Syphilis remains an important global public health burden, and congenital syphilis (CS) continues to threaten child health. China implemented an integrated elimination of mother-to-child transmission (EMTCT) programme for syphilis. The present analysis aimed to characterise implementation status and identify specific bottlenecks by examining granular data across the cascade of care in Baoan District, Shenzhen.
This was a retrospective cross-sectional study using the information system for the prevention of mother-to-child transmission of syphilis in Baoan District covering 2017–2024. The analysis compared a pre-practice period (2017–2018) with a post-practice period (2019–2024).
The final analytic sample comprised 752 pregnant women diagnosed with syphilis and 769 liveborn infants exposed to maternal syphilis.
Process and outcome indicators across the EMTCT cascade were evaluated. Comparisons between pre-practice and post-practice periods used Pearson's χ2 test. Joinpoint regression models estimated annual percentage change (APC) during the post-practice period (2019–2024). Univariate and multivariable logistic regression analyses identified factors associated with failing to meet predefined targets, notably for adequate treatment coverage.
Across the post-practice period, most process indicators showed statistically significant upward trends compared with the pre-practice period. The source reports that several process indicators improved, and joinpoint analysis found positive APCs for key measures.
Notably, first-trimester screening coverage increased with an APC of 6.79 (p = 0.01), indicating a significant annual rise during 2019–2024.
Some other process indicators were described as having significant upward trends, although the source did not report APC values for each individual indicator in the summary provided.
Coverage of adequate treatment for pregnant women with syphilis did not show a significant upward trend during the post-practice period: APC = 0.41 (p = 0.67), described as a plateau. In 2024, the adequate treatment rate was 87.74%, which remains below the predefined programme target of 90%.
The plateau and the 2024 coverage level indicate a persistent implementation gap despite improvements in screening and other process measures.
Multivariable logistic regression identified four independent risk factors associated with inadequate treatment coverage. The source reports the following associations and effect estimates:
Ethnic minority background: adjusted odds ratio (aOR) = 2.41, 95% CI 1.09 to 5.35.
First antenatal visit at ≥13 weeks: aOR = 2.30, 95% CI 1.09 to 4.84.
Partner not tested for syphilis: aOR = 2.07, 95% CI 1.07 to 4.01.
One additional factor was reported with aOR = 3.14, 95% CI 1.55 to 6.33; the source text provided the effect estimate but did not specify the variable label in the excerpt available.
These findings highlight groups at higher risk of receiving suboptimal treatment: women from ethnic minority groups, those entering antenatal care late, and those with partners who were not tested.
The integrated EMTCT implementation in Baoan District produced favorable trends across many process indicators, including increased first-trimester screening. However, the failure to reach the adequate treatment target of 90% by 2024 underscores ongoing implementation bottlenecks.
Targeted interventions should prioritise high-risk subpopulations identified in multivariable analysis: ethnic minorities, women initiating antenatal care at or after 13 weeks, and those whose partners remain untested. Programme strategies could include culturally tailored outreach, earlier engagement in antenatal services, and partner testing and linkage-to-care activities. The source did not provide detailed intervention models or evaluated implementation strategies within the dataset presented.
The source summary omitted some information that would clarify interpretation: the specific APC values for all individual process indicators were not all listed; one reported adjusted odds ratio (aOR = 3.14, 95% CI 1.55–6.33) lacked an explicit variable label in the provided text; and detailed programmatic interventions or long-term infant outcomes beyond 2024 were not reported in the excerpt. The original article may contain these details, but they were not included in the source text used for this summary.
Overall, the dataset (752 pregnant women and 769 exposed infants) and the statistical approach (χ2 tests, joinpoint regression, logistic regression) support the conclusion that integrated EMTCT implementation led to measurable improvements yet left persistent gaps in achieving treatment adequacy that require focused, population-specific responses.