To reduce costs and strengthen the quality and use of routine data, South Africa has considered transitioning from sentinel surveillance using laboratory-based testing to using routine data or medical records for HIV and syphilis surveillance.
The latest report from the Public Health Bulletin of South Africa (PHBSA) assessed the agreement between routine (facility-based) and survey (reference laboratory-based) syphilis test results and compared the reference laboratory-based prevalence of syphilis among women with and without a documented syphilis test result in their medical records.
Syphilis is a curable sexually transmitted infection caused by the bacterium Treponema pallidum (TP). South Africa has a high burden of syphilis.
The prevalence of maternal syphilis in the country was estimated to be 2% in 2015, increasing to 2.6% in 2019. In 2023, there were an estimated 1 739 congenital syphilis cases reported to the National Institute for Communicable Diseases, up from 373 cases reported in 2020.
This study describes the agreement between the two methods to determine whether relying solely on medical record abstraction is sufficient to estimate syphilis prevalence among pregnant women.
The study randomly selected 700 pregnant women from the 2022 South African Antenatal Care HIV/Syphilis Sentinel Survey database, with the inclusion criteria being women aged 15 to 49 years. To view the full report of this study, click here.
Ms Nelisiwe Swana, a lead investigator for the study “Individual-level agreement between antenatal HIV/syphilis survey syphilis results abstracted from medical records and laboratory-derived results among pregnant women in South Africa, 2022,” explains how the study came about and her role in it.
What is this study about?
This study assessed whether South Africa could reliably switch from its gold-standard, laboratory-based antenatal HIV and syphilis surveillance system to using data abstracted from routine medical records for maternal syphilis measurement. We measured the agreement between the two methods at an individual level to see if the routine data was accurate enough to monitor disease trends for syphilis.
Why does this matter?
Using existing medical records for surveillance would be quicker, more affordable, and less burdensome than testing collected samples in the laboratory. However, our key finding is that for maternal syphilis surveillance, medical records in their current form may underestimate the true burden of the infection. Relying on them alone would lead to a false sense of security and potentially misdirect resources.
What drew your interest in this area of research?
I am driven by the goal of making public health data both efficient and accurate. The push towards using “big data” from health records is a global trend, but it is critical to validate it first. This research sits at that exact intersection – ensuring that we make smart policy decisions based on data we can trust, especially for a devastating infection like congenital syphilis.
What was your role in the study?
My role as an epidemiologist, together with the team, was to design the study, write the protocol, conduct the study, analyse the data, write the manuscript, and disseminate the results.
Why should people read this article?
This article is crucial for public health officials, policymakers, and researchers globally who are considering similar transitions to routine data surveillance. It provides a clear, evidence-based framework for how to validate data sources and also highlights the profound consequences of getting it wrong for maternal and child health.
What impact do you hope this study will have on public health policy and access to healthcare?
I hope this study prompts immediate action on two fronts:
Policy: To pause any planned transition to solely using medical records for syphilis surveillance until data quality is significantly improved.
Healthcare access: To encourage investment into strengthening the health system – improving point of care testing, documentation, and patient tracking – to ensure that every pregnant woman is accurately tested and treated for syphilis, ultimately eliminating mother-to-child transmission.
Ms Nelisiwe Swana is an epidemiologist at the Centre for HIV and STIs, National Institute for Communicable Diseases, based in Johannesburg.
