache, fever, fatigue, and lymphadenopathy (disease of the lymph node). Progression to tertiary syphilis can result in damage in the nervous system, eyes, heart and brain (Sriniwasan et al., 2017). Syphilis can be easily treated with penicillin the disease almost disappeared in Western countries before it surprisingly reemerged in the late 1990 (Kirsten, 2015).
In Western countries, syphilis is now mainly encountered among men who have sex with men, and in developing countries the disease represents an extensive problem, and above all syphilis is concern especially to pregnant women due to the increased risk of congenital malformation of the newborn, stillbirth, spontaneous abortion and miscarriage (Kirsten, 2015). Approximately 12 million new cases of syphilis are detected each year and more than 2 million occur in pregnant women. The risk of contracting syphilis through sexual contact with a person that has primary or secondary syphilis is 30–50% (Fissehatsion et al., 2017).
In parts of the world where the traditional ‘venereal diseases’ have not been controlled, like in sub-Saharan Africa, the magnitude of the problems associated with congenital syphilis is reminiscent of those faced in the Western World during the early 1900s. Scarce data on congenital syphilis in Africa suggested that 1-3% of the neonates and infants less than 6 months of age are sero-reactive and/or have signs of congenital infection (Santis et al., 2012 and Lindstrand et al., 1993).
Therefore, in Enugu State where the research was carried out, the activities that was conducted is to know the Prevalence of Syphilis (Triponema Pallidium) in Women Attending Antenatal Care.
1.3 Statement of Problems
Investigation revealed that untreated syphilis is a significant cause of morbidities and mortalities in pregnant women. Maternal syphilis results in abortions, still births, non-immune hydrops, intra-uterine growth restriction, peri-natal death and congenital syphilis, and this remains an increasing problem in many countries of sub-Saharan Africa (Santis et al., 2012). While appropriate treatment of pregnant women often prevents such complications, the major deterrent to treatment has been the inability to identify the infected women.
In Ethiopia, an estimated 5.0% of all pregnancies were reported to be lost each year through syphilis induced abortions (75,000 pregnancies lose) (Hira, 1982). In that same country, the stillbirth among sero-reactive women was 5 times more common than in sero-negative women (Hira, 1982). In Zambia, 24.0% of all stillbirths could be attributed to syphilis, and congenital syphilis was implicated in 30.0% of all peri-natal mortality (Hira, 1984).
1.4 Aim and Objectives of Study
The aim of the study is to examine the Prevalence of Syphilis (Triponema Pallidium) in Women Attending Antenatal Care. In achieving this aim, the following specific objectives were laid out as follows:
- To determine the prevalence of Syphilis infection among women attending antenatal care in Enugu State PHC.
- To examine the risk factors of syphilis in pregnant women attending ante-natal care clinics in Enugu State PHC.
- To assess the socio-demographic characteristics and syphilis serology status of pregnant women attending antenatal care clinic at Enugu State PHC.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are there risk factors of syphilis in pregnant women attending ante-natal care clinics in Enugu State PHC?
- What is the prevalence of Syphilis infection among women attending antenatal care in Enugu State PHC?
- What are the socio-demographic characteristics and syphilis serology status of pregnant women attending antenatal care clinic at Enugu State PHC?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H0: There are no significant risk factors of syphilis in pregnant women attending ante-natal care clinics in Enugu State PHC
- H1: There are significant risk factors of syphilis in pregnant women attending ante-natal care clinics in Enugu State PHC
1.7 Significance of Study
This study showed that syphilis still remained one of the significant public health problems in our study area. The important risk factors for syphilis in pregnant women were history of multiple lifetime sexual partners, urban residence, woman’s educational level and husbands’ employment status.
This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The study focuses on the Prevalence of Syphilis (Triponema Pallidium) in Women Attending Antenatal Care using Enugu State Primary Health Care Centre as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Operational Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Perception: To notice something in a particular way or hold a view about something.
