Percentage of women accessing antenatal care (ANC) services who were tested for syphilis at first ANC visit

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Percentage of women accessing antenatal care (ANC) services who were tested for syphilis at first ANC visit
What it measures

Coverage of syphilis testing in women attending first ANC services


Testing pregnant women for syphilis early in pregnancy is important both for their health and the health of the fetus, and for second generation surveillance purposes. It also contributes to monitoring of the quality of ANC services.


Number of women attending first visit ANC services who were tested for syphilis


Number of women attending first visit ANC services


Numerator / Denominator

Method of measurement

How to measure: All pregnant women should be tested ("screened") for syphilis at their first antenatal care visit. Countries unable to distinguish first visit from subsequent visits can still report data on this indicator, but should clearly comment on this difference when reporting the data. This indicator should be measured annually.
Either non-treponemal tests that measure reaginic antibody (e.g., VDRL or RPR) or treponemal tests that measure treponemal antibody (e.g., TPHA, TPPA, EIA or rapid treponemal tests) may be used for screening. For this indicator simply being tested by either type of test is sufficient, although being tested with both is preferred. Please indicate in the "Comments" section what test type is generally used in your country.

Measurement tools: Ideally national programme records aggregated from health facility data should be used. However, if national programme data are not available, data from sentinel surveillance or special studies can be reported if it is felt to be representative of the national situation. Please specify the source and coverage of your data (for example, national programme data from all 12 provinces) in the "Comments" section.

Data Quality Control and Notes for Reporting Tool: Please comment on if the data you are providing is routine programme data, and if it is felt to be representative of the entire country.

Measurement frequency
Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

Additional considerations: Countries may wish to also monitor the week of pregnancy that each woman is tested. Preventing congenital syphilis requires testing early in pregnancy, as stillbirth may occur in the second trimester. Knowing that women are being tested late in pregnancy will indicate either that women are not accessing ANC early or that testing is not occurring early in pregnancy.
Programmes that test pregnant women for syphilis and those that test pregnant women for HIV should work together to enhance the effectiveness of their individual programme work.

Data utilization: Global: Examine trends over time to assess progress towards target levels of testing coverage required for elimination of mother-to-child transmission of syphilis. Knowledge of testing policies and practices should be used to assist with interpretation of trends in coverage.
Local: Data can be used to identify clinics not fully implementing national policy.

Further information

Other References: Recommended indicator in "National-Level Monitoring of the Achievement of Universal Access to Reproductive Health: Conceptual and practical considerations and related indicators" and "Methods for Surveillance and Monitoring of Congenital Syphilis Elimination within Existing Systems".