{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:47:18Z","timestamp":1790192838267,"version":"4.1.0"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005027","name":"Belgian Development Cooperation","doi-asserted-by":"crossref","award":["Not applicable"],"award-info":[{"award-number":["Not applicable"]}],"id":[{"id":"10.13039\/501100005027","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,12,6]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>We aimed to describe the challenges and outcomes of implementing a national syphilis follow-up system to improve syphilis management in maternal and child health (MCH) services in Cambodia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Operational study; quantitative cohort data and cross sectional qualitative data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Public health facilities at national level and in four provinces with high syphilis prevalence in Cambodia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Pregnant women screened for syphilis; MCH health care providers and managers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted an operational research using syphilis screening and treatment data collected from a national follow-up system (cohort data) and reported in the health management information system (HMIS) between 2019 and 2020. We also conducted indepth interviews with 16 pregnant women and focus group discussions with 37 healthcare providers and managers. Descriptive statistics and thematic content analysis were used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>Syphilis testing and treatment results and perceptions regarding these services.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 470 pregnant women who tested positive in rapid syphilis testing were recorded in the national syphilis follow-up system in 2019\u20132020. Of these, 71% (332 of 470) received a rapid plasma reagin (RPR) test and 95% (n=315) tested positive; 78% (246 of 315) received any syphilis treatment and only 28% (88 of 315) were treated adequately with benzathine penicillin G (BPG). Data from four provinces with high syphilis prevalence (more closely monitored) showed higher testing and treatment rates than at the national level. HMIS aggregated data reported a higher number of pregnant women screened and treated for syphilis than the follow-up system during the same period. Barriers to syphilis testing and treatment included late antenatal care, long distance to RPR testing and treatment, partners\u2019 lack of support to reach the health facility, BPG stockout and poor adherence to oral treatment in the absence of BPG. Providers and managers reported a lack of communication across services, insufficient skills to treat infants and absence of clear guidance regarding the revised follow-up system. Study findings contributed to changes in operating procedures nationwide to facilitate access to syphilis testing and adequate treatment and a systematic follow-up of pregnant women and exposed infants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Study results contributed to informing improvements to syphilis management in MCH services in Cambodia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-063261","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T10:46:54Z","timestamp":1673347614000},"page":"e063261","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Challenges and outcomes of implementing a national syphilis follow-up system for the elimination of congenital syphilis in Cambodia: a mixed-methods study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6299-2648","authenticated-orcid":false,"given":"Th\u00e9r\u00e8se","family":"Delvaux","sequence":"first","affiliation":[{"name":"Department of Publich Health, Institute of Tropical Medicine, Antwerp, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vichea","family":"Ouk","sequence":"additional","affiliation":[{"name":"National Centre for HIV\/AIDS Dermatology and STD, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sovannarith","family":"Samreth","sequence":"additional","affiliation":[{"name":"National Centre for HIV\/AIDS Dermatology and STD, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Socheata","family":"Yos","sequence":"additional","affiliation":[{"name":"National Maternal and Child Health Center, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Tep","sequence":"additional","affiliation":[{"name":"EpiC\/FHI360, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chamroen","family":"Pall","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vannak","family":"Keo","sequence":"additional","affiliation":[{"name":"EpiC\/FHI360, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serongkea","family":"Deng","sequence":"additional","affiliation":[{"name":"WHO, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Win Htin","family":"Khin Cho","sequence":"additional","affiliation":[{"name":"UNAIDS, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sivantha","family":"Hul","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somnang","family":"Chhorn","sequence":"additional","affiliation":[{"name":"National Maternal and Child Health Center, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sovannary","family":"Tuot","sequence":"additional","affiliation":[{"name":"KHANA Center for Population Health Research, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rattana","family":"Kim","sequence":"additional","affiliation":[{"name":"National Maternal and Child Health Center, Phnom Penh, Cambodia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"2025101810525725000_13.1.e063261.1","unstructured":"WHO . The global elimination of congenital syphilis: rationale and strategy for action. Geneva: World Health Organisation, 2007."},{"key":"2025101810525725000_13.1.e063261.2","doi-asserted-by":"crossref","unstructured":"Gomez GB , Kamb ML , Newman LM . Systematic reviews Untreated maternal syphilis and adverse outcomes of pregnancy\u202f: a systematic review and meta-analysis Maternal syphilis and adverse pregnancy outcomes 2013:217\u201326.doi:","DOI":"10.2471\/BLT.12.107623"},{"key":"2025101810525725000_13.1.e063261.3","unstructured":"WHO . Sexual and reproductive health. WHO publishes new estimates on congenital syphilis [Internet]. Available: https:\/\/www.who.int\/news\/item\/26-02-2019-who-publishes-new-estimates-on-congenital-syphilis#:~:text=This is known as \u2019congenital,globally%2C preceded only by malaria"},{"key":"2025101810525725000_13.1.e063261.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(11)70104-9"},{"key":"2025101810525725000_13.1.e063261.5","unstructured":"WHO, UNAIDS . Global guidance on criteria and process for validation of eMTCT of HIV, congenital syphilis, and hepatis B, 2021."},{"key":"2025101810525725000_13.1.e063261.6","unstructured":"Kingdom of Cambodia, Ministry of Health, National Centre for HIV\/AIDS, Dermatology & STD (NCHADS), National Maternal and Child Health Center (NMCHC) . National road map for elimination of mother-to-child transmission of HIV and congenital Syhilis eMTCT, 2021."},{"key":"2025101810525725000_13.1.e063261.7","unstructured":"Kingdom of Cambodia . 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Using Microsoft Excel to code and thematically analyse qualitative data: a simple, cost-effective approach. 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Elimination of mother-to-child transmission of HIV and syphilis, National validation template, 2021."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-063261","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:53:05Z","timestamp":1760809985000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-063261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,10]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bmjopen-2022-063261"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-063261","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}