Evaluation of the syphilis surveillance system among pregnant women at their first antenatal care visit in the Maritime Region, Togo, 2025

Abstract

Introduction Syphilis remains a public health concern in sub-Saharan Africa due to its impact on maternal and neonatal morbidity and mortality. The objective of this study was to evaluate the performance of the syphilis surveillance system among pregnant women attending their first antenatal care visit (ANC1) in 2025 in the Maritime Region of Togo. Methods A descriptive cross-sectional study was conducted from August 18 to 30, 2025, in the Maritime Region of Togo. It combined a documentary review, analysis of routine data from the DHIS2 platform, and interviews with surveillance stakeholders. System performance was assessed using the following attributes: simplicity, acceptability, representativeness, stability, responsiveness, and usefulness. Results A total of 46 participants were included, of whom 43 were female. The median age was 37 years [IQR: 28–44]. The surveillance system was rated as highly simple at 91.6%, with strong understanding of case definitions, use of the HIV/syphilis rapid test, and systematic screening at ANC1. Acceptability was very high (100%), reflecting strong provider adherence to screening and reporting. The system was representative (79.1%). Stability was moderate (61.5%), mainly affected by challenges related to supply management and connectivity. Responsiveness was overall satisfactory (77.0%), with early screening of pregnant women, although partner screening and treatment coverage remained low. The system proved useful (93.2%), particularly in generating information for epidemiological monitoring and decision-making. Conclusion The syphilis surveillance system demonstrates overall acceptable performance, although there is still room for improvement. Strengthening resources, training, and indicator monitoring is essential to enhance its effectiveness.