Prevalence & Risk factors associated with syphilis

among pregnant women at Banaadir Hospital,

Mogadishu, Somalia.

1. Chapter one

1.1 BAXCKGROUND
Sexually transmitted infections (STIs) are a serious public health problem in developing
countries, including Ethiopia and Somalia, so this study will conduct from Mogadishu. Syphilis
is STIs caused by the spirochete Treponema pallidum and constitutes a major public health
problem worldwide. Syphilis is an important cause of morbidity and mortality in pregnancy and
it is one of the greatest public health challenges. Pregnant women are sexually active and at risk
of sexually transmitted disease, including syphilis. Syphilis remains a major cause of
reproductive morbidity and poor pregnancy outcomes in developing countries. In prenatal care
screening and treatment for syphilis is routine and is a cost-effective intervention. Fetal infection
is a result of hematogeneous spread from an infected mother. Even though Treponema pallidum
can cross the placenta and infect the fetus in the early gestation, the risk of adverse pregnancy
outcomes increases with age. Adverse pregnancy outcomes are influenced by gestational age,
stage of maternal syphilis, and immunological response of the fetus(Assefa & Sciences, 2014).

1.2 PROBLEM STATEMENT

Sexually transmitted infections (STIs) are an emerging public health concern, especially in
developing countries. Syphilis, a genital ulcerative disease caused by the bacterium Treponema
pallidum, is associated with significant complications if left untreated and can facilitate the
transmission and acquisition of HIV(Zinabie, 2018). Syphilis occurs throughout the world. It is
more common among the under-privileged, in cities than rural areas and in blacks than
whites(Kebede & Chamiso, 2000). Somalia syphilis is stigmata. therefore, this study has
designed on this common STIs to understand the burden of these infections in pregnant women
which is an integral part to develop a strategy targeted on prevention and
intervention(Fissehatsion, Ali, & Getachew, 2017)

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 1.3 RESEARCH OBJECTIVES
1.3.1 General Objective
To identify prevalence & risk factors associated with syphilis among pregnant women at
Benaadir Hospital, Mogadishu, Somalia.

1.3.2 Specific objective

1) To identify prevalence of syphilis among pregnant women.

2) To identify socio demographic factors associated with syphilis.

3) To determine clinical related factors associated with syphilis.

4) To describe pregnancy related factors associated with syphilis.

1.4 RESEARCH QUESTIONS

1) What are the prevalence of syphilis among pregnant women at Banaadir Hospital, Mogadisho,
Somalia?

2) What are the socio-demographic factors associated with syphilis?

3) What are the clinical-related factors associated with syphilis?

4) What are the pregnancy-related factors associated with syphilis?

1.5 SIGNIFICANCE OF THE STUDY

After we saw that the syphilis is stigmata in our population, we decided to determine the
prevalence and the risk factors associated with syphilis to recognize the number of people
developed with syphilis especially pregnant women, and to acquire awareness about the risk to
get syphilis. We expect this study will improve the awareness of people descent in Mogadishu,
Somalia.

1.6 SCOPE OF THE STUDY

1.6.1 Scope of geographical area:
We preferred to select Banaadir Hospital, Mogadishu, Somalia.

1.6.2 Content scope:

This study is for purpose of identifying the number of people affected by syphilis and the risk
factors associated with syphilis.

1.6.3 Scope of time:

This study will conduct from December 12, 2019 to July 30, 2020.

1.7 Key terms

Syphilis: positive with trapenomal and non-trapenomal test in pregnant women.

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 1.8 CONCEPTUAL FRAMEWORK
Depedent variables Indepedent variables

Clinical-related factors

1. Having HIV infection

2. Previous STD

3. Presence of STD S
4. History of blood transfusion

5. History of induced abortion Y

6. Chronic disease

Hypertension
P
Renal failure

HBV
H
HCB
I
Pregnancy-related factors

1. Teenage pregnancy
L
2. Antenatal visit

Sociodemogdaphic factors
I
1. Age

2. Marital status
S
3. Residence

4. Occupation

5. Income

6. Education

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2. Chapter three
2.1 Methodology

2.2 Study design

This study will be descriptive cross-sectional study design. the study will also be quantitative in
design.

2.3 Population of study

2.3.1 Target population:
All pregnant women ATTENDING AT in Banaadir Hospital, Mogadishu, Somalia

2.3.2 Study population:

All pregnant women with syphilis and willing to participate and available at the time of data
collection.

2.3.3 Study area:

Banaadir Hospital, Mogadishu, Somalia

2.4 Study period:

This study will conduct from December 12, 2019 to July 30, 2020.

2.5 Inclusion and exclusion criteria

2.5.1 Inclusion criteria:
Pregnant women with syphilis who attend to the hospital and those who are willing to participate
will be included in the study.

2.5.2 Exclusion criteria:

Pregnant women with syphilis who are not attend to the hospital and those who are not willing to
participants will be excluded from the study.

2.6 Sample size determination:

Sample size = Z2pq/d2
The proportion of syphilis among pregnant women in east Africa was 3.2 %( Hussein, S., &
Tadesse, B.T.(2019).Prevalence of syphilis among pregnant women in sub-Saharan Africa.
Biomed Research International, 2019, 1-10, doi: 10.1155/2019/4562385).
For 95% confidence level Z(1-α)= 1.96
p=0.032 q=1-p = 0.968
Let’s take d= 0.016
N:(1.96)²(0.032)(0.968)/(0.016)²=465
Non response rate: 10%. 465/0.9= 517

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 2.7 Sampling procedure:
In this study will use purposive sampling as sampling procedure

2.8 Research instrument:

This study will be collected via a structured Questionnaire as a data collecting instrument. the
selecting of this tool has been guided by the nature of data to be collected. Questionnaire tool
was administered to collect quantitative data from the selected respondents. The researcher
preferred this method because it is the most appropriate in collecting view respondents whose
place was geographically spread.

2.9 Research tool:

Blood collecting tube, Rapid plasma regain, and Venereal disease research laboratory.

2.10 Data collection procedure:

Open-ended questionnaire

2.11 Data analysis:

The study will use chi-square test

2.12 Quality control

2.12.1 Validity:
This study will use questionnaire as instrument for data collection. The questionnaire will be
ensured to have all the variables necessary to identify prevalence and risk factors associated with
syphilis. Then it will be sent to 2 experts and their comments and suggestions will be included.

2.12.2 Reliability:
To ensure the reliability of the questionnaire it will be pretested to 10 participants from the actual
population

2.13 Ethical consideration

Respect: The researcher will respect respondent’s privacy when entering their private sphere and
when asking questions.

2.13.1 Confidentiality:
The researcher will guarantee maximum confidentiality for the participants. Their information
will only be used for the purpose of study.

2.13.2 Freedom to participate:

Participants will be informed that they are free to participate. They will also be informed that
they have the right to withdrawal.

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 2.13.3 Informed consent:
Consent will be secured from the participants after fully informing the nature, potential risks and
benefits of the study

2.14 Study limitation

During the study, here are some of the challenges that the researcher may encounter:

1. The first and for most limitation of study is that the study will carry out only Banaadir
Hospital in Mogadishu

2. Some respondents may refuse answering the questionnaire.

3. Security problems

4. Financial problems

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