The last decade has seen a pronounced resurgence of syphilis in China, (1-3) especially in south-eastern coastal provinces, which carry the greatest disease burden. (4,5) One such province is Guangdong. In 2009 it reported 39 112 syphilis cases and prevalence reached 41 cases per 100 000 total population, or nearly twice the rate in all of China (25 per 100 000). (6) Syphilis is now the second most commonly reported communicable disease in Guangdong province,6 where a high prevalence has been observed among female sex workers7 and men who have sex with men. (8,9)
Mother-to-child syphilis transmission is an important public concern in epidemic areas because syphilis can cause spontaneous abortion, stillbirth and irreversible congenital defects.'[degrees] These adverse outcomes are fortunately preventable through effective prenatal screening programmes. However, organizing such programmes is challenging, especially in places where the health system faces problems. For example, in 2001 the state of Florida in the United States of America (USA) passed a law requiring that at least two syphilis tests be administered during pregnancy, but operational research from Miami showed that only 83% of pregnant women were screened at least once." In a study from Mongolia, only 77% of 3519 pregnant women were screened and the presence of congenital syphilis showed an association with late-term antenatal care and with living farther from care services. (12) The influence of health systems issues on timely prenatal syphilis screening has been observed in several other countries, including Bolivia, Kenya and South Africa. (13)
In a project in Shenzhen (Guangdong province) in which 477 656 pregnant women were screened for syphilis, 0.5% had a positive treponemal test and mother-to-child transmission was prevented in 99.1% of these cases as a result of screening. (14) Although Shenzhen is the most developed city in Guangdong province and the one with the best medical infrastructure, most municipalities have far fewer resources, less equipped laboratories and limited syphilis testing capacity. The non-treponemal test, which is the one most commonly used to screen for syphilis, requires trained laboratory personnel, a refrigerator, a centrifuge and a rotator. (15) Although Chinas new 10-year National Syphilis Control Plan explicitly mandates widespread prenatal screening for syphilis, the existence of local capacity to undertake such screening, especially in resource constrained regions, is unclear. This study examined the status of syphilis testing capacity, prenatal syphilis screening coverage and types of syphilis tests in different types of medical facilities offering prenatal care in Guangdong province.
Guangdong province is in south-eastern China and borders the South China Sea. Several administrative levels exist in the province, from municipality down to county/district, to township and to village. In 2010 there were 21 municipalities divided into 121 counties/districts. Of these 21 municipalities, seven (Guangzhou, Zhongshan, Zhuhai, Dongguan, Shenzhen, Jiangmen and Fushan) are in the central, more developed region known as the Pearl River Delta. Of the 14 less developed, more resource-constrained municipalities, seven (Chaozhou,
Shantou, Jieyang, Shanwei, Huizhou, Heyuan and Meizhou) are in the east of the province, five (Zhaoqing, Yunfu, Yangjiang, Maoming and Zhanjing) are in the west and two (Qingyuan and Shaoguan) are in the north. (6) The Pearl River Delta had 11.4 primary syphilis cases per 100000 population in 2008, a rate much higher than the province's overall rate of 7.6 primary syphilis cases per 100 000. (4) The case definition of syphilis in China includes both clinical criteria as well as laboratory confirmation with treponemal and non-treponemal tests.
Like other parts of China, Guangdong has a vertically organized public hospital system that goes from the municipal level clown to the township level. …